Running head: Ethics Assignment
Student # 820526374
Scholarly Assignment for Ethics
Natashia Richardson
820526374
November 2, 2014
NURS 217 Legal and Ethical Concepts
Janet Jeffrey
Humber College ITAL
1
Running head: Ethics Assignment
Student # 820526374
2
Introduction
What Happened
“On November 24 and 25, 2010, the member failed to meet the standard of practice of the
profession. The member failed to intervene to protect the health and well-being of the client when
she was being abused physically by Nurse C"(Discipline Committee of the College of Nurses of
Ontario, 2014). At the time of the incident the client was a 17 year old adolescent. "At
approximately 23:58 on November 24, 2010, city police and paramedics brought the client to the
Emergency Department at the facility. The client had been found at a coffee shop with decreased
level of consciousness, due to alcohol and drug consumption and was also bleeding from her
wrists. The client did not have any identifying information with her and was not willing to provide
her name to facility staff "(Discipline Committee of the College of Nurses of Ontario, 2014).
Situation that lead to Misconduct/ Nurse involved
The member was working a night shift in the Emergency Department. "The client was
initially assigned to RN A, who was assisted by RN B. RN A performed a light sternal rub because
the client was not responding to voice or touch. The client responded by wincing and moving her
shoulders and arms, which indicated she was not unconscious. The client was conscious and
interacting with staff, but was non-verbal, when RN A went on break around 02:30. Nurse C went
to the member after 03:00 to ask for help to wake a client that was unconscious. "The member
flicked her on the cheeks and forehead with her fingers and also rubbed the client's sternum. The
client showed signs of consciousness. “Nurse C was trying to prompt the client to provide her
name, she made a comment to the client that was not appropriate. Nurse C suggesting they cut the
client's hair" (Discipline Committee of the College of Nurses of Ontario, 2014). " If RN B were to
testify, he would say Nurse C proceeded to take the client's left and right arms and hold her down,
Running head: Ethics Assignment
Student # 820526374
3
the client was crying and asking the member and Nurse C to stop" (Discipline Committee of the
College of Nurses of Ontario, 2014). The client had a six-inch bruise that was visible on her
sternum at shift change, between 06:30 and 07:00. "The client was transferred to the child and
adolescent mental health unit on November 25, 2010. A physical assessment was performed on
the client; where it was noted that her sternum was bruised and tender. There were no contributing
factors such as mental illness or hospital setting that affected the member. “The member has no
prior disciplinary findings with the college or any disciplinary issues at work"(Discipline
Committee of the College of Nurses of Ontario, 2014).
Discipline Committee Decision/ Penalty
The decision of the panel states “the panel finds that the member engaged in the conduct
that would reasonably be considered by members to be unprofessional. As it demonstrated a
serious & persistent disregard for her professional obligations" (Discipline Committee of the
College of Nurses of Ontario, 2014). The Panel direct the Executive Director to suspend the
member's certificate of registration for two months. The member needs to review and complete
Reflective Questionnaires and online learning module for Professional Standards and Therapeutic
Nurse- Client Relationship. I agree with the decision of the Discipline Committee because the
priority is to protect the public. With this decision the public is being protected and it enhances
public confidence in the ability of the College to regulate nurses. Also this penalty gives the
member an opportunity to learn from her mistakes and by completing the necessary requirements;
the member improves her skills and be prepared in dealing with a situation like this the professional
way in the future.
Running head: Ethics Assignment
Student # 820526374
4
Ethics
What it is
"To make decisions about ethical situations, nurses need to be aware of their personal
values"(College of Nurses of Ontario, 2009). "CNO has identified the following values as being
most important in providing nursing care in Ontario: Client well-being; client choice; privacy and
confidentiality; respect for life; maintaining commitments; truthfulness; and fairness" (College of
Nurses of Ontario, 2009). The two ethical values that were breached by the member were client
well- being and maintaining commitments.
