Running head: PROFESSIONAL MISCONDUCT

Professional Misconduct and Ethical Values Contravened

Name: Aderoju Temitope Michelle
Student Number: 823-350-194
NURS 366: Legal and Ethics
Instructor: Sylvia Wojtalik
Submitted On: November 6, 2014
Humber College ITAL

Running head: PROFESSIONAL MISCONDUCT

Professional Misconduct and Ethical Values Contravened

In the College of Nurses of Ontario (CNO) professional misconduct case, a female
registered practical nurse (RPN) Elizabeth Branton is being investigated for abusing her client
physically, verbally and emotionally. The RPN got her license in 1989 and has been working at
the facility where the incident for which she is being investigated for a period of six years. She
failed to respond to her client in a timely manner and imposed environmental restraints on him.
The client is an elderly man who speaks only Italian with a diagnosis of dementia, cardiovascular
disease, arthritis, past history of stroke, aggressive behavior and at a risk for falls. At the time of
the incident, the client is in an agitated state and the nurse locked him up in his room to stop him
from wandering the hallway and refused to let him out, despite his yelling and screaming. The
client went unconscious and upon getting to the hospital was found to have suffered a fractured
hip and inter-cranial hemorrhage, soon after the client passed as a result of the injuries. The CNO
disciplinary committee agreed that the nurse committed professional misconduct based on the
allegation of abuse, failure to follow the facilitys policies and procedures, in relation to
disobedience to authority. The nurse was reprimanded for a period of three months, license got
suspended for two months, and a twelve month employer monitoring period was enforced. The
committee made this ruling based on numerous factors such as: admitting about the allegations,
acknowledging her unprofessionalism, having no previous disciplinary issues. Furthermore, the
nature of the offense was against the nursing values, specifically providing safe and
compassionate care. The ruling of the disciplinary committee is fair because the nurse did not
deny the allegation which demonstrated honesty and humility toward being governed by the
college and she knows she is accountable for her actions; her long career without any prior

Running head: PROFESSIONAL MISCONDUCT

disciplinary issues was also considered. In as much as these factors were considered the nurse
needs to bear the consequences of her unprofessionalism and the penalty are just and fair.
Ethical Values Contravened
According to the CNOs document on Ethics (2009), the nurse contravened the ethical
values of clients well-being, and maintaining commitments to quality practice settings. The
nurse also contravened the ethical value of providing safe, compassionate, competent and ethical
care (CNA, 2008). In contravening the value of clients well-being, the nurse had prior
knowledge of the clients risk for falls and cognitive impairment, but her intervention of using
environmental restraints by locking the client in the room against his will, did not reflect her
professional nursing practice, ultimately putting the client at risk for harm. Nurses demonstrate a
regard for client well-being by minimizing risks and maximizing benefits to clients (Ethics,
2009). In contravening the value of maintaining commitment to the practice setting, the nurse has
received significant training on how to manage patients, especially those with similar diagnosis
of this particular client. Furthermore, she was aware of the facilities policies and procedures on
how to address these issues. She failed to follow the procedures set out and did not collaborate
with another health care worker; rather, she made her own decision and contravened the quality
practice settings. Nurses demonstrate regard for maintaining commitments to quality practice
settings by respecting the philosophy and policies of the practice settings and exploring solutions
within the setting that will meet the needs of the client and those of the setting (Ethics, 2009). In
contravening the value of providing safe, compassionate, competent and ethical care, the nurse
failed to collaborate with another colleague when she knew caring for the agitated client was
beyond her competence. But instead she chose a violent approach of addressing the issue leading
to the demise of the client. The Canadian Nurses Association document on Ethics (2008) states

Running head: PROFESSIONAL MISCONDUCT

that nurses work to prevent and minimize all forms of violence by anticipating and assessing the
risk of violent situations and by collaborating with others to establish preventive measures. It
further states that when violence cannot be anticipated or prevented, nurses take action to
minimize risk to protect client and themselves.
Strategies
Strategies that can prevent a situation like this from occurring again include educating
nurses on providing cultural competent care and continuous education on person centered
approach using different techniques. On the issue of cultural competency, Nurses lack specific
information about culture and how it affects patients. In this case, the patient is Italian and is
only able to communicate in his own language, which has formed a barrier in the nurse-client
therapeutic relationship. The nurse is unaware of what the illness means to the client in a culture
context and has no idea on how to provide care for him. Most of the time, nurses may perceive
that they are providing culturally competent care but actually lack specic knowledge and skills
to do so effectively. The gap between awareness, knowledge, and practice may contribute to the
nurses inability to provide rich descriptions of the care that they provide (Wilson, 2010).
Campinha-Bacote (2003) denes cultural competency as the process in which the health care
provider continuously strives to achieve the ability to effectively work within the cultural context
of a client. It is a continuous process in which the nurse maintains an open attitude and uses
skills and interventions that are culturally appropriate. Through the education of these nurses on
their approach to clients based on cultural aspects, a better understanding of the client would be
gained and not just the diagnosis. This would reduce hostility and increase clients well-being.
Haleck & Bartholomeyczik (2012) state, Awareness and interpretation of the behavior does also

