Ethical and Legal Issues in Professional Nursing Practice NUR3705

Introduction

This essay analyses the complex situation experienced by the resident names Cora in the case study to identify the bioethical and legal issues associated with the professional nursing practice. It will emphasise on the role of a nurse in obtaining the consent, fulfilling the professional responsibilities ad ethical decision-making. This essay will initially discuss the legal issue of content by correlating it with legislations and WA health policies and discuss the potential legal consequences of consent. Followed by this, it will define the professional practice guidelines along with the misconduct in nursing and further discuss the relevance of ethical principles in relation to the case study. Towards the end, it will propose a resolution by using recent case law or legislations.

Consent

In context of healthcare, informed consent is a process by which a nurse provides detailed information to the patient explaining the treatment plan or the medical procedures and take permission from the patients for conducting these procedures (Strini et al., 2021). The process of receiving consent, based on the principles of autonomy and justice, gives the patient a right to decide on selecting their treatment plan. Also, it is very important that the process of taking consent is informed, voluntary and ensures that the patient is in the right mental condition to take appropriate decisions for his health.

Legal Consequences Related to Consent

The National Safety and Quality Health Service (NSQHS) Standardsprovides a detailed set of guidelines for healthcare professionals in obtaining informed consent from the patients (Australian Commission on Safety and Quality in Health Care, 2021) It also mentions that any medical procedure conducted without obtaining any informed consent from the patient or their family members can lead to allegations of assault (Queensland University of Technology, 2024). It also can lead to civil liability if the patient reports any harm caused due to the treatment or medical intervention used without any proper consent. A recent case law by Ms B v An NHS Hospital Trust [2002] EWHC 429 (Fam) (22nd March, 2002) highlights the importance of obtaining informed consent from the patient who are in their correct mental state to take suitable decisions for improving their health.

Elements of Valid Consent

There are three major elements involved in an informed consent namely disclosure of information, competency of the patient and voluntary nature of the decision (Shah et al., 2023). The first vital element which involves disclosing the information involves informing the patient regarding the risks and benefits associated with the treatment. The second important element which discusses the competency of the patient ensures that the patient is able to correctly interpret the information provided by the nurses in relation to the treatment and take relevant decisions for improving his health. The third element ensures that patient has the right to take independent decisions for choosing the medical intervention or treatment plan for improving his condition.

Relevant Legislation and Policies

The Consent to Treatment Policy in Western Australia highlights several important legalities on the issue of consent. This policy holds the professional in the health care sector to their responsibility to make sure the patient is informed sufficiently to give consent for treatment (Consent to Treatment Policy, 2024). It also provides that consent should be obtained timely as treatment is needed not merely by the use of the consent form. In addition, the Health Care Complaints Act 1993 continues with measures and protection of the health consumer rights concerning their decision-making regarding the administration of treatments and the handling of complaints regarding consent matters (New South Wales, 1993).

Application to the Case Study

The critical issue in the case of Cora is the question of whether she has been able to give her informed consent due to her expressed concerns about a certain night nurse. This shows that despite confirming verbal consent she is vulnerable to lose her autonomy, and decision-making power due to fear of reprisal. The nurse must understand that an explanation for Coras bruising may be self-inflicted, or due to mistreatment by staff, a possibility that complicates the nurses assessment of Coras consent capacity. The nurse has legal and ethical responsibility to protect Cora from self-harm or abuse yet respect her autonomy and right to refuse treatment.

Professional Practice

Definition of Professional Practice and Professional Misconduct in Nursing

Professional conduct in nursing practice encompasses ethical predicaments, legal compliance and regulatory measures that check the behaviour of the nurses in discharging their duties. It involves the provision of humane quality of care which involves responsibility and professionalism. Professional misconduct, however, refers to actions by a nurse that are forbidden to them by the enumerated standards and ethical principles. Sometimes it encompasses negligence, failure in reporting suspected abuse or participating in discrimination against patients. Such misconduct not only compromise the quality of health care delivery to patients but also erode public confidence in nursing profession.

Relationship Between Legislation, National Board, and Professional Conduct

The state and federal laws regulate the practice of professional nursing in Australia while the national boards govern the profession. The Nursing Midwifery Board of Australia (NMBA) is a crucial regulatory body that establishes and or prescribes standard nursing education, practice as well as conducting. Legislations such as Health Practitioner Regulation National Law form the legal framework of these standards. Nursing Accountability Act for nursing practice hold the nurses accountable for their actions. The legislation governs the conduct of nurses. It defines what the expectation of a nurse is while outlining avenues for compliance enforcement through complaints and the disciplinary process.

