I am currently writing this ethics/legal nursing paper and I am stuck. Here is the scenario....I had this patient whose family was extremly unreasonable. The girl was 18, s/p fall after taking ecstasy & rock climbing. Family refused to obey visiting hours and refused to quit agitating the patient when they would visit. This pt had severe head injury with elevated ICP and pulmonary contusions which progressed into ARDS. They would come in the room, try to awaken her by shaking her, climb in bed with her, yell at her, etc. Every time they did this, her ICP would go up & she would desat. Nurse manager said let them do what they want, we don't need any unhappy families, bad for PR, etc. Finally, they got the patient so agitated one day that she extubated herself & before we could retube her, she desated into the 30's, suffered an anoxic brain injury, & one day later herniated and died. Now I need to ID 3 ethical issues and 2 legal issues from this case. Any help......PLEASE!!!!!

I think one ethical issue is the nurse manager's attitude. Her job is to advocate for the patient, and she was very obviously not doing her job.

(pulls out notes from "Ethics" lecture)

Ok..I found this in my textbook:

ANA code for nurses

#3 The nurse acts to safeguard the patient and the public when healtchare and safety are affected by the incompetent, unethical, or illegal practice of any person.

Also...

How about "beneficience"?

the family's right to make decisions for her falls under "autonomy".

Just a couple thoughts....hope it helps

Thanks guys! Keep it comin'. I have adressed the beneficence, nonmaleficence thingie but I need a ton of other ethical ideas. Honest to God, the guidelines for this paper are ridiculous. I'll be up all night.

What about abuse? or assault? The yelling could be abuse and the climbing in bed could be assualt.

Legally i would possible suggest that there is abuse or possibly assault on the patient.

Ethically what about neglect, and ?patient's right to recieve the most appropriate health care free from harm.

Nurse managers attitude and the view that they are not advocating for the patient, what about other staff advocating for the patient.

View that the unit is out to look after itself and not the patients surely that is worse publicity.

The scenario doesn't discuss is any family teaching was done. Failure to teach and document the efficacy of the teaching could be both a legal and ethical issue.

There could also be an ethical/legal issue with the nurse not going up the chain of command when the manager did not respond to the situation in a way that provided for the safety of the patient.

What about the physician's responsibility to protect the patient, to inform and educate the family?