Identification of the Issue

The issue that is presented here which is portrayed through the given situation deals with the medication errors. The registered nurse, Ryu Sakamoto has been working in a hospital in Brisbane and was given the duty in the general ward. In the same hospital the patient Kev Forbes was admitted after he had experienced a fall at his home. The patient suffered from a small head wound after the fall. As the patient had a past history of mechanical heart valve surgery therefore had been prescribed a blood-thinning medication after his surgery which he needs to take daily. While the ward was quite crowded on a day and most of the nurses were called in for the other patients, and the RN responsible for the patient was fatigued after a long shift. In spite of this, RN Sakamoto had to rush to get the medication rounds and he did not want to wait till another nurse becomes free therefore he himself administered medication to the patient, Kev. In doing so all of this so hastily, he forgot to cross-check the medications by another RN. He failed to double check the dosage and by an accident administered the patient with a much higher dose in comparison to the one that had been prescribed to Kev originally.

This was the major issue here, after the medication had been administered to the patient, he soon started feeling nauseated and started vomiting. While the treatment team started investigating the situation of the patient, it was discovered that a medication error has occurred. There was also an issue regarding delivering news to the patient’s wife. The patient did not want to reveal to his wife his present health condition whereas the RN thought it would be right to inform her about it.

ICN code of ethics:

The elements of the code are as follows:

1. Nurses and people
2. Nurses and practices
3. Nurses and the profession
4. Nurses and the co-workers (Epstein& Turner, 2015).

The elements of the code should be applied by the nurses during their practise. In terms of the given situation here, the nurses should have followed the following aspects of the code which being:

“The nurse’s primary professional responsibility is to people requiring nursing care” – Considering this, it can be stated that the RN responsible for the patient here Kev, failed to show a professional responsibility. While the patient did not wanted his health condition to be disclosed to his wife, the RN also had a dilemma which should not have been present.

Evaluation of the Issue

”The nurse maintains a standard of personal health such that the ability to provide care is not compromised.”- The RN by making a medication error failed to maintain the integrity of the patient care.

“The nurse is active in developing and sustaining a core of professional values.”- The RN although was fatigued after a long day, should not had compromised the well-being of her patient. This portrays that she could not sustain her professional values.

“The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields”- As evident from the given case, the RN did not share a collaborative relationship with the other nurses since there was a clear misunderstanding while attending the patient which ultimately caused the medication error (Zahedi et al., 2013).

The key ethical principles in nursing include:

Autonomy: Respecting the right of individual in terms of self-determination.

Beneficence: This refers to the duty to do good to others and to maintain a stability between the harms and the benefits. Hence, all nurses have the moral obligation of displaying kindness, mercy and charity towards their clients and service users, with the connotation of providing benefits to the latter. In other words, beneficence lays the foundation for the moral imperative of doing good.

Non-maleficience: It is the commitment of not doing or causing harm to others.

Justice: It is the unbiased distribution of the potential assistances along with the tasks, in order to determine the direction in which the patients should be cared for.

Veracity: It is the compulsion to tell the truth

Fidelity: It is the responsibility to do what one had assured (Parahoo, 2014).

Legal issues –

Is Kev allowed to give consent for letting the RN inform his wife about his present health condition?

Is the RN liable for any breach of professional of ethics as a nurse?
Is the nurse obliged for any proceedings of further inquiry related to the misconduct or medication error?

The legal issues which are related to the situation present here is mainly of negligence. The RN failed to establish the standard of care.

Another legal issue that rose was of documentation. In spite of the fact that the medication records were maintained, the RN failed to cross check the documents before administering the medicine (Griffith& Tengnah, 2017).

The principle 2 that focuses on delivering a person-centred, and evidence-based care for the wellbeing and health of the patients is vital in this regard.

• 2 Decision-making

Ethical Principles

Making essential decisions about healthcare often seems overwhelming to the health care professionals due to the range of issues that they encounter, in relation to their subjects. The RN Walsh should adopt a person centred approach for effectively managing the concerns of Kev regarding his wife Bernice, and her probable anxiety on knowing about the former’s health condition (NMBA, 2018). The RN should provide all possible support to Kev in a manner that are in complete alignment with his preferences and values.

