California State Regulations regarding Nurses
After the case study scenario is considered, it is obvious that the major issues that the nurse faces during the case of Mr. E include professional ethics matters, as well as legal regulations for nursing practice. First, the nurse is to participate in deciding on the tube feeding of Mr. E. Second, the nurse is to find people entitled to make a decision instead of Mr. E in case of his inability. Third, the nurse is to act accordingly on finding out that Dr. G revealed personal patient information to the unauthorized person, Mr. H. For this case, the California Regulations of the Board of Registered Nursing and the United States Code of Ethics for Nurses are applicable as legal and ethical documents regulating the nursing practice and conduct standards.
Nursing Code of Ethics Applied
Code Impact of Professional Decision
The code of ethics applicable to the nursing practice issues involved in the case study in the United States Code of Ethics for Nurses was designed and developed by the American Nurses Association (2009). One of the initial provisions of the Code (Provision 1 (1.3)) states: “The measures nurses take to care for the patient enable the patient to live with as much physical, emotional, social, and spiritual well-being as possible” (ANA, 2009). Accordingly, the decisions the nurse makes should be driven first by the patient’s needs. At the same time, it is obligatory, according to the Code of Ethics for Nurses (Provision 1 (1.4)) that the nurse should consult people entitled to make decisions instead of patients in case if he/she cannot do it: “In situations when the patient cannot make a decision, a designated surrogate decision-maker should be consulted” (ANA, 2009). Thus, the Code of Ethics for Nurses considerably affects the decisions the nurse should make in the case analyzed so that to consider both ethical principles and patient’s interests.
Ethics of the Doctor’s Decision
Based on the same Code of Ethics, the ethical character of Dr. G’s decision to carry out ventilation and tube-feeding procedures for Mr. E is rather arguable, as on the one hand patient’s interests are dominant in nursing practice, while on the other hand there is a strict rule to consult the patient or his/her surrogate decision-maker on controversial points. Thus, from the legal viewpoint, Dr. G’s decision to adopt tube feeding is unethical and wrong because he did not consult Mr. E’s authorized surrogate decision-maker and relied on his nephew’s, unauthorized for such decisions, permission (MDPR, 2009). On the other hand, healthcare ethics dictated the need for ventilation and tube-feeding to save the patient’s life, and from this viewpoint Dr. G’s decision is ethical.
Ethics of the Patient’s Brother’s Decision
The ethics of Mr.E’s brother’s decision is less controversial. On hearing from Dr. G, Mr. B set off to the hospital to examine his brother’s condition, consult with the doctor, and make the decision accordingly. The California Code of Regulations for Registered Nurses sees the patient’s surrogate decision-maker as the person with the primary right to decide the case like this, although it leaves the right for the nurse to be the advocate of the patient’s choices (BRN, 2009). Therefore, it is ethical that Mr. B did not decide instantly on tube feeding, but tried to investigate the situation and communicate the issue with Mr. E, his doctor, and the nurse involved in his care.
Nurse Autonomy in Professional Practice
Another important point in the professional ethics in nursing is the professional autonomy concept. Admitted by the Code of Ethics (Provision 7 (7.2)), “professional autonomy and self-regulation in the control of conditions of practice are necessary for implementing nursing standards…” (ANA, 2009). Moreover, scholars like Marriner-Tomey (2008) and McGhee and Perrin (2007) also recognize the right of nurses for professional autonomy and define the latter as the right of the nurse to make decisions based on professional standards without consulting the supervising authorities (Marriner-Tomey, 2008, p. 72). At the same time, the California Code of Regulations for Registered Nurses restricts professional autonomy depending on professional qualification, education, and experience. (BRN, 2009). Accordingly, the professional autonomy of the nurse in the considered case is limited by the California Code of Regulations for Registered Nurses.
Nurse’s Right/Obligation to Report Regulation Violations
One of the preserved autonomy elements that the nurse in the considered case can exercise is the right, according to the Code of Ethics for Nurses (Provision 3 (3.5)) to report the violation of the nursing practice regulations of usage of dangerous, illegal, and unauthorized practices (Marriner-Tomey, 2008, p. 12). The Abuse Reporting Requirement of the California Code of Regulations for Registered Nurses, on the other hand, requires the nurse to report any violation case and presupposes sanctions against the nurse if he/she does not report the violation. In the situation with Dr. G revealing Mr. E’s private information to Mr. H, it is more ethical for the nurse not to report this case as it does not endanger Mr. E’s, but on the contrary aims at saving it. However, based on potential sanctions presupposed by the California Code of Regulations for Registered Nurses, the case should be reported to the nurse to avoid organizational and employment issues (BRN, 2009). At the same time, Mr. H on coming to know the details from Dr. G is not authorized to make decisions; so, all he can do is report the data to Mr. B as soon as possible for him to decide as to the official surrogate decision-maker. Mr. H in this situation cannot authorize Dr. G to use a ventilator and tube-feeding as he is not the official surrogate decision-maker.
Nurse’s Accountability for Safety and Quality of Care
Finally, for the nurse in the case, it is essential to operate by the quality and safety accountability principles imposed on the nursing professionals by the Code of Ethics for Nurses (Provision 4 (4.1)) and the California Code of Regulations for Registered Nurses that requires from the nurses to “promote patient safety as an essential and vital component of quality nursing care” (BRN, 2009). Therefore, the nurse in the case is responsible for the quality of services presented to Mr. E, and if this patient needs urgent ventilation and tube-feeding to save his life, this procedure should be communicated to the patient’s surrogate decision-maker and authorized as soon as possible for the nursing professionals involved in the case not to violate the quality and safety accountability requirement (McGhee and Perrin, 2007, p. 136).
Drawing from this, it is possible for the nurse in the case to find the balance between ethical issues and nursing regulations of California state that are often contradictory and controversial. The point here is that the nurse should follow the ethical principles and the requirement for quality and safety accountability and exercise the right for professional autonomy of decision making in situations like the one involving Dr. G revealing a patient’s private health record to the unauthorized person. The driver of the nurse’s decision in this situation should be the interests of the patient and the obligation to provide high-quality and safe health services.
References
ANA. (2009). Code of Ethics for Nurses. Web.
BRN. (2009). California: Regulations of the Board of Registered Nursing. Web.
Marriner-Tomey, A. (2008). Guide to Nursing Management and Leadership. Elsevier Health Sciences.
McGhee, J. and Perrin, K. O. (2007). Ethics and conflict. Jones & Bartlett Publishers.