Ethical Issues in Nursing Assignment

NURS 412 – Ethics, Law, Economics, Policy

Purpose of Assignment
The purpose of the assignment is to provide the student with an opportunity to analyze an
ethical issue in nursing. The student will analyze an ethical dilemma, make a decision, and
support the decision with literature to include the American Nurses Association (ANA) Code of
Ethics for Nurses.

Student Approach to Assignment

The experience that I elaborated upon in this assignment had a massive impact on me as a
student nurse. Taking place in 2013, I have remembered the experience extremely vividly
because it encouraged me to always exercise safety in my nursing practice. In this assignment, I
elaborated on the incident, viewed the scenario from the perspectives of everyone involved, and
analyzed it from an ethical standpoint.

Reason for Inclusion of this Assignment in the Portfolio

I have included this assignment in my portfolio because it represents my commitment to
always providing excellent care whether those around me choose to do the same. Additionally, I
had the opportunity to practice therapeutic communication with an individual who had a large
amount of special needs. Even if the patient is unable meaningfully communicate, it is important
that the nurse practices therapeutic communication in order to minimize patient stress and
trauma. Finally, there were multiple teaching opportunities that took place during this
experience.

 Communication
 Adapts communication methods to patients with special needs.
 Example: The patient that I discussed in this paper was severely cognitively and
hearing impaired. I utilized therapeutic communication techniques by making eye contact
with the patient and holding and gently stroking her hand following the catheter insertion
in order to increase patient comfort and decrease stress levels. This had a noticeably
positive effect on her stress levels as expressed by decreased tensing of extremities and
decreased facial grimacing.

 Nursing Practice
 Establishes or utilizes outcome measures to evaluate the effectiveness of care
 Example: During care of this patient, I utilized the Pain Assessment in Advanced
Dementia (PAINAD) to assess patient pain levels. This tool is indicated for patients
experiencing cognitive impairments that impede their ability to communicate pain. Prior
to insertion of the indwelling catheter, the patient scored 8/10 on the PAINAD. Following
 insertion of the indwelling catheter, the patient scored a 3/10 on the PAINAD,
demonstrating the effectiveness of the intervention.

 Teaching
 Provides teaching to patients and/or medical professionals about health care procedures
and technologies in preparation for and following nursing or medical intervention.
 Example: Prior to insertion of the catheter, I explained the procedure from start to
finish and that we would require the help of multiple people to position the patient
such that catheter insertion was possible. Although the patient nodded when asked if
she understood the procedure, she was combative during the insertion. Following the
procedure, the patient began to attempt to remove the catheter, so I provided patient
teaching regarding the importance of not pulling on the catheter. The teaching was
ineffective and the patient required soft wrist restraints for protection.

 Teaching
 Provides relevant and sensitive health education information and counseling to patients,
and families, in a variety of situations and settings.
 Example: `The next day, the patient had managed to remove her indwelling catheter
and another had to be inserted. Her family members were distraught about the fact
that the patient had restraints applied. I provided education to the family regarding the
fact that the restraints were in place for patient safety. The family also required
education regarding the fact that the patient was at an increased risk for acquiring a
urinary tract infection following the patient’s removal of the catheter with the
retaining balloon still inflated with saline. These conversations took place in a
separate conference room since the patient was admitted to a semi-private room.

 Communication
 Demonstrates skills in using technology, informatics, and communication devices that
support safe nursing practice
 Example: While caring for this patient, I was able to view her chart and various lab
results. A urine sample was collected and it contained white blood cells. We paged
the physician who ordered a broad-spectrum antibiotic for coverage until the culture
and sensitivity was completed. We then contacted the pharmacy to request a STAT
delivery of the medication. Additionally, throughout care of this patient I utilized a
facility-provided communication board. She was able to request water and
repositioning using this communication device.

 Professionalism
 Applies an ethical decision-making framework and legal guidelines to clinical
situations that incorporate moral concepts, professional ethics, and advocacy for
patient well-being and preferences
 Example: While assisting the nurse with insertion of the catheter, the nurse inserted
the catheter into the patient’s vagina. The nurse had brought only one catheter kit and
was about to attempt to catheterize the patient with the now-contaminated catheter.
Knowing that this was against policy guidelines and nursing standards of care, I
advocated for the patient by asking the nurse if I could get her a new catheter kit. This
decreased the possibility of the patient developing a catheter-associated urinary tract
infection