Fuentes, Mary Dominica S.

BSN 4A

Ethical case: Nurse Roselind Jacusek was newly employed on the psychiatric ward of a large county hospital. 0ne of her patients was Daniel Forester, a 47-year-old man admitted for severe depression. Mr. Foresters depression had progressed to the point where he was refusing all medications, food, and water in hopes that he would die. Force feeding the patient, however, was distasteful to nurse Jacuseck. Each time she attempted to put food into Mr. Foresters mouth, he spit it out and move his head away and when NGT was placed, he still managed to dislodge it even in the presence of restraints, necessitating a new tube passed each time he was fed. The ordeal usually required the assistance of 3-4 individuals to hold Mr. Forester while the NGT was passed and being fed. Mr. Foresters bruises were inconsequential considering the necessary nutrition that was being supplied. Nurse Jacuzek wasnt sure this was adequate moral justification for physical coercion of a very sick psychiatric patient. 1. Ethical principle/s involved Autonomy- it involves self determination, and freedom to choose and implements ones decision, free from deceit, duress, constraint or coercion. Nonmaleficence- the principle of not to do harm 2. Provisions in the Nursing Code of Ethics that was violated Article 3 Section6 2.Quality and excellence in the care of patients are the goals of nursing practice. Section 7 Guidelines to be observed c. acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate effective nursing services through varied learning situations. f. see to it that quality nursing care and practice meet the optimum standard of safe nursing practice. i. insure that modification of practice shall consider the principles of safe nursing practice. Section 10 Registered nurses are aware that their actions have professional, ethical, moral, and legal dimensions. They strive to perform their work in the best interest of all concerned. Section 11 A. perform their professional duties in conformity with existing laws, rules, regulations, measures, and generally accepted principle of moral conduct and proper decorum.

Discussion of the Violation: Even if Mr. Forester is not an autonomous agent, the nurses in these cases do not necessarily have the right to treat the patient in ways that they think are beneficial to the patient. In the past decade or two it has become more common to recognize that patients cannot automatically be presumed to be incompetent just because they make judgments that most people wouldnt make. To the contrary, adults are presumed competent until found otherwise by the court. Because the patient is an adult who has never be found incompetent, he has the same rights as other adults. Forcing treatment against their consent is a legal violation. Unless the nurses in this institution are prepared to seek to have the patient declared incompetent, they will face severe moral and legal responsibilities if they treat against the patients consent, and for Ms. Jacuzek, Nurses should not participate in treatments or procedures that will harm the patient. They should make their stand known, and should withdraw from the team if what is to be done is against their conscience.

Legal case: Nurse Thao has positive performance evaluations over the past 13 years. On the day before the error, she had worked two consecutive 8-hour shifts, which caused her had a feeling of fatigue. Nurse Thao had intended to administer intravenous penicillin, which had been ordered for a possible strep infection. Instead, she mistakenly injected an epidural anesthetic into the I.V. line causing the patient to die. Nurse Thao admitted to her superior the incident and entered a no contest plea to two misdemeanor counts of illegally administering prescription drugs. The local prosecutors made the decision to charge her with one count of neglect of a patient causing great bodily harm, a class H felony in Wisconsin 1. Nursing standards that are not met/violated Nursing Standard III: Implementation of Care The nurse caring for patients implements nursing intervention and carries out medical orders utilizing critical thinking and sound clinical judgment for the promotion of health, prevention of illness, alleviation of suffering and restoration of health. Measurable Elements

1. There is an evidence that nurse caring for patients implements nursing intervention and carries out medical orders utilizing critical thinking and sound clinical judgment based on but are not limited on the following: 1.1. Ten (10) Golden Rules in Drug Administration 1.2. Code of Ethics for Nurses 1.3. Patient Bill of Rights

It is evident that implementation of interventions/care is delivered in an unsafely manner that causes complications and death of the patient.

2. Legal doctrine involved: Negligence- refers to omission or commission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person.

ELEMENTS OF PROFESSIONAL NEGLIGENCE a. Existence of a duty on the part of the person charged to use due care under circumstances b. Failure to meet the standard of due care c. The foresee ability of harm resulting from failure to meet the standard d. The fact that the breach of this standard resulted in an injury t o t h e plaintiff e. Errors due to family assistance f. Administration of medicine without a doctors prescription 3. Tort committed: Negligence 4. Circumstance affecting criminal liability Mitigating circumstances- are those which do not constitute or excuse of the offense in question, but which, in fairness and mercy, may be considered as extenuating or reducing degree of moral culpability. Specific circumstances that are considered by the law regarding the case was: Circumstances which are otherwise justifying or exempting were it not for the fact that all requisites necessary to justify the act or to exempt the offender from criminal liability in the respective cases are not attendant When the offender has no intention to commit so grave a wrong as the one committed. When the defender voluntarily surrenders himself to a person in authority or his agents, or that he/she voluntarily confesses his/her guilt before the court prior to the presentation of the evidence for prosecution. 5. Provisions in the R.A. 9173 that has been violated R.A. 9173 Section 23 Revocation and suspension of Professional license

The board shall have the power to revoke or suspend the professional license of a nurse upon any of the following grounds: a. For unprofessional and unethical conduct b. For malpractice or negligence in the practice of nursing c. For gross incompetence or serious ignorance

For violation of this Act, the rules and regulations, Code of Ethics for nurses and technical standards for nursing practice, policies of the Board and the Commission, or the conditions and limitations for practicing his/her profession during his/her suspension from such practice; Provided, however, that the suspension of the certificate of professional license shall be for a period not to exceed four (4) years.
6. The nurses legal responsibility is that she should care for patients and implements nursing intervention and carries out medical orders utilizing critical thinking and sound clinical judgment based on but are not limited on the following:

Performance of the Ten (10) Golden Rules in Drug Administration Performing interventions in line with the Code of Ethics for Nurses Performing interventions considering the Patient Bill of Rights