Moral and ethical issues

Brief overview

 Rita Ann Broadway, who passed away on 2nd January 2015 due to unprofessional
and negligence in care.

 A coroner’s report found a number of causes to death due to missed care

 Medical errors in caring for the urinary tract infection

Findings of the inquest

 According to the review of autopsy, following reasons are found and will be discussed

 Lack of appropriate diagnosis by Dr. Quigley about catheter associated urinary tract infection in Ms.
Broadway

 Prolonged duration of catheter in situ

 Deficits in the integration of data at Modbury hospital and SAAS paramedics

 Unprofessional and uncompassionate care by the RN

 Comorbidities and chances of survival with appropriate care

Medical errors and omission of care

 Medical errors or mistakes committed by health care professionals that can cause harm to the patient, leading
to death in some cases.

 Failure to identify, plan and implement the right treatment

 An omission of care or missed care can be avoided by identifying the cause and acting timely.

 For instance Ms. Broadway and improper care associated with urinary tract infection and replacing catheter
Acting with professional integrity

 Registered Nurses should embody honesty, integrity, respect and compassion.

 Ms. Bailey failed to provide compassion and respect to Ms. Broadway without giving her complete attention
to her and reviewing her records on the computer. For instance, misunderstanding the ‘flooding’ and
considering it menstrual blood.

 Lack of compassion about changing the catheter

Legal and professional obligations

 Mandatory reporting

 Documenting and reporting information from the call center at RDNS and SAAS and to the
health care practitioners

 Poor communication in between patient-nurse and among health professionals

 Collaborative practice and shared decision making

Comprehensive assessment

 According to nursing standard 4, it is responsibility of RNs and health care professionals to conduct a
comprehensive assessment
 The coroner report stated Ms. Broadway’s urine was not sent for culture and other comorbidities which
affected the administration of antibiotics for urinary tract infection
 Inadequate assessment of abdominal pain
 A lack of comprehensive assessment results in missed care and medical errors leading to improper care and
harm.
Providing safe and appropriate quality care

 According to nursing standard 6, RNs should provide ethical goal oriented and quality care to the patients

 The report reviews that her chances of survival could have been increased with safe and appropriate care of
changing catheter

 The RN Ms. Bailey did not provided care within her scope and instead of practicing patient-centered care,
she did not conduct comprehensive assessment and liaison with the hospital
Open disclosure

 An open disclosure of information to the patient and family about the medical errors

 Discussing the implications of an ongoing treatment and risks

 Legal and ethical responsibility of the health care professionals

 Ms. Broadway did not receive any information about the risks of mortality from the nurses caring for her and
Dr. Quigley

 As discussed she was a difficult historian, information was not integrated properly including the disclosing
of information from the paramedics
 Ethical issues

 Ethical principles are a guide to a nurse to make decisions and provide person-centered care. A few ethical issues were
noted in the coroner’s report

 Autonomy and self-determination

Ms. Broadway constantly complained about vaginal pain and change of catheter; lack of respect for her decision and integrity

 Beneficence

Doing what is best for the patient.

In the coroner’s report, it is found that changing catheter and giving medications for urinary tract infection would have
increased survival rate of Ms. Broadway which lacked in the care.
Continued

 Non-maleficence

“Do no harm’ – avoiding actions that can negatively affect the patient

Lack of compassion and quality care to minimize the risk of infection, poor assessment and carelessness

 Justice

Ensuring that the best care is provided to the patient – fair, equitable and safe practice

Ms. Broadway was not given instant care upon complaining about the vaginal pain by Ms. Bailey who failed to read

her electronic records and understand the problem timely

 Nurses code of ethics

 According to ICN code of ethics, nurses responsibilities entail promoting health, preventing illness, alleviating
suffering and restoring health.

 Some professional issues noted in the coroner’s report entailed

 Deficits in professional responsibility from Ms. Bailey

 The nurse did not demonstrate professional values (compassion, integrity, responsiveness etc.)

 Lack of judgment from the nurse to assess the impact of situation

 Implications

 Missed care or omission of care leading to adverse consequences

 Inadequate nursing practices and nonadherence to standards of nursing

 Legal and ethical obligations for the health care professional and hospital

 Unsafe care provided to Ms. Broadway and refusal from the hospital to meet her needs

 Inability of nurse to comprehend the ‘flooding’ problem (considering patient’s age)

 Disintegrated reporting leading to adverse events

Conclusion

 The coroner’s report on Ms. Broadway concluded that due to unsafe and disintegrated care provided to the
patient where several legal, ethical, moral and professional issues impacted the outcomes. These issues
influenced the way Ms. Broadway was diagnosed and decisions made about the planning of care. Therefore,
nursing standards and code of ethics should be followed for quality care.
References

 Bonney, W. W. (2013). Medical errors: moral and ethical considerations. J Hosp Adm, 32(32), 80-88.
http://dx.doi.org/10.5430/jha.v3n2p80
 Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
 Charles, A., Cross, W., & Griffiths, D. (2017). What do clinicians understand about deaths reportable to the
Coroner?. Journal of forensic and legal medicine, 51, 76-80. https://doi.org/10.1016/j.jflm.2017.07.024
 Griffith, R., & Tengnah, C. (2020). Law and professional issues in nursing. Learning Matters.
 Nursing midwifery (2020) Retrieved from: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
References

 Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A
general overview. Perspectives in clinical research, 6(2), 73. PMCID: PMC4394583
 Rodziewicz, T. L., & Hipskind, J. E. (2020). Medical error prevention. In StatPearls [Internet]. StatPearls
Publishing.
 Sorrell, J. M. (2017). Ethics: ethical issues with medical errors: shaping a culture of safety in healthcare.
OJIN: The Online Journal of Issues in Nursing, 22(2). http://doi.org/10.3912/OJIN.Vol22No02EthCol01
 Tenke, P., Mezei, T., Bőde, I., & Köves, B. (2017). Catheter-associated urinary tract infections. European
urology supplements, 16(4), 138-143. https://doi.org/10.1016/j.eursup.2016.10.001