Running head: PROFESSIONAL MISCONDUCT

always have a cultural component, which can be different in each culture, setting or system
(p.411).
A second strategy would be to provide continuous education on person-centered
approach. This method focuses on attempting to understand the poorly communicated need being
expressed by the aggressive person, and nding individualized ways of meeting that need
(Stokes 2000). The nurse in this case is providing care based on a general approach for all
dementia patients rather than factoring that the client is different from other individuals. The
nurse makes her assessments and interventions based on his uniqueness. This person-centered
approach program aims to increase staff understanding of the causes of aggressive behavior, and
their skills in managing such behavior by responding more individually and creatively to the
persons needs (Turner, 2005). An example of what to do in a person centered approach would
be structuring activities tailored specifically for the client; to help him dispel energy and more
relaxed. Structured activities include interventions used to engage residents in physical activity
to prevent boredom and decrease agitation and it should be individualistic (Aronstein, Olsen, &
Schulman, 1996).
Conclusion
The female RPN in the case has been found to have committed a professional misconduct
of physically, emotionally, and verbally abusing her client by locking him in his room against his
will to stop him from wandering the hallway. This act of abuse led to the demise of the client and
the CNO disciplinary committee penalized her by reprimanding her for three months, suspending
her license for two months, and a twelve month employer monitoring period. The nurse
contravened the ethical value of client well-being by using environmental restraints on him

Running head: PROFESSIONAL MISCONDUCT

which posed great risk to the client. She also contravened the value of maintaining commitment
to practice settings by not following the facilities policies and procedures for handling such
situations, and finally she violated the value of providing safe, compassionate, and competent
care by not realizing the care of the client was beyond her competence and did not collaborate
with a colleague to provide safe care. Strategies to prevent a situation like this from occurring
again include providing education on cultural competent care, and continuous education on
person-centered approach involving structured activities. Cultural competent care will help
nurses understand the clients diagnosis and behavior from the clients perspective and this will
help to provide better care. This strategy is based on the notion that awareness and interpretation
of a behavior does also always have a cultural component, which can be different in each culture,
setting or system (Haleck & Bartholomeyczik, 2012). The patient centered approach is based on
caring for clients based on their own uniqueness and using structural activities to help minimize
aggressive behaviors. The person-centered approach should be adopted as the strategy of choice,
with physical and pharmacological methods used only as a last resort (Stokes, 2000). Not only
are person-centered approaches held to be ethical and free of side effects, but they also
acknowledge that aggressive behavior by people with dementia is commonly a reaction to events
in the persons environment, including un-therapeutic approach adopted by health care
professionals. It is important that nurses consider the full range of strategies open to them for
reducing incidences of aggressive behavior and when a situation proves beyond their
competence, seek help to avoid all forms of professional misconduct.

Running head: PROFESSIONAL MISCONDUCT

References
Canadian Nurses Association. (2008). Code of ethics for registered nurses. Retrieved from
http://www.cna-aiic.ca/ CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf
College of Nurses of Ontario. 2013. Discipline decisions. Retrieved from http://www.cno.org/enprotect-public/discipline-decisions/HI06356
College of Nurses of Ontario. (2009). Ethics practice standard. Retrieved from
http://www.cno.org/CNO/standards/pdf/publications/Ethics_2009_e.pdf
Halek, M., & Bartholomeyczik, S. (2012). Description of the behavior of wandering in people
with dementia living in nursing homes: A review of the literature. Scandinavian Journal
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McGonigal-Kenney, M. L., & Schutte, D. L. (2006). Non-pharmacologic Management of Agitated
Behaviors in Persons with Alzheimer Disease and Other Chronic Dementing Conditions:
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Pulsford, D. (2006). Aggressive behavior by people with dementia in residential care settings: A
review. Journal of Psychiatric and Mental Health Nursing, 13, 611618.
Wilson, D.W. (2010). Culturally competent psychiatric nursing care. Journal of Psychiatric and
Mental Health Nursing, 17, 715724.