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Running head: NURSING ETHICS SCHOLARLY ASSIGNMENT

Scholarly Assignment: Applying Ethical Values of Client Well-Being and


Respect for Life in Nursing Ethical Conflicts
Student: Toyin Fakus-Atundaolu
Student No: 8xx xxx xxx
Due Date: November 7, 2014
NURS 217: Legal and Ethical Concepts
Professor:
Humber College (ITAL)

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

Introduction
There is no doubt that in order to protect the public, nurses are expected to play a major
role as advocates to support patients and families with complex health situation and decisions.
As nurses in their daily clinical practices encounter various situations that require ethical
judgment; there is the need for them to gain knowledge and expertise in delivering care in an
ethical manner. To demonstrate ethical practice, nurses need to act as moral agents. According
to a comparison studies of ethical issue in nursing done by Park, Jeon, Hong and Cho (2014),
nurses from different nursing units experienced differences in the types or frequency of ethical
issues. In particular, intensive care units had the greatest means of all the units in terms of endof-life treatment, patient care, and human rights issues. Yet all nurses are mandated by the virtue
of their chosen profession and their regulatory bodies to protect the public. This is why in the
Province of Ontario, besides regulating them, investigating concerns about the behavior of nurses
is one of the ways the College of Nurses of Ontario acts to protect the public regardless of the
circumstances. To further protect the public, all disciplinary hearings are made open to the public
and published on the Colleges website. All cases are individualized and treated separately.
Thus, the purpose of this assignment is to examine and discuss a recent ethical issue of
professional misconduct that resulted in an investigation by the Discipline Committee of the
College of Nurses of Ontario (CNO). The chosen case for this paper is the case of Gibson vs. College
of Nurses of Ontario heard in February of 2014. What is unique about this case is the installation
of a secret camera into a 76 years old clients room of a nursing home by her daughter who was
concerned that her mother, a resident, may not be getting adequate care there. Unfortunately,
Gibson, a RPN since 1993, was caught live committing a professional misconduct of neglect and
abuse of the client during her overnight shifts. This was found to be true on a few occasions.
Firstly, Gibson physically rough handled the vulnerable senior diagnosed with dementia,

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

Parkinsons disease and osteoporosis. Secondly, Gibson, on another occasion failed to respond to
the clients assistance alarm in a timely manner to assist her when she fell knowing that the client
was prone to falling and wandering. Finally, on another day, Gibson was caught engaging in both
demeaning and unacceptable verbal and nonverbal communication towards the frail senior.
Gibson, in her written plea admitted to having done all these misconduct.
As part of her reprimand, Gibsons license was suspended for three months, had to attend
three meetings with a Nursing Expert approved by CNO at her own cost, and had to review some
CNO learning modules as refresher (CNO, 2014). This penalty was lenient based on: Gibsons long
history of practice, no previous disciplinary proceedings involving her, no indication of serious
concerns to the client, and her admission and willingness to work with CNO. The two ethical values
of client well-being and respect for life would be discussed as was contravened by Gibson as well
as recommendations on how such professional misconduct can be avoided in the future. The
findings can serve to deepen the importance of those in the nursing profession, in understanding
and following passionately the ethical standard set by CNO and other regulatory bodies.

Discussion
The Ethical Values As Described In the CNO Ethics Document (2009)
Nurses have the responsibility of building a therapeutic relationship that facilitates the
client in achieving and maintaining an ideal overall wellness of health through the nursing process.
There are seven ethical values identified by CNO as being most important in providing nursing
care: client well-being; client choice; privacy and confidentiality; respect for life; maintain
commitments; truthfulness; and fairness (CNO, 2009). Based on a review analysis of the Gibson
case, in the light of the CNO Ethics 2009 document, the two main values Gibson contravened were
the clients well-being and maintaining commitments. It is important to note that all the seven
ethical values are interrelated depending on the context they are being applied to.

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

The Ethical Values of Client Well-Being


The ethical value of client well-being is defined in the above CNO document as the
facilitation of the clients health and safety, and preventing or removing harm. According to the
behavioral standard outlined in the ethics document (CNO, 2009, p.6.), there are nine ways that
nurses demonstrate a respect for client well-being of which the first six directly applied to the
Gibson case. These include: listening to, understanding and respecting the client; supporting
clients in finding best possible solution while respecting the clients personal attributes, providing
empathic care, preserving self-dignity of client, keeping a therapeutic nurse-client relationship
and seeking assistance when in ethical or moral conflict. In the CNO Therapeutic Nurse-Client
Relationship document (May, 2013 p.3.), trust, respect, professional intimacy, empathy, and
(unequal) power are the main five components of this bond between the nurse and the client. All
nurses are accountable for knowing and uniquely applying these attributes in their daily
professional practice.
Furthermore, a trusting relationship requires, active listening, genuine interest, patience
and honesty. As related to the senior client in this case, patients with dementia may also have
difficulty communicating verbally and nonverbally (Jootun & McGhee, 2011), and so may require
the nurses to be extremely enduring and compassionate. Research has shown that without a
trusting relationship, seniors may refuse to take their medications, meals, treatments, or follow
their ADL routines as well as participate in social activities (Rolfe, Cash-Gibson, Car, Sheikh, &
McKinstry, 2014). These may lead to other behaviors and attitudes such as fear, anxiety, isolation,
depression, aggression, unexplained weight loss, and sleep difficulties. Healthcare providers may
want to apply pharmacological interventions to treat symptoms while ignoring the fundamental
psychological underlings.