Elements from the Professional Practice Framework

The two key elements selected from the different frameworks available for professional practice that helps the nurses in decision-making processes are:

1. Code of Conduct for Nurses

2. Registered Nurse Standards for Practice

1. Code of Conduct for Nurses

This is one of the reference tools that provides guidelines in ethical practice among the nurses. It aims to respect the safety of the patient and provide competent treatment by respecting the dignity of the patient and providing patient centered care. This code may be seen as the key reference document that sets out the framework of appropriate behaviours and decision-making processes to be followed by the nurses (Kleemola et al., 2020). In this case, Coras self-determination and self-respect should be protected by the nurse who takes the time to understand mistreatment. In the light of the Code of Conduct, I can protect Cora without neglecting her decision since it states that decision should not be made that endanger a patients life while they are competent to make the decisions. This entails writing down Cora and her status together with her emotional conditions while at the same time explaining to her what she needs to know in regard to victims rights.

2.Registered Nurse Standards for Practice

The Registered Nurse Standards for Practice is framework that defines the competencies necessary for safe practice. These standards focus on the patient, logical reasoning, clinical discretion and good communication and implementation of personalized care (Oldland et al., 2019). These standards can be applied by the nurse for conducting detailed assessment, of both physical and emotional state of the client Cora. Critical thinking enables the nurse to assess reports of mistreatment and presence of bruising by Cora to make the right decisions. Communication skills would be useful here for reminding Cora that no one would punish her for what she says.

Ethical Issues

In nursing practice, ethical decision-making is essential for ensuring the safety and well-being of patients. It revolves around four main bioethical principles namely autonomy, beneficence, non-maleficence, and justice.

Autonomy

The definition of autonomy concerns the patients freedom of choosing their medical treatments themselves without medical interference. It also affirms rights of individuals or decisional autonomy, that is the ability of an individual to make decisions for themselves (Martins et al., 2020). In Coras case, her fear of reporting mistreatment by a night nurse, expressed to her friend on the phone is her self-governance. Despite aspiring for peace in her interactions with her care givers she may not effectively be in a position to stand up for herself when need arises.

Beneficence

Beneficence is the ethical theory that requires the improved position of the patient and positive action on the part of the healthcare deliverer being viewed to work for the benefit of the patient. The nurse must take the appropriate action and make decisions for the patients benefit in that she needs her physical and emotional needs to be met (Martins et al., 2020). This includes assessing the levels of injury identified on the arms of the patient, Cora, and making sure she does not receive any more abuse. In order to provide a safe environment and report any cases of abuse the nurse is being beneficent.

Non-maleficence

Non-maleficence is the principle that means that the health care provider has the moral obligation not to harm the patient. This principle therefore emphasises on a cautious approach when trying to reduce harm (Lamb & Pesut, 2021). Non-maleficence as a virtue is also essential in this situation as the night nurses actions may cause harm to the patient. Thus, the nurse needs to step up and prevent any further physical or, in her case, emotional abuse of Cora. This comprises of reporting and documenting any observation of Coras condition, expressing ones suspicion on possible abuse of Cora, and assuring that his/ her safety is considered.

Justice

Justice can be defined as the moral virtue or the composition that the concept of fairness or equality in the delivery of health care. It means making sure that regardless of individual dispensation of the measure, the common denominator is fair treatment of patients (Lamb & Pesut, 2021). In crude term, justice demands that Cora be given equal treatment like other individuals and no discriminates on any grounds. Concerns that she faces when reporting abuse point to another possible structural violence within the healthcare facility. The nurse has to stand for Coras rights, so she would be able to achieve the same opportunities as disabled people in getting the necessary help from healthcare facilities.

Prioritization of Bioethical Principles

In this case, non-maleficence should triumph because there is an eminent dangerous likely to be inflicted by the night nurse. Safety and well-being dominate over power becomes the guiding principle in not honouring Coras current choice to not report concerns because of safety. In this regard, it is ethical for the nurse to insist that the clients safety be prioritized first before anything else, and this case is not an exception by proposing her idea to the doctor in charge of treating Cora.

