When it comes to the profession of healthcare, professionals such as nurses and doctors are expected to adhere to high standards related to legal compliance and ethical conduct. Despite this, there are situations that involve the breach or non-compliance of these standards which leads to comprise in the health and safety of the patient along with the integrity of the professionals involved (Johnstone, 2022). The following case involves Gordon who is a registered nurse and his colleague Homer who is a student nurse, who exhibits various types of breaches related to their legal and ethical obligations during the process of administration of medication to Mr. Calvin Broadus who is the patient in this scenario. The breaches observe in this case raise concerns regarding various aspects such as informed consent, patient safety, professional boundaries and protocols associated with the administration of medications. The following discussion aims to shed light on the potential implications of the breaches for the people involved through the lens of frameworks and nursing codes and standards and also provide information on the necessary corrective measures which could be taken by the RN and the student nurse.
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The first ethical breach which can be observed in the case study is the lack of care and diligence which is evident by the failure on Gordon’s part related to the cross-checking of the medications to ensure accuracy before its administration to the patient. For a healthcare professional, it is extremely important that due diligence is exercised and all the aspects related to the administration of medications such as the right dosage, medication and route of administration (Hayes et al., 2019). The actions of Gordon demonstrated negligence towards ethical responsibilities, with respect to the verification of medications which put the life of Mr. Broadus at risk giving rise to potential effects which could have been adverse and even life-threatening. In addition to this, the second breach on the ethical front was the violation of informed consent. This breach can be observed on the part of Homer as he was responsible for instructing Gordon for the administration of the subcutaneous insulin injection without seeking the consent of Mr. Broadus. Through the violation of this principle, Homer takes no notice of the autonomy of the patient and the right he has related to his participation in decisions that involve his own care.
Talking about legal breaches, the first instance that can be considered to be a potential legal breach is the decision made by Gordon regarding the administration of medication with no verification related to the accuracy of the medications. Professionals involved in the field of healthcare have legal obligations associated with the adherence protocols and standards related to patient care. This usually comprises checking medication orders, confirmation of appropriate medication and dosage, verification of patient identity and making sure that a suitable route of administration is chosen (Rodziewicz et al., 2018). Apart from this, the second legal breach which was exhibited in the case study was the administration of medication in an unauthorized manner. The decision taken by Homer to allow the administration of medication through the hands of Gordon in the absence of any appropriate authority or training demonstrates a legal breach. It is essential for healthcare professionals to have the necessary skill set, knowledge and authority related to the execution of certain procedures (Rosen et al., 2018). Through his decision, Homer does not take into account the existence of professional boundaries which leads to the potential violation of legal regulations which govern the scope of practice and can lead to patient harm.
Firstly, the lack of care and diligence exhibited by the steps taken by Gordan led to the violation of standard 6 of the Nursing and Midwifery Board of Australia (NMBA) code of conduct which makes it mandatory for nurses to ensure the delivery of nursing practice that is safe and adheres to quality (Nursing and Midwifery Board Aphra, 2023). Gordon’s failure regarding the verification of medications demonstrated disregard towards the safety of Mr. Broadus and, him receiving competent care. Secondly, the principle of informed consent was also violated which is in contradiction with standard 1 of the NMBA code of conduct which focuses on the analysis related to the practice of nursing and the concept of critical thinking (NMBA Aphra, 2023). Giving respect to the autonomy of the patient and seeking informed consent before the initiation of any procedure or intervention act as one of the core ethical principles that Homer is unable to adhere to.
Thirdly, the ethical breaches also contradict the National Safety and Quality Health Service (NSQHS) Standards, particularly with respect to Standard 1: Governance for Safety and Quality in Health Service Organizations which focuses on systems that ensure the safety of the patient along with the delivery of quality which is violated when Gordon shows ignorance with respect to the verification of medications which lead to to the compromise of patient safety (Australian Commission on Safety and Quality in Healthcare, 2023). In addition to this, the breaches also contradict Standard 2: Partnering with Consumers which focuses on the involvement of patients in procedures related to their care and giving respect to their autonomy (ACSQH, 2023). This gets violated by Homer due to his disregard towards the principle of informed consent when he gives the responsibility for the administration of medication to Gordon without the consent of the patient which shows a gap in the area of shared decision-making.
Furthermore, the scope of practice of a student nurse is also not adhered to since Gordon being a student nurse is expected to practice within the boundaries of his authorized scope of practice which involves the completion of tasks under appropriate supervision and relevant training (Royal Children’s Hospital, 2021). The administration of subcutaneous insulin injection in the absence of supervision and authorisation exhibits a breach of his scope of practice and a violation of set expectations. Lastly, there was a breach in the administration of medication due to a lack of verification and authorisation that contradicts the principles associated with the rights of medication. The Five Rights of Medication Administration which encompass the right patient, right medication, right dose, right route, and right time - must be adhered to ensure safe and accurate medication administration (Hanson & Haddad, 2022). Both Gordon and Homer neglect these aspects which leads to the violation of medical rights and puts the safety and well-being of the patient in jeopardy.
