Transition to Professional Practice
June is a newly graduated nurse and has eight months part-time work experience in a nursing home. She loves her job and has always wanted to work with elderly clients. June finds their stories and life experiences fascinating. She also likes that she is appreciated for her efforts by those she cares for. Since working at the nursing home June had developed a good rapport with Emily an eighty year old lady who loves visits from her family and friends and helping others (in the nursing home) where she can. Despite some short term memory loss, Emily is relatively healthy for her age. June is consistently allocated to Emily’s section as she knows those residents well.
While June was on her four days off, Sue another RN with 30 years aged care experience was looking after Emily. On the Monday0/740m+88 Emily complained to Sue that she was feeling a little nauseous, hot and had a headache. Sue gave her some Panadol to relieve the symptoms and told her to rest for the day as she was probably getting a virus. By the afternoon Emily was still feeling unwell and she thought she was getting worse so reported this to the Assistant Nurse Ben, who then told Sue. Ben was working in the nursing home to gain practical experience as he was completing his Bachelor of Nursing and was just entering his second year. Sue replied to Ben that she probably was getting a cold and tell her just to rest. That evening Emily did not have dinner and stayed in bed.
The next morning both Sue and Ben were on again and as Ben entered Emily’s room she was lying in the bed and more difficult to rouse, she was not responding well to his questions, she looked glazed in the eyes and was very hot to touch. Ben took her temperature and pulse, T39.2 and P120. Ben reported all of this to Sue. Sue responded and told Ben to give her some Panadol from the medication trolley as she was too busy and was behind in her work. She also got Ben to give Emily her morning medications at the same time. These were difficult for Emily to swallow. Ben had not given out medications before at the nursing home however followed Sue’s orders. Once again Emily did not eat and stayed in bed all of the day. Sue did not see Emily until later on that day and it appeared that Emily was sleeping so did not wake her up.
By the next morning Emily was very confused, she was incontinent, did not know where she was and appeared agitated and frightened. Her condition continued to deteriorate and by the afternoon Ben asked if the resident GP was going to review her and Sue replied ”He is not due to make a visit until tomorrow………Ben she probably has the flu……..as like most of the residents here she is palliative and we are keeping her as comfortable as we can.” Ben was confused about what she meant by palliative and why she was now confused. Ben asked about this and Sue replied ”there is also a bit of dementia there too you know, remember she gets forgetful……sometimes it’s best just to let the oldies go when it’s their time.” Ben remained concerned, but did not question any further and did not know what to do.
The following morning June returned back from her four days off (on the Thursday) and listened to the recorded handover from the morning shift. To her surprise Sue describes a serious deterioration in Emily’s health status. The report describes Emily as being confused, incoherent, very drowsy and incontinent. Ben tells Emily what had happened over the past few days and that she had eaten and drunk very little in that time. He said the doctor had not seen her, although he thought he was due to come any minute that that afternoon. June asks Sue what has been happening and why the Dr had not visited yet, to which June replied that she would tell him (the Dr) about Emily that afternoon when he does his ‘resident rounds’. June asks ”so he hasn’t been notified about her poor condition?’ Sue replied ‘that’s the way we do things around here, we wait for the weekly GP visit unless it is an emergency.” June asks if the family had been notified and Sue said she didn’t think it necessary if someone had a cold.
At this point the Dr appears and June tells the Dr that Emily is very unwell. He asks what was wrong and how are her observations? Sue quickly replies ”I think she has a cold her obs were okay when I did them at 0900 this am……I will write them in her chart now.” Ben was dumfounded and later confided in June that they had not been taken and that he had been around Emily most of the morning and had not observed Sue take them. The Dr asked ‘how long has she been like this? Sue replied ”just a couple of days, she has only developed confusion and lethargy this morning.” Ben concerned told the Dr that she has not eaten or drunk anything since Tuesday. To which the doctor says to Sue ”why didn’t you notify me earlier?”
Later that afternoon Emily was transferred to hospital in a serious condition, with a provisional diagnosis of urinary tract infection and ? septicaemia. June is very concerned about the events of the week particularly after what Ben had told her and wonders what she should do.
Assessment Framework –
Use the Kerridge, Lowe and McPhee’s (2005) modified ethical decision-making framework (below) to examine the facts from this case study in light of their ethical and legal issues.
Remember you need to make comments from a nursing perspective
1. Clearly state the problem/s
? Identify all the issues (facts) within the context of the case study and distinguish between
o legal issues and
o any other clinical problems such as health/medical, risk, social, cultural, linguistic, gender, ageist.
? Explore the meaning in any value-laden terms identified.
? Identify the facts that support or refute the issues, you can include these in your discussions above.
? What else would you like to know about or consider i.e. further information which may be helpful?
Students can grid, list, dot point this section here if they like (or use columns) – see the example below
Dear writer please use a columns with tis section
Legal issues • Lack of documentation Supporting evidence includes…….No observations recorded since…
2. Consider and explore the fundamental ethical principles and their meanings and whether they were upheld or breached (you will also have to consider whether or not they apply in the case study circumstance)
? Autonomy: how was this approached from the patient’s perspective?
? Beneficence: what benefits were / were not obtained for the patient?
? Non-maleficence: what are the risks / harms and how can they be avoided?
? Confidentiality /Privacy: what information is private and does confidentiality need to be limited or breached? Is it an issue in the case study?
? Veracity: has the patient and their family been honestly informed and is there any reason the patient cannot know the truth?
? Advocacy: what (if any) are the issues from the scenario?
Students can also grid this section, however be careful to explain where required (& reference of course) e.g. sample below
Dear writer please use a columns with tis section
• (definition given) The scenario reveals Emily’s autonomy (upheld or breached)….. Clearly in not communicating……..
3. Consider and explore the Law and Professional Nursing standards and whether they were upheld or breached (this section needs to be completed in essay style as you are developing an argument)
? Identify relevant legal principles and laws and nursing standards that indicate unlawful/unprofessional behaviour. Here you need to research both the law and professional nursing standards, and make comment about where there are problems/ breaches and give examples to highlight your argument from the case study.
4. Consider how the problem would look from another perspective
Consider a range of the following:
? Who are the relevant stakeholders? (e.g. patient, hospital, nurses, doctors)
? What is their interest?
? What do they have to lose?
? How significant are their interests?
? How powerful are they? How legitimate are they?
? How urgent are the problems?
? How would the problem look from an alternative ethical position? e.g. deontological
Only include here what is relevant to the case study
5. Identify any ethical conflicts in the case study (this section needs to be completed in essay style as you are developing an argument)
? Are there any ethical conflicts (e.g. between nurse/s, patient, treatment options) in the scenario? Can you explain why the conflicts have occurred and how they may be resolved?
? Identify the relevant ethical concepts and how they might guide management
? Identify relevant legal concepts and laws and how they might guide management
6. State the ethico-legal decision and justify it: (this section needs to be completed in essay style as you are developing an argument)
? What decision needs to be made, specify how guiding principles were balanced and why
? Outline how you would communicate the decision and assist relevant stakeholders to determine an action plan