Additional Ethical Theory: Virtue Ethics

Another theory that can be applied to this case is Ethic of Virtue. This theory is more or less centered on personal attributes that reflect professional values, including love, honesty, and bravery, as practised by the nurses (Falc?Pegueroles et al., 2020). According to virtue ethics, a nurse would understand that it is virtuous to comfort a patient and, in this case Cora, by listening to her anxieties with enthusiasm and then reassuring her. It would also underscore the need for trustworthy reporting of the observed concerns of maltreatment despite Coras decision. Thus, the application of the bioethical principles and virtue ethics to manage this labour of resolution to ensure that patient safety is upheld in as much as patients self-determination is respected. These frameworks therefore offer a systematic approach in ethical decision making in nursing practice especially in legally complex situation like that of Cora. In conclusion, using the bioethical approach facilitates a middle ground in handling ethical issues that nurses encounter while providing care to patients like Cora. While considering the principle of non-maleficence as a priority to autonomy, beneficence, and justice, the nurses will be able to deliver total healthcare that considers both the patient rights and the patients overall welfare.

Resolution

The ideal approach in handling the case of Cora is for the nurse to write down what she sees and how Cora is feeling and then tell her supervisor or the facility safeguarding officer even if the latter two do not want this move to happen. From a legal perspective it complies with the Health Care Complaints Act 1993 which requires any member of staff to report any suspicion of abuse of patients. In terms of ethical principles, it supports the principles of beneficence and non-maleficence, thus, putting Coras life at risk and denying her request to keep Nigels secret. This will make it possible to take necessary action to find out if she is being harassed or otherwise in any way mistreated.

Introduction

This essay analyses the complex situation experienced by the resident names Cora in the case study to identify the bioethical and legal issues associated with the professional nursing practice. It will emphasise on the role of a nurse in obtaining the consent, fulfilling the professional responsibilities ad ethical decision-making. This essay will initially discuss the legal issue of content by correlating it with legislations and WA health policies and discuss the potential legal consequences of consent. Followed by this, it will define the professional practice guidelines along with the misconduct in nursing and further discuss the relevance of ethical principles in relation to the case study. Towards the end, it will propose a resolution by using recent case law or legislations.

Consent

In context of healthcare, informed consent is a process by which a nurse provides detailed information to the patient explaining the treatment plan or the medical procedures and take permission from the patients for conducting these procedures (Strini et al., 2021). The process of receiving consent, based on the principles of autonomy and justice, gives the patient a right to decide on selecting their treatment plan. Also, it is very important that the process of taking consent is informed, voluntary and ensures that the patient is in the right mental condition to take appropriate decisions for his health.

Legal Consequences Related to Consent

The National Safety and Quality Health Service (NSQHS) Standardsprovides a detailed set of guidelines for healthcare professionals in obtaining informed consent from the patients (Australian Commission on Safety and Quality in Health Care, 2021) It also mentions that any medical procedure conducted without obtaining any informed consent from the patient or their family members can lead to allegations of assault (Queensland University of Technology, 2024). It also can lead to civil liability if the patient reports any harm caused due to the treatment or medical intervention used without any proper consent. A recent case law by Ms B v An NHS Hospital Trust [2002] EWHC 429 (Fam) (22nd March, 2002)highlights the importance of obtaining informed consent from the patient who are in their correct mental state to take suitable decisions for improving their health.

Elements of Valid Consent

There are three major elements involved in an informed consent namely disclosure of information, competency of the patient and voluntary nature of the decision (Shah et al., 2023). The first vital element which involves disclosing the information involves informing the patient regarding the risks and benefits associated with the treatment. The second important element which discusses the competency of the patient ensures that the patient is able to correctly interpret the information provided by the nurses in relation to the treatment and take relevant decisions for improving his health. The third element ensures that patient has the right to take independent decisions for choosing the medical intervention or treatment plan for improving his condition.

Relevant Legislation and Policies

The Consent to Treatment Policyin Western Australia highlights several important legalities on the issue of consent. This policy holds the professional in the health care sector to their responsibility to make sure the patient is informed sufficiently to give consent for treatment (Consent to Treatment Policy, 2024). It also provides that consent should be obtained timely as treatment is needed not merely by the use of the consent form. In addition, the Health Care Complaints Act 1993continues with measures and protection of the health consumer rights concerning their decision-making regarding the administration of treatments and the handling of complaints regarding consent matters (New South Wales, 1993).

