Bachelor of Science in Nursing (Top up)

2023

(Ethics and professional issues)

Assignment

Enrolment Number : BSCN/20/GC/016

Student Name : S A G k sampath bandara

Date of Submission : 2023 08 31

Signature :

IIC University of Technology

Bldg No. 650, Road No. 2, Chak Angre Krom,
Mean Chey, 12353 Phnom Penh, CAMBODIA.
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01)

a) Ethics refers to the guidelines for conduct, that address question about morality. Value is
defined as the principles and ideals, which helps them in making the judgement of what is more
important. Ethics is a system of moral principles. In contrast to values, which is the stimuli of our
thinking.

Values strongly influence the emotional state of mind. Therefore, it acts as a motivator. On the
other hand, ethics compels to follow a particular course of action.

Ethics are consistent, whereas values are different for different persons, i.e., what is important for
one person, may not be important for another person.

Values tell us what we want to do or achieve in our life, whereas ethics helps us in deciding what
is morally correct or incorrect, in the given situation.

Ethics determines, to what extent our options are right or wrong. As opposed to values, which
defines our priorities for life.

b) 1. Deontological Ethics: These theories focus on the inherent nature of actions rather than
their consequences. One well-known deontological theory is Immanuel Kant's Categorical
Imperative, which states that actions are morally required based on their adherence to universal
rules. For instance, lying is considered wrong regardless of the situation.

2. Consequentialist Ethics: Consequentialist theories emphasize the outcomes or consequences of

actions. Utilitarianism is a prominent example, which asserts that actions should be judged by
their ability to produce the greatest overall happiness or utility. For instance, choosing to save
more lives in a crisis would be a morally right decision according to utilitarianism.

3. Virtue Ethics: Virtue theories focus on the development of virtuous character traits in
individuals. Aristotle's virtue ethics suggests that moral actions arise from cultivating virtues like
courage, honesty, and compassion. For example, an individual who consistently acts with
kindness and generosity is considered virtuous.

4. Ethical Relativism: This perspective holds that morality is relative and varies across cultures,
societies, or individuals. Cultural relativism argues that what's right or wrong depends on the
cultural context. For instance, practices considered ethical in one culture might be seen as
unethical in another.

5. Ethical Egoism: Ethical egoism asserts that individuals ought to prioritize their own self-
interests above others. Advocates of this view argue that individuals are naturally inclined to act
in their own best interest. An example of ethical egoism might be a person pursuing a career
opportunity that benefits them, even if it negatively impacts others.

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6. Feminist Ethics: This approach seeks to address and rectify historical biases in traditional
ethics, often focusing on issues related to gender and power dynamics. Carol Gilligan's work on
the ethics of care is an

example, emphasizing the importance of relationships, empathy, and compassion in ethical

decision-making.

c)

1. Respect for Autonomy-This principle emphasizes respecting an individual's right to make their
own decisions and choices. For example, a doctor should obtain informed consent from a patient
before performing a medical procedure.

2. Beneficence-This principle is about promoting the well-being of others and doing what is in
their best interest. For instance, a social worker might ensure a homeless person is provided with
shelter and food.

3. Nonmaleficence- This principle states the obligation to avoid causing harm or minimizing
harm whenever possible. An example is a pharmaceutical company thoroughly testing a new
drug to ensure it doesn't have adverse side effects.

4.Justice- This principle revolves around fairness and treating individuals equitably. An example
is a company providing equal pay for equal work, regardless of gender or other factors.

5. Fidelity- This principle refers to keeping promises and being faithful to commitments. A
therapist maintaining confidentiality with their clients is an example of fidelity.

6. Veracity-This principle emphasizes honesty and truthfulness. A journalist reporting accurate

information, even if it's uncomfortable, demonstrates veracity.

7. Confidentiality-This principle involves safeguarding private information shared by

individuals. A lawyer not disclosing client information without consent is an example of
maintaining confidentiality.

8. Respect for Others-This principal underscore treating others with consideration, regardless of
differences. An example is a teacher promoting a classroom environment where every student's
perspective is valued.

9. Cultural Sensitivity- This principle involves being aware of and respectful toward cultural
differences. A company adopting diverse cultural practices in its workplace policies demonstrates
cultural sensitivity.

10. Responsibility- This principle pertains to being accountable for one's actions and their
consequences. A software developer taking responsibility for fixing bugs in their code before it
goes live is an example.