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

The Ethical Values of Maintaining Commitments


The ethical value of maintaining commitments is directed towards placing the needs of
the clients first while also recognizing ones personal values, physical and mental limitations.
Nurses are obligated to uphold the pledges they made when they initially applied for their license
to protect the public (CNO, 2009). This involves keeping promises, integrity, and ethics towards
the clients, each other, the nursing profession, while collaborating with other health care
providers, and to maintain a standard practice. In committing to the welfare of clients, nurses are
expected to provide a safe, effective and ethical care by acting in the best interest of the clients
based on the clients choice (autonomy) and the standards of practice. This way, by being
committed to the clients well-being, they are expected to maintain a highest standard of morals
especially, since another persons life is being entrusted to their care. Gibson violated this value
thereby placing the nursing profession at jeopardy as viewed and respected by public.
Therefore as it applies in the case of Gibson, nurses are not supposed to abandon, abuse
in any form, neglect, or jeopardize the physical and mental wellbeing of their patients. Clients as
defined by CNO in the Ethics document extend to the family members and the substitute decisionmakers. Even in our working environment whether in an institution or within the community,
nurses are expected to advocate for quality health care for patients and not contribute to its
demise. Thus, upholding the safety and well-being of clients at all times should be the back bone
of what nursing practice is all about.
Finally, nurses are committed to their own career goals for accepting the responsibility to
be a regulated health care provider. Nurses also need to understand that they do not work in
isolation but as collaborators with other healthcare stake holders working together toward the
patients optimal wellbeing. Sometimes, personal responsibilities may have negative impact on
ones ability to work effectively. It is okay to take a break. This is why CNO requires all nurses to

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

declare any form of physical or mental limitations which may negatively affect their ability to
effectively care for clients. Nurses need to recognize their physical, mental and professional
limitations. In their interactions with each other, nurses and other health care workers need to
trust and work together in the best interests of the clients.

Strategic Recommendations for Preventing Future Reoccurrences of Such Misconduct


The first recommendation for preventing such future occurrences of such professional
misconduct is for every nurse to follow the golden rule of treating others as she or he wants to be
treated. Life is one of developmental stages of childhood to late adulthood; and everyone hopes
to experience these stages including overcoming the various life challenges that come with each
stage. Thus, valuing life and showing respect and compassion at all times by focusing on the
positive aspects of situations can enhance rapport and fosters effective coping skills (Barba,
Stump, & Fitzsimmons, 2014) for both the nurse and the client.
Secondly, nursing is a profession that requires continuous education not only in terms of
medical knowledge but also in terms of soft skills development. Currently, Humber College and
likely other Ontario nursing faculties only offers general introductory and developmental
psychology courses for its practical nursing students. Perhaps, in order to produce a more
empathic licensed nurses, students should also be exposed to counseling and clinical psychology
as part of their elective courses. This way they will be more professional and equipped in handling
uncooperative and mentally ill patients and their families. Significantly, best evidence nursing
practice comes with experience and application. Thus it may be worthwhile if uprising nurses can
link up with mentors that are more experienced and successful in the profession. Employers also
ought to invest in the mental health development of their nursing staffs to prevent burn outs.

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

Lastly, encouraging students to attend live CNO discipline hearings may be a reality check
for them to know how just one decision that could had been avoided could have a heavy costs on
their professional standard. This student author was privileged to attend one just before this
assignment with three other peers. The overall feedback was that it was an enriching and eyeopening experience apart from the pre-grad hours incentive. It made one realize that a little
careless talk, action, or expression made in a little time can leave a lasting record on ones ability
to practice as a licensed nurse. Moreover, the key evidence in the Gibson case was the secret
camera that saved a seniors life while exposing the hidden malevolence of a nurse that was
entrusted with a dear life. Therefore, with improvement in technology, nurses need to live both
their public and private lives like they are part of the grey anatomy cast with camera rolling
from all angles. One never knows when a good intention can be misunderstood as being morally
wrong by bystanders and the receiver.

Conclusion
In conclusion, apart from maintaining a professional standard of practice, nurses are
expected to be advocates and moral agents. The Gibson case shows the power technology can
contribute to expose bad elements of nursing. Gibson contravened the two CNO ethical values of
Clients wellbeing and maintaining commitment. The case was discussed based on the Ethic
document of CNO (2009) as well as supporting peer reviews on fostering clients wellbeing.
Strategic recommendations were provided, including valuing life, soft skills educational
development, and benefits for nursing students who attend a CNO Discipline hearing which are
made open to the public. It is the authors hope that nurses will live a standard transparent life
filled with integrity, and commitment to uphold the standard of the profession in the public eye.
Whether the camera is rolling or not, nurses should always provide an honest, empathic, and
compassionate care as one day they may be on the receiving end in need of compassion.

NURS 217 SCHOLARLY ASSIGNMENT: ETHICAL ISSUES

Reference:
Barba, B., Stump, M., & Fitzsimmons, S. (2014). The role of therapeutic use of self in the
application of nonpharmacological interventions. Journal of Gerontological
Nursing, 40(8), 9-12. doi:http://dx.doi.org/10.3928/00989134-20140609-02
College of Nurse of Ontario. (2013, May). Therapeutic Nurse-Client Relationship Revised 2006.
Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
College of Nurses of Ontario. (2009, June). Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario. (2014, February 19). Retrieved from http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2014/Joan%20Gibson,%20IC15490,%
20February%2019,%202014.pdf
Dobb, L. (2013). Ethical practice. Nursing Standard, 27(44), 57. Retrieved from
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Rolfe A., & Cash-Gibson L., & Car J., & Sheikh A., & McKinstry B. (2014). Interventions for
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