Running head: Ethical Implication of Nursing: A Scenario 1

Ethical Implications of Nursing: A Scenario

Emily Suprynowicz

James Madison University

Ethical Implications of Nursing: A Scenario 2

Ethical Implications of Nursing: A Scenario

Introduction

Maltreatment of the elderly population placed in nursing homes is a significant issue in

the United States. According to DeHart, Webb, and Cornman (2017) in the Journal of Elder

Abuse and Neglect, “[a]pproximately half of the staff [from a nursing home] self-reported

committing psychological or verbal abuse, and 10%-17% report enacting some form of excessive

restraint or physical abuse of residents” (p. 361). There are Medicaid records showing that

psychological and physical harm associated with abuse in communities are associated with

higher rates of mortality (Schiamberg, 2012). The impact of abuse in nursing homes is greatly

overshadowed and is an apparent issue that deserves immediate confrontation and resolution.

Background

In my high school, a program was offered to obtain my certified nursing assistant

certificate. As an aspiring nursing student, I was intrigued by this opportunity and opted to

participate in this program my senior year. Part of the curriculum was to obtain clinical hours at a

local nursing home in my hometown. In nursing school, it is engraved in our minds that the

patient is to be treated with the utmost dignity and respect. As nursing students, we devout

ourselves to practice under the Florence Nightingale Pledge, which states “[w]ith loyalty will I

endeavor to aid the physician in his work, and as a missioner of health’ I will dedicate myself to

devoted service to human welfare,” (Marian, 2015).

In one particular instance during my experience, a certain nurse asked if the students

wanted to help her perform wound care on a patient. All fourteen students entered the room and

hovered over the bed to warrant clear sight of the procedure. The nurse arrived without a knock

or an introduction. The patient was a non-oriented, lethargic, frail 91-year-old woman. The nurse
Ethical Implications of Nursing: A Scenario 3

donned gloves and got her supplies set up at the foot of the bed. She began the procedure failing

to say anything to the patient. She reached toward the bed pad and rolled the patient onto her side

making the patient shriek in pain. On the patient’s back is what looked like to be a white cotton

ball. She asked if any of the students wanted to help her and I raised my hand, I donned gloves

and reached over to pull what I thought to be a cotton ball. Instead, I kept pulling…and pulling…

and pulling. It turned out to be a calcium deposit that was stuffed into a thirteen-centimeter-long

tunnel, which was trailing from the wound through the skin underneath of her back. Several of

my colleagues opted to leave the room at this time, and the patient herself was crying in pain. I

held the nurses hand as she debrided the wound and shoved a new calcium deposit back into the

patient’s sore. The nurse gripped the Q-tip in her fist as she inserted it into the wound. The tunnel

expanded so far that the Q-tip was almost too short to reach the end of the sore. After much

force, the Q-tip reached the end of the wound, resulting in the patient to shriek in pain. The nurse

turned to look at the few of us left in the room, seeming unaffected by the patient’s horrific cries

echoing in the background. She then proceeded to explain the calcium deposit to us, and pulled

the patient into a supine position. In this instance I got my first taste of moral distress in the field

of nursing. I recognized what was wrong and was presented opportunities to do what was right,

but due to my uncertainty in skills as well as difficulty in questioning an authoritative figure, I

chose to do nothing

Methods/Findings

At no point during the entire procedure did the nurse acknowledge the patient. She failed

to introduce herself, state why she was there, what she was doing, ask about pain, or comfort the

patient in any way. As the one holding the nurses hand, I had the chance to break the hold of the

nurse’s grasp and question why she had to push so hard, why the patient didn’t get pain
Ethical Implications of Nursing: A Scenario 4

medicine, and to simply talk to the patient. I also should have introduced myself, and put a hand

on her side to let give her a small sense of reassurance. I should have asked my colleagues to

back away from the bed and allow her some space, and give her a sense of privacy.

In provision 3.5 of the American Nursing Association Code of Ethics it states that

“[b]eing an advocate means that the nurse takes action against any member of the health care

team or healthcare system that jeopardizes the health, well being or rights of the patient” (2015).

