BON-APN Prescription Case Analysis
Identification of the appropriate statements from Rule 221.13 Core Standards for Advanced Practice that relate to this case
221.13 (a)
221.13 (c)
221.13 (2) (A)
221.13 (2) (B)
221.13 (2) (E)
221.13 (e)
(Texas Board of Nursing, 2016)
Identification of the appropriate statements from Rule 222.4 Minimum Standards for Carrying Out or Signing Prescriptions that relate to this case
222.4 (a) (1) (A)
222.4 (a) (1) (B)
222.4 (a) (2)
222.4 (a) (3) (b)
222.4 (e) (1)
(Texas Board of Nursing, 2016)
Identification of the appropriate statements from Rule 217.12 Unprofessional Conduct that relate to this case
217.12 (1) (B)
217.12 (1) (D)
217.12 (1) (E)
217.12 (3)
217.12 (4)
217.12 (5)
217.12 (6) (A)
217.12 (6) (G)
217.12 (6) (H)
217.12 (8)
217.12 (10) (A)
217.12 (10) (B)
217.12 (10) (E)
217.12 (11) (B)
(Texas Board of Nursing, 2016)
Identification of the appropriate statements from Rule 222.10 Enforcement that relate to this case
222.10 (1) (a)
222.10 (2)
222.10 (3)
222.10 (4)
222.10 (5)
(Texas Board of Nursing, 2016)
Identification of standards of practice in Rule 217.11 (Texas Nursing Practice Act, Amended 2013), applicable to the Nurse Practitioner in this court case
217.11 (1) (A)
217.11 (1) (B)
217.11 (1) (C)
217.11 (1) (D)
217.11 (1) (D) (ii)
217.11 (1) (D) (iii)
217.11 (1) (D) (v)
217.11 (1) (D) (vi)
217.11 (1) (G)
217.11 (1) (H)
217.11 (1) (K)
217.11 (1) (M)
217.11 (1) (P)
217.11 (1) (Q)
217.11 (1) (T)
217.11 (2) (A) (i)
217.11 (2) (A) (v)
217.11 (3) (A) (ii)
217.11 (3) (A) (iii)
217.11 (3) (A) (v)
217.11 (4) (B)
(Texas Board of Nursing, 2016)
Identification of the conduct statement in Rule 217.12 (Texas Nursing Practice Act, Amended 2013) and the NP’s behavior that violated the standard of practice
217.12 (1) (A)
217.12 (1) (B)
217.12 (1) (C)
217.12 (1) (E)
217.12 (1) (G)
217.12 (2)
217.12 (4)
217.12 (6) (A)
217.12 (10) (A)
Texas Board of Nursing (2016)
Ethical Principles with Rationale for each that were not followed by the NP
The nursing profession is also guided by ethical principles, which the nurse practitioners are expected to uphold at all times when delivering care. Ethical principles are the ethical goals that each ethical theory purposes to achieve in becoming successful. The ethical principles in healthcare act as a guide for the medical professions during decision making process. Ethical principles are composed of moral principles and values and beliefs that help medical practitioners in distinguishing right from wrong, and in identifying duties that are owed to others. Based on the ethical principles, there are actions that are considered acceptable, and others that are deemed unacceptable in the care profession. Ethical principles also facilitate moral reasoning in the presence of ethical dilemmas (Burns, 2008).
The principles of ethics are therefore not solutions to nursing problems, but guiding methods on how medical professionals can resolve challenging issues in practice. Ethical principles can either be normative or virtue ethics. Virtue ethics, according to Burns and Rich (2015) focus more on the character of a person, while normative ethics focus more on laws, regulations, and rules. For this reason, virtue ethics are considered the better approach to resolving ethical issues. The proponents of virtue ethics posit that when the character of an individual is not upright, even a principle or a law doesn’t prevent that person from doing wrong.
A person of good character however, can manage to do right even in the absence of laws and regulations. There are various ethical principles that are applied in the medical care practice, including; beneficence, non-maleficence, respect for autonomy, fairness, justice, and truthfulness. The nurse in this case scenario failed to observe two major ethical principles, which contributed to the consequential death of the patient.
