HLT51612 HLTEN509B - Apply Legal & Ethical Parameters - Nursing Case Study Assessment Answer

Nursing Case Study Assignment

Scenario Beth

Beth is 86 years old and resides in a nursing home. She is alert and has no signs of dementia. Unfortunately she is very unsteady on her feet and has a history of falls. The nurses are becoming increasingly concerned that she may injure herself seriously one day and it is highly likely that if she falls she may break her hip and may never walk again. They have spent a lot of time explaining this to Beth and she says she is aware of the dangers. The nurses have been asking Beth to call for help when she wants to walk, but she has not been doing this as she likes to be independent. They have also organised a walking frame for her which she is refusing to use, even though she is capable of using it properly and the nurses have explained the benefits. They have also included her family in the discussions to try and persuade her to use the walking frame and call for assistance but Beth is adamant that she wants her freedom. They have now suggested to Beth that when she sits down she wears a belt which is tied to her chair. The nurses hope this will remind her not to get up without asking some-one to walk with her and will also prevent her from getting up unaided. Beth objects. She is unwilling to give up her ability to move about the nursing home as she chooses. In desperation a nurse tells Beth that she must use the belt as it is a new rule of the nursing home (this is not the case). Beth reluctantly agrees to wear the belt because she is scared of the consequences of breaking the rules at the nursing home. The nurses are all very relieved that Beth is now using the belt.

Assignment Task

• Discuss what ethical principles are involved in this case study. Provide appropriate definitions with direct reference back to the case study
• Discuss the ethical principles that are in conflict
• Discuss what legal concepts are involved in this case study. Provide appropriate definitions with direct reference to the case study
• Discuss the actions of the nurses and discuss whether they are legally and ethically justified

Introduction

In the case study, 86 years old patient, Beth is although active but had history of falls which could embark the health condition of a disorder but not dementia. Nurses are very concerned for her health condition as she wants to perform her work independently without getting support from healthcare staff. She has refused to use a walking frame despite making request from the nurses. Beth wants her freedom and want to live happily without any assistance. Family members of the patient are known as invisible second patient (Brodaty & Donkin, 2009). They were also taken into loop for treatment purpose of Beth as she was very reluctant to comply with the nursing home instructions though they were in favor of her health. Combined efforts finally resulted into change in behavior of her and she started following all the instructions thinking that breaking of nursing home rules will leave her in a difficult situation.

Ethical issues

The most common ethical principles are based upon the following core values:

Autonomy – Right to make own decisions

Principle of autonomy defines the role of respect and opportunity needed for own decisions. It is the fundamental guideline for medical ethics where medical professionals respect right of an individual for self-determination. Patients are allowed to participate in their plan of action of treatment. In the given case study, Beth wants to enjoy autonomy by doing all her task independently without knowing her health condition. Although she has full right to do so but her current condition is not allowing to decide upon the treatment plan. That is why support of her family was sought. Hence patient feels valued and involved family support for the improvement purpose (Nuffield Council on Bioethics, 2009). Nurses have understood the needs of the patient in the case study and have provided enough supportive care.

Beneficence – Do good

It is an action performed for the benefits of the patients. In other words, principle of beneficence improves the conditions pertaining to any health issue. Nurses involved in care took all the necessary action for the benefit of her health. They all provided her good care and support for early recovery. Nurses used the power of communication to impart knowledge or information to Beth that was ethically correct otherwise she would have hurt herself by falling down. Communication ethics has an impact on an individual’s behavior as witnessed in the case study (Whitehouse, 2000). Effective communication helps to achieve set targets with greater level of satisfaction. (Zwarenstein & Reeves, 2006).

Non maleficence – No harm

Non maleficence deals with safety measures taken for an individual’s benefits. It acts by providing effective treatment and avoidance of it can cause serious health consequences. Nurses took safety measures by providing a belt attached to her chair so that Beth does not fall again. Nurses understood the personhood to provide good care to her (Hughes & Beatty, 2013). Hence carer and patient relation is one of the key factor along with cognitive ability of patient (Campbell et al, 2008). Trust, knowledge sharing and respect are the three main proponents of an effective healthcare system. Improved decision making through inter professional practices defines effective team work. Though nurse tried to develop a relation with Beth to help her early recovery but she is reluctant to follow their advices.

Fidelity – Be loyal

The concept of fidelity refers to loyalty and fairness to the patients. Virtue of caring is the basis of the principle stating importance of commitment of medical professionals to provide best care. Though Beth was reluctant to follow the treatment being given by staff but nursing staff was loyal and were concerned for her health. They do not want her to put her in any kind of health risk.

Justice – Fair actions

It deals with evaluation of merits and demerits associated with medical procedures performed for patient treatment. Fair action needs to be considered for patient care and treatment. Beth was provided a chair along with a belt which was a fair action for her health safety purpose. It is ethically correct that fair actions denotes the importance of patient centered care which is equally important as good quality of services (Brooker, 2003).