Firstly, in the case of the registered nurse (RN), the failure related to the exercise of care and diligence with respect to the verification of medications demonstrates the inability to adhere to the fundamental principles of ethics associated with nursing such as quality of care and patient care (Johnstone, 2022). This breach can lead to a damaged professional reputation and loss of trust from colleagues, patients, and the healthcare system. Secondly, the administration of medications with a lack or absence of verification can cause harm to the patient, lead to medication errors and result in possible legal liabilities (Robertson & Long, 2018). The RN might face suspension or revocation of license in addition to being a part of lawsuits or being presented in front of regulatory bodies as a part of disciplinary proceedings.
The next individual of focus in the case study is the student nurse. Being a student nurse, the failure on Gordon’s part in ensuring that diligence is exercised and medications are checked for accuracy and seeking appropriate authorisation contradicts the underlying principles involved in the ethics related to nursing practice. It raises questions on the commitment shown by Gordan towards ensuring the safety of the patient along with his competence and his attention to detail. In addition to this, Gordon’s actions also make him liable to face legal implications such as being held legally accountable for his actions being subjected to disciplinary actions and facing restrictions with respect to clinical placements.
The last, but potentially the most important person involved in this scenario is the patient who can experience emotional and physical implications directly. For instance, the incorrect administration of insulin and the failure in checking medications led to physical harm to the patient which caused pain and distress to the patient. In addition to this negligence could have resulted in adverse outcomes which could have negatively impacted the health outcomes of the patient, leading to delayed recovery, complications, or even life-threatening situations (Stroup & Gray, 2018). In addition to this, at that moment the patient might have experienced feelings of emotional distrust along with anxiety and loss of confidence and trust in the system of healthcare and the professionals involved.
On Gordon’s part, firstly, he should have checked the label of the medication against the medication order in a diligent manner, ensuring accuracy in the name of the drug, its dose, time, and route of administration. This would have played an important role in the prevention of medication errors and ensured the safety of the patient (Alrabadi et al., 2021). Secondly, before the administration of insulin, he should have sought guidance from his supervisor or another nurse who was more experienced than him. This would have acted as evidence of Gordon’s proper training and his knowledge about authorisation and supervision. Lastly, being a student nurse, he should have been aware of his limitations and acted in accordance with his scope of practice. This would have demonstrated his sense of responsibility and acknowledgement of his limitations (ABA, 2019).
As far as Homer is concerned, as an RN he should have been more responsible with his delegation of medication administration and should have had knowledge about Gordon’s competence and authorisation beforehand. Secondly, he should have sought the informed consent of the patient, prior to the initiation of the medication administration or any other procedure or intervention. Respecting patient autonomy and obtaining consent is a vital ethical and legal obligation (Pietrzykowski & Smilowska, 2021). Lastly, being the person with greater experience, Homer should have provided proper supervision and oversight to ensure safe and appropriate care. This includes closely monitoring the administration of medications, verifying the accuracy of medication administration, and stepping in when necessary to prevent errors or potential harm (Fylan et al., 2018).
In conclusion, patient safety, professional integrity, and legal liability are all seriously affected by ethical and legal violations in healthcare. To keep patients' trust and ensure the best quality of care, it is crucial to uphold ethical standards, adhere to established processes, and respect professional limits. To protect patients, deliver high-quality care, and uphold their professional integrity, nurses must abide by these standards and directives. Healthcare workers like Gordon and Homer run the danger of jeopardising patient outcomes, incurring penalties, and possibly even being subject to NMBA disciplinary action by breaking these rules. To deliver quality care and preserve public confidence in the healthcare system, it is crucial to uphold ethical obligations, abide by legislative mandates, prioritise patient safety, and maintain professional integrity. Corrective measures should emphasise upholding moral standards, exercising professional responsibility, delegating tasks appropriately, seeking advice when necessary, and protecting patient safety and autonomy. Forging a culture of patient safety and high-quality treatment requires that mistakes are learned from, competency is increased, and legal and professional obligations are complied with.
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Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., & Al-Faouri, I. (2021). Medication errors: a focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12 (1), 78-86. https://doi.org/10.1093/jphsr/rmaa025
Australian Commission on Safety and Quality in Healthcare. (2023). The NSQHS standards. https://www.safetyandquality.gov.au/standards/nsqhs-standards
Fylan, B., Armitage, G., Naylor, D., & Blenkinsopp, A. (2018). A qualitative study of patient involvement in medicines management after hospital discharge: An under-recognised source of systems resilience. BMJ Quality & Safety, 27 (7), 539-546. http://dx.doi.org/10.1136/bmjqs-2017-006813
Hanson, A., & Haddad, M.L. (2022). Nursing rights of medication administration . StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK560654/
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Johnstone, M. J. (2022). Bioethics: A nursing perspective . Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=PsWHEAAAQBAJ
Nursing and Midwifery Board Aphra. (2023). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Pietrzykowski, T., & Smilowska, K. (2021). The reality of informed consent: Empirical studies on patient comprehension—systematic review. Trials, 22 , 1-8. https://doi.org/10.1186/s13063-020-04969-w
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Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17 (3), 341-356. https://doi.org/10.1002/wps.20567
The Royal Children’s Hospital. (2021). Scope of practice for student nurses . https://www.rch.org.au/uploadedFiles/Main/Content/nursing-education/Scope%20of%20Practice_July2021.pdf
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