Registered nurses have a moral and legal responsibility to uphold a patient’s rights in relation to their personal health care. An important nursing standard of practice speaks to the registered nurse acting as a patient advocate. WAC 246-840-700 section 3c states “The registered nurse…acts as client advocates in health maintenance and clinical care. ” (Washington State Legislature, Practice Standards, 2004) The role of the registered nurse in this particular case study in relation to the above WAC is quite applicable because there is cause for concern related to Mr. E’s patient rights being violated.
Mr. E, though mildly developmentally delayed, has a right to self determination. He has the right to choose whether he wants to be placed on a ventilator or not. A mild hypoxia of 88% is common with pneumonia and is seen quite often, this in and of itself is not usually enough to affect one’s decision making ability. The registered nurse caring for Mr. E needs to be a patient advocate and fight to see his wishes followed. Even though there is an available medical power of attorney, this is to be utilized in the event that Mr. E is unable to make his own decisions related to health care. Mr. E has both previously and currently made his wishes known in regards to being placed on a ventilator.
The registered nurse has an obligation to help see these wishes adhered to. This may mean following the applicable chain of command and notifying the charge nurse or nursing supervisor or involving the hospital ethics committee. Mr. E has a right to see his clearly expressed desires followed. Within this case study there are several violations of the nursing code of ethics, one violation being the registered nurse witnessing unethical practice by the doctor and making no attempt to prevent it. Provision 3. The nurse’s promotes, advocates for, and strives to protect the heath, safety, and rights of the patient” (Code of Ethics for Nurses, 2001).
Never once did the case study note the nurse objecting to Mr. E being placed on a ventilator though it was in direct discordance with his wishes. Dr. K’s willingness to circumvent Mr. E’s patient rights, obtain consent from someone other than the patient himself and not even discuss the case with Mr. E’s medical power of attorney was questionable and unethical. The case study also made it clear that Dr. K did not fully inform those he was attempting to obtain consent from that Mr. E had an advance directive expressing his wishes to not be ventilated. The registered nurse had an obligation to act as an advocate for Mr. E which she did not fulfill by allowing unethical practice by the doctor. As the registered nurse caring for Mr. E, I would fight for his right to choose and make his own decisions related to his care. The ANA code of ethics clearly values this right and holds nurses to a standard of care to be advocates for said rights.
This violation of Mr. E’s right to self determination calls for action on the nurse’s part. The first action would be notifying the charge nurse on duty or the DNS requesting help to honor Mr. E’s rights and if necessary climbing the hospital’s chain of command to remedy the violation. Mr. E clearly expressed his wishes to remain off of a ventilator should the need for one ever arise, both seven years ago and currently. His opinion did not change in those seven years making it quite clear that these are in fact his wishes. To place Mr. E on a ventilator is morally and ethically wrong. It is a violation of his right to self determination, both morally and legally. Mr. Y as Mr. E’s medical power of attorney needs to carefully consider the ethics of the situation. He needs to weigh his own desires and opinions against what he feels Mr. E would want.
This will most likely be quite difficult for several reasons, he is the patient’s brother and there is confusion as to the understanding of Mr. E’s advanced directive. The case study indicates that it is unknown if he was informed of Mr. E’s wishes when he was made medical power of attorney which is leaving Mr. Y with the responsibility to make uniformed decisions for his brother. Mr. E’s advance directive is being held in question for several reasons. Mr. E is mildly developmentally delayed, though this does not make him incompetent, it is a factor to consider.
The advance directive is seven years old, there is no indication that this has been reviewed annually and remains in line with Mr. E’s wishes. It is unknown if any family members were present or even aware of the contents of Mr. E’s advanced directive making it difficult to judge whether Mr. E truly understood the wishes he was expressing. Mr. E had his privacy violated by staff several times in this scenario. Dr. K discussed Mr. E’s status with Ms. H without first obtaining consent from Mr. E. This was done in the presence of Ms. H’s boyfriend and in a waiting room with other people sitting within hearing distance. Dr. K should never have spoken with Ms. H and especially in front of others.
If Dr. K strongly felt that he needed to speak with Ms. H, Mr. E should have been asked for consent and if given, his case should have been discussed in an appropriate setting away from the hearing of others non-related to his care. The nurse violated Mr. E’s rights by discussing him and his case in detail with other nurses not directly involved with his care. HIPPA is about providing the minimum necessary information to do one’s job. These other nurses did not need to know the details of Mr. E’s case to adequately do their jobs. If the nurse felt she needed to discuss Mr. E’s case with someone, she should have taken her concerns to her supervisor.
The nurses in this case study were quite unprofessional in several ways. The patient’s case was discussed with nurses uninvolved in his care and this was done in a very public setting. Mr. E has a right to have his privacy protected and he also has a right to trust and expect the nurse caring for him to honor this. The three other nurses at the table should have stopped the primary care nurse when she began to divulge specific details. The coworker’s attitudes were also unprofessional. The first nurse making a statement basing a patient’s care on his health and mental abilities exhibited poor conduct.
The second nurse alleging that HIPPA is not important showed a complete disregard for honoring the privacy rights of a patient which is a violation of both the nurse practice act and the nursing code of ethics. The third nurse violated the nursing code of ethics by not taking the initiative to remain educated on current medical practice. Advance directives are commonplace in current world nursing and to ignore them or remain uneducated about them only does an injustice to the patients. The registered nurse caring for Mr. E would have done her job appropriately ad she fought for his rights as a patient and a human being. Mr. E should never have been ventilated and upon coming back from lunch, the nurse should have fought to have him extubated as this would honor his wishes. Had I been the primary nurse, I would have protected Mr. E’s right to self determination utilizing my chain of command starting with the charge nurse and climbing as high and needed to ensure Mr. E’s self-expressed desires were followed. From the first moment that intubation was mentioned as a treatment option, Mr. E made his disinclination of this treatment known.
As the primary care nurse, I would have expressed Mr. E’s desires related to intubation with Mr. Y when I called him. Mr. Y would not be able to make an informed decision without this information. Mr. E’s HIPPA rights would not have been violated as I would not have discussed his case in detail with coworkers unrelated to his care. I would have gone to an appropriate person with my concerns, such as my supervisor. Mr. E needs a patient advocate and it is the job of all involved in his health care to be this for him. I as his nurse would have protected his privacy and personal rights.
Nurses are looked upon by the general public with high regard, held as working in one of the most trusted professions. To remain so, patients must feel they are safe when they enter our realm, that we will protect them and their inherent rights above all.
Code of Ethics for Nurses, ANA, (2001). Retrieved March 18, 2012 from http://nursingworld. org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics. pdf Washington State Legislature. (5/2/2011). Washington Administrative Code, Practice Standards. Retrieved March 18, 2012 from http://apps. leg. wa. gov/WAC/default. aspx ? cite=246-840