Legal and Ethical Issues in Nursing – Essay Answer

Introduction

Nurses are bound by professional and ethical obligations for ensuring appropriate boundaries are set in the relationship such that it remains purely professional and to ensure the avoidance of any behaviour that could act as a possible reason behind any form of exploitation, harm, or emotional and mental harassment. The chosen scenario describing the relationship between nurse Jackie and patient X raises significant legal and ethical issues related to duty of care, professional practice standards, and ethical and legal considerations. This essay aims to shed light on the above-mentioned violations made by Nurse Jackie.

Duty of Care

Nurse Jackie had a duty of care to ensure the well-being and safety of her patients, including patient X. The duty of care finds its basis in the principle of non-maleficence, which dictates that healthcare professionals must never harm their patients (Varkey, 2021). In the case of Patient X, Nurse Jackie had a professional responsibility to ensure that Patient X receives appropriate care and treatment while making sure that there was no exploitation or harm towards Patient X from her side in any manner. The engagement of Nurse Jackie in a personal relationship with Patient X resulted in a potential breach of her duty of care as a nurse by exposing Patient X to exploitation, harm and psychological harassment (McAllister & Brien, 2020). As a registered nurse, Nurse Jackie was accountable for maintaining the trust of Patient X and a professional relationship regarding his care and safety. In addition to this, she also was professionally obliged to ensure that appropriate professional boundaries are taken care of from the side of both the individuals involved and that the relationship between Nurse Jackie remained purely professional (Barlow et al., 2018).

Professional Practice Standards

Nurse Jackie was also bound by professional practice standards, including the Nursing and Midwifery Board of Australia's (NMBA) Code of Conduct. This code lays out a guideline concerning the professional obligations and ethical standards that nurses are required to adhere to, including the necessity of maintenance of a professional boundary with the patient. The NMBA's Code of Conduct states that nurses must maintain professional boundaries with patients at all times, including not engaging in any behaviour that could lead to exploitation, harassment or harm (International Council of Nurses, 2023). Nurse Jackie getting herself involved in a relationship with Patient X led to the violation of this code of conduct since it could have led to possible harm, exploitation and psychological harassment.

Ethical Issues

In addition to the violations, the relationship between Nurse Jackie and Patient X raises several ethical concerns, including exploitation, power imbalance, and conflicts of interest. As a vulnerable patient with a history of family violence and childhood trauma, patient X may have been at risk of exploitation and harm due to the dynamics of the relationship he shared with Nurse Jackie (Brandt & Rudden, 2020). Nurse Jackie, being a healthcare professional in the area of psychology was aware of the vulnerabilities of Patient X. In spite of this, her actions led to the possible infringement of the principle of beneficence, which requires healthcare professionals to act in the best interests of their patients (Varkey, 2021). Additionally, her relationship with Patient X created a conflict of interest, since it compromised her capability of providing care with an impartial and objective mindset.

Legal Issues

Nurse Jackie's actions also resulted in the violation of various laws, including the Health Practitioner Regulation National Law, which strictly necessitates the prohibition of registered healthcare professionals from engaging in sexual or any other form of inappropriate relationship with their patients. This law safeguards the vulnerability of the patient and acts as a watchdog for the protection of patients from any instances or possibility of any form of exploitation, harm, mental and emotional distress and/or breaches of professional boundaries (Australian Capital Territory, 2022). Any breach of these professional and ethical obligations could lead to disciplinary action, including the potential loss of license and receiving a potential ban on medical practice for the individual’s lifetime (Levine & Courtois, 2021). It was, therefore, necessary for Nurse Jackie to have been aware of her legal and ethical obligations and maintain appropriate boundaries in her professional relationships with Patient X.

Ethical Dilemma

Firstly, the ethical dilemma that acts as the centre of conflict from Nurse Jackie’s perspective involves the obligations she has towards the hospital and her profession. She, being a registered psychiatric nurse is bound to ensure that professional boundaries are maintained with her patients (Hwang et al., 2018). In addition to this, she also has the responsibility of maintaining her own relationship with Patient X. However, the actions of Nurse Jackie have acted as the root cause behind Patient X’s distress and harm which are very evident from the report which reveals that Patient X was harassed by her. As a result of her actions, Nurse Jackie has become more vulnerable to possible professional and legal consequences due to the violation of ethical standards.

Secondly, the other stakeholders that might get indirectly affected by Nurse Jackie’s case comprise firstly, the healthcare facility with the management and the legal team in particular as they might have to deal with legal situations as a consequence of Nurse Jackie’s actions, putting the hospital’s reputation at stake (Mannion et al., 2018). Secondly, other patients admitted to the facility, if exposed to the occurrence of such an incident might experience a feeling of distress and distrust regarding not only Nurse Jackie but also other working healthcare professionals and the healthcare system as a whole (Currie et al., 2019). The third and final stakeholder getting affected is the other personnel working in the hospital as they might develop an emotion of distrust towards Nurse Jackie and might demand her resignation or cancellation of her medical licence (Abbasinia et al., 2020).

