Running head: SCHOLARLY ASSIGNMENT ETHICAL VALUES

Scholary Assignment: Ethical Values

Student Name: Navjyoti Suri
Student Number: N01031326
Course: NURS 217: Legal, Professional and Ethical Issues in Nursing Practice
Date of Submission: Nov11, 2015
Humber College ITAL

SCHOLARLY ASSIGNMENT ETHICAL VALUES

Older adults who live in long term centers and other institutions including hospitals and
retirement homes are vulnerable to abuse because of their dependence and isolation especially in
the facilities, which lack client centered care models due to lack of knowledge, low level of job
satisfaction, less experience and personal stress among staff members (Touhy et al., 2012, p.379).
The College of Nurses of Ontario being governing body for the nurses of Ontario protects the
public by assessing concerns about the conduct and proficiency of the nurse. Most of the matters
are resolved by the Colleges Discipline Committee through remediation and resolution
processes. The case mentioned below was published by the College as required by legislation
under discipline decisions (CNO, 2012, p.3) on January 23, 2012. This analysis paper is about
the matter in which the nurse working in a long term center, abused an elderly client physically
and emotionally by standing outside his room, while he was agitated and kicking the door from
inside. She did not let him wander in hallway, as mentioned as an intervention in his care plan.
The nurse was imposing an environmental restraint to a patient of dementia, cardiovascular
disease and stroke. The client died next day after hospitalization because of injuries and an
investigation was conducted (CNO, 2012).
The nurse was responsible for not acting in clients best interest and breached the
professional standards by not recognizing the limitations of her practice. The nurse didnt have
any medical conditions and there werent any factors in the environment which could lead to the
abuse. The nurse herself failed to check and monitor the very agitated client and clients safety
was compromised. The nurse was orally reprimanded and suspended for two months by the
Discipline Committee. Because it is abusive to leave an agitated client isolated in a closed room,
the decision is agreed by me after evaluating all possible probabilities. This sends a clear

SCHOLARLY ASSIGNMENT ETHICAL VALUES

message to the nurse and other members that CNOS standards must be adhered to and the
facilitys procedures and policies should be followed strictly.
Ethical Values and professional standards
The nurse had breached the professional standards by not providing client centered care.
She contravened the client well-being an important ethical value, because promoting client well
-being means facilitating clients health and welfare and removing any harm to health. The nurse
is responsible for watching adverse responses in client and reporting responses to research team
(CNO: Ethics, 2009). The client was suffering from dementia, had a language barrier and was at
high risk of falls. If the nurse could have followed the care plan, which was set out with specific
interventions to deal with his aggressive behavior and wandering, the client well-being would not
have been breached. The client was yelling and kicking on the door. The panel viewed a security
video of the facility which showed that nurse was standing outside clients room for at least six
minutes. Suddenly when the noise stopped, the nurse opened the door and found the client in a
puddle of urine with bleeding from his head (CNO, 2012). Hence, the nurse was unsuccessful to
monitor the very agitated client. She didnt collaborate with the registered nurse on duty before
the incidence and failed to evaluate the outcomes of her interventions.
As the nurse did not act in clients best interest and by not letting him wander, she
thereby contravened the therapeutic nurse- client relationship standard. Nurses work with the
client to ensure that all the professional behaviors and actions meet the therapeutic needs of the
client (CNO: Therapeutic Nurse-Client Relationship, 2006, p.6). She also breached the client
choice another important ethical value by not letting him move around. The CNOS document
ethics practice standard illustrates that the clients choice means that the client have rights to

