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Scholarly Assignment: Ethics

Scholarly Assignment: Ethics


Friday, November 7th, 2014
Enma Serrano Alvarado
810 043 372
NURS 217: Legal, Professional and Ethical Issues in Nurses Practice
Professor Sylvia Wojtalik
Humber College

Scholarly Assignment: Ethics

Introduction
Nurses are the largest health professional group in the health system. They are welleducated, highly skilled, and positively regarded by the patients and families they serve (Berry
& Curry, 2012, p. 12). They have the responsibility to provide care to clients according to the
standards of practice of the profession. However, there are instances when these standards are
breached and this leads to a case of professional misconduct.
In order to better gain understanding on how the nurses actions may affect the clients
well-being, this paper will discuss the case involving Registered Practical Nurse, Joan Gibson.
She has been a member registered with the College of Nurses of Ontario since 1993. The case of
professional misconduct happened in 2011. At the time, she worked full time in a long term care
facility that is home to residents mostly with dementia. The client affected by this act of
misconduct was, at the time of the incidents, 76 years old with a history of dementia, Parkinsons
disease and osteoporosis. The client was at risk for falls and wandering. For this reason, her bed
was alarmed. This helped staff to be warned when client had fallen out of bed.
There were two instances when RPN JG committed an act of professional misconduct. In
the first instance, RPN JG is seen in the video footage trying to administer a suppository to the
client. During this attempt, RPN JG handles the client very roughly by shaking and pushing her
for about 30 seconds. Ultimately, RPN JG gives up on the effort and she can be heard saying
not going to fight with (Discipline Committee of CNO, 2014, p. 4) to the client.
In second instance, RPN JG was working the night shift and it can be seen on the video
footage how the client wakes up from her sleep and ultimately manages to get out of bed. As

Scholarly Assignment: Ethics


soon as the client is attempting to get out of bed, the alarm began to ring. Fifty-two minutes went
by before anyone came in the clients room to check on her. During this time, the patient had
wandered around the room and laid down on the floor. After 52 minutes, a Personal Support
Worker and RPN JG came in the room. Instead of assisting the client, RPN JG is seen to walk
pass the client to turn the alarm off. Then she acknowledges the client and attempts to lift her up
but does so by grabbing the clients shoulder forcefully. Moreover, RPN JG said to the client
Get up, Im not lifting you (Discipline Committee of CNO, 2014, p. 4)
As a result of her actions, RPN JG was found to have committed acts of professional
misconduct by the CNO disciplinary committee. The penalty imposed for her unprofessional and
dishonorable actions was suspension of RPN JGs certificate of registration for a period of three
months and applying some terms, conditions and limitations on her certificate of registration. I
agree with the decision taken by the committee. It is obvious that RPN JG committed an act of
professional misconduct. The fact that there had not been any disciplinary proceedings involving
her and that there were not serious consequences to the client as a result of her actions, worked
on her favour. Yet, judging from her actions, she struggled working with this particular client
since there were more than one instance on where she was unprofessional with the client.
Ethical Values
As outlined in the College of Nurses of Ontario practice standard Ethics document, there
are seven values that are important when providing nursing care. For this specific case I will talk
about Client Well-being, and Maintaining Commitment to the Nursing Profession.
Firstly, RPN JG contravened the Ethical Value of Client Well-Being by not facilitating
the clients health and welfare, and preventing or removing harm (CNO, 2008, p. 5). RPN JG

