Nurses are subject to a large number of ethical, legal and professional duties which are so many to be discussed in this essay so that is why only main important ethical and legal duties will be discussed in this essay. According to the scenario, these main ethical and legal duties will be respect of patient’s autonomy and the duty of care which is given to all the patients. These duties are professional and legal in New Zealand and even all over the world which when breached can lead to legal implications. These duties are ethical duties as well because ethical considerations arise when these duties are breached, considerations such as when can these duties be contemplated, so there for these duties are ethical duties as well. In this essay, the whole critical discussion will be about the professional, ethical and legal issues that arise according to the given scenario.
According to nursing council of New Zealand, nursing profession is bounded by its own code of ethics. Ethics is defined as the branch of philosophy that addresses questions about morality, that is, concepts such as good and evil, right and wrong, justice, virtue, etc. In this critical discussion, Autonomy will be the main aspect, autonomy of patient and judgement of health professional in betterment of the patient. The competencies and codes related to the above scenario according to nurse perspective are that the nurses should act ethically maintaining the standards of practice and nurses should respect the rights of the clients. These codes used in this scenario actually mean that a nurse should acknowledge and allows the individuality of a person, should act in a culturally safe manner, should use knowledge and skills for the benefit of the patients, nurse is responsible for maintain standards in her professional practice and should practice in her own scope of practice.
A registered nurse is actually defined as the person who uses nursing knowledge and critical nursing judgement to assess health needs of a patient so that the best health care can be provided and advises people to self manage their health. In this scenario, the patient states the pain score as 8/10 after three hours of having morphine and the doctor thinks the patient has become dependent on morphine. Being a nurse one should ask the patent to wait for another hour so that he can have another dose of morphine and then nurse should assess if the patient is actually dependent on morphine or he is actually in pain. As a nurse, she needs to have courage, honesty and should maintain the advocacy role. In this scenario, it is very critical to decide that if the patient has become dependent on morphine or is it the doctor who thinks the patient has become dependent, being a registered nurse; one should maintain the autonomy of the patient keeping the standards of health care provided to the patient. “Autonomy refers to the human capacity for self-determination and independence” (Journal of clinical oncology:2001). Autonomy has two aspects, one from the nurse’s view and another one from patient’s perspective, so n this essay we will discuss autonomy issues from perspectives of nurse and the patient.
In this case Mr. S is making constant requests for having 40mgs of morphine which is prescribed to him every 4hours PRN. He also states that the morphine is not actually relieving his pain and after three hours of having morphine he asks for another dose. Doctors think that the patient has become dependent on morphine so the doctors prescribe him for a placebo of normal saline instead. There is a case study which is concerning about issues in autonomy of patients which is mainly focused on nurses perception of patient’s autonomy and category of regaining autonomy in patients. The autonomy of patients is usually affected by circumstances such as family, health care provider, community etc. It is believed that the autonomy issue can only be resolved by a team effort, which can include processes of health education, self management etc (Proot et al: 2002).
The main point of concern in this scenario is that the patient is given a placebo instead of the morphine, so that the patient would not ask for morphine again and again. “The justification for giving placebos is that in the judgement of the giver, the act is beneficial to the patient” (Rumbold. G, 1999). This point has both positive and negative impacts on the patient and on the health practitioners and the nurses. This is also according to Health Practitioners Competence Assurance Act 2003 that the patient should be safe.”The Health Practitioners Competence Assurance Act 2003 provides a framework for the regulation of health practitioners in order to protect the public where there is a risk of harm from the practice of the profession” (Ministry of health: 2010). The positive point is that if the patient has become dependent on the morphine, which is not good according to the patient’s health, which is why prescribing a placebo would be a better alternative for patient’s health. This is the good point of this scenario according to the nurse’s perspective as the nurse would always work for the better health of the patient which can only become positive results for them instead of them being dependent on any medication. There is another positive point according to the nurse perspective which could be a main concern that the patient is demanding morphine repeatedly to make him feel satisfied and relieved from pain, but according to the nurse’s assessment, the patient feels satisfied and relieved mentally but that is not true, actually the patient has become mentally stuck that morphine s the only medication which can heal his pain. So, giving him placebo is a better option.
