Identify and discuss nursing, ethical and legal issues that can arise in practice

The purpose of this assessment is to identify and discuss nursing, ethical and legal issues that can arise in practice. You need to select one of the two case studies (see below).

This academic paper needs to be written in sentences and paragraphs, not in note form, and your writing needs to be supported by academic references. Do not use dot points.

Note: Use the Harvard referencing system. The end text reference list is not included in the word count.

The layout of the paper will consist of an introduction, the main body and a conclusion. Write in the third person and use the following headings from Kerridge's Decision-Making Framework (adapted).

Section 1 Your introduction

Section 1 State the ethical problem: Offer a summary of the issue. What is the main problem? What is the ethical dilemma? Consider ethical, medical, social and legal perspectives. What appears (prima facie) to be the legal issues? For example, is it the application of an Advance Directive or informed consent?

Sections 2, 3, 4 & 5 form the main body of your paper.

Section 2 Get the facts: Find out as much as you can about the problem. What is the medical problem (current and historical)? Are there any relevant tests or investigations? What is the pathophysiology of the disease? What is the prognosis, and what are the implications? Is any other treatment available? Are any psychological/social (family) issues impacting the situation? Who are the relevant people? Who will be affected by the decision?

Section 3 Consider the four ethical principles

Autonomy: Define autonomy and then consider the following questions about your selected case study:

• Is the person mentally capable and legally competent?
• Is there evidence of incapacity?
• If competent, what is the person stating about preferences for treatment/intervention?
• Has the person been informed of benefits and risks, understood the information and given consent?
• If incapacitated, who is the appropriate substitute decision-maker?
• Has the person expressed prior preferences? (e.g. Health Care Directive or has stated verbally). Is the person unwilling/unable to participate in medical treatment/interventions? If so, why?

Beneficence: Define beneficence. What benefits can be obtained for the patient in your selected case study?

Non-maleficence: Define non-maleficence. What are the risks and how can they be avoided for the patient in your case study?

Justice- Define Justice. How are the interests of different parties to be balanced in your selected case study?

Section 4 Identify ethical conflicts(approx 300 words)(e.g. between principles): Identity what the ethical conflicts are. Explain why the conflicts occur and how they may be resolved in your selected case study. Refer to the International Council of Nursing Code of Ethics (2012) in this section.

Section 5 Consider the law (approx 250 words): Identify relevant legal concepts and laws and how they might guide management. Consider the registered nurse Standards for Practice (Nurses and Midwifery Board of Australia {NMBA} Standards, 2016) and how they apply to the case study. How does duty of care apply to the patient?

Sections 6 & 7 is your conclusion

Section 6 Make an ethical decision (approx 250 words) - why is your chosen option the best approach?

Clearly state the clinical ethical decision and justify. Specify how guiding ethical principles were balanced and why (i.e. justify the decision). Use the information that you have in the Law and Get the Facts section to support the decision (ensure it is evidenced based).

Section 7 Evaluation of the decision, identify a way forward (approx 250 words):Identify the strategies that could be adopted to resolve any conflict that exists (i.e. family issues) using an inter-professional approach.

You must incorporate ten (10) references (Harvard referencing system). These need to include:

• The Registered Nurse Standards of Practice (Australia);
• The ICN Code of ethics and
• any relevant legislation relating to your selected case study.

The following audio outlines the requirements for this assessment

• You need to selectoneof the two case studies below and apply the Ethical Decision Making Framework.

Case Study One

Mrs C is an 83 year old mentally competent women who lives alone since her husband died ten years ago. She was admitted to the hospital, feeling faint, she is bradycardic, with a pulse of 48 and hypotensive, with a blood pressure of 98/58. The doctors and nurses stabilise her condition with medications but later inform her and her only son that she has 'sick sinus syndrome' and needs a pacemaker to regulate the arrhythmia that is present in her heart. After the doctor explained the procedure and risks involved, Mrs C pondered the situation for a while before discussing it with her son and the doctor. Her medical history includes long-term adult onset diabetes, chronic renal failure and arterial insufficiency, which have resulted in numerous episodes of hospitalisation over the last 8 years. She feels very tired. She decides she does not want a pacemaker. Once Mrs C tells her son her wishes, he is quite upset and meets with the doctor to discuss options. The doctor and her son speak to Mrs C again in an attempt to try and get her to change her mind, but she continues to refuse the recommended treatment. She and her son argue. The doctor tries to explain to Mrs C that the pacemaker is for her benefit, in her ‘best interests', and involves very minimal risks to her. She tells the registered nurse that she feels that they are ‘ganging up' on her. Using the ethical decision making framework investigate and analyze this case.

Case Study Two

Sandra, an exceptionally bright and articulate 15 year old girl, has a diagnosis of acute lymphocytic leukemia. She has presented back at the hospital tired and pale. She has dyspnea on exertion and is tachycardic. Blood tests were taken, which revealed that Sandra was anemic and had thrombocytopenia. Her family are practising Jehovah's Witnesses. Based on their religious beliefs, her parents do not consent to medical treatment that includes any blood transfusion or blood products, and Sandra agrees with them. The doctor explains that all non-blood alternatives have been attempted or deemed inadequate and that in refusing blood transfusions Sandra's chances of a cure were probably diminished by at least 50%. Later on, when you and your colleagues are alone with Sandra, she tells you that she's really very scared of dying and would like you to do whatever you think is best. Using the ethical decision making framework investigate and analyze this case.

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