Ethical Legal Dilemma in Advanced Practice Nursing Case Study Case Study

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Ethical-Legal Dillema in Advanced Nursing Practice

Ethical-Legal Dilemma involving a Patient in Emergency Department (ED)

The case study discussed in this paper presents ethical-legal principles in nursing which protects patient's privacy, confidentiality and security. Nurses have a professional obligation to protect the privacy of patients. Nursing Law and confidentiality define privacy as the right of patients to have their personal, identifiable medical information kept discrete and only accessible to the physician of record and other health care and insurance staffs as necessary. The governments have laws that maintain the confidentiality and privacy of patient's medical data, particularly to information about transmittable diseases and mental health issues. According to Mullinex & Bucholtz (2009), nursing information is transforming the nursing field rapidly and the major issues causing the changes are the nursing ethics relating to patients privacy. According to Pearson (2009), there are penalties, both civil and criminal crimes that are enforceable if there is any breach of health information. Application of these penalties provides motivation for conformity among nurses with the confidentiality principle observed.

When nursing standards, rules and policies are set and intended in maintaining the privacy of patient's information prevents any deliberate and unpremeditated breach in patient's confidentiality. The crucial element to maintaining confidentiality is to ascertain that only competent personnel have access to patient's information that is relevant to them. Nursing informatics has policies that preserve secret codes in order to prevent illegal viewing of patient data. According to Ritter & Hansen-Turton (2008) legal reasoning constructs entails comprehensive understanding of the legal statutes pertaining to particular medical conditions of patients and application of deductive and inductive logic skills in dealing with the situation. Sarhan (2009) define ethical reasoning constructs as the application of suitable role of ethical reasoning to promote the welfare of the patients.

Advanced Practice Ethical-Legal Dilemma

In this paper, Hispanic male, 30 years old in the emergency department after sustaining serious injuries following a car accident. After the diagnoses, the patient showed signs and symptoms of internal bleeding and nurses advised the patient the significance of accepting blood transfusion and immediate surgery to identify the injured parts, but the patient refused on the ground of his religious beliefs. The ethical-legal dilemma in this case is whether to respect the patient's decision and ignore standards of care or disrespect the patient's independence in an effort to save his life. This paper presents a clinical case study, identifies the ethical-legal dilemma, and discusses the ethical and legal principle that applies in this case.

Violation of Ethical Principles and Law

Ethical reasoning

An ethical dilemma emerges when the patients and nurses disagree in their understanding of the right and wrong decisions in caring and treating patients. Nurses deal with ethical dilemmas in their everyday nursing practice; and they have the obligation of analyzing and examining any ethical problem that may emerge. Any decision made by nurses should come from on ethical-legal standards that protect the rights and privileges of both the patient and the nurse. There are numerous ethical principles that provide guidance to the caring and treatment of patients. They comprise, respect for patients, beneficence, justice and autonomy. This case addresses patient's autonomy in medical diagnoses. First, it is essential for nurses to evaluate patients' knowledge of their risk of health, and reasons for recommending particular diagnoses, and possible results so that they can make knowledgeable medical-based decisions.

Informed decision ascertains the right of patients to make independent decisions based on their personal values and beliefs, whether cultural or religious. The informed decision depends on the ability of the patient s to make autonomous decisions about their healthcare information following sufficient examination of the patients' medical conditions and recommendable diagnoses. Prior to diagnosing the patient, nurses should disclose to the patient about their health status, the risks involved and the diagnoses suggested to save his/her life. Such disclosures should comprise an explanation of the nature and rationale of the diagnoses, the health risks and benefits, the principle of confidentiality, the right of refusal without legal attachments and other options.

The ethical standard of autonomy coerces nurses to avoid any harm towards their patients, capitalize on the likely benefits, and reduce the likely harms of the diagnoses recommended. However, misunderstanding may cause psychological anguish to the
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patient. For instance, in the case study, misunderstanding arises based on the patient's religious beliefs and mistrust of medical procedures, especially, when the recommended diagnoses lacks treatment options. Some patients feel pressure from their families and concerns about the effect on their future life or discovery of other health issues during the diagnoses.

