Nursing Assessment 2 – Decision Making Case Study Guidelines

The purpose of this assessment is to identify the principles of professional nursing practice, outline the ethical and legal frameworks for professional practice and apply them to a complex scenario to establish an ethically and legally sound decision.

The professional practice framework provides direction for nurses on their responsibilities. Standard 1.4 and 1.5 of the Registered Nurse Standards for Practice instructs nurses to consider ethics, law and professional frameworks when making decisions and providing care (Nursing and Midwifery Board of Australia, 2016). This guidance is supported by the Code of Conduct for Nurses principle 1.2 which describes the expectations for nurses to maintain professional conduct by practicing ethically and lawfully (Nursing and Midwifery Board of Australia, 2016).

Elements of ethical behaviour for nurses are explained in the ICN Code of Ethics for Nurses to ensure patients receive ethical care (International Council of Nurses, 2012).

Discuss your ethical, legal, and professional considerations as a Registered Nurse related to the case study provided using the framework below and decide the best course of action to resolve this situation.

CASE STUDY

I am the Recovery Room Nurse Joan handing over the care of Kevin Murphy to you, registered nurse on the Intensive Care Unit. Kevin’s MRN is J926703, and his date of birth is 8/10/1948.

S          Kevin was admitted for a cholecystectomy, due to ongoing pain and discomfort from gallstones, this morning. The procedure was aborted in the operating room when he developed cardiac changes following the anaesthetic. He was returned to the recovery room with the diagnosis of possible myocardial infarction. Kevin went on to go into ventricular tachycardia/ventricular failure (VT/VF) and needed defibrillation x3, cardiopulmonary resuscitation (CPR), intubation, lidocaine and vasopressors to maintain his blood pressure (BP)

O         Temperature 36.1 degrees Celsius. Pulse 130 bpm, sinus tachycardia. Respiratory rate 20 breaths/min ventilated with 100% oxygen, o2Sa 92%. BP 76/40 mmHg, maintained with IV dopamine, 26 mcg/kg, and IV dobutamine, 8 mcg/kg. Kevin is occasionally responding to verbal commands, responding to pain. Kevin is being kept alive by the ventilator and medications.

B          Kevin has a history of previous myocardial infarction (MI) and cancer of the prostate. Kevin was a builder for 45 years, with his own business and is now officially retired. His only son took over the business and Kevin continues to help him out on a part time basis. Kevin’s wife died last year. Kevin’s son is his next of kin. Following the code, the cardiologist, Dr Levitt, attended and recognised Kevin. He stated to the nursing and medical staff, “I know him from his last hospitalisation. I think he has an Advance Health Directive (AHD).” We have not been able to contact Kevin’s son as yet. However, on review of the notes, we have found a “Not for Resuscitation (NFR)” formed signed by a doctor and Kevin from his last admission.

A          So the plan is for Kevin to be moved to the ICU. The medical team will continue to try and contact Kevin’s son. Kevin will be reviewed as soon as you return to the ICU with him to decide whether to continue with conservative management, ventilation and medication, until the AHD can be located or whether treatment should be slowly withdrawn.

R          I will contact the doctors now to let them know you are transferring Kevin now. You should let your unit manager know what is happening.

FRAMEWORK

1. INTRODUCTION

• clearly describe the purpose of the paper
• introduce structure of essay
• DO NOT summarise the case study
• separate and identify the main medical, social, legal and ethical issues relevant to this case study

3.  CONSENT

Use this section to

• describe and apply the legal issue of consent.
• describe and apply the legal issue of civil
• consider how an emergency situation impacts the consent process
• does the patient have decision-making capacity?
• ensure any relevant legislation, case law or WA Health Policy is

4.  LEGAL ISSUES

Use this section to

• consider the other legal issues raised by this situation.
• describe and apply the legal issue of negligence.
• describe and apply the legal issue of professional
• describe and apply the legal issue of Advance Health Directives.
• ensure any relevant legislation and case law is included.

5.  ETHICAL ISSUES

• describe and apply the 4 fundamental ethical principles - Beneficence, Non- maleficence, Autonomy, Justice
• identify 2 sets of conflicts between the ethical principles

6.  PROFESSIONAL ISSUES

• what are the professional issues raised by this situation?
• describe and apply the professional issue of
• describe and apply the professional issue of person-centred
• use specific elements of the professional framework to demonstrate the professional expectations for these
• Professional framework includes the Code of Conduct for Nurses, ICN Code of Ethics, RN Standards for Practice, NSQHS Standards

7.  CONCLUSION

• what is the best course of action to resolve this situation?
• clearly state what action the nurse should take
• justify the proposed course of action using law, ethics, and professional standards

References

International Council of Nurses. (2012). ICN code of ethics for nurses. https://www.icn.ch/sites/default/files/inline- files/2012_ICN_Codeofethicsfornurses_%20eng.pdf

Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/Professional-standards.aspx

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines- Statements/Professional-standards/registered-nurse-standards-for- practice.aspx