Application to the Case Study

The critical issue in the case of Cora is the question of whether she has been able to give her informed consent due to her expressed concerns about a certain night nurse. This shows that despite confirming verbal consent she is vulnerable to lose her autonomy, and decision-making power due to fear of reprisal. The nurse must understand that an explanation for Coras bruising may be self-inflicted, or due to mistreatment by staff, a possibility that complicates the nurses assessment of Coras consent capacity. The nurse has legal and ethical responsibility to protect Cora from self-harm or abuse yet respect her autonomy and right to refuse treatment.

Professional Practice

Definition of Professional Practice and Professional Misconduct in Nursing

Professional conduct in nursing practice encompasses ethical predicaments, legal compliance and regulatory measures that check the behaviour of the nurses in discharging their duties. It involves the provision of humane quality of care which involves responsibility and professionalism. Professional misconduct, however, refers to actions by a nurse that are forbidden to them by the enumerated standards and ethical principles. Sometimes it encompasses negligence, failure in reporting suspected abuse or participating in discrimination against patients. Such misconduct not only compromise the quality of health care delivery to patients but also erode public confidence in nursing profession.

Relationship Between Legislation, National Board, and Professional Conduct

The state and federal laws regulate the practice of professional nursing in Australia while the national boards govern the profession. The Nursing Midwifery Board of Australia (NMBA) is a crucial regulatory body that establishes and or prescribes standard nursing education, practice as well as conducting. Legislations such as Health Practitioner Regulation National Law form the legal framework of these standards. Nursing Accountability Act for nursing practice hold the nurses accountable for their actions. The legislation governs the conduct of nurses. It defines what the expectation of a nurse is while outlining avenues for compliance enforcement through complaints and the disciplinary process.

Elements from the Professional Practice Framework

The two key elements selected from the different frameworks available for professional practice that helps the nurses in decision-making processes are:

1. Code of Conduct for Nurses

2. Registered Nurse Standards for Practice

1. Code of Conduct for Nurses

This is one of the reference tools that provides guidelines in ethical practice among the nurses. It aims to respect the safety of the patient and provide competent treatment by respecting the dignity of the patient and providing patient centered care. This code may be seen as the key reference document that sets out the framework of appropriate behaviours and decision-making processes to be followed by the nurses (Kleemola et al., 2020). In this case, Coras self-determination and self-respect should be protected by the nurse who takes the time to understand mistreatment. In the light of the Code of Conduct, I can protect Cora without neglecting her decision since it states that decision should not be made that endanger a patients life while they are competent to make the decisions. This entails writing down Cora and her status together with her emotional conditions while at the same time explaining to her what she needs to know in regard to victims rights.

2.Registered Nurse Standards for Practice

The Registered Nurse Standards for Practiceis framework that defines the competencies necessary for safe practice. These standards focus on the patient, logical reasoning, clinical discretion and good communication and implementation of personalized care (Oldland et al., 2019). These standards can be applied by the nurse for conducting detailed assessment, of both physical and emotional state of the client Cora. Critical thinking enables the nurse to assess reports of mistreatment and presence of bruising by Cora to make the right decisions. Communication skills would be useful here for reminding Cora that no one would punish her for what she says.

Ethical Issues

In nursing practice, ethical decision-making is essential for ensuring the safety and well-being of patients. It revolves around four main bioethical principles namely autonomy, beneficence, non-maleficence, and justice.

Autonomy

The definition of autonomy concerns the patients freedom of choosing their medical treatments themselves without medical interference. It also affirms rights of individuals or decisional autonomy, that is the ability of an individual to make decisions for themselves (Martins et al., 2020). In Coras case, her fear of reporting mistreatment by a night nurse, expressed to her friend on the phone is her self-governance. Despite aspiring for peace in her interactions with her care givers she may not effectively be in a position to stand up for herself when need arises.

Beneficence

Beneficence is the ethical theory that requires the improved position of the patient and positive action on the part of the healthcare deliverer being viewed to work for the benefit of the patient. The nurse must take the appropriate action and make decisions for the patients benefit in that she needs her physical and emotional needs to be met (Martins et al., 2020). This includes assessing the levels of injury identified on the arms of the patient, Cora, and making sure she does not receive any more abuse. In order to provide a safe environment and report any cases of abuse the nurse is being beneficent.

