Law and Ethics - Principles of Nursing - Case Study Assessment Answers

Introduction

The nursing fraternity is one of the areas that have attracted most studies. In addition, nursing as a career has seen most of the people lose their jobs due to unethical behaviors. Ethics can be defined as the principles or guides or norms or the values that guides the concepts of right and wrong. Ethics are therefore important in nursing since they guide the nurses in their behaviors. In addition, it helps in protecting patients from malpractices. Recent studies indicate that most of the nurses are facing a lot of ethical dilemmas in their career (Crisp & Taylor, 2008). Ethical dilemmas are some coincidences that affects the nurse’s moral imperatives leading to conflicts. The conflicts are in such a way that if one is obeyed then it leads to the transgression of the other. There are seven ethical principles of nursing most of which lead to ethical dilemmas. The first ethical principle is the principle of non-maleficence that argues that no injury or suffering should be caused by the nurses and hence they should conduct their work with a lot of competence. The second principle is that of beneficence that states that nurses should aim at doing well to their patients. The third principle that will be used in the case study is the principle of autonomy that requires the patients to have their rights. That means they should enjoy the independence and self-direction in addition to self-determination. The fourth principle that is also applicable is the principle of justice that requires that all the nurses treat their patients with a lot of fairness and equality (Berman & Kozier, 2010).

Beth is 86 years old. She has not been diagnosed with any form of dementia. However, she has a history of falling down whenever she is walking. Nurses are now worried that next time she falls down the repercussions will be worse. She may break her hip bone or even her legs. The nurses wants none of such to happen. On the other hand, Beth insists that she is okay. She feels that she can walk alone. Nurses have explained to her the dangers of walking alone and designed for her a good walking frame that can assist her to walk. However, Beth has been adamant and she wants nothing like that. The nurses decided to come up with a new trick to ensure that Beth does not get hurt. They suggested to Beth that the hospital requires such patients to put on a belt that is tied to the seat so that whenever the patient’s wakes up she is reminded to ask for a walking aid. Beth is still adamant even though it is not a rule but a lie to contain Beth. Beth agrees to the lie thinking that it is a new hospital rule. Beth does not want to break the hospital rules. Was it a must for the nurses to use a belt to restrain Beth? The question poses an ethical dilemma on the right for freedom versus the right for safety. Beth as an adult has all the rights to make her decisions to remain free. She has the right to walk and move anywhere within the hospital without restrain. However, she is not safe and that worries the nurses. The nurses cares for her and does not want her to get injured. That is why they lie to her and restrain her.

The case above touches on some of the ethical principles stated earlier. The principle of beneficence requires that the nurses do well to their patients. That is exactly what the nurses have done. They are doing their best to protect Beth from falling down and injuring herself. That is why they have restraint her in a chair with a belt. Similarly, the principle of non-maleficence that argues that the nurses must not do any harm to their patients is applicable in the case study. The principle supports that fact the nurses are forced to lie to Beth so that she is not harmed. On the other hand, the principle does not support the lies by the nurses. That is because the lies may lead to fear, stress, and loss of trust to the nurses. The principle of autonomy is also well expressed in the scenario. Beth is supposed to move freely through the hospital. She has the self-determination and she has the ability to self-direct herself (Kerridge, 2009). That is because she is an adult and further diagnosis reveals she is not infected by any form of dementia. The principle of veracity is also applicable in the case study. Veracity requires that the nurses have the duty of being truthful. The principle supports Beth because the nurses lied to her. The nurses broke the principle the moment they lied to protect Beth. The principle of fidelity means that there should be concepts of dedication, advocacy, truthfulness, fairness, and loyalty. The principle supports the nurse’s support by protecting her. However, the nurses also broke the principle by lying to her. The nurses were also not loyal.

From the scenario it is evident that some of the principles are conflicting with each other. For example, the principle of beneficence vs non-beneficence. The principle of autonomy vs beneficence. Principle of non-beneficence vs autonomy. The above mentioned principles are conflicting by each other. That is because the principle of autonomy requires the patient to have her own right to make her own decisions, but the nurses forced their decisions anyway after the client became adamant of their suggestions. Principle of beneficence conflicts with that of non-beneficence because the nurses lied to Beth even though their intentions was to do well.

The legal aspects and principles also finds their way into the case study. The criminal law or common law is applicable in this case. For example, there is the issue of the wrong use of restraints. In most cases there are rules and guidelines on how retrains should be used. The best practices under the clinical guidelines requires that the restrains are used under a very free environment hence not causing any negative feedback (Corey, 2011). For that reason, the retrains are supposed to be at their most minimum level and not causing any harm or risk to the patient. The restrains should also be constantly monitored and in most cases they are the final option once the risks have been weighed. Negligence is also another legal aspect of law that drags itself into the case study. Negligence occurs when an individual causes harm to the client by not being careful. In this case, the nurses were careful and were not negligent. They prevented any harm by restraining the client and offering an option of walking frame. On the other hand restraining Beth through the belt could also lead to cases of depression and stress and that would lead to negligence. The contract law also finds itself in the case. The law shows that the nurses have a contract with their employers to remain professional and ethical in addition to following the best practice guidelines. The Code of Ethics for Nurses in Australia and Code of Professional Conduct for Nurses in Australia) demands that the nurses’ keeps up with all the codes of ethics that are listed earlier (Fry & Johnstone, 2008). For example, the principle of non-maleficence was broken by the nurses when they lied to Beth. In order to keep up with the law the nurses ought to have not lied to Beth.

The ethical decision is that the nurses did the right thing by restraining Beth. That is because preventing her from injury and further fall was better than letting her make her own decisions. That is in consideration that her decisions were wrong and had progressively led to her falling many times. The decision to restrain her support many ethical principles like beneficence, non-beneficence, autonomy, and even fidelity.

Conclusion

Ethics are important in nursing because they guide and protect the nurses and patients relationship at work. The ethical dilemma in the case has been that Beth was retrained by the nurses against her will. Her will was to walk freely around the hospital. However, the decision to restrain her was to protect her from constant falls that she had experienced while walking alone. The nurses were now worried even though their decision is not a rule within the institution. The ethical dilemma was if the nurses were justified to restrain Beth using the belt or not. The essay has looked and identified some of the ethical principles that guide and protect nurses and patients at work. The essay then concluded that it was the right thing for the nurses to restrain Beth because that prevented her from harm and it was a better decision than that of her walking freely due to the dangers related to it.