SCHOLARLY ASSIGNMENT ETHICAL VALUES

make choices and if client is incompetent, a therapeutic relationship is maintained with the
substitute decision maker (CNO: Ethics, 2009). It is evident from the case history that client was
moved to a room close to his wife and his care plan was set out with ways to make him familiar
with his new room. The nurse never informed the substitute decision maker as apparent in the
case study.
The nurse was imposing an environmental restrain without an order, which contravened
the restraint standard and may have caused increased agitation in the client. CNO recommends
the least restraint approach. Least restraint means all possible alternative interventions are
exhausted before deciding to use a restraint (CNO: Restraints, 2009). The nurse did not
implement other interventions which were mentioned in the care plan, while she was fully aware
of the facility policies and procedures regarding restraints. Nurse cannot use any form of
restraints without client consent. The nurse has to inform the client or the substitute decisionmaker before applying restraint (CNO: Restraints, 2009).
The nurse had a failure to maintain the standard of practice in carrying out her
professional responsibilities and thus committed a professional misconduct. The use of
executive force or inappropriate physical conduct amounts to physical abuse and constitutes an
abuse of authority and power over the client (CNO: Professional Misconduct, 2014, p.6). She
forcibly kept the client in room and abused him emotionally by making him more aggressive in
that environmental restraint (CNO, 2012). Although the client had dementia which could have
compromised the clients ability to make decisions the nurse should have informed the client of
what she was doing and could spent some time with him to calm him down.

SCHOLARLY ASSIGNMENT ETHICAL VALUES

Strategies to prevent abuse

In order to prevent a situation like this from recurring again there should be strategies
which can work effectively for both client and staff. As the estimated life expectancy in Canada
is 81 years (Statistics Canada, 2012) and also The number of Canadians (of all ages) with
dementia is expected to increase to 2.3 times the current level of 1.1 million by 2038,
representing 2.8 percent of Canadian population (Kelly& Mc Cable, 2012) . So with increasing
elderly population the first strategy suggested is the education of staff and family members. So
there should be seminars, training sessions, and continuing education programs on how to
prevent and identify elder abuse. WHO suggests prevention of elder abuse starts with
awareness and simplest way of awareness is education and training (WHO, 2002).The nurse in
above case was not aware of the consequences, and restrained the patient. Probably, she was not
well educated for the client centered care.
RNAO (2014) suggests that education is important for staff as well as residents to
prevent, identify and respond to abuse and neglect. Staff education should be mandatory which
should include thorough teaching about ageism and changes related to it, therapeutic nurse client
relationship skills, and special training to deal with vulnerable clients with special needs such as
dementia. Further, in support of the above suggested strategy, it has been illustrated in Core
Public Health Functions for BC: Evidence Review, (2010) that educating providers is one of the
six levels of spectrum of prevention tool of violence, abuse and neglect which has been accepted
widely in areas of research in the United States and internationally by World Health Organization
(Cohen & Swift, 1999).

SCHOLARLY ASSIGNMENT ETHICAL VALUES

A variety of approaches for coping with patients resistance should be used to prevent
abuse and neglect. By postponing few procedures for some time to avoid the anxiety can be one
of them. In support of my view, when an international study was done in Norway nursing homes
and during the interviews, staff revealed wide range of approaches to prevent abuse. One of the
staff members told that by their deflective and persuasive strategy they were successful in
making patient do what they wanted. In this strategy they distracted the patient by letting him
focus on something positive and thus turning off the tension which lead to anxiety. The staff
experienced that patients mood changes quickly and they were successful, if the action was tried
later on. For example, they postponed feeding for some time if client refused and were successful
in feeding by distracting him later on (Gjerberg et al., 2013, p.636). Similarly, the nurse in above
mentioned case could distract the client and calmed him down.
Second important strategy for preventing injuries and calm down an agitated wandering
client is to accompany him. Isolation and seclusion often lead to frustration and increased
aggression. (Gjerberg et al., 2013, p.638). Similar approach was followed by a nurse in the study
done in Norway and he reveled that when he was left alone with an agitated patient, the patient
talked to him and shared his feeling with him. He was successful in calming him down and
bringing him back to his room (Gjerberg et al., 2013, p.638). The nurse in the above mentioned
case could spend some time with the client to explore. Also the facility based preventive
measures and policies should be followed strictly. The proposed intervention may be cost
effective because of overpayment to staff, but it can be implemented by promoting family
members to accompany the elderly on regular basis. Also, the nurse in her response to allegations
never mentioned that she was having overload of work. She in fact herself documented her