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d) In Sri Lanka, as in any country, ethical conduct and positive work-related factors lead to
improved patient care quality and contribute to the healthcare sector's growth and sustainability.
Conversely, neglecting these aspects can lead to compromised care quality, decreased patient
satisfaction, and challenges in attracting and retaining skilled healthcare professionals. Ethics
and work-related factors play a crucial role in shaping the quality of healthcare services provided
by nurse practitioners in Sri Lanka. Adhering to strong ethical principles ensures patient safety,
trust, and the overall reputation of the healthcare sector. Nurse practitioners who uphold ethical
standards contribute to better patient outcomes and a more positive healthcare experience. Work-
related factors such as workload, job satisfaction, and professional development also
significantly impact nurse practitioners' performance. Adequate staffing levels and manageable
workloads are essential to prevent burnout and maintain the quality of care. Job satisfaction
directly influences the enthusiasm and commitment nurse practitioners bring to their roles,
affecting patient interactions and overall service delivery. Investments in continuous professional
development are vital for nurse practitioners to stay updated with the latest medical
advancements and evidence-based practices. This enhances their clinical skills and decision-
making abilities, ultimately benefiting patient care.

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02)

a) Documentation is important because it communicates clinical information about a client

including data related to their state of health and illness. The documentation record is a vehicle of
communication within the interprofessional healthcare team. By documenting information, the
healthcare team is made aware of assessments, interventions, and responses. This allows for a
continuity of care for the client that is connected and coordinated throughout their experience.
Additionally, the documented data allows for healthcare providers to incorporate this information
in clinical judgment and decision-making (Lapum, 2019).

b) Forgetting to document our tasks from the morning shift could lead to confusion and a lack of
accountability. It might become challenging for me and our team to track progress, share
information, and identify any issues that arose during your shift. Proper documentation helps
maintain clear communication and ensures a smooth transition between shifts.

c) All relevant information must be recorded

All paper records must be legible, signed and dated

Records must be contemporaneous, accurate and kept up to date

Records must be written in plain English avoiding jargon

Records must clearly distinguish between statements of fact and opinion

Paper records if moved to a new location must be monitored and kept securely

d) Minimizing errors in documentation involves several steps. First, ensure clarity by using
concise language and organizing content logically. Proofread thoroughly for grammar and
spelling mistakes. Incorporate visuals like diagrams and screenshots to enhance understanding.
Implement a review process involving multiple people to catch any overlooked errors. Regularly
update documentation to reflect changes accurately.

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03)

a) Proving allegations against healthcare workers requires a thorough and fair process. Patients
can take several steps to support their claims, such as documenting incidents, collecting medical
records, seeking second opinions, and gathering witness statements. It's important to follow the
appropriate channels, like contacting hospital administration, filing formal complaints with
relevant medical boards, or engaging legal assistance if necessary. Keep in mind that due process
and evidence are key elements in establishing the validity of allegations.

b) medical negligence in mental health comes in different forms. Common examples include
surgical errors, medication or prescription errors or even suing the NHS for misdiagnosis. In a
mental health negligence claim, a psychiatrist can be held responsible for failing to render
standard care to patients. Psychiatrist negligence can lead to a lawsuit and victims can claim
compensation to help them in their recovery process. Mental health illness has been a growing
concern across the UK. Whether a patient in a mental health facility is suffering from depression,
anxiety or emotional pains, they can get medical attention from health professionals like
psychiatrists to get better. But sometimes the reverse is the case when they come out of treatment
feeling worse than before. Some common examples of negligence in mental health treatments
include: When a doctor fails to notice symptoms of possible mental illness. When mental care
services discharge patients too early those results in injury. When the mental health team fails to
give the right treatment and this causes a patient avoidable harm. When a doctor or psychiatrist
gives a wrong medication that causes adverse side effects to patients (national Institute of health,
2009).

c) In recent times, medical science has witnessed exponential technological progress. However,
health-care delivery remains very much a human endeavor. Evidence shows that errors are often
the result of not from a lack of knowledge but from the mindless application of unexamined
habits and the interference of unexamined emotions. Preventing or minimizing medical
negligence for psychiatric patients involves a combination of careful practices and protocols.
Some steps to consider include maintaining clear and thorough communication between
healthcare professionals, providing proper training for staff, following established treatment
guidelines, conducting regular reviews of patient care, and ensuring patient confidentiality and
informed consent. It's important to foster a culture of empathy, understanding, and ongoing
education within the healthcare team.

d) Surgery performed on the wrong site

Surgery performed on the wrong patient
The incorrect surgical procedure performed on a patient
Unintentional retention of a foreign body in a patient after surgery

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As nurses, we can help minimize these errors by following strict protocols, double-checking
patient information, maintaining sterile environments, and ensuring accurate medication
administration. Communication with the surgical team and advocating for patient safety also play
crucial roles in preventing these errors.

