Ethical Nursing Dilemma: Patient's Assistance Contrary to the Doctors Directives – Medical Ethics Example

Download free paperFile format: .doc, available for editing

"Ethical Nursing Dilemma: Patient's Assistance Contrary to the Doctor’ s Directives" is a well-written example of a paper on medical ethics. It was during my routine shift in the orthopedic wing when a patient in a side room rang a bell, and I was promptly notified by my mentor to attend to the patient. The patient had had a knee operation. I believe he noticed that I was still undergoing training. The patient then asked me to assist him to answer a call of nature within the hospital's washrooms: however, the doctor had directed the nursing staff to ensure that the patient rested in bed or up to one week, and answer the calls of nature within the confines of his room.

As a result the hospital made available to the patient urine bottles and bedpans to be used whenever he felt that he needed to relieve himself to the call of nature. However, the patient was feeling embarrassed performing these actions within the confines of his room and requested that I give him permission to attend to a proper toilet so that he may open his bowel.   In addition, he assured me that e could stand and walk to the toilet and would probably need minimal assistance from me.

He looked genuinely stressed and desperate, and this act finally made me yield to his demands, and eventually, I did allow him to walk to the toilet. Further, the patient went ahead and acclaimed that in the event I did allow him to answer the call of nature in the washroom he would not confide to any other soul. Feelings and thoughts That was a very difficult decision to make; on the one hand, the doctor had given his instructions and, on the other hand, the persistent patient needed to use a bathroom within his own privacy away from disgusting pieces of plastics given to him for such purposes.

This was a confusing situation and I was probably scared of the dilemma that I did the face on that day. On the one hand, felt genuine compassion for my patient and, on the other hand, the doctor’ s directives were clear enough to the nursing staff.

In retrospect, I think I might have committed an ethical and professional blunder, by allowing my actions to be motivated by sympathy and compassion, and not medical instruction. Since the patient had sworn to keep the information between us I could not consult my mentor and this added to the confusion occasioned by permitting a patient to visit a toilet contrary to a physician directive.   Evaluation I had been a rookie nurse and although my actions must be adjudged in a similar manner I got carried away with the ignominy of the situation.   The event provided me with the opportunity to interact with a different personality, and how to react when faced with such a situation.   Further, the event made review my notes and issues that dealt with the ethical and professional conduct of nurses and made me sharper on the issues.

I became cognizant of my weakness when faced with tough choices, and further, the experience exposed gaps in my knowledge. Though showing compassion during the course of one’ s duty is good, doing at the behest of a patient could be counterproductive, and my case slots perfectly in this sentence. However, the negative decision I made could have far led to reaching consequences for the patient, as it was against professional instruction.

Further, the patient could have been at risk of aggravating his injury, thereby permitting new infections in the new, which could have implied a new implant into the knee. Analysis According to Benjamin & Curtis (2010), tradition demands that nurses should always obey the doctor when medical advice is concerned. Scrivener, Hand & Hooper (2011) drawing their view from the code of professional conduct, hold that the nurse owes the patient a duty of care, and the unnamed patient in this paper was under my care, therefore I owed him a duty of care.

According to Basford & Slevin (2003), if a patient has reasonable expectations from the nurse over the treatment he expects then the nurse should act with reasonable skill and care in execution, and this aptly describes the duty of care a nurse owes to the patient. According to Buka (2008), a nurse walks a thin line between professional duty and observing the rights of the patient, and each needs careful consideration.

  However, disregarding the advice would have been professional misconduct as the doctor had evaluated the patient’ s physiological situation and directed that he stays in bed (Carr, 2012). Moving to the washrooms could have aggravated the situation and could have lead to lawsuits against the hospital and the doctor, assuming that the patient could have maintained a shut lip over our deal. Mossé (2011) observes that obedience to the doctor is one amongst many unwritten rules in the medical profession and going against the advice of the doctor was a huge mistake.

I should have taken time to explain to the patient the gravity of the situation and that a mere short call in a plastic bottle would have a huge impact on how he recovers from the surgery than a visit to the washroom. Dealing with different personalities should be a trait that is should develop, and the mistake could have had more far-reaching consequences on my training and education as a nurse had the patient aggravated his knee.

Things could have gotten worse on a night of my indecisiveness and incorrect decision. Nursing and Midwifery Council (2002) provides nurses with the discretion to act in order to identify and reduce risk to patients and clients. My actions on that night were completely shameful and in complete violation of this code of ethics required of the nurse. As I reflect on this incident, I realize that still have more to learn on professional and ethical consideration in my daily activities caring for my patients.

The patient’ s incessant and persistent request to be allowed to use the bathroom is typical of many patients who want to things contrary to doctor’ s advice due to their own personal conveniences. As a nurse I must be careful in the manner in which I listen to a request from a patient, in fact, Childs, Coles& Marjoram (2009:60) observe that ‘ nurses can be tempted to try and help the patient by doing something that makes the patient feel better; however they should be worry of the doctor’ s advice’ .  In dealing with such a patient I should be calm and collected, and I should not mix my own personal feelings to cloud the professional advice given by a doctor (Meeks & Hallsworth, 2010).   This was extremely wrong for a nurse who is supposed to prevent risks to the patient, and Sheppard & Wright (2006) advises that when a nurse is dealing with a patient he or she must put aside any personal biases, prejudices, or judgments, as well as personal opinions.

I should have overlooked the pact the patient made with me and could have sought advice from my mentor, and probably would not have allowed the patient to go to the washroom against the advice of the doctor. As I am still training, I am still in the learning curve, and situations such as this continue to mold me into the perfect nurse who must deal with a myriad of situations.

The significance of mentors though I did ignore should not be taken lightly, but of vital importance to the relationship between a doctor and a patient on one hand and a doctor and a nurse on the nurse on the other hand is the professional advice (Thistlethwaite, 2012).

I cannot blame my mentor as this was a real-life situation that I did not handle properly and neither did I have confidence in her to confide in her what I underwent. I did not act properly in accordance with the expected professional well as ethical conduct of a nurse, thereby exposing my huge inexperience. Conclusion This personal reflection has illuminated a number of mistakes I made during the incident with the orthopedic patient. My inexperience, though inexcusable had the better of me, and made me act in contravention of the medical profession in general and nursing in particular.

The patient could have aggravated his knee, thereby permitting new infections into the knee and subsequently knew surgery and replacement of the implants into the knee.   Consequently, the hospital, doctor, and other institutions could have stared directly at an impending lawsuit. The doctor and the nurse (my mentor) could also be liable for professional negligence, and to be punished through their respective bodies. Action Plan Short term Look into the professional and ethical codes of the UK Review other what other nurses have gone through in similar predicament Study how to deal with different personalities Study the art of persuasion Long term Consult mentors and doctors whenever such comes up. Abide by hospital decrees


Ashcroft, R. E. 2007. Principles of health care ethics. Chichester, West Sussex, England, John Wiley & Sons.

Basford, L., & Slevin, O. 2003. Theory and practice of nursing: an integrated approach to caring practice. Cheltenham, Nelson Thornes.

Benjamin, M., & Curtis, J. 2010. Ethics in nursing cases, principles, and reasoning. Oxford, Oxford University Press.

Carr, C. 2012. Unlocking medical law and ethics.

Buka, P. 2008. Patients' rights, law, and ethics for nurses: a practical guide. London, Hodder Arnold.

Childs, L. L., Coles, L., & Marjoram, B. A. 2009. Essential skills clusters for nurses: theory for practice. Chicester, U.K., Wiley-Blackwell.

Meeks, M., & Hallsworth, M. 2010. Nursing the neonate. Chichester, West Sussex, U.K., Wiley-Blackwell.

Mossé, P. 2011. Hospitals and the nursing profession: lessons from Franco-Japanese comparisons: paths to modernization. Montrouge, J. Libbey Eurotext. Nursing and Midwifery Council 2002 Code of Professional Conduct. London, NMC.

Scrivener, R., Hand, T., & Hooper, R. 2011. Accountability and responsibility: Principle of Nursing Practice B. Nursing Standard. 25, 35-36.

Sheppard, M., & Wright, M. 2006. Principles and practice of high dependency nursing. Edinburgh, Baillière Tindall.

Thistlethwaite, J. 2012. Values-based interprofessional collaborative practice: working together in health care. Cambridge, Cambridge University Press.

Download free paperFile format: .doc, available for editing
Contact Us