Code of Ethics Vicki Brinson, RN Western Governor’s University Nursing Roles and Values
CODE OF ETHICS Code of Ethics
Mr. E is a 67-year-old male who has been brought to the emergency department for lung congestion. Mr. E is diagnosed with pneumonia secondary to aspiration and Dr. K has determined that the best course of action is to intubate Mr. E. The nurse on duty discovers that Mr. E has an advanced directive that clearly states he does not want to be intubated. While looking at the medical notes she also discovers that Mr. E is mildly developmentally delayed. When Dr. K tries to discuss the situation with Mr. E he becomes very upset, shouts that he does not want to be intubated, and says he wants to go home. Dr. K has instructed the nurse to contact Mr. E’s next of kin because he fears that Mr. E is incapable of understanding the severity of his situation. The nurse contacts Mr. Y and advises him of the situation. The nurse then goes on break and discusses the situation in the cafeteria with other staff members who do not have any direct responsibility for the care of Mr. E. In South Carolina this nurse would be in direct violation of Section 40-33-110 of the Nurse Practice Act. Section 40-33-110 paragraph 8 states that the Board of Nursing has the right to fine, suspend, cancel, or issue public reprimand to any nurse who, “disseminated a patient's health or personal information acquired during the course of practice to persons not entitled by law or hospital or agency policy to disclosure of this information” (South Carolina Nurse Practice Act, 2012). When Mr. E’s nurse spoke with the medical-surgical unit nurses about his situation the nurse was not following the South Carolina Nurse Practice Act. If the nurse was reported to the State Board of Nursing for this violation she could face fines and her nursing license could be suspended. Provision 3 of the American Nurses Association (ANA) Code of Ethics states that it is the nurses responsibility to promote, advocate, and protect the health, safety, and rights of the
CODE OF ETHICS
patient (American Nurses Association, 2001). If I was the nurse in this situation I would have advocated for Mr. E’s wishes to be upheld. He did not want to be intubated or placed on life support. He created an advanced directive stating his wishes so that others would know what he wanted and I would have encouraged his family members to follow those wishes. The nurse in this situation also violated the ANA Code of Ethics by discussing Mr. E’s situation with other hospital staff that was not involved in his direct care. It is our duty as nurses to protect the patient’s confidential health information and this nurse was clearly not doing this by speaking about Mr. E in such a public place. The nurse also violated this by allowing the doctor to discuss Mr. E’s situation with Ms. H and her boyfriend in such a public place with other people present who were not even related to him. The nurse should have moved Ms. H to a more private area before the allowing the doctor to talk with her. Allowing Ms. H to make the decision to intubate Mr. E carries some serious ethical implications. It’s not clear in the scenario if Ms. H is even related to Mr. E so the staff involved should not be allowing her to make medical decisions on his behalf. Mr. Y is the one who is designated as Mr. E’s power of attorney and legally he should be the only one to make those decisions. The patient does have low oxygen levels and a fever so this could impair his ability to make appropriate decisions but I do not believe that it is ethically sound to perform a procedure on a patient who is verbalizing his refusal to have the procedure performed. The ANA Code of Ethics was created to give nurses a standard of behavior to reference. It is in place to ensure that nurses are rendering competent and ethical nursing care to their patients when they are at their most...