Running Head: SCHOLARLY ASSIGNMENT: ETHICS

Scholarly Assignment: Ethics

NURS217
Amanda da Silva
823377171
November 11, 2015

SCHOLARLY ASSIGNMENT: ETHICS

College of Nurses of Ontario (CNO) member E.B. was a Registered Practical Nurse
(RPN) since 1989. At the time of her incident E.B. had been an employee of the facility it took
place in for four year, from October 2006 to July 14, 2010. E.B. was working the night shift from
1900hrs on July 9, 2010 to 0700hrs on July 10, 2010. The patient involved was a resident on the
unit, which E.B. worked. He was an elderly Italian man suffering from dementia, cardiovascular
disease, arthritis, and a previous stroke. Furthermore, the patient was at high risk for falls and
had a history of aggitative behavior. On the night of July 9, 2010, the patient was in an agitated
state and wandering the halls of the facility. He had been escorted back to his room multiple
times by E.B. However, around 0045hrs on July 10, 2010 E.B. brought the patient back to his
room and shut his door as she stood outside it, all while the patient yelled and kicked the door.
After approximately six minutes the noise had stopped, so E.B. entered the patients room, only
to find him lying on the floor in a puddle of urine and bleeding from a gash on his head. E.B.
instructed the Personal Support Worker (PSW) on duty to call the RN, who then in turn
instructed E.B. to call 911. The patient was transferred to the hospital via ambulance. As a result
of this incident, the patient had suffered a fractured hip and an intracranial hemorrhage. He
succumbed to his injuries the next day. An investigation was conducted after the facility
administrator learned of the patients death, and E.B. was terminated four days later on July 14,
2010.
The Discipline Committee decided to suspend E.B.s certificate of registration for two
months, have her complete online learning modules for Professional Standards (Revised 2002),
Restraints, and Therapeutic Nurse-Client Relationship (Revised 2006). As well as successfully
complete a course related to working with aggressive patients in a long-term care facility. I do
not agree with the final decision the Discipline Committee made, because E.B. had received

SCHOLARLY ASSIGNMENT: ETHICS

extra training for patients with dementia and aggressive behavior; therefore, she was fully
knowledgeable and possessed the skills to deal with this patient in a professional manner. The
nurse was also provided with interventions in the patients care plan to use in a situation if the
patient were to become agitated or aggressive; however, she chose not to use any of these
interventions on the night of the incident. Therefore, I believe the punishment this nurse should
receive should be tougher than a two-month suspension. As the actions of this nurse resulted in
the harm and death of a patient, this nurse should no longer be allowed to practice.
According to CNOs Practice Standards: Ethics 2008, promoting client well-being
means facilitating the clients health and welfare, and preventing or removing harm (p. 4). In this
situation E.B. failed to promote client well-being by neglecting the patients needs and inflicting
harm onto the patient by the use of environmental restraint, in the form of confining the patient
to his room, and preventing him from being able to leave. As a result the patient was harmed in
this case, and thus the nurse contravened the ethical value of client well-being. The nurse failed
in this case to facilitate the patients health and welfare, because she did not attend to the patients
needs, and as a nurse it is your duty to be listening to, understanding and respecting clients
needs (CNO, 2009, p. 6). As it is required at this facility that all nurses familiarize themselves
with their patients charts and care plans, the nurse had a great deal of knowledge on the patients
dementia and history of agitation and wandering. Furthermore, the nurse had received
significant training regarding residents with aggressive behaviors and dementia (CNO. v.
Elizabeth B, 2012), but instead chose not to use her knowledge and skills to help the patient.
His care plan set out specific interventions to deal with his aggressive behavior and wandering
(CNO. v. Elizabeth B, 2012). However, the nurse failed to provide client-centered care because
she did not use any of these interventions, although she had documented that she was aware of

SCHOLARLY ASSIGNMENT: ETHICS

the challenges presented in caring for this specific patient, and also noted that she was aware of
the interventions that helped deal with the patient. By enclosing the patient in his room while in
an agitated state, the patient was put at risk for harm, because not providing the attention and
interventions the patient needed at this time may have increased his agitation and made him more
aggressive. The patient was also at high risk for falls, and it was noted that he should be
supervised for his safety and allowed him to wander on his home unit (CNO. v. Elizabeth B,
2012). Instead he was placed in an environment where he could not be monitored, because he
was trapped alone behind closed doors; therefore, E.B. failed to provide a safe environment for
this patient and increased his risks for falls and bodily harm. Furthermore, as it was known to the
staff this patient was allowed to wander in his unit, by not following these interventions in his
care plan, the nurse failed to provide care in his best interest. Moreover, the nurse failed to
maintain a therapeutic nurse-client relationship because the patient was neglected and put under
environmental restraints that also inflicted physical and emotional abuse on the patient, because
his needs as a patient were not met and necessary care was withheld. In a therapeutic nurse-client
relationship, the patient should be able to trust the nurse will put the patients best interest first;
however, in this situation, the trust was breached because the patient was not able to trust his
nurse.
Environmental restraints control a clients mobility (CNO, 2009, p. 4). As CNO
explains in their Practice Standards: Restraints document, restraints are not only physical and
chemical, but also include environmental. Therefore, by confining the patient to his room, E.B.
had placed him on restraints. However, as all restraints are physician ordered, E.B. had
committed an act of professional misconduct. Moreover, nurses cannot use any form of
restraints without client consent (CNO, 2009, pg. 4). When the nurse confined the patient to his