Another principle of supportive care emphasize upon care and understanding the needs of the patient and the family. Treatment of possible symptoms or health conditions with support of family is known as supportive care or comfort care. Seeking family support for Beth is ethically justifiable. It assists to treat problems associated with psychological issues, social issues etc. This motivates people having some trouble in managing balance and other activities. Healthcare professionals must be aware of the patient’s happiness level in an order to start an effective therapy line (Strech,et al, 2013).

Conflicts

Patient are not aware of the disease severity so it is difficult to measure the importance of their participation into decision making process. Hence principle of autonomy has conflict of whether patients have understanding pertaining to health issue. For example, Beth was not aware of doing things without asking for assistance.

It is conflicting issue is that the principle of beneficence will prevent health hazards completely by taking necessary actions. Many treatment therapies have serious risks so whether a physician would be able to evaluate these risks before performing an action. Here the decision of using belt to restrict someone’s movement is against human ethics. Analyzing the fact that by relying on other means of support to walk would reduce the autonomy of the patient (Nuffield Council on Bioethics, 2009). Hence risk – opportunity assessment is important rather than just concentrating on risk (Nuffield Council on Bioethics, 2009).

Conflict arises due to non-maleficence in determining whether benefits outweigh negative consequences or harm. Balancing out risks and benefits both are an essential prospectus of the part of the care. Care givers try to do all to reduce the risk associated with the health condition in the same manner as nurses are persuading Beth to use a walking frame and a belt for her safety.

Fidelity is associated with an issue of medical malpractices which are often involve during medical care. Justice constitutes an important ethical issue as various medical procedure can raise for negative health outputs.

Legal concept

Common law

As per Mental Capacity Act, decisions are taken which are valid for the treatment of the patient. Decisions are taken by the health professionals if they are applicable to resolve the current health issue. Promoting patient’s competency for their own well-being is an important legal issue. Competency is defined in terms of an individual’s capability to remain mentally active to perform his duties.

Care must be taken of those who understand about their health and wants to have a good quality of life. Patients who are not able to make their informed choice often over ruled by nurses or other people involved to protect the interest of them.

It must be noted that any decision must be taken in the best interest of the patient. Here, Beth is active and has not developed any form of disorder as of now except having history of fall. Hence she must be involved for making any decision pertaining to her health as she is in full capacity to comprehend the things in correct manner. It would also benefit her by developing a sense of responsibility. It is a legal principle to take views of people when they are at their early stage of dementia.

Use of restraint

Use of restraint is another legal concept used for care of the patient for safety. Restraint is defined as prevention of freedom of movement by using anything. Beth was suggested to wear a belt while she uses her chair which might reminds her to call for the nurse assistance whenever she gets up to walk. On the other hand, it has a psychological impact on patient as they start feeling like burden on others and in this way, thinking power gets hampered.

False imprisonment

False imprisonment appears as an important legal concept which defines use of some means to restraint a person in a particular area with or without consent. The legal issue is pertaining to informal and formal decision making process. The term informal is used to define voluntary actions. A person can withdraw from nursing center or treatment anytime. It is revealed from the given case study that consent was not asked before taking decision of a chair and belt. It constitutes a legal concept. Patient perceive it as distressing that might hamper their freedom. It is used as there is no other option of behavior control. Also it leaves an impression of being dependent on others which exert a negative behavior to do unusual things. Therefore a concept of an advanced care was introduced to encourage people to live quality of life.

Actions taken

Nurses have expressed their concern for Beth as she is trying to walk independently. She might injured herself and break her hip restricting the future movement. To raise awareness for the same issue, they have communicated all the risks associated with not following their medical advices. Ethically they adopted a communication strategy to convenience her. In the next step, nurses suggested her for their assistance whenever she wants to walk. Providing supportive care is ethically correct in this regard. A walking frame was provided to her in an order to prevent her from falling that might hurt her. Using an object for supportive supervision is considered as one of the important aspect being ethically justifiable. Beth refused to use the walking frame though she was capable of using it. Responding to this, nurses explained benefits of using the frame. A belt was also given to her which was tied to her chair that would probably secure her from falling. In the beginning, Beth refused to follow all the instructions despite putting best efforts. Lastly, she was suggested to follow the nursing home rules with some force which was legally correct as it was essential from her health point of view. Nurses were involved in providing good support services to Beth for early recovery which was acceptable from legal perspective. Supportive strategies of the patient family were also considered (Schulz, & Martire, 2004).

Solidarity is an important point of discussion as Beth wants to enjoy her autonomy without any assistance. Solidarity is an important ethical issue as it is in built in human nature (Hughes, 2010). Each human being wants to work independently of others assistance and support which mostly seen during patient with mental disturbances or other disorders.