Decision-making Framework

The ICN Code of Ethics can be a relevant framework for Nurse Jackie and Patient X since it provides a framework related to nursing practice through a set of guidelines. It emphasizes the need for maintaining a professional boundary with patients; in addition to the focus on the well-being of the patient and giving respect for the autonomy of the patient (International Council of Nurses, 2023). Firstly, the Code dictates that professional boundaries must be maintained by nurses under all circumstances in addition to abstinence from any kind of personal or sexual relationship with patients (ICN, 2023). Nurse Jackie through her actions compromised the relationship between a nurse and a patient and ultimately violated the Code of Ethics. Secondly, the Code highlights the need to respect the autonomy of patients and their right to make informed decisions concerning their healthcare as well as personal relationships (ICN, 2023). Nurse Jackie crossed this boundary by uploading pictures that involved herself and Patient X, to a social media website and also lying about the ending of their relationship. These actions led to a compromise regarding Patient X’s autonomy and also were disrespectful towards the dignity of Patient X. In addition to this, Nurse Jackie failed to ensure that Patient X is treated with respect and compassion.

Thirdly, the Ethics Code necessitates that the well-being of the patient should be the first and foremost priority and this involves steering clear of any kind of actions that can compromise the safety of the patient (ICN, 2023). The behaviour and actions exhibited by Nurse Jackie in the following scenario led to the violation of Patient X’s privacy, causing harassment; in addition to emotional and psychological harm to Patient X. Lastly, the ICN Code of Ethics, emphasizes that it is important for nurses to be responsible and accountable for their actions (ICN, 2023). Nurse Jackie should have taken responsibility for her actions and behaviour which led to the violation of ethical and professional boundaries. She should have informed the concerned authorities at the right time and maintained the confidentiality of the pictures.

Personal Reflection

I would make sure that the ethical guidelines are followed by me, in my future practice. I would avoid any kind of personal relationships with my patients and strictly adhere to professional boundaries. I would also ensure that my patient receives appropriate care and treatment and is treated with dignity and compassion. I would also take complete accountability for all actions and any mistakes that happen in future.

References

Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141-151. https://journals.sagepub.com/doi/pdf/10.1177/0969733019832950

Australian Capital Territory. (2022). Health Practitioner Regulation National Law (ACT). https://www.legislation.act.gov.au/a/db_39269/current/pdf/db_39269.pdf

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

Brandt, S., & Rudden, M. (2020). A psychoanalytic perspective on victims of domestic violence and coercive control. International Journal of Applied Psychoanalytic Studies, 17(3), 215-231. https://doi.org/10.1002/aps.1671

Currie, G., Richmond, J., Faulconbridge, J., Gabbioneta, C., & Muzio, D. (2019). Professional misconduct in healthcare: Setting out a research agenda for work sociology. Work, Employment and Society, 33(1), 149-161. https://journals.sagepub.com/doi/pdf/10.1177/0950017018793352

Gryesten, J. R., Brodersen, K. J., Lindberg, L. G., Carlsson, J., & Poulsen, S. (2021). Interpreter-mediated psychotherapy–a qualitative analysis of the interprofessional collaboration between psychologists and interpreters. Current Psychology, 1-14. https://doi.org/10.1007/s12144-021-01345-y

Hwang, B., Choi, H., Kim, S., Kim, S., Ko, H., & Kim, J. (2018). Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study. Nurse Education Today, 69, 159-164. https://doi.org/10.1016/j.nedt.2018.07.015

International Council of Nurses. (2023). The ICN Code OF Ethics For Nurses. https://www.icn.ch/system/files/2021-10/ICN_Code-of-Ethics_EN_Web_0.pdf

Levine, S. B., & Courtois, C. A. (2021). Boundaries and ethics of professional conduct. In A. (L.) Steinberg, J. L. Alpert, & C. A. Courtois (Eds.), Sexual boundary violations in psychotherapy: Facing therapist indiscretions, transgressions, and misconduct (pp. 45–65). American Psychological Association. https://doi.org/10.1037/0000247-003

Mannion, R., Blenkinsopp, J., Powell, M., McHale, J., Millar, R., Snowden, N., & Davies, H. (2018). Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews. Health Services and Delivery Research, 6(30). http://dx.doi.org/10.3310/hsdr06300

McAllister, M., & Brien, D. L. (2020). Paradoxes in nurses’ identity, culture and image: The shadow side of nursing. Routledge. https://books.google.co.in/books?hl=en&lr=&id=ojDNDwAAQBAJVarkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119 https://www.ncbi.nlm.nih.gov/books/NBK470309/

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