Case Summary
The case study provides patient information about Mrs. Pearce, an 80-year-old woman who was admitted to the hospital with cellulitis on her leg. A nursing student, Kathie Smith, assisted the woman in performing Activities of Daily Living (ADLs) because the woman had limited mobility and a high risk of falling. The previous evening, Mrs. Pierce had fallen while trying to get to the bathroom, so assistance was needed.
However, the woman wants to be independent in performing her ADLs, so she intends to shower independently. Later, the woman refused to perform her exercises because of pain in her leg and asked for pain medication. That evening, student nurse Smith saw a photo of her friend Nick Roan on his Facebook account showing him with a patient.
Nursing Guidelines
Due to the dread of pain, the patient refuses to do ADL. The capacity for muscular contraction is also impaired to some extent due to a lack of activity in the limbs. Consequently, muscular strength is reduced. The metabolic rate steadily declines in the aged, and muscular atrophy and weakness are more prevalent (Choukou et al., 2023).
The first guideline that a nurse should follow in such a situation is to recognize and appreciate what has occurred before reporting the occurrence (NMBA, 2018). The nurse should inform Pearce’s patient about their greater risk of falling and emphasize the importance of regular exercise. The lady should understand that the capacity to manage balance during activities of daily living (ADLs) in older persons is decreased owing to degeneration of the sensory systems, cognitive system (central nervous system), and musculoskeletal system.
Most falls and accompanying injuries significantly reduce one’s quality of life by causing physical limitations, worry, loss of confidence, and a fear of falling. Pearce should be aware that practicing ADLs independently might be hazardous in her position. A lady should not shower alone, as recent experience has shown it to be a dangerous practice. Kathy Smith should gently incorporate activities into Pearce’s life, enabling the trainee to adjust while assuring their safety. The program should include exercises that incorporate both passive and active postures to promote equilibrium, changes in the foundation of support, variations in the center of gravity, and diverse surfaces for standing.
Furthermore, the nurse should gradually proceed to higher task levels through more complicated workouts that incorporate both physical and cognitive activities (dual and multi-tasking). Similarly, the patient will be able to improve and begin to execute things independently after some time. As a result of the examination, Smith should change the patient’s treatment strategy (NMBA, 2016).
A complete plan of care should include measures to address both functional and cognitive deficits, as well as methods and particular technology to assist ADLs that the client is unable to accomplish (Maresova et al., 2020). A technique for monitoring ADL function and general health is required as part of the comprehensive care plan (Lee-Cheong et al., 2022). This is necessary to ensure the success of the treatment plan and to make any necessary revisions.
A comprehensive care plan for older adults should include interventions that, at the very least, focus on maintaining physical health and well-being. This area encompasses monitoring and maintaining the physical health of older adults, including vital sign monitoring, physician-led dynamic monitoring, medication administration in various forms, exercise, and diet. Support for cognitive status is also crucial since it entails monitoring and managing the older person’s mental health, including cognitive function, memory, and emotional well-being.
Socialization is another vital care part. Group outings, involvement in shared activities, and collective activities are examples of activities that foster socialization and engagement with others. Moreover, the most crucial aspect of caring is safety. This domain encompasses keeping older individuals safe at home or in a care facility, including fall prevention, emergency response plans, safety measures, and ensuring compliance with infection control protocols.
Analysis of Misconducts
The first instance of misconduct is that, during working hours, Nick, a nursing student, participated in extracurricular activities. Sleeping during work shifts and lunch breaks is governed by labor rules. During working hours, a nurse may not engage in personal activities such as chatting on the phone, watching television, embroidering, crocheting, studying fiction, or using an employer’s computer or social smartphone for private purposes, according to the law. These issues can be addressed through the Internal Regulations, which are made available to employees upon signing an employment contract. If a healthcare organization’s internal policies prohibit workers from using their cell phones for personal reasons outside working hours, the organization’s top surgeon can impose an administrative penalty on the nurse.
