How Nurses Can Apply Ethical Standards And Advocacy

How Nurses Can Apply Ethical Standards and Advocacy in the Care of Mr. Gold

Mr. Gold is a patient in your rural ICU who has been on a ventilator for four months due to an advanced case of amyotrophic lateral sclerosis (ALS). His condition leaves him unable to communicate except through blinking, and he exhibits signs such as crying that are distressing to caregivers and family members. His wife frequently questions his status and struggles emotionally, especially when she requests the removal of life support. The medical team has ordered routine tests and a weaning trial, which Mr. Gold failed. Additionally, a computer system outage hampers access to vital patient data, raising concerns about continuity of care and informed decision-making. This scenario prompts considerations around ethical nursing practice, advocacy, and potential legal implications such as malpractice or negligence.

Application of Scope and Standards of Practice, Code of Ethics, and Patient Advocacy

In caring for Mr. Gold, nurses are bound by the American Nurses Association (ANA) Scope and Standards of Practice, which emphasize the importance of providing compassionate, competent, and ethically sound care. Specifically, Standard 1—Assessment—requires nurses to gather comprehensive data about the patient's condition, including non-verbal cues and emotional distress, which are critical given Mr. Gold’s inability to speak. Standard 2—Diagnosis—guides nurses to identify patient needs and potential issues such as distress, pain, or emotional suffering, even if expressed non-verbally.

Additionally, Standard 3—Outcomes Identification—and Standard 4—Planning—stress the importance of setting realistic goals aligned with the patient's condition, including comfort measures and communication options. Given Mr. Gold’s inability to communicate verbally, employing alternative communication strategies, like eye blinking or assistive technology, becomes integral. Standard 5—Implementation—calls for executing interventions that promote dignity, comfort, and ethical decision-making, which includes advocating for the patient’s expressed or presumed wishes.

The Code of Ethics for Nurses with Interpretive Statements further advocates for respecting patient autonomy, beneficence, nonmaleficence, and justice. Applying these principles, nurses should strive to honor Mr. Gold’s dignity by ensuring that his care plan reflects his values and preferences, with input from his family when appropriate. Nurses must also provide emotional support to his wife, acknowledging her distress while guiding her through complex medical decisions.

Patient advocacy is a core nursing responsibility, especially in cases like Mr. Gold’s where communication barriers and emotional turmoil challenge decision-making. Advocating involves ensuring informed consent, explaining medical procedures and prognosis in understandable terms, and supporting the patient’s and family’s rights to participate in care decisions. In light of the computer system outage, nurses should seek alternative methods to access vital information or advocate for data recovery to uphold informed and ethical care. This includes collaborating with the multidisciplinary team to clarify treatment goals, especially concerning the withdrawal of ventilatory support in a patient with a terminal condition.

Overall, applying these ethical standards requires balancing respect for patient autonomy, beneficence, and the professional obligation to provide compassionate, competent care. Recognizing emotional distress and potential suffering mandates a holistic approach, integrating ethical principles with clinical judgment to honor the patient's dignity and uphold moral responsibility.

Malpractice and Negligence: Lessons from the Quaid Video

The Quaid video depicts a case where malpractice and negligence are identified through failure to adhere to established standards of care. Elements such as omission of essential assessments, communication breakdowns, and lack of documentation are central to malpractice claims. In Mr. Gold’s case, similar concerns may arise if neglect, inadequate communication, or failure to respect patient rights occur.

In the Quaid scenario, key issues included failure to recognize and address the patient's worsening condition, insufficient documentation, and a breakdown in team communication. These factors led to harm, illustrating the importance of diligent assessment, timely intervention, and comprehensive record-keeping. For Mr. Gold, neglecting the psychological and emotional needs, inadequate documentation due to the computer outage, or failure to honor patient wishes could similarly foster claims of negligence.

Underlying issues common to both cases involve systemic problems such as inadequate staffing, poor communication, or failure to follow protocols. Ethical dilemmas also surface when confronting end-of-life decisions, emphasizing the need for clear documentation, shared decision-making, and adherence to legal and ethical standards to prevent malpractice claims. Supporting evidence from nursing literature underscores the importance of meticulous assessment, communication, and documentation to mitigate legal risks and uphold patient safety.

In conclusion, vigilance in documentation, communication, and respecting patient autonomy are vital to minimizing malpractice risks. Recognizing warning signs of neglect and addressing systemic issues proactively can prevent harm and ensure that ethical obligations are met, as exemplified by the Quaid case and relevant legal standards.

References

• American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. ANA.
• Henneman, E. A., & Lee, H. (2018). The Scope and Standards of Practice for Nursing. American Nurses Publishing.
• Jacobson, A. (2020). Communication Challenges in Critical Care Settings. Nursing Critical Care Journal, 15(2), 45-52.
• Jones, C., & Ward, M. (2019). Ethical Decision-Making at the End of Life. Journal of Nursing Ethics, 26(3), 123-132.
• Levy, M., & DeMuro, P. (2021). Navigating Legal and Ethical Issues in Critical Care. Nursing Law & Ethics Review, 10(4), 203-210.
• Martin, L., & Campbell, A. (2017). Patient Advocacy and the Role of Nurses. American Journal of Nursing, 117(4), 42-48.
• Quaid, J. (2016). Medical Malpractice Case Analysis. Medical Legal Review, 22(1), 89-96.
• Smith, R., & Johnson, T. (2018). End-of-Life Care and Ethical Considerations. Nursing Ethics, 25(5), 702-711.
• Williams, P. (2019). Implications of IT Failures on Patient Care. Journal of Healthcare Information Management, 33(2), 34-41.
• Yates, M., & McArthur, R. (2020). The Role of Systematic Assessment in Reducing Negligence. Journal of Clinical Nursing, 29(19-20), 3707-3715.