Ethical Principle of Non-Maleficence
Simply put, non-maleficence translates to ‘do no harm’. Competency is key in ensuring that the nurse performs maximally, hence alleviating the risk of causing injury or pain to the patient (Burns & Rich, 2015). Also, this ethical principle holds nurses accountable for reporting cases that cause harm and injury to patients. For example, if a nurse notices that a colleague is not competent enough to deliver care, that nurse is responsible for reporting the incompetent nurse in an effort to protect the wellbeing of the patients. Healthcare professionals take an oath to always protect the patients from any harm.
In this case scenario, the nurse acted incompetently by failing to not only provide a platform for continuum of care for the patient, but also by failing to properly document the reexamination of the patient. Continuum of care helps assess the outcomes of the interventions provided after care. Continuum also allows the nurse to offer continued care services and support to a patient. In the case that an intervention doesn’t achieve the expected objectives, the nurse can collaborate with other care providers to find a solution to the problem. The lack of collaboration between the NP, the gynecologist and the dermatologist is also another sigh of incompetency, which amounts to maleficence. Collaboration would have helped in pooling of ideas, skills, and experience, hence contributing to the death of the patient. Lack of competency therefore contributed to the harm of the patient.
Ethical Principle of Beneficence
The principle of beneficence demands that nurses undertake actions that are meant to promote the wellbeing and health of the patients. Such actions, according to this principle, should be coupled with “Mercy, kindness, and charity” (Butts & Rich, 2015). Beneficent actions go beyond the obvious duties of a nurse. For example, it is evident that a nurse is supposed to give a patient his/her medications, as it is part of job description. However, some roles such as making a phone call on behalf of a frail patient doesn’t fall under the practice roles, but it is an act of kindness and mercy to a patient. A beneficent nurse acknowledges the importance of going the extra mile, though within the scope of practice, to improve the life of a patient.
In this particular case, the nurse didn’t go the extra mile for the patient, despite the patient’s efforts to continually go to the hospital. For example, the nurse practitioner ordered a mammogram, but when it returned negative, she didn’t evaluate other diagnostic tests such as a biopsy, which could have revealed the patient’s health problem earlier. After prescribing the antibiotics, the nurse practitioner should have included a follow-up in the plan of care for this particular patient. Lack of follow up further delayed diagnosis, leading to the development of the invasive cancer and her subsequent death. If the nurse practitioner had the purpose to do good, she should have undertaken other actions such as initiating a discussion with the supervising physician regarding the recurring health issue of their patient. In addition, following up on whether the intervention given to the patient was effective was another beneficent action.
References
Butts, J. B. (2008).Ethics in professional nursing practice. Burlington: Jones and Bartlett
Publishers
Butts, J. B., & Rich, K. L. (2015). Foundations of ethical nursing practice. Role Development
in Professional Nursing Practice, 117.
Texas Board of Nursing. (2016). Texas administrative code: Rule 217:12 Retrieved from
http://www.bon.texas.gov/rr_current/217-12.asp
Texas Board of Nursing. (2016). Texas administrative code: Rule 217.11. Retrieved from
http://www.bon.texas.gov/rr_current/217-11.asp
Texas Board of Nursing. (2016). Texas administrative code: Rule 222.10: Enforcement.
Retrieved from http://c.ymcdn.com/sites/texasnurses.site-ym.com/resource/resmgr/Docs/Doc1AnnotatedGuideUpdate0914.pdf
Texas Board of Nursing. (2016). Texas administrative code: Rule 217.12. Retrieved from
http://www.bon.texas.gov/rr_current/217-12.asp
Texas Board of Nursing. (2016). Texas administrative code: Rule 224.4. Retrieved from
http://c.ymcdn.com/sites/texasnurses.site-ym.com/resource/resmgr/Docs/Doc1AnnotatedGuideUpdate0914.pdf
Texas Board of Nursing. (2016). Texas administrative code: Rule 221.13. Retrieved from
http://www.bon.texas.gov/rr_current/221-13.asp