SCHOLARLY ASSIGNMENT ETHICAL VALUES

awareness of difficulties in dealing with the client and noted some of the interventions that had
worked for him. But unfortunately, she failed to use those interventions that day (CNO, 2014).
Conclusion:
In conclusion, the nurse was accused of physically and emotionally abusing a vulnerable
client when she was seen forcing him to be in his room, neglecting his choice by not letting him
wander and by imposing an environmental restraint for more than six minutes by standing
outside his room in video footage (CNO, 2012). As per this evidence, she violated two ethical
values which are the clients wellbeing, his choice and the professional obligation she had
towards her as her nurse. The reasons behind this incident were not clearly cited (CNO, 2012).
Some suggestions for preventing similar incidents from occurring again are education and
providing one on one care for cognitively impaired clients. These proposed interventions can
help promote lessening of factors leading to abuse as well as increase awareness of what
generates as elder abuse and methods to prevent it from arising. The clients with cognitive
dysfunctions and who require more assistance need to be properly cared for to safety of their
physical and psychosocial wellbeing. It is a serious concern and all health care providers should
understand their limitations of practice, keeping client centered care as their focus. Hence,
educating health care providers and the public about elder abuse and special methods such as one
on one care are the effective strategies for the prevention of abuse.

SCHOLARLY ASSIGNMENT ETHICAL VALUES

References:
Cohen L. & Swift S. (1999) .The spectrum of prevention: Developing a comprehensive approach
to injury prevention. Injury prevention, 5,203-207.Retrieved from
http://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/maternalchild-and-family-health/prevention_of_violence_abuse_neglect-evidence_review.pdf
College of Nurses of Ontario (2014). Discipline-Decisions. Retrieved from
http://www.cno.org/Global/2HowWeProtectThePublic/ih/decisions/fulltext/pdf/2012/Elizabeth
%20Branton,%20HI06356,%20Jan.242012.pdf
College of Nurses of Ontario (2009). Ethics. CNO: Standards and Guidelines. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf
College of Nurses of Ontario (2014). Professional Misconduct. CNO: Reference document.
Retrieved from http://www.cno.org/Global/docs/ih/42007_misconduct.pdf?
epslanguage=en
College of Nurses of Ontario (2009).Restraints. CNO: Practice Standards. Retrieved from
http://www.cno.org/Global/docs/prac/41043_Restraints.pdf.
College of Nurses of Ontario (2006). Therapeutic Nurse-Client Relationship. CNO: Practice
Standards. Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf

SCHOLARLY ASSIGNMENT ETHICAL VALUES

Gjerberg, E., Hern, M. H., Forde, R., & Pedersen, R. (2013). How to avoid and prevent coercion
in nursing homes: A qualitative study .Nursing Ethics, 20(6), 632-44. Retrieved from
http://search.proquest.com.eztest.ocls.ca/docview/1432697320?pqKelly, F., & McCabe, L. (2012).Key Issues in Evolving Dementia Care International Theorybased Policy and Practice.London: Jessica Kingsley, p. 4.
Registered Nurses Associations of Ontario. (RNAO). (2014). Preventing and addressing abuse
and neglect of older adults: Person-centered, collaborative, system-wide approaches.
Retrieved fromhttp://rnao.ca/bpg/guidelines/abuse-andneglect- older-adults.
Touhy, T., Jett, K., Boscart, V., McCleary, L. (2012). Ebersole and Hess' gerontological nursing
and healthy aging. Canadian Edition (VitalSource Bookshelf version). Retrieved from
http://pageburstls.elsevier.com/books/978-1-926648-23-1.
World Health Organization (WHO) (2002). World report on violence and health. Retrieved from
http://www.who.int/violence_injury_prevention/violence/world_report/en/.