Non-maleficence

Non-maleficence is the principle that means that the health care provider has the moral obligation not to harm the patient. This principle therefore emphasises on a cautious approach when trying to reduce harm (Lamb & Pesut, 2021). Non-maleficence as a virtue is also essential in this situation as the night nurses actions may cause harm to the patient. Thus, the nurse needs to step up and prevent any further physical or, in her case, emotional abuse of Cora. This comprises of reporting and documenting any observation of Coras condition, expressing ones suspicion on possible abuse of Cora, and assuring that his/ her safety is considered.

Justice

Justice can be defined as the moral virtue or the composition that the concept of fairness or equality in the delivery of health care. It means making sure that regardless of individual dispensation of the measure, the common denominator is fair treatment of patients (Lamb & Pesut, 2021). In crude term, justice demands that Cora be given equal treatment like other individuals and no discriminates on any grounds. Concerns that she faces when reporting abuse point to another possible structural violence within the healthcare facility. The nurse has to stand for Coras rights, so she would be able to achieve the same opportunities as disabled people in getting the necessary help from healthcare facilities.

Prioritization of Bioethical Principles

In this case, non-maleficence should triumph because there is an eminent dangerous likely to be inflicted by the night nurse. Safety and well-being dominate over power becomes the guiding principle in not honouring Coras current choice to not report concerns because of safety. In this regard, it is ethical for the nurse to insist that the clients safety be prioritized first before anything else, and this case is not an exception by proposing her idea to the doctor in charge of treating Cora.

Additional Ethical Theory: Virtue Ethics

Another theory that can be applied to this case is Ethic of Virtue. This theory is more or less centered on personal attributes that reflect professional values, including love, honesty, and bravery, as practised by the nurses (Falc?Pegueroles et al., 2020). According to virtue ethics, a nurse would understand that it is virtuous to comfort a patient and, in this case Cora, by listening to her anxieties with enthusiasm and then reassuring her. It would also underscore the need for trustworthy reporting of the observed concerns of maltreatment despite Coras decision. Thus, the application of the bioethical principles and virtue ethics to manage this labour of resolution to ensure that patient safety is upheld in as much as patients self-determination is respected. These frameworks therefore offer a systematic approach in ethical decision making in nursing practice especially in legally complex situation like that of Cora. In conclusion, using the bioethical approach facilitates a middle ground in handling ethical issues that nurses encounter while providing care to patients like Cora. While considering the principle of non-maleficence as a priority to autonomy, beneficence, and justice, the nurses will be able to deliver total healthcare that considers both the patient rights and the patients overall welfare.

Resolution

The ideal approach in handling the case of Cora is for the nurse to write down what she sees and how Cora is feeling and then tell her supervisor or the facility safeguarding officer even if the latter two do not want this move to happen. From a legal perspective it complies with the Health Care Complaints Act 1993 which requires any member of staff to report any suspicion of abuse of patients. In terms of ethical principles, it supports the principles of beneficence and non-maleficence, thus, putting Coras life at risk and denying her request to keep Nigels secret. This will make it possible to take necessary action to find out if she is being harassed or otherwise in any way mistreated.

Conclusion

This paper analysed the bioethical and legal aspects of nursing practice using a case of a resident, Cora, showing signs of possible abuse. Some concepts defined were the concept of informed consent, roles and responsibilities of professional nurses, concepts of autonomy, beneficence, non-maleficence and justice. It focused on the solution that a nurse has for supporting Coras safety while considering her perceived or real fears. In conclusion, it becomes relevant for the maximization of non-maleficence for the sake of Coras safety, and for the purpose of this paper, legislation and principles of nursing ethics are used.

This paper analysed the bioethical and legal aspects of nursing practice using a case of a resident, Cora, showing signs of possible abuse. Some concepts defined were the concept of informed consent, roles and responsibilities of professional nurses, concepts of autonomy, beneficence, non-maleficence and justice. It focused on the solution that a nurse has for supporting Coras safety while considering her perceived or real fears. In conclusion, it becomes relevant for the maximization of non-maleficence for the sake of Coras safety, and for the purpose of this paper, legislation and principles of nursing ethics are used.

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