Scholarly Assignment: Ethics


did not respond to the clients bell promptly and fortunately the client was not injured; however,
even when RPN JG and PSW get to the room, they show no sense of urgency as evidence by not
acknowledging the client first thing but rather walking pass the client to turn off the alarm. As
outlined in the CNO document Therapeutic Nurse-Client Relationship (2006), nurses have the
responsibility to provide client-centred care to all patients. By nurses gaining an understanding
of the clients abilities, limitations and needs related to his/her health condition and the client s
need for nursing care or services (CNO, 2006, p. 6), they are able to provide a better care that is
shaped according to the clients needs. In this case, RPN JG was aware that the client was at risk
for falls and wandering; yet, she did not pay close attention to the client. For a fact, we know that
nurses have multiple patients in a shift; however, in the facility she was working at there were
PSWs that could have easily been available to answer the bell. It could have been enough to
instruct PSWs working that shift that in the event of the clients alarm going off, they should
check on her to make sure she had not suffered any injuries related to a fall. Numerous studies
have concluded that work group teamwork leads to higher staff job satisfaction, increased patient
safety, improved quality of care, and greater patient satisfaction (Kalisch, Curley & Stefanov,
2007). Without a doubt, RPN JG did not act properly in order to ensure and promote client wellbeing by not answering to the clients bed alarm promptly and not showing a sense of urgency
and empathy to the client when assisting her.
Secondly, RPN JG contravened the Ethical Value of Maintaining Commitments to the
nursing profession. Nurses have a duty to uphold the standards of the profession, conduct
themselves in a manner that reflects well on the profession and to participate in and promote the
growth of the profession (CNO, 2008, p. 11). RPN JGs actions towards the client were not
professional and put the client at risk for harm. As members of the nursing profession, we need

Scholarly Assignment: Ethics


to conduct ourselves in the best way possible regardless of the situation. We have to remember
we are caring for human beings just like us. So, we have to treat clients with respect and empathy
in order to ensure that the image of nurses is not distorted and the profession is not undervalued.
The nurse-client relationship is one of unequal power. Although the nurse may not immediately
perceive it, the nurse has more power than the client (CNO, 2006, p. 4). In this case the client
has dementia which made her prone for abuse due to cognitive decline and behavioural changes
(Yukon Health and Social Services, n.d, p. 1). RPN JG did not conduct herself in a way that
promotes respect for the profession, did not promote the goals of the profession in a manner that
meets the needs of clients and did not follow the standards of practice and expectations of the
profession (CNO, 2008).
Strategies
As mentioned before, RPN JG was reprimanded for her unprofessional behaviour
towards the client. She was asked to meet with a Nursing Expert, to review CNO publications
such as Professional Standards and Therapeutic Nurse-Client Relationship and to complete selfdirected modules related to preventing client abuse (Discipline Committee of CNO, 2014, p. 67). This would help RPN JG to refresh the CNO standards and to be better informed about what
is client abuse and how to prevent it. Yet, I think that more can be done in order to prevent this
from happening again. I suggest that health care facilities should provide training targeted to
effectively working with dementia patients. Caring for a person with dementia can be
challenging. Training, information and respite can assist caregivers in meeting these challenges
(Yukon Health and Social Services, n.d, p. 1). If nurses and other health care staff are able to
understand dementia and how to work with clients with dementia, there would be less chance of
abuse. A training program that I believe would be beneficial for nurses to take part in is the

Scholarly Assignment: Ethics


Virtual Dementia Training by Second Wind Dreams. This training program provides the
participants with a realistic perception on what is like to have dementia. The program consists of
doing a series of tasks with the obstacles that dementia patients face on a daily basis. Participants
are to wear goggles simulating macular degeneration and glaucoma, latex gloves with fingers
taped so they feel arthritic, a substance on their shoes to make it harder to walk and headphones
that emit an non-stop jabbering noise that some patients with Alzheimers claim to hear.
(Alzheimers weekly, 2012). I believe that both the nurses and clients family would be able to
benefit from this program and therefore, I would encourage both parties to participate in it. By
gaining understanding of how the disease affects ones body, one is better able to relate to the
affected individual and develop empathy when providing care.
Another strategy that I would suggest is involving family in the clients care and
maintaining family informed about the care being provided to the client. This can help to
alleviate the anxiety on the families and preventing resentment towards the clients caregivers.
Ultimately, this could lead to a more harmonious atmosphere in care facilities where nurses
provide the best care to all clients. Communicating effectively with patients and families is a
cornerstone of providing quality health care. The manner in which a health care provider
communicates information to a patient can be equally as important as the information being
conveyed (Patient-Centered Care, n.d.). In the case, RPN JG states that the clients daughter
was difficult to please and had issues with many staff at the Facility (Discipline Committee of
CNO, 2014, p. 5). Although this is not a valid excuse for RPN JGs actions, it gives us a hint that
she might have been under a lot of stress and pressure to please the family. The clients daughter
became concerned about the care being provided to her mother and she took it upon herself to
install a camera that recorded both video and sound without telling anyone. (Discipline

