Ethical Reflection on Nursing Practice: A Case Study of Mary’s Experience

QUESTION

Mary is a newly qualified graduate Enrolled Nurse who is on her first medical ward rotation.  Over the last three days, along with a Registered Nurse, Mary has been allocated to take care of Mrs Marcia Granger.  Marcia is a 76yr old lady admitted for unstable diabetes and abnormal blood results.  She lives alone in a ground floor apartment and reports being independent with her Activities of Daily Living (ADLs), however since admission her functional level has declined and she requires the assistance of one nurse for most of her ADLs.

Marcia rings her bell frequently but only wants Mary to care for her as she feels Mary ‘knows what she likes’.  Mary tries her best to meet Marcia’s needs but feels torn between caring for her other patients.  She finds herself hurrying the other patients so that she can have more time to attend to Marcia.  Mary believes she can not say no to Mary without compromising the therapeutic relationship.

Today the Registered Nurse and Mary plan their patients’ care together noting a patient requires hourly BGL’s.  Mary agrees with the time planner and instructions from the RN and continues her work.  During the morning Marcia rings her bell and demands that Mary takes her to the toilet which Mary proceeds to do.  Mary is rushing as she needs to do the other patients BGL.  Whilst in the toilet Marcia nearly falls which leaves both of them shaken but not hurt.  Marcia tells Mary it was not her fault and asks her “not to mention it to the Doctor in case he decides not to let me go home”.  Mary reassures her and continues with her work.

When she takes the other patients BGL it is 20 minutes late and high at 20mmols.  Feeling frustrated and under pressure Mary writes the result in the time it was due not the time she actually took the BGL.  She justifies this to herself by thinking that the BGL was within the patients limits set by the Dr and therefore can see that there was no harm done.  Mary was unaware that the Doctor had since changed the patient’s prescription and should have received insulin.

The RN proceeds to take the patients BGL according to the time planner and finds the patient clammy, lethargic, shaking with a BGL of 24 mmols and ketones in her urine.

That night Mary feels guilty, cannot sleep and is anxious about what happened in the day.

Reflect on Mary’s experience and your own nursing practice. Refer to the NMBA Code of conduct for nurses (2018), Enrolled nurse standards for practice (2016), and ICN Code of ethics for nurses (2012).

Describe how these codes and standards assist you to consider legal and ethical implications for reviewing and improving your own practice, include the specific section or sub-section of each document you are referring to (one paragraph is required for each answer):

Link to NMBA codes and standards https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

a) Enrolled Nurse standards for practice domain: Reflective and analytical practice

b) Enrolled Nurse standards for practice domain: Professional and collaborative practice, specifically Duty of Care

c) ICN Code of ethics for nurses, specifically your rights and responsibilities in nursing practice and that of your employer
d) Code of conduct for nurses domain: Acts with professional integrity

ANSWER

Ethical Reflection on Nursing Practice: A Case Study of Mary’s Experience

Introduction

Nursing practice is guided by various codes and standards, which serve as essential frameworks to ensure legal and ethical considerations are taken into account. In this essay, we will analyze Mary’s experience with Mrs. Marcia Granger and discuss how the NMBA Code of conduct for nurses (2018), Enrolled nurse standards for practice (2016), and ICN Code of ethics for nurses (2012) can assist nurses, like Mary, in reviewing and improving their practice in challenging situations.

Enrolled Nurse standards for practice domain: Reflective and analytical practice

The Enrolled Nurse standards for practice emphasize the importance of reflective and analytical practice. In Mary’s case, after the incident with Mrs. Marcia Granger, she experiences guilt and anxiety about what happened during her shift. By engaging in reflective practice, Mary can critically evaluate her actions, identify areas for improvement, and learn from her mistakes. This standard encourages nurses to honestly examine their experiences, emotions, and actions, leading to personal growth and enhanced patient care. (ENSP 3.1, ENSP 3.2)

Enrolled Nurse standards for practice domain: Professional and collaborative practice, specifically Duty of Care

Duty of Care is a fundamental principle in nursing, outlined in the Professional and collaborative practice domain of the Enrolled Nurse standards for practice. Mary felt torn between caring for Mrs. Marcia Granger and attending to her other patients, resulting in compromised care for some individuals. Adhering to the Duty of Care principle, nurses must prioritize patient safety and well-being above all else. In such situations, effective communication and collaboration with the Registered Nurse and the healthcare team can help balance patient needs appropriately. (ENSP 1.1, ENSP 1.2)

ICN Code of ethics for nurses, specifically your rights and responsibilities in nursing practice and that of your employer

The ICN Code of ethics for nurses addresses the rights and responsibilities of nurses in their practice. In Mary’s case, she felt pressured to meet Mrs. Marcia Granger’s demands, even at the expense of other patients’ care. However, the Code highlights the need for nurses to advocate for their own well-being and exercise their professional judgment to ensure safe and effective care delivery. Employers also have a responsibility to create a supportive work environment that fosters patient safety and staff well-being. Mary can use this Code to assert her rights and responsibilities while seeking assistance or discussing workload concerns with her employer. (ICN 4.4, ICN 6.1)

Code of conduct for nurses domain: Acts with professional integrity

The Code of conduct for nurses emphasizes the importance of acting with professional integrity. In Mary’s case, she made a crucial error in documenting the patient’s BGL incorrectly, which led to severe consequences for the patient. This incident raises concerns about professional accountability and ethical decision-making. By adhering to this Code, Mary should have promptly reported the error to the appropriate authorities, ensuring patient safety and taking responsibility for her actions. Acting with professional integrity involves honesty, accountability, and a commitment to learning from mistakes. (NMC 6.1, NMC 6.2)

Conclusion

In this reflective analysis of Mary’s experience, we have explored how the NMBA Code of conduct for nurses, Enrolled nurse standards for practice, and ICN Code of ethics for nurses can assist nurses in reviewing and improving their practice. These essential guidelines promote reflective practice, emphasize the Duty of Care principle, highlight nurses’ rights and responsibilities, and underscore the importance of acting with professional integrity. By internalizing and applying these codes and standards, nurses like Mary can navigate challenging situations with confidence, improve patient care, and uphold the highest standards of ethical conduct in their nursing practice. Moreover, continuous self-improvement and adherence to ethical principles contribute to a culture of excellence and patient-centered care in healthcare settings.