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It is generally agreed today that nursing practice is often connected with ethic dilemmas. Working with patients as a nurse in a modern medical environment causes a lot of stress. The reason is mainly because nurse’s duties are often connected not only with caring and nursing but with making choices, which may have vital consequences. As in the studied case, where the patient, suffering from a neuron disease, complicated with the respiratory failure and dependent on oxygen therapy, dies. It happens after the nurses’ decision to suspend the oxygen therapy for a couple of minutes while transferring her from one cubicle to another.
Almost every day nurses are facing different ethical issues, which should be resolved in accordance with right principles, good morals, and actions. In the context of the medical environment, it is clear that nurses have a responsibility for their assigned patients. It is their duty to care for and support any patient not only in a patient’s room, but also during the transfer of the patient to surgery or anywhere else inside the hospital. When a person chooses to become a nurse, he or she makes a moral commitment to care for all patients (Lachman, 2012). That is why each case of nursing malpractice should be studied accurately in order to assist nurses in making right choices and avoiding mistakes in their nursing practice. It will lead to an increase in the quality of caring and nursing as well as saving people’s lives. This paper considers some of the aspects of the problem of nursing malpractice in modern hospitals and analyzes them, discussing qualities the modern nurse should possess.
Firstly, it should be noticed that according to the statistics of the National Practitioner Data Bank (NPDB) the number of nurses being named defendants in malpractice lawsuits tends to be increasing. For example, the amount of malpractice payments made by nurses had increased from 253 to 413 in the period from 1998 to 2001 (Eileen, 2003). Such a complicated situation in a medical sphere is driven by the list of factors. The first one is entrusting their duties to the personnel that lack required skills. For example, there was the case, when the nurse failed to adequately assess and monitor the patient post operatively, which resulted in the patient’s death. Experts that studied the case determined that the nurse had breached the standards of care including such failures as: formally clarifying her work arrangement, a proper assessment of the patient, following the physician’s post operative care orders, notifying the physician of changes in the patient’s conditions, initiating the CPR immediately upon finding the patient to be unresponsive (“Nurses and medical malpractice,” 2013).
Increasing the workload for nurses due to the nursing deficiency at the hospital is also a reason of nursing malpractice caused by mental pressures and lassitude. For example, there could be the case where a nurse was caring for the impaired and restrained patient and had to perform assessment checks every 15 minutes. Because of caring for another patient, the nurse missed one patient’s check. During this miss the restrained patient attempted to burn off his restraints with a lighter leading to igniting his bed lines and clothing. As a result, the patient suffered of severe burns over 25 per cent of his body. One of his hands was injured so seriously that he had lost his fingers on one hand (“Nurses and medical malpractice,” 2013). Other cases include the lack of competence while working with the modern medical equipment with all its safety limitations and capabilities. Moreover, the rate of independent choices nurses should make due to their increasing autonomy increases.
Secondly, depending on the disease and treatment of the conditions of a patient can change suddenly and greatly. The above mentioned fact requires enough nursing skills for complying with the standards of care and meeting ethical obligations especially in the today’s nursing with the pressure of complex moral choices. Studies have shown that approximately 20% of patient deaths occur during or shortly after an intensive care unit (ICU) admission. They constitute more than 500 000 patients each year (Chow, 2014). The professional skills of caring nurses, which work at the ICU, are to be extremely high as the nature of this lever of care is connected with the sickest phases and critical stages of illnesses. It demands quick and right decisions to make in a short period of time. The personnel, working at the ICU, should be well trained to deal with the distressing symptoms of thirst, pain, and dyspnea. Pain management it this case requires enough skills to decide upon a dosage of such medicine as opioids, especially in the setting of hypotension. Caring for nonverbal patients at the ICU is of the special importance due to the following fact. Nurses have to monitor the patient’s will and concerns and document any pain or symptoms in order to prevent the deterioration of the patient’s conditions.