There are some negative points as well. According to the New Zealand legislation, this action of nurses comes against The Human Rights Act 1993, which states that every individual has a right to know the truth. In this scenario, the patient is unknown of the fact that he has been administered for a saline instead of morphine.
According to a nurse, the biggest ethical, legal and the professional issue here is autonomy of the patient. Autonomy is a very powerful aspect of ethical framework of almost all over the world. “Autonomy is a concept found in moral, political, and bioethical philosophy” (Autonomy: 2010, July). In these contexts, it refers to the capacity of a patient to make an informed decision. “In moral and political philosophy, autonomy is often used as the basis for determining moral responsibility for one’s actions” (Autonomy: 2010, July). Autonomy means to respect rights of others to determine a course of action. So in this scenario, according to the right of autonomy based on standards of ethics, nurses should respect the patient’s decision and should respect of what they want. Health professionals have no right to deny patient’s decision. Nurses should respect patient’s decisions and their autonomy to develop a trustworthy and professional relationship. According to this scenario, the patient’s autonomy should be respected as the patient states the pain score of 8/10 after three hours of having morphine. Mr. S has a right to decide if the morphine is relieving his pain or not and the health professionals are meant to respect his decision as patient is the person who is suffering from a very severe pain. Nurses should provide proper education to the patient and should inform about the consequences of having morphine repeatedly so that the patient can chose the best possible intervention for him.
The patient also has the right to have the informed consent about any medication which is prescribed to him. If he is given an unknown medication without his consent, it comes against legal issues and can cause legal implications. In Mr. S case, if placebo of saline instead of morphine is administered to the patient without his consent, then he has the right of action to say that the medication was given to him without the consent and it can make legal implications. So, before prescribing or administering any medication to the patient, doctors or nurses should have full consent of the patient. Therefore informed consent is an ethical, legal and a professional duty of nurses and even every health professional.
Consent is very effective in abiding ethical and legal duties. Sometimes, according to a nurse, it can be effective for a patient not being informed about the medication, to get positive outcomes for patient’s health. It is effective according to the nurse, but it is actually enabling patient’s decision and his condition. In some cases if a patient is unable to express what he wants, only then a nurse can decide what is best for the patient but a person like Mr. S, who can state his condition must be informed of the placebo of saline.
The nurse has a duty to prevent the patient from anything worse happening to the patient but if the patient is not mentally ill, he/ she should have full right to take any decision for them. If the patient says that morphine is not relieving his pain it means that it is not really working for him. It is not good to say that the patient has become dependent on morphine. For example, if nurse administer Mr. S a placebo of saline instead of morphine, his pain can go worst which is not good for the patient and it is not the best practice of a nurse.
The New Zealand legislation says that a person has a right to be informed and a right to have freedom. It is under Human Right Act of 1993 which when applied ensures that a person has a right to decide what they want without any interference of any other person. In this act there is a point of having informed medical treatment and a person has right to chose if they want the treatment or not.
Ethical issues and changes in society are responsible for nurse-client relationship. The role of the nurse is to maintain client’s autonomy, maintain and improve health and promote a professional relationship of trust. “The key ethical principles of respect for persons, autonomy, beneficence, nonmaleficence, justice, and veracity should be inclusive in the models of the provider-patient relationship” (Margret. M, 1998, para. 1 ). There are some contracts in nurse-client relationship which are boundaries, confidentiality and therapeutic nurse behaviours. Therapeutic nurse behaviours are self awareness, being genuine, respectful, culturally safe, responsible and ethical practice. These are the things which are expected from a nurse by a client and the society. All these contracts are applicable internationally. Nurses being culturally safe with clients have become the nursing practice more powerful. This concept of cultural safety was first introduced from New Zealand and is now used all over the world. Cultural safety is to keep own culture in mind and respecting other’s culture and practicing in the same manner.
In this essay, we looked at the case of Mr. S who is in severe pain and is in need of another dose of morphine. He states pain score of 8/10 and doctors think that the patient is dependent on morphine which he would never realise that is healing his pain or not. Mr. S condition successfully states the ethical, legal and professional issues that surrounds nurse’s and patient’s autonomy as patient’s need of morphine would be conveyed by the nurse to the doctor. Here patient’s condition has been critically discussed and the main influence is on patient’s autonomy and informed consent of the patient. Nurses roles and the code of ethics have also been discussed in the essay.