• 4 Adverse events and open disclosure

Owing to the fact that Kev suffered due to the adverse drug event, for which RN Sakamoto was held directly responsible, the RNs must adopt an honest and direct approach, while communicating with him and his family members, on what exactly had happened. RN Sakamoto must take all possible efforts for identifying her drawbacks and the circumstances that led to the overdose of drug administration. Furthermore, this should be followed by submission of an appropriate explanation and apology by RN Sakamoto to Kev and the hospital administration(NMBA, 2018). Although RN Walsh is in charge of the home arrangements of Kev, RN Sakamoto should also act as an active listener and acknowledge all forms of distress that Kev has experienced due to the adverse event.

The principle 3 also holds relevance in this case since it emphasises on establishment of respectful relationship and an effective cultural practice.

• 3 Effective communication

Owing to the strong positive association between the communication skills of a health care professional and the capacity of a service user to abide by the medical recommendations, the RNs must communicate in an appropriate manner with Kev. They must gain an insight into the health literacy of the patient, and make possible arrangements for meeting the specific cultural, communication and linguistic needs of Kev. They should also adopt a non-judgmental approach while communicating with Kev(NMBA, 2018).

The principle 4 of professional behaviour also holds relevance in this case.

• 1 Professional boundaries

Both the RNs should recognise any kind of power imbalance and should manage the expectations of Kev by avoiding sources of possible conflicts and complications. RN Walsh should also take into account that over-involvement of any kind might create a detrimental impact on delivery of healthcare services(NMBA, 2018).

For the implementation of the above actions, RN Walsh must perform the following duties in accordance to the Nursing Codes of Conduct by the Nursing and Midwifery Board of Australia (Nursing and Midwifery Board of Australia, 2018):

• In accordance to Principle of 2.2, which informs about Decision Making, RN Walsh must consider that decisions pertaining to treatment and healthcare is a collective responsibility which must be shared not just across nurses and associated healthcare professionals but must also involve participation of the patient as well as associated family members in the decision-making process. Hence, in accordance to this Code of Nursing Conduct, RN Walsh must adopt a patient centred and family centred approach to treatment wherein he must inform Kev’s wife considering the recent incidents during his hospital stay and the proposed extension of residing in the hospital for further observation before discharge.
• In accordance to the Principle 2.4 of Nursing Code of Conduct which emphasises on Adverse events and Open Disclosure, RN Walsh as well as RN Sakamoto, must also consider the occurrence of medication error for Kev. Hence, as stated in this principle, RN Walsh and RN Sakamoto, must reflect on the details of the adverse incident and inform the same to Kev and his wife with honesty and further acknowledge their feedback or distress considering the issue while further seeking supervision from his supervisor or employer.
• In accordance to Principle 3.3 outlining Effective Communication, RN Walsh must consider the importance of transparent communication practices for the purpose of maintaining healthy nurse-patient relationships. Hence, he must consider that despite Kev’s disinterest in informing his wife, the registered nurse must engage in effective communication by taking into account patient’s health literacy levels and hence, must inform his wife concerning his extended stay in the hospital.
• In accordance to the Nursing Code of Conduct of 4.1 outlining Professional Practice, RN Walsh must respect his professional nursing relationship with Kev which necessitates avoidance of personal belief and necessitates recognition of imbalance between nurses and  patients. Hence he must undertake an ethically correct decision of informing his wife, which is in accordance to his professional duties as a nurse.

The registered nurses appointed for Kev, must evaluate the reasons behind the incidence of medical error which had occurred, inform and obtain feedback from Kev concerning his views on the incident and then work actively to prevent this in the future.

RN Walsh must consult RN Sakamoto along with his supervisors and other healthcare professionals for a final decision to be undertaken considering informing Kev’s wife Bernice about his hospital stay extension.

References

Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2), 1-10.

Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning Matters.

Huston, C. J. (2013). Professional issues in nursing: Challenges and opportunities. Lippincott Williams & Wilkins.

Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient safety: implications for nursing management. Nursing ethics, 20(8), 904-916.

Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. Retrieved from https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D.

Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.

Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., … & Dastgerdi, M. V. (2013). The code of ethics for nurses. Iranian journal of public health, 42(Supple1), 1.