Nursing Assignment Discussing Legal & Ethical Aspects Of Medical Case
This nursing assignment task is based on two medication case studies. You can access the case studies below.
Case study 1
Janet Ann Cook, 79, was admitted to St Elsewhere hospital on 25 March 2020 for end-stage cardiac failure, complicating liver and renal failure.
She was placed in room 26 – however, just two doors away in room 28 was a lady by the name of Norma Cock.
Mrs Cock was a patient who required both subcutaneous Novorapid 52 units mane, a drug kept in the fridge in the medication room, and 12 units Lantus subcutaneously mane.
Meanwhile Mrs Cook was prescribed Metformin 500mg BD and Actrapid as per sliding scale chart. There were two nurses present at the bedside when Mrs Cook was mistakenly administered Novorapid 32 units and Lantus 12 units subcutaneously, after which she died nine days later. One of them was an enrolled nurse primarily responsible for the care of both Mrs Cook and Mrs Cock, as well as two other patients in the ward.
This nurse, who has since been the subject of an inquiry by AHPRA, was adamant that a registered nurse who had accompanied him had administered the medication to Mrs Cook without calling out the identity numbers first. He also claimed that he did not see the medication being given because he was busy looking at the patient chart. “It is apparent also that he observed the medication being administered to Mrs Cook who, had he been concentrating, he would have identified as the wrong patient, having nursed both Mrs Cook and Mrs Cock that morning.” “It is consistent with that state of inattention that he would also have failed to listen carefully to the identification as read out from the wristband.”
“That, in summary, is the coroner’s findings as to the explanation for the medication error in this instance.”
An expert witness told the inquiry that the medication error “materially shortened” Mrs Cook’s life expectancy and that the dose of insulin would have “flattened her”—as she was a frail elderly patient who had liver impairment. “It is no coincidence that her health dramatically deteriorated in the hours following the administration of the insulin,” the coroner found.
Case study 2
A student nurse (Mides) was undertaking clinical placement in a busy medical inpatient unit. Mides was preceptored by Registered Nurse (RN) Jones. They commenced their shift at 0700. The inpatient unit was busy and appeared chaotic. In addition, the registered nurses were under added pressure because of a new policy to administer medications in compliance with physician-ordered scheduled times.
Registered Nurse Jones and Mides reviewed the National Inpatient Insulin Medication Chart for their patient, which included reviewing the physician-ordered sliding scale doses of Insulin titrated to the patient’s blood glucose level (BGL). The RN noted that a BGL reading was obtained at 0600. Despite the need for insulin coverage as ordered using the sliding scale, there was no record that insulin was administered to the patient that morning by the night shift nurse. Mides searched for his clinical facilitator to communicate about the opportunity to practice his skills and administer a sub-cutaneous injection of insulin, however he could not find his facilitator.
After reporting to RN Jones that the facilitator was not available, RN Jones reinforced the importance of administering the insulin as soon as possible because it was already past the medication's administration scheduled time. Registered Nurse Jones stated that he would watch Mides because the facilitator was not available. Mides again reviewed the BGL with the sliding scale on the order, verified the correct type and quantity of insulin, and drew up two units of Actrapid Insulin, He checked this with RN Jones The medication was then administered by Mides under the supervision at 0730. While electronically charting the administration of insulin, Mides noticed that the night shift nurse had retroactively charted the medication administration of two units of regular insulin for 0700.
You are required to examine the key legal and ethical aspects of one of the case studies, taking into account the scope of practice of the registered nurse and consideration of safety and quality in medication management practices via national standards.
-Identify scope of practice issues that relates to the case study.
-Identify the legal aspects of the case with reference to legislation.
-Identify the ethical aspects of the case in relation to nursing codes and standards. -Adheres to academic writing principles.
The cases in the nursing profession are pretty complex to evaluate and analyse as these are connected with both legal and ethical issues. This nursing assignment will discuss the scope of practice issues related to the first case study. The death of Mrs. Cook due to wrong medication will be given priority while discussing the range of practices, legal aspects and ethical aspects related to the case.
