Nurses are to provide compassionate, competent, and ethical care, and follow the moral principles and guidelines set out by the College of Nurses and the Canadian Nurse’s Association’s code of ethics. The nursing profession is a self-sacrificing one, and nurses take on the Nightingale Pledge, to elevate the standard of their practice and dedicate themselves to those committed in their care (Keatings & Smith, 2010, p. 64) However unfavourable working conditions, inadequate patient to nurse ratios, and intensive job-related stress can lead to poor performance of daily routines, and adversely patient safety (Ozata et al., 2013). In the situation regarding Mr. Gurt who suffers from Parkinson’s disease, it is vital for the nurse to weigh him at the beginning of each month. This is her obligation under her employing institution’s standards of care, as well under the autonomy of her practise in which any deviation from this could result in exposure to liability (Austin 2006, p. 62).
In order for the nurse to properly care for Mr. Gurt, assessing his accurate weight is essential in providing a care plan that will focus on his overall wellness and healing. Because Mr. Gurt is frail, and has stage one pressure ulcers on both heels and his coccyx, it is imperative that he has every opportunity to build up his skin integrity and prevent future disruption of his skin surface. Complications that may arise because of the nurse’s neglect in failing to weigh him, may contribute to other underlying problems. General health concerns Mr. Gurt would be facing on top of his current co- morbidities would include a decline his general appearance, gastrointestinal, neurologic, integumentary, and musculoskeletal systems (Holloway, 2004, p. 80). By recording a weight of 70kg with a height of 170cm, the nurse calculated Mr. Gurt’s Body Mass Index (BMI) at 24.2 which is borderline overweight, when in fact it was 14.5, with 18.5 being the baseline for being underweight (http://www.nhlbi.nih.gov/guidelines/ obesity/ BMI/bmicalc.htm., n.d.).
According to this value, it would be likely that Mr. Gurt would suffer from imbalanced nutrition, less than his body requirements leading to other complications and failing to thrive. Nanda defines failure to thrive as the progressive functional deterioration of a physical and cognitive nature. The individual’s ability to live with multisystem diseases, cope with ensuing problems, and manage his care are remarkably diminished (Ackley & Ladwig, 2011, p. 350). To add on to potential problems, drug doses are given based on factors such as age, gender, and the weight of a patient (Raman-Wilms, 2013). Since Mr. Gurt is elderly and suffering from the effects of Parkinson’s with an imbalance of neurotransmitter activity between dopamine and acetylcholine, there may be fewer receptors and a decrease in neurotransmitters to take up his drugs (Raman-Wilms, 2013). Levadopa a dopaminergic medication which treats the symptoms of Parkinson’s disease should be reviewed with body weight changes (Raman-Wilms, 2013). A study looking into the factors of weight loss in Parkinson’s looked at the effects of dopaminergic treatment which suggested that the drug had a lipolytic effect and body mass fat was decreased with the advancement of Parkinson’s symptoms (Lorefalt, 2004, p.186).
The potential magnitude and likelihood of harm occurring in this case is significant as drug tolerances, adverse effects, and toxic effects are high, making the liver and kidneys susceptible to disease (Urquhart, 2014), as Mr. Gurt’s body mass index indicates he is underweight and a higher risk for drug overdoses. Effectiveness of this drug will diminish over time in which the adverse effects may become severe and may include palpitations, abdominal movement, dizziness, and confusion (Raman-Wilms, 2013, p. 331). Incorrect doses of his medication could lead to physical and psychological issues based on the nurses documented weight and his actual weight. Failing to weigh Mr. Gurt will have a great impact on his nutritional needs, but will also affect his ability to heal his pressure ulcers on his heels and coccyx. Mr. Gurt is emaciated which may be in part to dysphasia, tremors, still muscles, and slow movements among other symptoms of Parkinson’s (Wilk & Newmaster, 2013, p. 288). As well, Mr. Gurt’s weight is evidence that he is not receiving the nutritional intake his body’s immune system requires to create the proteins and blood cells (macrophages the body’s first line of defence), needed to attack and repair his wounds, and prevent the risk for infection (Raman-Wilms, 2013).
The nurse’s blatant disregard to weigh Mr. Gurt puts him at greater risk for infection and is a form of negligence. Negligence in nursing can be unintentional, however it is important to understand the effects this has on health professionals practicing in Ontario. A registered nurse is responsible to follow the standard of care when performing nursing acts under autonomy within their scope of practise (College of Nurses, 2004) (CNO, 2004). Standard of Care is the legal benchmark against which a person’s conduct is measured to determine whether a person has been negligent and whether the person’s conduct or actions in a given situation have met those expected of a competent health care professional (Keatings & Smith, 2010). The College of Nurses is the governing body for registered nurses that protect the public through regulating the nursing profession (CNO, 2014). A practising nurse is obliged to follow the standards of care and ethical guidelines set out by this governing body (CNO, 2014). The College of Nurses lists seven ethical values which are all important, but recognizes that client well-being is a primary value (CNO, 2014).
The College of Nurses connotation of client well-being is to promote the patients health, while preventing or removing harm (CNO, 2014). In the case regarding Mr. Gurt, where the nurse is required to weigh him monthly and record the data, she is morally responsible for the patient’s well-being and for any adverse outcomes regarding his health for failing to provide safe care. The nurse’s complacency in failing to weigh Mr. Gurt, a simple act, would be of concern in investigating her moral responsibility in providing ethical care in her work environment. The nurse’s ethical duty is to advocate for her patients and provide safe, effective, and ethical care (CNO, 2014). Possible outcomes that could arise for the nurse in failing to provide ethical care include: her co-worker filing a complaint to the College of Nurses, a discipline hearing with the College of nurses, and possibly a lawsuit (CNO, 2014). Potter & Perry note the criteria nurses can be found liable for negligence as summarized; the nurse owed the duty to the patient; to whom that duty was not carried out; and the patient was injured for failing to carry out that duty (Potter & Perry 2013, p. 96).
A common negligent act is failing to monitor a patient’s condition adequately (Potter et al., 2013, p. 97). For a nurse to be sued, and in the case with Mr. Gurt, the nurse had carelessly not performed a duty which was vital to his ongoing care. While the ability to predict harm is evaluated is this case, the nurse had committed a wrong doing to Mr. Gurt and could be tried as an unintentional tort. (Potter et al., 2013, p. 97-98). According to the Criminal Code, 1985, if Mr. Gurt was to pass away as a result of improper care or toxic levels of medication being given due to the nurse failing to weigh him, the nurse could also face criminal liability if the nurse was proven to have a reckless disregard for her patient (Potter et al., 2013, p. 99-100). The best way for nurses to avoid being negligent is to follow the standards of care; be self aware and to reflect on their nursing practise; to follow the ethical framework established by the College of Nurses; and to continually educate themselves on best practices, assessments, and evaluations within their nursing abilities (Potter et al., 2013, p.98). With that in mind, one final thing I would suggest is to have professional liability and legal assistance protection insurance coverage.
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