The second misdemeanor is the disclosure of professional secrets, specifically in the case of medical information. This applies if the nurse has taken a photograph without the patient’s consent, but the patient’s identity can be established from the photo. If the patient’s identity cannot be established from the photo, then medical confidentiality has not been violated. However, according to Nick, the patient agreed to take the photo, so the nursing student did not violate the norm.
The third misconduct Nick is alleged to have committed is a breach of moral standards. If the employment agreement or the Professional Regulations of the medical organization require medical personnel to treat patients with respect, the nurse may potentially face disciplinary action. Taking selfies in front of a patient can be perceived as inattentive and disdainful towards them.
Ethical Standards
Professional groups created the ethical standards contained in codes of conduct to maintain the quality and independence of their purpose. Nurses must actively create and maintain a set of professional values (World Health Organization, n.d.). Given the control physicians and nurses have over patients’ lives and deaths, as well as their physical and emotional well-being, they must adhere to medical professional ethics (Disantara et al., 2022). They strive to safeguard patients from medical abuse and physicians from societal and political pressures (Turale et al., 2020). Refusal to adhere to medical ethical norms may result in disciplinary action by professional organizations, and civil courts may order physicians or nurses to make reparations to victims. Failure to follow ethical norms may be criminalized and result in criminal actions by the courts for exposure of medical secrets or cooperation in torture.
The healthcare practitioner has a duty to maintain a balanced doctor-patient relationship and to preserve the patient’s dignity. This commitment limits the doctor’s authority over the patient. Most national laws preserve this commitment, and failing to comply can result in a civil action (Tien et al., 2019). When a patient is unable to provide consent due to medical or legal reasons (e.g., an unconscious patient or a juvenile) or when consent cannot be freely given (e.g., patients undergoing compulsory treatment or those deemed incompetent), the physician is held accountable for the ethical nature of the choice and action taken. Ethical principles may diverge from or conflict with legal or administrative rules.
The nurse must continually observe and maintain professional standards of practice as defined by professional nursing associations. Continuous improvement of special competencies and raising their cultural level is the first professional duty of a nurse. A nurse must be competent in understanding the moral and legal rights of the patient.
Maintaining professional, legal, and ethical competence is a measure of personal responsibility for each nurse. This goal is accomplished by continuous improvement of knowledge. Based on the given case study, it is concluded that non-compliance with the norms and principles can lead to deterioration of the patient’s condition or legal problems for the nurse.
References
Choukou, M. A., Olatoye, F., Urbanowski, R., Caon, M., & Monnin, C. (2023). Digital health technology to support health care professionals and family caregivers caring for patients with cognitive impairment: Scoping review. JMIR Mental Health, 10, e40330.
Disantara, F. P., Chansrakaeo, R., Jazuli, M., Ratnayutika, N. P., Umiasih, R. T., & Putri, C. I. (2022). The enigma of ethics: Code of ethics enforcement on covid-19 health protocol. De Lega Lata: Jurnal Ilmu Hukum, 7(1), 1-21.
Lee-Cheong, S., Amanullah, S., & Jardine, M. (2022). New assistive technologies in dementia and mild cognitive impairment care: A PubMed review. Asian Journal of Psychiatry, 73, 103135.
Maresova, P., Hruska, J., Klimova, B., Barakovic, S., & Krejcar, O. (2020). Activities of daily living and associated costs in the most widespread neurodegenerative diseases: A systematic review. Clinical Interventions in Aging, 1841-1862.
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice.
Nursing and Midwifery Board of Australia. (2018). Professional standards.
Tien, N. H., Thuong, T. M., & Yen, N. T. H. (2019). Enhancing independence of local auditing services by profiting from experiences of the Big4 group (KPMG, Deloitte, PWC E&Y) operating in Vietnam market. Cogent Business & Management.
Turale, S., Meechamnan, C., & Kunaviktikul, W. (2020). Challenging times: Ethics, nursing and the COVID‐19 pandemic. International nursing review, 67(2), 164-167.
World Health Organization. (n.d.). The ICN Code of ethics for Nurses. World Health Organization.