Case Study
This is a critical analysis on the ethical and legislation issues that emerges in patient care. It will start off with a brief description of a case study. Two, there will be identification of the ethical issues that emerges from the case study. The ethical issues will focus on the human rights, dignity, the professional codes of ethics/conducts, the relevant professional legislation/policies and on the principles of the health care ethics. Three, the identified ethical and legislation consideration will be described and analyzed further in details. Four, there will be recommendations to the professional practice on the subject. Lastly, there will be a conclusion to summarize all the above.
A case study of a two-year old child (Milly), who was rushed to the emergency department by two paramedics. The mother (Sandra) reported that she fell. On examination by the paramedics she is in pain and she is clutching her arm. The paramedics suspects that she has a fractured humerus. There is a struggle to get Milly to the hospital as Sandra’s partner is reluctant. He is intoxicated and verbally abuses Sandra and the paramedics. The paramedics threatens to call the police if he continues to be reluctant. He finally agrees. On the journey to the hospital, Sophie (paramedic) notices small burns on Milly legs and abdomen. On arrival to the hospital, they handover the patient to the triage nurse, Beth. They report they concerns that Milly has been physically abused. The nurse tells them that she will report it to the doctor. Before attending to Milly, she is called in to check on morphine dose whereby they share the rest to themselves.
It is estimated that more than 40 million children aged between 0-14 years are abused and neglected every year. Most of these children requires health care and social care (World Health Organization [WHO] 2016). Child abuse can be dated back in the ancient days. Children has suffered lots of violence at the hand of the adults (Johnstone 2010). Today child abuse is one of worlds tragic and longstanding public health issues (WHO, 2012); International Society for the Prevention of child abuse and neglect [ISPCAN], 2016). In the current day, the issues of children maltreatment and the urgency to have an effective protection services for children remains a problem and an endless challenge in many countries in the world. According to the Australian Institute of Health and Welfare [AIHW], (2013) the number of child protection notification has doubled over the past five years. Despite child abuse being epidemic and being addressed globally, its incidences and the negative effects/outcomes continues to be under-reported, under-recognized and it is poorly addressed by most governments (Pinheiro 2016: WHO, 2010; ISPCAN, 2016; Administration for Children and Families [ACF], (2011)
Ethical and Legal Issues in Patient Care
The following ethical and legislation issues/considerations emerges from the above case study. Milly is being physically abuse. The fracture she got is probably as a result of abuse by Sandra’s partner or from child neglect. She has burn scars on the legs and abdomen and Sandra’s partner had refused the paramedics to take her to the clinic. This clearly supports that she is being physically abused. Children who lives with intoxicated parent’s chances of being abused are usually high (Ammerman, Kolko, Kirisci, Blackson, Dawes, 2011). Appel and Holden (2012) states that children who are raised by co-parents the chances of being maltreated are also high. Milly lives with an intoxicated guardian and also it seems as if Sandra and her partner are co-parenting.
When a child is being abused his/her human rights and dignity are breached. The law states that a case of child abuse should be reported and responded to immediately. Milly’s case does contrary to this law. Milly seems to have been physically abused for a while now with no action being taken. Another law states that children should be protected from domestic violence. This is not the case in Milly’s situation. On the hospital, this was a forensic case. It should have been handled in a sensitive way following the professional codes of ethics and conducts. The care given to her should have followed the principles of the health care ethics. The above were not followed. Nurse Beth, did not incorporate the principles of forensic care, the principles of the health care ethics and relevant policies when attending to her.
Milly, is denied quality health care as the emergency nurse did not follow the professional codes of ethics/conducts and the principles of health care. Milly’s case is a forensic case. The emergency nurse should have followed the six principles of forensic nursing to manage the patient (Goleman, 2016). Legally the Milly’s case should be followed up by the local authorities. It should be reported, evidence collected and documented. This did not happen. Milly is being denied quality health care and just. Secondly, the professional codes of ethics states that the health care provider and in this case the nurse should respect the patient’s dignity, should be responsible, accountable, should provide quality care and lastly should be trustworthy and confidant (Rawls, 2013; Morrison, 2011). The nurse leaves the patient alone to go and help counter check morphine dose and on top of that the remaining dosage they inject themselves. This clearly shows that this nurse is not responsible, competent and accountable. This will translate to Milly not getting quality care. Thirdly, the nurse does not incorporate the principles of care ethics in her care. There are four principles, autonomy, beneficence, non-maleficence, and justice. Patient Milly is denied the last three (Beauchamp and Childress 2011). The kind of care she is receiving does not benefit her and also is not just/fair. She has been physically abused, her care should be done in accordance to the forensic principles.
