Here we have Mary, an 86 year old lady who has sustained many injuries due to ambulating unassisted. Nurses have attempted many interventions, and recently have made a suggestion to tie Mary to a chair, which Mary has refused. The nurses have now decided to tell Mary this is a rule of the facility in order to prevent potential future falls.
The facts in this scenario are that Mary is an elderly 86 year old lady who has sustained previous falls due to being unsteady on her feet. The nurses have tried previous interventions by asking Mary to call for assistance with walking, and using a walking frame which she has refused. Other possible considerations to find out also would be Mary's level of comprehension and whether or not she has the mental capacity to make informed decisions regarding her safety. Additionally, seeking out if Mary has any other external people involved with her care, such as children, partner etc.
Consider the fundamental ethical principles
Ethical principles that refer to this scenario are veracity, beneficence, non- maleficence and autonomy (Kerrige, Lowe & Stewart 2011).
Veracity relates to Mary's right in knowing the truth whilst in care, which allows her to make her own informed decisions, which is closely linked with the next principle of autonomy. Autonomy is Mary's right to make decisions with regards to what happens to herself.
The principle of beneficence is evident from the previous attempt of a walking frame, and now the idea of implementing Mary with a belt to her chair. These interventions are all measures that are done in order to benefit Mary by preventing potential falls, and ensuring her safety. Non- maleficence is the final principle which is relevant with regards to the nursing staff lying to Mary about the belt, in order to prevent her falling. This is meeting non-maleficence as the lie itself is done in order to 'do no harm' which is the basis of non- maleficence.
Identify ethical conflicts
In this study the ethical principal of veracity is breached as the Nursing Staff are being dishonest with Mary. This principle is conflicting as it affects Mary's right to autonomy, which cannot be obtained unless she has the truth to make an informed decision. Although the staff breached veracity, this was done in order to obtain non- maleficence. This means that even though they lied to Mary, there was a greater good coming from the harm of the lie, which was to ensure Mary's safety by preventing any future falls.
Consider the law
According to The Aged Care Act (1997), Quality of care is a point of focus regarding a level of care that is expected within a residential facility (Aged Care Act 1997).
In this scenario, the nurses are focusing on their obligations to care for Mary by implementing the belt. By doing so they are following their requirement of complying with a quality of care standard. As nurses following this standard, they have what's called a duty of care for Mary (Gault 2012). This means that they are to look after Mary, preventing any foreseeable harm occurring to her. Intentional non- compliance with this obligation would result in a civil tort known as Negligence, which is neglecting to prevent Mary from harm (Gault 2012).
These two considerations show the compliance from the nurses, however the final legal consideration is the civil tort known as Trespass to person, more specifically false imprisonment (Gault 2012). False imprisonment is restraining someone against their will, which in term takes away their freedom, and choice (Gault 2012). There are exemptions to this law, however Mary doesn't come under any of these as she is competent, non- threatening and is of sound mind.
Make the ethical decision
In this instance, autonomy and veracity are going to be breached in order to obtain non- maleficence and beneficence. Mary is an elderly woman, who regularly forgets things and has a history of falls. Previous attempts have been made (asking for help, walking frame) to ensure Mary's safety from the nursing staff however have been to no avail. Mary's health and safety are paramount, and therefore need to be placed at the top of priorities.
'The Code of Professional Conduct for Nurses in Australia', comprises of a set of statements that set a standard for the manner in which nurses should conduct themselves state wide (ANMC 2006). There are three statements that are relevant in this scenario regarding Mary.
Statement 4; Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues (ANMC 2006).
This statement is relevant as the manner in which the nurses have conducted themselves is not a way that's adhering to this. Mary's initial request in not wanting the belt was not respected, and therefore Mary's values and beliefs of wanting her own freedom are not being respected. The nurses are also making a professional judgement in Mary's care, regarding her interests and rights. Implementing this facet, they're unrightfully detaining her which is illegal.
Statement 6; Nurses provide impartial, honest and accurate information in relation to nursing care and health care products (ANMC 2006).
The relevance in statement 6 is evident as the nurses have lied to Mary regarding the belt. This is a breach of this step as they have not been completely honest about what's happening.
Statement 7; Nurses support the health, wellbeing and informed decision making of people requiring or receiving care (ANMC 2006).
Statement 7 is of high relevance to this scenario, as Mary's rights and decision making abilities have been completely disregarded. By the Nurses lying to Mary, and failing to inform her of the truth, it doesn't support Mary's wellbeing, nor does it support her ability in making an informed decision.
Continuing on from the 'Code of Professional Conduct', The next guideline we're going to look at is 'The Code of Ethics for Nurses in Australia', this guideline refers to a set of statements that reflect a standard of ethics nurses should abide by and follow whilst caring for individuals
(Funnell, Koutoukidis & Lawrence 2010).
Regarding scenario 1, the following value statements of the Code of Ethics are relevant;
Value statement 5, Nurses value informed decision making and Value statement 6, Nurses value a culture of safety in nursing and health care (ANMC 2002).
Value statement 5; Nurses value informed decision making (ANMC 2002). This statement refers to Mary's right to make informed decisions; alongside this it's also relevant as the nurses must make decisions regarding the treatment of individuals. In this instance Mary's decision is not being valued, which is a breach of this statement, however the nurses are valuing their rights, by making a decision based on the circumstances of Mary's health. The other relevant value statement is statement 6; Nurses value a culture of safety in nursing and health care (ANMC 2002). The nurses involved in Marys care are all implementing strategies to prevent potential falls, this shows them abiding by their obligation to value Mary's safety.
After taking into consideration these statements and perspectives, I have changed my decision, and would like to allow Mary to make her own decision.
Although Mary's physical health is important, Mary's health as a whole is more important. As discussed in many of the above mentioned statements, e.g. Statement 7; Nurses support the health, wellbeing and informed decision making of people requiring or receiving care (ANMC 2006), it indicates nursing at a standard that not only comprises caring for one's physical health, but regards health holistically, encompassing more than just externals, and respects the rights of individuals. Another contributing factor to my change in decision is regarding Statement 4; Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues (ANMC 2006). This statement focuses not only on respecting individuals, but also the reverse of not. Neglecting, and failing to abide by this statement is making a professional judgement which can lead to legal ramifications, and possibly a loss of registration.
Scenario 2- Professional boundaries
According to the 'Nurses guide to professional boundaries (2010), professional boundaries is having limitations to the therapeutic relationship between a professional and a person in their care.
In this particular scenario there is a breach in professional boundaries. This breach has come about due to the nature of the relationship between the patient and the nurse that is personalised, and therefore crosses professional.
There are three areas, known as the 'continuum of professional behaviour' (ANMC 2010), that display how behaviours can affect the level of care provided to an individual. In this instance there is a boundary violation as there is over involvement, resulting from a relation between the nurse and patient.
In the 'guide to professional boundaries' (2010) it states when regarding dual relationships and boundaries, 'Nurses seek support and guidance from professional leaders when they have concerns relating to boundaries in therapeutic relationships'. This area was not abided by, and therefore adequate steps could not be taken to help support the nurse in taking appropriate steps.
This isn't a decision I would support. If I was to be in this position, I would advise my manager, or person in charge. These standards were implemented to not only protect the patients, but also the nurses as well. As the nurse's guide to professional boundaries affirms, there is an extreme power imbalance in therapeutic and care relationships, and to take advantage of your own power, could potentially place and individual of a place of extreme vulnerability.
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