Scope of practice issue that relates to case studies
According to Martyn, Paliadelis and Perry (2019), the scope of practice in the nursing profession is a range of activities or decisions that a registered nurse works in hospitals. The nurse is highly responsible and accountable for doing the right thing best on the decisions made by the importance of the tasks given to him or her. According to the international council of nurses, mainly two approaches are there for the scope of nursing practices, and they are restrictive and permissive. Based on case study 1, it can be said that without identifying the correct patient and the correct medicine, a registered nurse is not expected to give medication. The registered nurse who accompanied the primarily responsible nurse for both Mrs. cook and Mrs. cock was careless while giving Mrs. cook medication. Becoming careful and aware about the administration process of medication falls under my scope of practice. In my opinion, it does not fall under the nurse's scope of practice to be so absent-minded when providing medicines to the patients. There is a policy in the nursing profession that nurses should be conscientious about their patients, especially when giving medication to the patients (Punithavalli, 2019). However, if talking about the scope of practice of the primarily responsible nurse for both Mrs. cook and mister cock, it can be said that she did the right job. Reporting the incident and reason for the death of a patient falls under the scope of practice in the nursing profession. According to NMBA, the registered nurse may use ethical frameworks while making decisions. Negligence in supervising assistant nurse also does not come under scope of practice for the enrolled nurse. Hence, if broader aspect is analysed, the actions of both the Registered nurse and enrolled nurse do not support the scope of practice of nurse (NMBA, 2022). On the other hand, according to the guidelines of ICN, the nurses are active participant in the promotion of patient safety and it is not expected form registered as well as enrolled nurse to be so careless in time of treatment of the patients.
Legal aspects of the case concerning legislation
According to the health policy of Tasmania, the role of a nurse in giving medication to patients is vital. Hammoudi, Ismaile and Abu Yahya (2018) opined that it is essential to check the dosage and read the container label before giving it to any patient as wrong medication can take the patient's life. The registered nurse who gave medicine to the patient did not check the container label and the identity of the patient before giving it to her. The policy also mentions that sufficient information should be available to the nurse to identify and provide the correct dose of medicine to the patient (ACSQHC, 2017). In this case, the information required was already known, but the lack of concentration and care was the main reason behind such life taking action of the nurse. According to the policy, the first legal aspect is that the registered staff member can have supervised suspension from the administration dispenser for prescribing medications the next time (Campbell et al., 2020). In worst cases, they can also be suspended in terms of the code of conduct in the nursing profession.Insulin is an S4 medication and a careful administration is needed in this case. The registered nurse did not carefully investigate before giving the medication. Unexpectedly, the enrolled nurse also did not administrate the medication and is equally responsible for the death of Mr. Cook due to wrong medication. On the other hand, according to the disciplinary process, the staff member can be managed based on the disciplinary trust process. This is more likely if the error results in serious harm to the patient. The most switchable legal aspect for case one is that the registered nurse may be suspended from all types of specified medication management activities (SCANLONet al., 2016). In such cases, human resource colleagues will indeed support all the individual staff and managers in the capability process for the nursing profession.According to the section 59C of Poisons act, restricted substance or narcotic substances can be used for the treatment of a person in time of emergency (TASMANIAN GOVERNMENT, 2008). Hence, the use of insulin was legal but the administration of medication was not done properly.
Ethical aspects of the case about nursing code and standards
The ethical issues spotted in this case of Mrs. Cook include the inability to perform medication-related activities of the registered nurse. Haahr et al. (2020) stated that the code of conduct always focuses on getting the correct information and acting when giving medication to a patient. It is unethical to provide the wrong cure to the patient without being careful about their requirements and medical condition. The tomb in 1.2 of the code of conduct mainly expects nurses to practice ethically and honestly, and they are not allowed to engage in any careless work while taking care of patients. The health policy of Tasmania also expects nurses to be open, honest and responsible while making communication with other people (Dyabet al., 2018). Here the registered nurse should communicate at first with the patient if they could not identify the name of the patient and the requirement for her treatment. The exchange of Mrs. Cook and Mrs. Cock doses shows how irresponsible and careless the nurse was while giving medication to such severe patients. Standard 4 of ANMAC suggests that the applicant nurse provides evidence of practicing as a nurse or as a midwife within a specific period of time preceding the application. For this case study, it is important to ensure that this standard is taken onto consideration.