SCHOLARLY ASSIGNMENT: ETHICS

room, not only did she not have an order but she also did not have any consent from the patient
or his substitute decision maker. Furthermore, by placing this patient under restraints, E.B. also
physically and emotionally abused the patient. The nurse committed an act of physical abuse in
that she secluded [the Client] in his room (CNO. v. Elizabeth B, 2012). Likewise, because the
patients emotional needs were not satisfied she also committed emotional abuse because it is
abusive to leave a distraught, agitated client isolated behind a closed door (CNO. v. Elizabeth
B, 2012).
According to the College of Nurses of Ontarios Practice Standards: Therapeutic NurseClient Relationship (Revised 2006), neglect includes non-therapeutic confining or isolation (p.
16). As the nurse in this case confined the patient to his room, the nurse chose to neglect the
patient. E.B. withheld interventions that would have helped the patient in his agitated state, and
failed to respond to his needs.
Each nurse is accountable to the public and responsible for ensuring that her/his practice
and conduct meets legislative requirements and the standards of the profession (CNO, 2009, p.
4). As each nurse is accountable to the public his or her practice should always be up to date with
the practice and learn new techniques to improve practice. Therefore, to prevent an incident like
this one from occurring again I think all nurses should be required to take an online course or
review an online module related to specialized training like how to deal with an agitated or
aggressive patient. In this case a refresher course would benefit the patient and promote clientcentered care because if the nurses were always learning new interventions to deal with these
patients, there would be an increase in patient safety. Moreover, it would also be beneficial to
have a policy in place to keep all doors open during the night shift. This way the nurses can be
fully aware of what is happening in their patients rooms and will be able to hear if a patient is in

SCHOLARLY ASSIGNMENT: ETHICS

need without the barrier of a door. Furthermore, if the doors are left open the nurses will be able
to hear if a patient has fallen and be able to assist them in a timely manner.
After a Notice of Hearing on November 8, 2011, the allegations against E.B. included
violating a standard of practice by failing to meet the needs of a patient, imposing the use of an
inappropriate restraint on a patient, abusing a patient physically, emotionally, and neglecting the
patient, and engaging in practice that is viewed by the College of Nurses of Ontario as
dishonorable and unprofessional. As a result of this incident, this nurse contravened the ethical
value of client well-being because she did not promote her patients health and safety. Instead of
practicing client-centered care, this nurse did not do what was in the patients best interest and in
the end, the patient suffered physical abuse, emotional abuse, and physical bodily harm resulting
in death. The nurse neglected her patient and failed to meet the patients needs. As a solution I
propose all nurses take yearly courses on how to deal with complicated patients. This will help
nursing practice because it will make nurses more knowledgeable and comfortable when they are
put into situations with aggressive or agitated patients. Nurses will not think of restraints being
the best possible solution for their patients, because they will have a refreshed mind of different
techniques to help calm these patients down. This will also help because when a nurse finds a
new way to help calm a patient, he/she can then share it with other nurses and it can become a
method used in everyday practice that helps keep restraints off patients. Furthermore, I think
having a policy in place to keep all doors open during a night shift will also be beneficial to the
nursing practice because nurses will easily be able to check on their patients every hour, and can
better hear what is happening in the rooms because there is no door as a barrier preventing the
nurses from being able to hear their patients. This will also be beneficial to patients that are at

SCHOLARLY ASSIGNMENT: ETHICS

high risk for falls because the nurses can hear if a patient has fallen and will be able to assist
them in a timely manner.

SCHOLARLY ASSIGNMENT: ETHICS

Citation List
CNO. v. Elizabeth, B. (2012). College of Nurses of Ontario. Retrieved from
http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2012/Elizabeth%20Branton,
%20HI06356,%20Jan.242012.pdf
Professional Standards: Ethics. (2009). College of Nurses of Ontario. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
Practice Standards: Therapeutic Nurse-Client Relationship. (2006). College of Nurses of
Ontario. Retrieved from
http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Practice Standards: Restraints. (2009). College of Nurses of Ontario. Retrieved from
http://www.cno.org/Global/docs/prac/41043_Restraints.pdf
Professional Standards: Revised 2002. (2009). College of Nurses of Ontario. Retrieved from
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf