Scholarly Assignment

Student Number: 823-018-478

NURS 217 Scholarly Assignment: Ethics

Harshpreet Lobana
823-018-478
November 4, 2014
NURS 217Legal, Professional & Ethical Issue in Nursing Practice

Humber College

Scholarly Assignment

Student Number: 823-018-478

Introduction

This paper reflects on the incidents of physical, emotional and mental abuse of the
elderly resident with dementia and falsified presentation of documents during job interview by
the registered practical nurse named Daniels, Susan Jane in Facility A. The incident took place
on 22 February 2009 in the dining room around 1245 hours in the presence of two personal care
providers. According to the witnesses, the member approached the resident in a firm manner. The
resident is known to be aggressive and resistant to care among the whole unit. The member
attempted to remove the client from the dining area which resulted in the client throwing a glass
of milk at the member. The member poured the remaining liquid onto residents head in response,
and stated how do you like that and laughed at the resident. As a result, member was
terminated from her position shortly after the incident took place. In the written response during
the college investigation of the incident, the member denies the allegation and explains the
incident as slip of her foot on liquid that was present on the floor during her arrival that caused
milk to go onto clients head. The member also accuses personal care providers for not doing
their job correctly in an attempt to excuse herself from the allegation (Disciplinary hearing,
College of Nurses in Ontario (CNO), 2013).
Thereby, another incident regarding the representation of falsified document of reference
by the member took place in Facility B shortly after the termination in Facility A. The formal
reference letter was produced under the name of Director of Nursing (DON) from previous
Facility A and was handled to Facility B during the interview. The member advised interviewer
to contact cellular number for reference during interview, in doing so, interviewer was suspicious
in regards of the voice similarity of the referred individual with that of the member. Furthermore,
interviewer was informed that the person giving the reference is off work due to knee surgery,

Scholarly Assignment

Student Number: 823-018-478

which was later relieved that this information was falsified as well, when DON from facility B
contacted facility A and spoke to the referred individual regarding the member (Disciplinary
hearing, CNO, 2013)
Opinion
I agree with the decision of the Discipline Committee. There is an imbalance of power in
nurse client relationship. Nurses have more power than clients, which leaves the clients in a very
vulnerable position. The member took advantage of that position and acted in an unprofessional
and disrespectful manner, thus abusing the patient. The penalty was fair in regards to keeping the
member under direct supervision for six months along with providing limitation and restrictions
on her practice, organizing two meeting with the expert to help understand professional standards
and therapeutic nurse client relationship before she starts to practice nursing again and a
suspension of license for five months. These restrictions and penalty will help the member reflect
on her practice and teach appropriate responses that can be used in provoking situations.
(Disciplinary hearing, CNO, 2013).
Client well-being
Nurses are asked to act towards health promotion and welfare of the client by eliminating
or preventing situations that can compromise the well-being of the client Nurses have a
professional obligation to use their knowledge, skills and judgement to ensure and demonstrate
safe and competent care to the client (Ethics, CNO, p. 5). It is important that nurses develop
therapeutic nurse-client relationship that will build trust and promote wellness of the client.
Nurses are to show empathy and respect to client values, beliefs and decisions.

Scholarly Assignment

Student Number: 823-018-478

In this scenario, the member contravened the client well-being by physically and verbally
abusing the client. The member poured the remaining milk onto the resident head in retaliation
and stated, How do you like that in an unprofessional and unethical manner. Member has
committed a professional misconduct under subsection seven which states that it is a misconduct
if a nurse is, Abusing a client verbally, physically or emotionally. Further discussion under
subsection also states that nurses have breached the therapeutic nurse client relationship
boundary if the nurses misuses the authority of power or acts in a disrespect manner towards the
client (Professional Misconduct, CNO, p.5-6).The use of force and power against the client
welfare is evident in this scenario. The member provided harm intentionally to the incapacitated
client. The whole unit including the member was aware that resident is resistant to care and acts
in an aggressive manner. So, it was not an unpredictable behavior of the client that caused an
instant defensive reaction from the member to emerge. Furthermore, the use of sarcastic remarks
does not demonstrate empathic behavior rather it shows disrespect and dishonour towards the
elderly client with dementia (Ethics, CNO, p.11). The member did not seemed to be concerned
about her irrational behavior rather seemed undisturbed and carried out her normal activities.
This type of response puts client well-being/health status at high risk (Therapeutic Nurse-Client
Relationship, CNO, p.9).
Truthfulness
Nurses have most interaction with clients than any other member of the health care team.
So, it is important that nurses conduct themselves in honest and fair manner without intending to
deceive. Clinicians have a fiduciary obligation to their clients. Fiduciary obligation is a legal
term defined as the responsibility of those entrusted to place the best interests of others above
their own personal interests (Kelly & Crawford, 2013, p. 423). Client have a right to know the

Scholarly Assignment

Student Number: 823-018-478

truth about their health, so using the truthful and honest approach with clients is best way to omit
harm to therapeutic relationship.
The member breached this ethical value by denying the allegation of abuse and
falsification of documents. Member explains in her writing that she slipped on some liquid that
was on the floor which resulted in the remaining milk going onto residents head. She also blame
personal care providers for their lack of responsibility to clear the liquid that was on the floor.
Secondly, member admits to making of reference letter, however claim that there was an error
when she was transferring files and reference letter was created due to that error (Disciplinary
hearing, CNO, 2013). Member explanation of incidents clearly shows evidence of lack of
integrity and honesty. Professionalism requires nurses to be truthful and acceptance of their
mistakes. The importance of veracity is crucial in order to protect public from harm. The actions
of the nurse affects the delivery of care provided to the client (Ethics, CNO, p.13). The member
have conducted a professional misconduct under subsection 14 and 15. Accurate presentation of
the documents relieves an important clinical and health data which is necessary for client safe.
Therefore, falsification of documents breaches the college/public trust on the members
qualification and abilities (Professional Misconduct, CNO, p. 8-9).
Preventative Strategies
As a Director of Nursing (DON) in a facility, I would implement mandatory educational
in-service and improved working conditions to avoid abuse in my facility. Firstly, I would
organize an educational in service on client abuse and client safety that will be mandatory for all
the nursing staff in the facility to attend. Nursing employees have to attend two mandatory inservices on these topics every year in order to be able to work with patients on one to one basis.
These educational services will provide employee with strategies that will help eliminate

Scholarly Assignment

Student Number: 823-018-478

environmental, emotional and physical factors that contribute to incidents of client abuse. In
service will also provide nurses with resources that they can approach during period of emotional
distress. They will also teach nurses appropriate behaviour/ responses in client-provoking
situations by giving them scenario and doing role playing. In the end, nurses are human being
they can act in an aggressive manner when they feel threatened, however, it is unprofessional to
act in that manner in nursing profession because they will put the client health and well- being at
risk (Therapeutic Nurse-Client relationship, CNO, p. 9). So behaviour modification teaching and
techniques will be the focal point of these mandatory in-services. At the end of the in-service,
employees will get a certificate of completion plus regular pay related to number of hours spent
during in-service to ensure every one attend these in- services on regular basis.
Secondly, a policy on improved workload will be introduced to nurses. Heavy workload
in clinical setting puts the patient safety at risk and provide inadequate nursing care to clients. In
order to reduce the workload, nurse-patient ratio will be put into consideration. The number of
patient to nurse ratio will be decreased depending on the patient condition as well. For example,
one nurse will not receive two patients will dementia. The ratio of patients to a nurse will also be
decreased if nurse have clients that require close monitoring. The management of nurse staffing
per unit will be another important factor that will be taken into account to avoid overwork on
nurses. Short staffing can lead to unenjoyable work environment and frustration while providing
care to client, thus contributing to client abuse. I will also hire more personal support workers
that will assist patients in ADLs, therefore, releasing some of the workload from RNs and
RPNs. This technique will help clients receive maximum quality care. Nurses experiencing
stress and burnout will not be able to work as effectively because their physical and cognitive
ability is impaired, thus puts the client at risk for harm (Carayon & Gurses, 2009). The main

Scholarly Assignment

Student Number: 823-018-478

purpose of this policy is to improve nurse-client ratio and increase staffing in order to prevent
burnouts and reduces incidents of abuse in the facility.
Conclusion
In conclusion, this paper reflects on the incident of abuse and falsification of document
done by the member. The member had convicted verbal, physical and emotional abuse of the
elderly resident with dementia. Member approached the client in firm manner and tried to
remove client from the dining environment against clients choice. The resident threw milk on
the member. As a result, member physically and verbally abused the client by throwing the
remaining milk onto residents head. Secondly, member is convicted for professional misconduct
by providing falsification of reference letter from her pervious facility. The member was charged
under the act and was given the penalty of five month license suspension, oral reprimand,
restrictions on her practice and two mandatory meetings with the expert to understand the role of
nurse. In addition, client well-being and truthfulness are three main ethical values under ethics
that are breached by the member. The member acted in an unprofessional, dishonourable and
disgraceful manner by jeopardizing the well-being of the client. Furthermore, the principle of
honesty and integrity was contravened by the member as well. This principle plays an important
role to provide safe and competence practice and care to the public. Two preventative strategies
were also discussed in this paper to prevent the incidents of abuse and promotion of clients
overall health. Mandatory Educational in-service will be put into place for behavioural
modification of nurses to dealt in difficult situation. Workload policy on adequate client-nurse
ratio and availability of staff is used to prevent nurse burnouts and client abuse. Therefore,
providing optimal quality care with limited disadvantages is the main goal for implementing
these policies.

Scholarly Assignment

Student Number: 823-018-478

Reference

Carayon, P., & Gurses, A. (2008). Patient safety and quality: An evidence-based handbook for
nurses. : Agency for Healthcare Research and Quality (US), Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK2657/
College of Nurses of Ontario. (CNO). (2009). Practice Standards: Ethics. Retrieved from
www.cno.org
College of Nurses of Ontario. (CNO). (2013). Practice Standards: Professional Misconduct.
Retrieved from www.cno.org
College of Nurses of Ontario. (CNO). (2006). Practice Standard: Therapeutic Nurse-Client
Relationship, Revised 2006. Retrieved from www.cno.org
Kelly, P. & Crawford, H. (2013). Nursing leadership and management. (2nd ed., p. 423). United
States: Nelson Education Ltd.
Discipline Hearing of College of Nurses (CNO) (2013). Retrieved from
http://www.cno.org/Global/2-HowWeProtectThePublic/ih/decisions/fulltext/pdf/Daines.pdf