Example Case Study
You are on placement at a large metropolitan hospital. As you are walking down an otherwise empty corridor to start your shift, you encounter a person lying on the floor. Your initial assessment shows they are breathing but unresponsive. The person seems to be a hospital patient as they are wearing a hospital name band.
|Decision-making framework – adapted from McDonald & Then, 2019.|
Step 1: Identify issues and collect information.
|Outline key ethical and/or legal issues (for example, ethical violation, ethical dilemma or ethical distress) that are present in the case study. This includes summarising who is involved (or should be involved), their interest in the matter and what further information is needed (approx. 250 words).|
This situation presents an ethical dilemma, which means the appropriate course of action is unclear (McDonald & Then, 2019). The unconscious person could suffer harm or even death without intervention. However, it is unknown whether the person would want to receive treatment, or what kinds of treatment they would be willing to receive.
It is clear that two people immediately involved are the unconscious person and myself, the nursing student. Nursing students must work within their scope of practice, which refers to what I am educated, competent and legally permitted to perform (Nursing and Midwifery Board of Australia (NMBA) 2016). As I am legally required to work under supervision I would immediately alert other health professionals such as the emergency response team. Other people who might be involved include any people walking past who could provide assistance dependent on their role. More broadly, Flinders University and the hospital are also involved because my actions are regulated by their policies, and my actions could have legal and reputational repercussions for both organisations.
Further information that I would seek to assist my decision-making include considering my scope of practice, such as what I have previously learned about how to respond to these types of situation. If possible, I would gather information about the client from their identification band, such as their name and their ward/department. This might help me learn more about whether the person had any allergies or specific wishes for medical treatment, such as an advanced care directive. However, this is an emergency situation so I would need to act very quickly to ensure the unconscious person’s immediate wellbeing.
|Step 2: Evaluate the issues|
|Choose one ethical or legal issue identified in Step 1. Identify relevant legal, ethical and professional guidelines and explain how you would apply them to the chosen legal/ethical issue (approx. 400 words).|
|You only need one issue in your assignment – legal OR ethical issue. However, some issues may be equally legal and ethical like this case study. This is also fine but not a requirement.|
One issue that raises both legal and ethical questions is whether to provide care to an unconscious person when their wishes are unknown. The provision of health care without valid consent could lead to the nurse being charged with assault or battery (Atkins, de Lacey, Ripperger & Ripperger, 2020). The importance of obtaining valid consent is based on the ethical principle of autonomy, which refers to an individual’s right to make their own decisions (McDonald & Then, 2019). Respect for autonomy is also outlined in professional guidelines such as the ‘Code of Conduct’ which explains that nurses must obtain consent before providing any treatment (NMBA, 2018). Similarly, the nursing ‘Code of Ethics’ highlights the importance of providing sufficient information to permit informed consent (International Council of Nurses, 2012), which is not possible for an unconscious person. As such, it difficult to respect the autonomy of the unconscious person in this case study because it is unclear what, if any, treatment they would consent to.
Fortunately, there are legal and ethical guidelines that enable nurses to provide life-saving emergency care to an unconscious person. For example, in South Australia, the legislation that supports clients’ rights to consent to or refuse health care also allows for the provision of life-saving treatment without consent. According to s. 13 of the Consent to Medical Treatment and Palliative Care Act 1995 (SA),a health professional may “lawfully administer medical treatment to a person” if the person is “incapable of consenting”. This means that I would legally be able to provide emergency care to the unconscious person who is not currently able to give consent. The legal provision to provide emergency life-saving treatment without consent is based on the ethical principles of beneficence – doing good by treating the illness, and non-maleficence – avoiding harm such as potential death (Atkins, de Lacey, Ripperger & Ripperger, 2020). The nursing ‘Code of Conduct’ also supports the provision of care without consent by acknowledging that obtaining valid consent might be impossible in an emergency (NMBA, 2018). Consequently, it is both legal and ethical for me to provide life-saving care to the unconscious person in this case study.
|Step 3: Action – what to do in practice|
|Based upon Steps 1 and 2, outline a plan to respond to the situation. You need to consider your scope of practice as a nursing student and what options/resources are available to you (approx. 350 words).|
|One possible action could be to do nothing and ignore the situation because I would feel afraid providing emergency care alone as a first-year nursing student. However, this is not an ethical or legal response because I have a legal duty of care to clients (Atkins, de Lacey, Ripperger & Ripperger, 2020) and I am expected to show professional integrity in all my actions (NMBA, 2018). Failing to provide care due to lack of confidence would not be consistent with the values of the nursing profession to promote beneficence and non-maleficence. Furthermore, failing to act during an emergency situation could lead to professional or legal repercussions, such as charges of professional negligence due to not providing a “reasonable standard of care” (Atkins, de Lacey, Ripperger & Ripperger, 2020, p. 120).|
Instead of doing nothing, I would provide emergency care to the unconscious person within my scope of practice, which is what I am educated, competent and legally permitted to perform (NMBA 2016). As I have completed basic life support training as part of my pre-placement requirements, I have the education and competence to provide emergency care to an unconscious person. This means I would provide emergency care based on my basic life support training, but I would not attempt activities beyond this limited scope. In line with my basic life support training, I would immediately “send for help” to summon other health professionals and l would roll the unconscious person on their side (Australian Resuscitation Council & New Zealand Resuscitation Council, 2016). Furthermore, as soon as other health professionals became available, I would promote beneficence by allowing the experienced professionals to take over and provide more advanced care.
When other health professionals had taken over the care of the unconscious person, I would attempt to locate further information about the person to assist the health care team. For example, I would attempt to ascertain whether the person had an advanced care directive that outlined their treatment wishes. I could do this by contacting the person’s ward/department informed by the details on the person’s identification band. This would show respect for the unconscious person’s autonomy by seeking out evidence of any instructions they made about their care before they became unconscious.