Recommendations for Professional Practice
Milly’s human rights and dignity are being compromised (UN, 2010). She has the right to quality life and right to parents. The state has obligations to protect children against abuse or/and maltreatment That is by ensuring that she is not tortured or subjected to degrading or inhuman treatment. It is obligations to ensure that children who have been subjected to abuse gets good recovery. Lastly, it is obligated to ensure they receive quality health care (Wenar, 2011). These are compromised by, one, she has a fracture of the humerus and burn scars on her legs and abdomen. This is as a result of child abuse. Her rights to quality life are being compromised. The state has failed in providing protection and safety to her. As mentioned above the state has an obligation to ensure she is not being tortured.
The recommendations to the nursing practice are as follows; one, the emergency nurses should get education on forensic nursing. This will be beneficial as patients whose cases has legal issues will receive quality care. Two, the hospitals should have stipulated policies to ensure that the nurses use their professional codes of ethics/conduct and principles of health care ethics. Three, there should be campaigns to advocate early reporting of child abuse. Four, there should be laws and policies on actions to be taken on those who abuses children.
Conclusion
In summary, patient Milly was a forensic patient whose case was not handled as per the expected standards. Ethical and legal issues/considerations were not followed. Her rights and dignity was not observed. The health care providers attending to her were not responsible, accountable and competent. The health care providers were not forensic nurses. They did not incorporate the principles of forensic nursing, principles of health care ethics and the professional codes in her care. With this it is clear that she did not receive quality health care. The state also failed in protecting her from being maltreated and being tortured. It also failed in ensuring that she received quality care as it is its obligation. As stated above, there should be forensic nurses to handle these patients and also there should be policies and laws to ensure professional codes are observed
References
Administration for Children and Families [ACF], (2011). Child maltreatment, 2010 report. Washington, DC: U.S. Department of Health and Human Services, ACF.
Ammerman, R., Kolko, L., Kirisci, T., Blackson, M., Dawes, E., (2011). Child abuse potential in parents with histories of substance use disorder. Child Abuse & Neglect. 23(12):1225-1238.
Appel, A. E., and G. W. Holden. (2012). The co-occurrence of spouse and physical child abuse: A review and appraisal. Journal of Family Psychology12(4):578-599.
Australian Institute of Health and Welfare [AIHW], 2013. Child abuse. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/. Accessed on 8/5/2018.
Beauchamp G., and Childress, J., (2011). Principles of Biomedical Ethics. 5(9), 389-390.
Goleman, D., (2011). The roots of compassion. Principles of Biomedical ethics. New York: Oxford University Press.
International Society for the Prevention of child abuse and neglect [ISPCAN], (2016). Child abuse. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/. Accessed on 8/5/2018.
Johnstone, T., (2010). Child maltreatment. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/ . accessed on 8/05/2018.
Morrison, E., (2011). Ethics in Health Administration. 2(6). 48-52.
Pinheiro, U., (2016). Child abuse and maltreatment. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/ . Accessed on 8/05/2018.
Rawls, T., (2014). A Theory of Justice. Cambridge, MA: Harvard University Press. 47-48.
United Nations, (2010). The rights of children. Retrieved online on https://www.unhcr.org/refworld/pdfid/3ae6b38f0.pdf . Accessed on 8/5/2018.
Wenar, L (2011). Rights. Stanford Encyclopedia of philosophy. Retrieved online from http;//plato.stanford.edu/entries/rights accessed on 8/05/2018
World Health Organization [WHO], (2012). Child abuse. Retrieved online https://clinicalgate.com/8-ethical-issues-associated-with-the-reporting-of-child-abuse/ . Accessed on 8/05/2018.
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