Scholarly Assignment: Ethics


Committee of CNO, 2014). In order to alleviate the clients family concern, the facility should
arrange periodic meetings with the clients family in order to give an opportunity for family
members to voice their concerns. A patient- and family-centered approach recognizes that the
very young, the very old, and those with chronic conditions-the individuals who are most
dependent on hospital care and the broader health care system are also those who are most
dependent on families (Johnson et al., 2008, p. 6). Probably, the facility where this incident
occurred did not provide an opportunity for families to inquire or to voice their concerns about
the care provided to their family member. Therefore, the daughter might have not felt
comfortable to speak to staff regarding her mother. This might have led to frustration and
resentment towards the staff that eventually had repercussions on the caregivers in the facility by
bringing stress to them.
Conclusion
Nurses are responsible for their actions and the consequences of those actions. They are
also accountable for conducting themselves in ways that promote respect for the profession
(CNO, 2002, p. 4). In the case of RPN JG, she committed an act of professional misconduct by
treating the client roughly and raising her voice inappropriately (Discipline Committee of CNO,
2014). According to the CNOs Ethics practice standard, she contravened two Ethical Values,
Client Well-Being and Maintaining Commitments to the Nursing Profession. She was
reprimanded for her unprofessional actions in order to ensure that behavior like this does not
happen again. I agree with the measures that the Discipline Committee of CNO took in this case.
However, by looking at the whole picture of the situation I was able to come up with two more
strategies in order to prevent situations like this from happening. I suggest that more training is
provided to health care providers and families in order to better understand what having

Scholarly Assignment: Ethics


dementia feels like. By doing so caregivers, whether it is family or a nurse, are able to provide
care with empathy. Likewise, involving the family in the clients care as much as possible could
help relief the fear and anxiety that the clients family may experience and that may create a
tense environment for nurses caring for that client. All in all, client abuse should not be taken
lightly. Nurses need to provide client-centred care by ensuring that all of his or her actions and
behaviours are professional according to the standards of practice outlined by the College of
Nurses of Ontario (CNO, 2006).

Scholarly Assignment: Ethics


References
Alzheimers Weekly. (2012, August, 21). Experience 12 Minutes in Alzheimers Dementia
[Video file]. Retrieved from http://www.youtube.com/watch?v=LL_Gq7ShcY&list=PLNfZGT4tlCYa42l8tzIQx-tJVzOoZVOPr
Berry, L., & Curry, P. (2012). Nursing Workload and Patient Care. Canadian Federation of
Nurses Unions. Retrieved November 5, 2014, from
https://nursesunions.ca/sites/default/files/cfnu_workload_paper_pdf.pdf
College of Nurses of Ontario, 2008. Ethics. Retrieved November 5, 2014, from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario, 2002. Professional Standards. Retrieved November 7, 2014, from
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf
College of Nurses of Ontario, 2006. Therapeutic Nurse-Client Relationship. Retrieved
November 5, 2014, from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Discipline Committee of College of Nurses of Ontario. (2014, February 19). Decision and
Reasons re: Joan Gibson. Retrieved November 1, 2014, from
http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2014/Joan
%20Gibson,%20IC15490,%20February%2019,%202014.pdf
Johnson, B., Abraham, M., Coway, J., Simmons, L., Edgman-Levitan, S., Sodomka, P.,
Schlucter, J., Ford, D. (2008) Partnering with Patients and Families to Design a Patientand Family-Centered Health Care System. Institute for Patient- and Family-Centered

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Scholarly Assignment: Ethics


Care. Retrieved November 5, 2014, from
http://www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf
Kalisch, B., Curley, M., & Stefanov, S. (2007). An Intervention to Enhance Nursing Staff
Teamwork and Engagement. Journal of Nursing Administration, 37(2), 77-84. Retrieved
November 5, 2014, from
http://journals.lww.com/jonajournal/Abstract/2007/02000/An_Intervention_to_Enhance_
Nursing_Staff_Teamwork.10.aspx
Yukon Health and Social Services. (n.d.). Dementia, Abuse and Neglect. Retrieved November 5,
2014, from http://www.hss.gov.yk.ca/pdf/abuse_dementia.pdf