Client well-being
"Client well-being means facilitating the clients’ health and welfare, and preventing or
removing harm. Nurses must have the client's views as a starting point" (College of Nurse of
Ontario, 2009). However the member did not uphold the client’s well-being. The member breached
this ethical value by failing to intervene to protect the health and well-being of the client when she
was being abused by another nurse; Nurse C to be specific. The member failed to maintain the
standards of practice for professional misconduct number seven which includes "abusing a client
verbally, physically or emotionally" (College of Nurses of Ontario, 2014). “The use of excessive
force or inappropriate physical conduct amounts to physical abuse & constitutes an abuse of
authority and power of the client. A nurse must not exhibit behaviour towards a client that maybe
perceived by the client to be violent or inflict physical harm. This includes hitting, pushing,
slapping, shaking, using force, using restraints unnecessarily or inappropriately and handling a
client in a rough manner" ( College of Nurses of Ontario, 2014). Nurse C took both left and right
arms of the client and held her down. Even though the client was crying and asking both nurses to
stop, the abuse continued and the Client was left with a six-inch bruise on her sternum that was
Running head: Ethics Assignment
Student # 820526374
5
visible. The member did not try to stop the abuse that the client was enduring. The member did
not tell Nurse C to stop, or call for help by yelling from the client’s room. Prior to even starting to
touch the client, the member and Nurse C should have obtained consent from the client. In this
situation, they failed to obtain a verbal consent from the client. "According to the College of Nurses
of Ontario (CNO) standards, nurses are accountable for obtaining consent whether the intervention
or service relates to a treatment (as defined in the HCAA or as required in common law), admission
to a facility or the provision of a personal assistance service" (College of Nurses of Ontario, 2009).
Maintaining Commitments
"Maintaining commitments means keeping promises, being honest and meeting implicit or
explicit obligations toward their clients, themselves, each other, the nursing profession, other
members of the health care team and quality practice settings" ( College of Nurses of Ontario,
2009). For this situation the member failed in maintaining commitments to clients. “Nurses, as
self-regulated professionals, in implicitly promise to provide safe, effective and ethical care.
Because of their commitments to clients, nurses try to act in the best interest of clients according
to client’s wishes and the standard of practice. Nurses are obliged to refrain from abandoning,
abusing or neglecting clients, and provide empathic and knowledge care" (College of Nurses of
Ontario, 2009).The member did not try to act in the best interest of the client in any way possible.
The member failed in showing accountability to the client. "Each nurse is accountable to the public
and responsible for ensuring that his/her practice and conduct meet legislative requirements and
the standards of the profession" (College of Nurses of Ontario, 2009). A nurse demonstrates the
standards for accountability by " identifying her/himself and explaining her/his role to clients;
providing, facilitating, advocating and promoting the best possible care for clients and taking
action in situations in which clients safety and well-being are compromised"(College of Nurses of
Running head: Ethics Assignment
Student # 820526374
6
Ontario, 2009). The member did not introduce herself to the client or explain her role to the client
about what she was there to do. The member didn't take any course of action while the client safety
and well-being while patient was put at risk. The client did not receive the best possible care from
the member. Knowledge was also one of the key standards that the member lacked while attending
to the client. “Each nurse possesses, through basic education and continuing learning, knowledge
relevant to her/his professional practice" (College of Nurses of Ontario, 2009). A nurse
demonstrates her understanding of the standard for knowledge by “understanding the knowledge
required to meet the needs of complex clients"(College of Nurses of Ontario, 2009). At the time
the member was dealing with a complex client because the client was non-responsive. But the
member didn't gather all of her facts and knowledge from the other nurse that was taking care of
the client before her. The member didn't find out if the client was responsive to the nurse caring
for her before she arrived. Communication between the member and Nurse A was a key aspect of
the problem.
Strategy 1
The first strategy that I would suggest would be for the CNO to mandate that the facility
operator of the hospital to organize a learning workshop that nursing staff must attend twice a year.