In examining a nursing ethical dilemma, the first procedure is analyzing the medical condition and diagnoses based on the underlying ethical-legal standards that are applicable and the likely related ethical theories involved. In understanding the decision-making procedures, the healthcare providers apply the ethical standards of autonomy, beneficence, nor-maleficence, and justice. These are some of the nursing healthcare standards applied by healthcare providers in the case of a patient presented in the emergency department. The recommendations proposed by the nurse regarding the patient's status ascertained that the patient was in a critical condition that required immediate attention. Even if there were other treatment options to treat the patient, surgery was the only appropriate diagnosis to establish a meaningful tension of preserving life. However, the patient disagreed with the suggestion, and such a disagreement with the proposed plan of care compromises the moral responsibility of adhering to the patient's decision and his preferred mode of treatment. When the condition of the patient worsens, there is a need to resolve the conflicts of reciprocal autonomy.

Patient's Autonomy empowers patients to make their own decisions without interventions from the nurses or other people. The ethical dilemma presented in the case study is whether to adhere to the patient's autonomy or ignore his wishes by performing the surgery in order to save life. In such a scenario, the healthcare provider either presents an alternative medical treatment that may favor the patient's wishes. However, based on the patient's condition, nurses recommend immediate surgery. Even though respecting the patients autonomy yields contentment for the individual, while intervening with the decision may impose pain and suffering, nursing ethics preserves the patient s' autonomous. Pearson (2009) states that adhering to the patient's autonomy takes priority over beneficence, as the care of the patient is the proposed care. Thus, nurses evaluate treatment options that keep the patient alive before discharging him/her.

In essence, disrespecting the patient's autonomy means defying the patient's medical preference and this may result to severe legal penalty. Autonomous directs the nurses to follow the patient's medical preference. This principle emphasizes on making the patient comfortable and free of pain in the process of treatment. In some instances, nurse face dilemmas when there is communication breakdown between nurse-patient, and therefore, the stress of illness and dying creates tension even if nurses recommend a diagnosis without the patient's interference. In some situations, family members can cause the dilemma, whereby, the decision of the patient differs with the decision of the family members. In solving such conflicts, nurses provide counseling to the patient and the family members pertaining to the health status of the patient and the recommended diagnosis. Nurses emphasize on the value of immediate care required to the patient based on his/her status and the efficiency of the suggested diagnosis as opposed to their own decisions.

Nurses face difficulties expressing emotional statements about the dying patients, but, they must provide facts about the health status of the patient in order to assist create harmony around the immediate medical decisions and course of action. In this case, the health providers feed the patient with facts concerning his health status and the effect on his quality of life. However, what are the obligations of nurses, when either the patient or the family members disagree about the suggested treatment options? The dilemma that nurses face while attending to a dying patient is whether to respect the wishes of the patient or perform their own obligations. The decision of maintaining patient's autonomy may have devastating effects and poor medical care at the final stage of the illness. According to a recent research by Sandman & Munthe (2009) on ethical issues in nursing practice, extending the living-dying process with wrong measures is one of intense and disturbing experiences that nurses face and witness. Even though saving life is the obligation of the nurses, providing medical treatment against the wishes of the patient is a violation of the nursing ethics -- Autonomy.

Legal reasoning

Failure to adhere to nursing standards constitutes either a civil or a criminal violation. Ethical standards work hand in hand with legal principles. This implies that patients are entitled to fair treatment using available resources to save life. Therefore, in this scenario, it is justifiable for the patient to enjoy the comfort care he requires based on his religious belief. However, the involved nurse's attempts to interfere with the patients decision which results into a conflict. When a…

Sources Used in Documents:


Ekman, B.B, Granger & I. (2007). Standard medication information is not enough: poor 40 concordances of patient and nurse perceptions', Journal of Advanced Nursing 60 (2), 181-186

Mullinex, C., & Bucholtz, D. (2009). Role and quality of nurse practitioner practice: A policy issue. Nursing Outlook, 57

Needleman, J., & Minnick, A.F. (2009). Anesthesia provider model, hospital resources, and maternal outcomes.

Pearson, L. (2009). The Pearson report. American Journal for Nurse Practitioners, 13 (2), 8 -- 82.

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