Introduction
A nurse is responsible for providing high-quality care for the patients to improve their health and wellbeing. Decision-making and professional judgment are the most crucial soft skills that enhance the quality of care a registered nurse provides. In the given case study published in Tribunal, an enrolled nurse named Maura Katherine Bannister gave an overdose of morphine to a palliative patient, leading to her death. In the following section, this essay will elaborate on the conduct of enrolled nurses (EN), the ethical considerations that have been violated in the given case study, and the critical evaluation of the ethical principles of the registered nurses (RN) that were violated.
Critical Evaluation
The Enrolled nurse in the given case study case overdoses liquid morphine on an older woman suffering from ischaemic heart disease, kidney problems, and emphysema. The EN administered the overdose without the general practitioner's consent led to the patient's death. The enrolled nurse justified her act and had no regrets. She had admitted to her co-workers that she supported euthanasia, believed that she helped the elderly patient get relief from the pain she was going through, and referred to herself as an "angel of death." This act violated the conduct of Enrolled nurses. According to the Enrolled Nurses Standard of Practices given by NMBA, the first standard explains that the enrolled nurse is entitled to fulfill the duty of care that undertakes the practice of enrolled nurses. The act should have safe outcomes according to the needs of the patients that will protect people and minimize the risk of potential harm ("Professional standards", 2022). In the given case study, the EN did not abide by her duty of care and did not protect the patient from harm, and performed unsafe practice. Her decision to administer morphine to the patient led to potential harm.
The second standard practice standard states that the EN should promote safety for others and for self in all aspects of practicing nursing. The EN should provide care within the scope of practice and consult with the Registered nurses for appropriate information and guidance ("Professional standards", 2022). In the given case study, the EN violated this standard as she did not consult with registered nurses before giving the morphine to the patient. However, registered nurses are not professionally allowed to administer medications without supervision. There was a breach of the scope of practice from the EN's end. The fifth standard of the enrolled nurse practice states that one must collaborate with a registered nurse, other health care team, and the patient when forming a care plan ("Professional standards", 2022). The EN in the given case study violated this standard as she neither collaborated with the registered nurse, general practitioner, patient, or family before administering the medication.
There are seven ethical principles of a registered nurse that one must adhere to (McDermott-Levy, Leffers & Mayaka, 2018). In this given case study, two ethical principles arose: beneficence and nonmaleficence. According to beneficence, the health professional should act for the benefit of the patient and to protect them from harm and rescue them from danger. The health professional should support moral values and rules to defend others' rights and prevent harm (Manda-Taylor, Mndolo & Baker, 2017). In this case study, the Enrolled nurse did not consider the patient's safety, rather than supporting the patient and the family with utmost care. The principle of beneficence was violated as she gave an overdose of liquid morphine that caused harm to the patient. The second principle that was violated was nonmaleficence. According to nonmaleficence, the health professional is obliged not to harm the patient or related person during the duty of care. The act of the health professional should not cause suffering, pain, aggression, or even death to the patient (Sturdivant, 2020). As stated in the case study, the EN believed that no one should suffer. This ideology goes against the principle as the nurse must provide care in terms of clinical treatment and not by performing euthanasia.
Presentation Of Key Findings
According to NMBA's framework of assessing standards of registered nurses, a decision-making framework provides advice to the registered nurses and enrolled nurses on individual decision-making practice. In the given case, the EN told the RN that she intentionally gave the patient the overdose of morphine to kill her and give her relief from the pain. In such cases, the registered nurse should follow the decision-making framework to resolve conflicts. The registered nurse plays a major role in identifying whether consent was taken from the patient or the family and what exactly happened. In this case, consent was not taken from the patient or the family, and the act was done out of overconfidence or mental stress. The registered nurse is responsible for elevating issues to the higher authority in case the issue gets out of hand. The RN should provide an appropriate level of education and supervision to enrolled nurses to avoid professional conflicts.
Nurses' ethical, legal, and professional responsibility is to provide the patient with utmost care. Nurses should advocate safe and high-quality care in professional practice as it will protect the nurse and the patient. The registered nurse establishes appropriate judgment as it is the tool that will enhance the quality of care and interventions. A registered nurse should abide by nursing theories and guidelines to deliver quality care for ethically accurate judgment (Barlow, Hargreaves & Gillibrand, 2018). Professional collaboration is essential for enhancing clinical judgment. Even family and other individuals involved in providing care are essential for collaboration. Collaboration in planning care helps avoid errors by the nurses while delivering care to the patient. Registered nurses' actions must be guided by the code of ethics that enables them to think critically in clinical situations (Reese et al., 2021). Nurses should uphold their integrity by applying the knowledge of ethical principles of nursing (Haddad & Geiger, 2021). The registered nurses can communicate these clinical obligations and responsibilities to their colleagues and additional information about educational programs. This will help in improving the clinical judgment of enrolled nurses.
It can be concluded that the case study helped to elaborate on the ethical principles and the code of standards that have been violated. Registered nurses can improve their clinical judgment through educational programs. These programs will be beneficial in improving decision-making skills that will lead to better clinical judgment. Teamwork and collaboration of interdisciplinary roles like registered nurses, general practitioners, and other health professionals also improve critical thinking and the quality of care the enrolled nurses provide.
References for Critical Evaluation of Angel of Death
Barlow, N. A., Hargreaves, J., & Gillibrand, W. P. (2018). Nurses' contributions to the resolution of ethical dilemmas in practice. Nursing ethics, 25(2), 230-242. https://doi.org/10.1177/0969733017703700
Haddad, L. M., & Geiger, R. A. (2021). Nursing Ethical Considerations. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013
Manda-Taylor, L., Mndolo, S., & Baker, T. (2017). Critical care in Malawi: The ethics of beneficence and justice. Malawi Medical Journal, 29(3), 268-271. 10.4314/mmj.v29i3.8
Professional standards. Nursingmidwiferyboard.gov.au. (2022). Retrieved 25 July 2022, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx.
Reese, C., Sehlbrede, M., Brühmann, B. A., & Farin‐Glattacker, E. (2021). How do nurses and physicians assess inter‐professional collaboration in long‐term care homes? A survey study. Nursing Open, 8(6), 3616-3626.https://doi.org/10.1002/nop2.912
Sturdivant, T. (2020). Ethical Decision-Making for Nurses Treating Acute Pain in Patients with Opioid Abuse History. Medsurg Nursing, 29(1). https://www.researchgate.net/profile/Azita-Amiri-2/publication/339067544_Ethical_Decision-Making_for_Nurses_Treating_Acute_Pain_in_Patients_with_Opioid_Abuse_History/links/5e3b956fa6fdccd9658a8fed/Ethical-Decision-Making-for-Nurses-Treating-Acute-Pain-in-Patients-with-Opioid-Abuse-History.pdf