The first workshop will be an orientation; to introduce Therapeutic Nurse-Client Relationship. The
staff will be quizzed to see how much they remember from the CNO document. The second
workshop will be going through the document in detail. At the end of the workshop, the staff must
write a test and pass in order to receive a certificate of attendance. Failure to pass test, the staff
member must attend second workshop again until certificate is earned. Failure of not attending
workshops will result in temporary licence suspension. “At the core of nursing is the therapeutic
nurse-client relationship. The nurse establishes and maintains this key relationship by using
Running head: Ethics Assignment
Student # 820526374
7
nursing knowledge and skills, as well as applying caring attitudes and behaviours. Therapeutic
nursing services contribute to the client’s health and well-being"(College of Nurses of Ontario,
2013).
Strategy 2
My second strategy that I would suggest would be for the CNO to make a learning module
on restraints that is mandatory for the staff to complete. As well as a training session for restraints,
that will engage staff in how to practice the right restraints to be used for a situation that requires
the use of restraints. “Restraints are physical, chemical or environmental measures used to control
the physical or behavioural activity of a person or a portion of his/her body"(College of Nurses of
Ontario, 2009). Staff members will be able to access the module at home or any place with internet
access. The module consists of a video and a quiz that staff members must complete and receive a
certificate of completion that needs to be shown to facility operator. The staff will be given six
months to complete the module. Failure to complete and show proof of certificate by due date will
result in member meeting with the facility operator to create a plan to complete module. The
training session will be based on the module staff completed. It is expected by the end of the
session staff can demonstrate the right restraint for scenario given to staff member. Staff member
will receive a certificate of completion once staff demonstrates restraint properly. Failure to
demonstrate correct knowledge, staff member will need to attend session again. Staff should
adhere to the policy direction: least restraint. "Least restraint mean all possible alternative
interventions are exhausted before deciding to use a restraint"(College of Nurse of Ontario, 2009).
Running head: Ethics Assignment
Student # 820526374
8
In Conclusion of this allegation, the member failed to follow one of the nursing standard by
committing an act of professional misconduct number seven abusing a client physically, verbally
and emotionally. The member did not stop the physical abuse that the client was enduring from
Nurse C. The member should have not allowed Nurse C to hold down both the clients arm as an
unnecessary physical form of restraint and should have intervened to stop the abuse immediately.
The two ethical values that were contravened were client well-being and maintaining commitment
to client. The member did not promote clients well-being or safety. The member did not maintain
commitment to client for not abusing the client. The member along with Nurse C caused bruising
(six-inches) to client’s sternum. The member did the opposite as a nurse to “DO NO HARM", the
client was harmed and to be transferred to an adolescent mental unit. My two proposed solution
are: (1) staff must attend two mandatory learning workshops that include an orientation, which
introduces Therapeutic Nurse-Client Relationship to staff members and a quiz to determine how
much they know about the CNO document. The second workshop is more detailed in teaching the
document to the staff members. Staff members must pass the test to obtain certificate of
completion. Failure to pass test, member will not receive a certificate and must attend workshop
again. (2) Staff members complete module on restraint that is accessible anywhere with internet
access. Staff members have six months to complete the module and print the certificate for
completing the module. Failure to complete module, staff member will have to meet with facility
operator and will not be able to advance to training session. Training session will be to practice
what members learned from restraint video. Staff member must demonstrate that they understand
how to use a restraint properly. Failure to demonstrate restraint to instructor will result in member
not receiving certificate and be required to take session again.
Running head: Ethics Assignment
Student # 820526374
Reference
College of Nurses of Ontario. (CNO). (2009). Practice Guideline: Consent. Retrieved from
www.cno.org
College of Nurse of Ontario. (CNO). (2009). Practice Standard: Ethics. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2013). Reference Document: Professional Misconduct.
Retrieved from www.cno.org
College of Nurse of Ontario. (CNO). (2002). Practice Standards: Professional Standards.
Retrieved from www.cno.org
College of Nurses of Ontario. (CNO). (2012). Learning Module: Restraints. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2012). Learning Module: Therapeutic Nurse- Client
Relationship. Retrieved from www.cno.org
Discipline Committee of the College of Nurses of Ontario. (CNO). (2014). Retrieved from
www.cno.org
9