Another great concern of nursing practice is an attempt to follow the code of nursing ethics. Numerous nurses face with ethical dilemmas that provide a high level of stress and influence his or her behavior. It can lead either to a mistake or to a case of malpractice. More than that, the continuous stress may lead nurses to feel worn out and exhausted as if from hard labor. Many of nurses report to feel powerless while facing ethical dilemmas. It occurs when a wish to care is confronted with repeated interactions that remain unresolved leading to moral apathy (Ulrich et al., 2010). Sometimes, these cases might involve religion, as in the case with a 20-year-old pregnant female in critical conditions following a single-vehicle car accident. Blood transfusion was assigned together with emergency surgery in order to save her and the fetus, but she refused to accept blood and rejected surgery on the basis of her beliefs in the Bible scripture (Pacsi, 2008). Anyway, most of the cases are connected with the patient’s or his relatives’ will to know his or her clinical prognosis. It is also related to the nurse’s decision not to follow directives of informing or the patient’s desire to commit a medical assisted suicide and the nurse’s attempts to ease the patient’s pain and suffering. Such cases create a huge distress among nurses especially those who lack working experience. NPDB divides health care practitioners into four categories in accordance with their working experience: non qualified nurses, nurse anesthetists, nurse midwives, and nurse practitioners. And it is no surprise that non qualified nurses have been responsible for 3,615 malpractice suits together with most malpractice payments (63,9%) over the history of NPDB (Croke, 2003). Thus, it becomes clearly that in modern medical conditions, where even experienced nurses face with ethical dilemmas, the lack of nursing study, experience and awareness appears to be one of the key points of nursing ethics’ code cases.
Speaking about the way to lower nursing malpractice cases we should consider several important factors. One of them is the quality of the nursing staff. It is desirable that the nursing staff has included as many skillful workers as possible. More than that there should be a rational balance between skilled and unskilled nurses from the ICU team, for example, not to consist of nurses that lack the experience in treatment and solving ethical dilemmas. Also, it should be considered that in hospitals with poorer nurse staffing levels and high levels of the patient’s death nurses show higher burnout rates. They are twice as likely to be dissatisfied with their job. It is followed with the reports about low or deteriorating quality of care in their hospitals (Ball, 2010). Thus, along with the proficient nursing staff the hospital should provide a motivating and friendly atmosphere. The nurse shouldn’t be already distressed with personal problems or issues facing the colleagues or patients before coming to the hospital. It will lead to deterioration of the levels of care, making wrong decisions while solving ethical dilemmas, distraction at the workplace and distressing influence on the colleagues. One of the ways to improve the nursing staff’s ability to solve ethical dilemmas is a close connection with more experienced nurses and doctors together with a constant revision of the code of ethics. Some postulates of the code, such as treating the patient’s life as the highest good, should never be doubted. It is so even when the patient is being in a critical condition and asks for a medical assisted suicide. The nurse should always consult a physician on the patient’s concerns and wishes in case there is any doubt to make a decision on one own because of its difficulty. What is more, the nurse should never doubt the physician’s methods of treatment and prescriptions. It should be so as long as they follow the code of ethics and get familiar with the methods of treatment of the today’s medicine. Following the previous pattern the nurse should follow exact physician’s instructions avoiding personal interpretations, which might cause more harm than good. The last but not the least one is the nurse’s ability to foster his or her proficiency as modern medicine is in a constant state of development. It results in the appearance of new medicine and equipment one has to be familiar with.
It is very clear from these observations that nursing practice requires a lot of skills both to care, nurse, and solve various ethical problems. As far as the nurse owes him or her the same duties as the others, the latter one obliges him or her to be competent enough to preserve integrity and safety at a workplace. In addition, one should maintain competence, foster professional growth, and do everything to keep the patient alive, assisting his treatment. The quality of nursing will improve greatly if typical cases of malpractice will be accurately studied at medical institutions and considered for every nurse to be informed and examined with. It will raise the quality of staffing at every medical institution.
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