Nursing Ethics and Accountability

Nurses have to adhere to the legal aspects of the nursing practice. As client advocates, nurses should ensure the client’s right to informed consent or refusal. Nurses have a role in the aspect of obtaining informed consent. In the given case, Mr. E refused the medical treatment. The nurse has the responsibility of informing the patient of the possible consequences of his actions while carefully not imposing the nurse’s opinion into his decision making. The law states that health care providers disclose a reasonable amount of information for the patient to make a decision.

The following should be included in the informed consent: the purposes of treatment, what client can expect to feel or experience, intended benefits and risks of treatment and advantages and disadvantages of possible alternatives to the treatment (including no treatment). In this case, the nurse should consider the three major elements of informed consent such as the consent must be given voluntarily, must be given by a capable and competent patient, and the appropriate amount of information disclosed to the patient (Kozier et al. , 2004).

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This case deals with the ethical issue of conflicting obligations. It is in the best interest of the health care team to assist the recovery of the patient; however, the patient declined the medical interventions. In any health care setting, it is a nursing standard to adhere to the informed consent regulations. B. Nursing Code of Ethics One must consider that the existence of the code of ethics represents the ethical principles shared by the nursing profession, reflects the moral judgment of nurses and gives standard measures for professional actions (Kozier et al.

, 2004). The nursing code that may be suitable in this situation is the provision for the right to self-determination. This is a subsection under the statement, “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (American Nurses Association, 2001).

For nurses to provide the right to self-determination, they should show respect for their patient by recognizing the rights of patients in making their own decisions regarding their health situation. The nurse assists in their patient’s decision making by giving information about the benefits, risks and alternative options in their medical management, including the choice of no treatment. In any circumstances, the nurse should disclose to the patient his rights to make decisions to accept, refuse or terminate treatment without deceit, undue influence, duress and coercion.

Nurses are obligated to know the moral and legal rights of patients to self-determination. In the presented situation, the nurse can provide the patient the number of risks of his decision of not allowing medical intervention. The nurse has the capability to assess if the patient can fully comprehend these associated risks. However, the doctor was in doubt about the patient’s ability to understand so he requested for the nurse to contact the designated surrogate decision maker. In this instance, the nurse must be aware of an existing advance directive.

According to the advance directive, the patient does not wish for ventilator, feeding tubes or CPR. The nurse must be aware of the fact that the role of the surrogate is to base his decisions upon the previously expressed conditions of the patient (American Nurses Association, 2001). In this case, the nurse may assist the surrogate decision maker, Mr. B, by providing guidance through identification of problems in decision making. It would be unethical for the doctor to put Mr. E to a ventilator. This is due to the fact that Mr. E refused the medical intervention when asked for consent.

Dr. G should consider the patient’s right for self-determination or autonomy. Besides this, Mr. E has an advance directive describing his wish not to be put on a ventilator, feeding tubes or CPR. In this case, Dr. G was concerned that the patient does not understand the implications of his decisions and rendered him as incapable of making medical decisions so he contacted the designated surrogate decision maker. Although Mr. B was given the durable power of attorney (DPA), it would be unethical for him to authorize a ventilator.

This durable power of attorney (DPA) is another kind of advance directive that becomes active anytime the patient becomes unconscious or unable to make medical decisions (American Academy of Family Physicians, 2009). In the case, it was not mentioned that Mr. E lost consciousness; it was Dr. G who assumed that he was unable to make medical decisions. Even in the event that the patient became unconscious or cannot make medical decisions, the surrogate decision maker should base his decisions to the advance directive and known values of the patient. C. Role of Nurse Autonomy in Professional Practice

The nurse has a primary responsibility to help promote health and conserve human life corresponding with her or his knowledge, training and experience. A nurse has dependent, independent and collaborative functions that one has to fulfill to help the client achieve optimal health. However, a nurse that practices autonomy in one’s profession can also recognize that each client has a right to make his or her own decision. Adhering to the principles of autonomy equates to the nurse respecting the client’s right to make decision even though the nurse disagrees with it.

For example, the nurse has the responsibility to preserve life; however, the client signed a Do Not Resuscitate (DNR) form. The nurse’s right to make decision (autonomy) is affected by the client’s personal decision. D. Nurse’s Obligation to Report According to the nurses’ code of ethics, the nurse promotes, advocates and strives to protect the health, safety and rights of the patient. Nurses have a commitment to be alert and take suitable action about unethical practice by any health care member. The reporting should undergo official channels and be reported to appropriate authorities or committees.

In this case, the nurse must be aware that Dr. G violated the patient’s confidentiality and privacy. There was an inappropriate disclosure of information. According to the Privacy Rule of Health Insurance Portability and Accountability Act of 1996 (HIPPA), the basic principle is that: “A covered entity may not use or disclose protected health information except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual’s personal representative) authorizes in writing.

” Mr. H was not the personal representative of the patient, Mr. E. He also has no authorized written permission to access the patient’s health information. Even after knowing the situation of the patient, Mr. H has no legal rights to make medical decisions for the patient. E. Nurse’s Accountability According to the nurses’ code of ethics, nurses are accountable for their actions and judgments. Accountability means being answerable to oneself and others for one’s own actions that are based on the designated code of ethics of the profession.

In this case, the nurse must be accountable for explaining carefully to the patient the risks of his medical decision. The nurse should also be able to provide assistance to the surrogate decision maker in making the medical decision that is congruent to the client’s previous expressed wishes. Nurses also play the role of advocates in the health care field. They should be accountable in safeguarding the patient’s rights. As an advocate, the overall goal is to provide protection to the patient’s decision and give them mutual responsibility in decision making in capable patients.

Being an advocate allows nurses to directly intervene on the client’s behalf. In this case, the nurse should report the inappropriate behavior of the physician. The client’s right to refuse the treatment was ignored by Dr. G. He also crossed the patient-doctor confidentiality rule when he carelessly disclosed the patient’s medical condition to unauthorized person and he got consent from this unqualified person. References American Academy of Family Physicians (2009). Advance directives and do not resuscitate orders. Retrieved July 18, 2010, from

http://familydoctor. org/online/famdocen/home/pat-advocacy/endofl ife/003. html American Nurses Association (2001). Code of Ethics for Nurses. Retrieved July 19, 2010, from http://nursingworld. org/ethics/ethicscode150. htm Kozier, B. , Erb, G. , Berman, A. , & Synder, S. J. (2004). Fundamentals of Nursing: concepts, process, and practice 7th Edition. Philadelphia : Pearson Education Inc. United States Department of Health and Human Services. (1996). Summary of the HIPAA privacy rule. Retrieved July 18, 2010, from http://www. hhs. gov/ocr/ privacysummary. pdf


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