Lastly, the code of practice also expects nurses to provide person-centered, safe, and evidence-based service to the patients to be treated without any error and with safety guidelines (Fosch-Villarongaet al., 2018). It is possible if the nurse does proper planning before giving medication to the patients and cross-checks the medicines' labels before giving them to the patient. Before administering and providing the drug to the patient, it is essential to communicate better with the nurse appointed mainly for the patients.
According to the scope of practice in the nursing profession, it was not under the scope of practice to give the wrong medication to a patient. On the other hand, the legal aspect mainly deals with the suspension notice for the registered nurse, but doing wrongful actions becomes a reason for the death of a patient. Lastly, the ethical issue here includes the reputation of the nurse and the hospital in terms of such shameful activity from a registered nurse.
ACSQHC (2017). National Safety and Quality Health Service Standards. 2nd ed. Sydney, Australia: Australian Commission on Safety and Quality in Health Care, viewed 10 October 2021, https://www.safetyandquality.gov.au/standards/nsqhs-standards. NMBA, (2022). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. [online] Nursingmidwiferyboard.gov.au. Available at:
Campbell, L.A., Harmon, M.J., Joyce, B.L. and Little, S.H., (2020). Quad Council Coalition community/public health nursing competencies: Building consensus through collaboration. Public Health Nursing, 37(1), pp.96-112. https://www.researchgate.net/profile/Monica-Harmon/publication/336344301_Quad_Council_Coalition_communitypublic_health_nursing_competencies_ Building_consensus_through_collaboration/links/5ea2c45ea6fdcc88fc3a2f6b/Quad-Council -Coalition-community-public-health-nursing-competencies-Building-consensus-through-collaboration.pdf
Dyab, E.A., Elkalmi, R.M., Bux, S.H. and Jamshed, S.Q., (2018). Exploring nurses' knowledge, attitudes, and perceived barriers towards medication error reporting in a tertiary health care facility: A qualitative approach. Pharmacy, 6(4), p.120. https://www.mdpi.com/2226-4787/6/4/120/pdf Fosch-Villaronga, E., Felzmann, H., Ramos-Montero, M. and Mahler, T., (2018, October). Cloud services for robotic nurses Nursing assignment Assessing legal and ethical issues in using cloud services for healthcare robots. In 2018 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) (pp. 290-296). IEEE. https://www.duo.uio.no/bitstream/handle/10852/72827/Final_IROS_robotic_nurses.pdf sequence=2
Haahr, A., Norlyk, A., Martinsen, B. and Dreyer, P., (2020). Nurses' experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), pp.258-272. https://journals.sagepub.com/doi/pdf/10.1177/0969733019832941 Hammoudi, B.M., Ismaile, S. and Abu Yahya, O., (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian journal of caring sciences, 32(3), pp.1038-1046. https://www.researchgate.net/profile/Baraa-Hammoudi-2/publication/321244931_Factors_associated_with_medication_administration_errors_and_why_nurses_fail_to_ report_them/links/5a21544c4585150259b853d8/Factors-associated-with-medication-administration- errors-and-why-nurses-fail-to-report-them.pdf https://www.legislation.tas.gov.au/view/whole/html/inforce/2017-12-13/sr-2008-162. Martyn, J.A., Paliadelis, P. and Perry, C., (2019). The safe administration of medication: Nursing behaviours beyond the five rights. Nurse education in practice, 37, pp.109-114. https://s1106788.stacksdiscovery.com/sites/default/files/safe%20med%20admin%20for%20112_0.pdf
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