04)

a) medical officer came late, no functioning oxygen cylinders in the hospital, wrong dose drug
administration.

b) Preventing negligence in nursing involves fostering a culture of safety, continuous training,

and effective communication among healthcare professionals. Implementing strict protocols,
regular audits, and reporting systems can also help identify and rectify potential issues early on.
It's crucial to encourage a collaborative approach and provide resources for ongoing professional
development to ensure high-quality patient care and minimize the risk of negligence.

c) medical negligence law suit is a very complex situation which involves extensive review of
records, expert interviews, which takes long hours. The precise meaning of the term standard of
care is unclear in a medical malpractice claim and also it is hard to prove the causal link between
the breach and the injury. Even a huge number of malpractice cases come before the court in
countries like USA, UK and Australia, Sri Lankan society is less aware of medical negligence
and ill treatments. High number of malpractice claims can be harm to the medical profession and
it will lead to reduce the trust between doctors and patients. On the other hand, it is essential to
protect an innocent patient who is coming to a doctor with lots of expectations about their health
and life. In a country which respect rule of law, the court should be given the opportunity to take
the ultimate decision with regard to standard of care required by the doctor. ADR with no fault
compensation mechanisms have to be introduced in to the Sri Lankan legal system with the aim
of ensuring doctor’s clinical freedom and reducing defensive actions practiced by doctors. A
hybrid of no-fault compensation system with Alternative Dispute Resolution will be immense
helpful for patients both who are rich or poor and educated or uneducated. Due to granting
compensation without waiting until proving fault or negligence, this system enhance the scope of
patients who can obtain compensation. Also this system do not have procedural barriers, time
consuming, and less expensive, because no need to pay for lawyers and the claims can proceed
faster than a lawsuit in the court. Doctors are not being sued and rather than concentrating on
defensive medicine, doctors can concentrate more on patient’s lives. The data and the ideas
which derived from discussions and negotiations can be used to make future improvements for
both doctors and patients. The most appropriate way to reduce malpractice claim is to prevent
before the error occurs. This can be done by developing a good relationship with the patient by
doctors. In Sri Lanka there’s a huge knowledge gap between doctors and patients. Patients should
be given a chance to ask questions regarding the medical treatment and an opportunity to involve

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in the decision-making process about their lives. This communication is a platform to identify
patient injuries before they become a law suit (Dayarathna, 2015)

d) The scenario presents a complex medical case involving a 70-year-old male with a history of
hypertension and smoking. He presented with a severe headache, loss of consciousness, and
subsequent cardiopulmonary arrest. The suspicion of intracranial pathology led to diagnostic
tests revealing subarachnoid hemorrhage with ventriculomegaly and intracranial hypertension.
Despite interventions, the patient was declared brain dead, and his family was approached for
surgical evacuation without detailed explanations. Performing surgery without clear
communication and informed consent raises ethical concerns, as proper communication and
patient autonomy are vital ethical principles. Negligence could be inferred if medical decisions
were made without involving the patient's family or without thorough explanations of the
proposed treatment and its risks. The subsequent death of the patient after surgery could raise
questions about the adequacy of the medical interventions or the informed decision-making
process.

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05)

a) Consent is our agreement for a healthcare professional to give you treatment and care,
including any tests, medicines, treatments, or procedures you agree to. capacity to consent
implies that the consent is voluntary, informed and the person has to capacity to make the
decision. Capacity to consent brings together the ethical, legal and professional responsibilities
of healthcare practitioners with regards to consent to treatment and decision making.

b) Implied consent is assumed based on actions or circumstances, while verbal consent is given
explicitly through spoken words. For example, a patient extending their arm for a nurse to take
blood implies consent. Verbal consent, on the other hand, involves directly saying "Yes, you can
take my blood." Both forms have legal and ethical implications, depending on the context.

c) Ensuring adequate informed consent involves explaining the procedure, risks, benefits, and
alternatives clearly to the patient. To confirm their understanding, we can ask them to summarize
what they've heard or encourage them to ask questions. It's also important to assess their capacity
to make decisions and provide information in a language they comprehend. Additionally,
documenting the conversation and the patient's agreement helps ensure we have covered all
necessary information.

d) When obtaining informed consent from a confused patient, it's essential to follow ethical
guidelines. I would typically try to assess the patient's ability to understand the situation. If
they're unable to provide informed consent due to confusion, we should seek consent from their
legal representative or next of kin, if possible. If urgency is a concern, I may need to involve the
medical team and follow established protocols for emergency situations while prioritizing the
patient's well-being.

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References
Dayarathna, K. (2015, november). medical negligence law, pp. 115-120.

Lapum, J. (2019). documentation in nursing. In C. Ronquillo. Ontario.

national Institute of health. (2009). Retrieved from https://www.ncbi.nih.gov.

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