A nurse must express his or her concern to the person who is preforming the questionable

practice (ANA, 2015). My reaction to moral distress was not one that resulted in a better patient

outcome, nor did it allow a reflection on the nurse’s part for her malpractice. According to the

ANA, “the nurse [should consult] supervisory personnel, [and] it may also be necessary to

confront the nurse in a supportive manner [as well as] assist the impaired nurse in accessing

appropriate resources” (2015). Prolonged exposure to moral distress in experiences like this can

lead to “burnout” along with higher illness levels and more staff resignations (Young, 2017).

Several articles mention staff “burnout” being the cause of maltreatment amongst residents.

There is a constant issue with higher staff-to-patient ratio along with the added complexity of the

residents in nursing homes who often require help bathing, eating, and toileting (Cooper, 2016).

A higher staff-to-patient ratio leaves less time for comfort measures and directs staff using a task

oriented system that neglects basic needs of patients, ultimately leading to neglect.

James Madison University’s eight key questions are a guideline for students and faculty

to ethically reason through situations like the one presented. Each question is stemmed from a

human value. These values include: fairness, outcomes, responsibilities, character, liberty,

empathy, authority, rights. Each of the questions can be used to analyze the scenario mentioned

earlier. In the sense of fairness, respectfully telling the nurse what she is doing is wrong is both
Ethical Implications of Nursing: A Scenario 5

being fair to her future practice as well as the patients well-being. As for responsibilities, it is our

duty to instill the safety and comfort of our patients. This could have been accomplished by

asking the patient if students could be in the room or not. My realization as a student that what

the nurse was doing was not the way things should have occurred indicates a sense of morality

and honesty reflects my character as a future nurse. As for liberty, the patient did not consent to

anything that was occurring nor did the nurse give the patient a chance to contribute to the care

being given. Empathizing with this patient was inevitable as I envisioned my own family

member in her place and being in that much pain. Authority was the reasoning behind my silence

and the rights were not being taken into consideration and explain why I wanted to question my

authoritative figure.

Conclusion

Advocate can be considered a synonym for nurse. As an advocate, I should have voiced

my thoughts on the way my patient was being treated. Going fourth I vow to actively promote

the total well-being in each of my patients regardless of bridges in authority or lack of

confidence. Unfortunately, as a healthcare professional situations such as this are more

prominent in the workforce than most would like to think. However, through this encounter with

turmoil such as mentioned, I have become wiser regarding my choices in an ethically

challenging situation. Due to my lack of confidence as a student nurse, my patient missed an

opportunity to be comfortable and painless. Considerations such as fairness, responsibilities and

authority have been identified to be overarching matters that may need to be challenged or are

challenged in a morally distressful situation. Through gaining self confidence in skills and self

awareness, I will be able to use the human values such as those presented I the eight key

questions to navigate yet another morally displeasing situation.

 Ethical Implications of Nursing: A Scenario 6

References

About Code of Ethics. (n.d.). Retrieved November 05, 2017, from

http://www.nursingworld.org/codeofethics

Cooper, S. L., Carleton, H. L., Chamberlain, S. A., Cummings, G. G., Bambrick, W., &

Estabrooks, C. A. (2016). Burnout in the nursing home health care aide: A systematic review.

Burnout Research, 3(3), 76-87. doi:10.1016/j.burn.2016.06.003

DeHart, D., Webb, J., & Cornman, C. (2009). Prevention of Elder

Mistreatment in Nursing Homes: Competencies for Direct-Care Staff. Journal of Elder Abuse &

Neglect, 21(4), 360-378. doi: 10.1080/08946560903005174

Schiamberg, L, B., Oehmke, J., Zhang, Z., Barboza, G. E., Griffore, R. J., Von Heydrich, L., …

Mastin, T. (2012). Physical Abuse of Older Adults in Nursing Homes: A Random Sample

Survey of Adults With an Elderly Family Member in a Nursing Home, Journal of Elder Abuse &

Neglect, 24(1), 65-83. doi: 10.1080/08946566.2011.608056

Marian University Nursing. (2015). The nightingale pledge modernized. Marian University Accelerated

Nursing Programs. Retrieved from https://onlineabsn.marian.edu/blog/the-nightingale-pledge-

modernized/.

Young, A., Froggatt, K., & Brearley, S. G. (2017). ‘Powerlessness’ or ‘doing the right thing’ –

Moral distress among nursing home staff caring for residents at the end of life: An interpretive

descriptive study. Palliative Medicine, 31(9), 853-860. doi:10.1177/0269216316682894