Running head: BRIDGE TO PRACTICE ETHICS PAPER

Bridge to Practice Ethics Paper

BRIDGE TO PRACTICE ETHICS PAPER

INTRODUCTION:
Maltreatment of the elderly population in long-term care facilities is a serious issue
commonly overlooked. As many as 2.5 million older people are abused in some form each year
and this number will only continue to grow as the elderly population does too (Kleinschmidt,
1997). It is associated with an increased rate of morbidity and mortality in patients that reside in
long-term facilities. There are various types of elder mistreatment including neglect and physical,
psychological, financial, and sexual abuse, all of which occur in nursing homes, residential care
facilities, and assisted living facilities (Gibbs & Mosqueda, 2004). Sadly enough, most elderly
abuse cases go unreported. Surveys conducted in Boston showed that only 1 out of every 14
cases were reported. As of today, all states have laws mandating the report of suspicion of elder
abuse. However, mandatory reporting of elder abuse brings about various ethical conflicts.
(Kleinschmidt, 1997)
BACKGROUND:
During my very first clinical experience at a long-term care facility for the elderly, I came
across an ethical situation. I was assigned a 98-year-old female patient and was told to follow the
CNA whose care the patient was under. The first incident occurred while the CNA and I were
changing and bathing my patient. During the process, I watched the CNA pretty much throw the
patient over on her bad side; the patient had a weak left arm and leg. The patient also had a
sore left breast that needed to be taken care of gently and required extra care because of a rash.
However, the CNA disregarded this and wiped her roughly even after the patient had nicely
asked her if she could be careful with her left breast because it was very tender and had
expressed the pain she was putting her through. The CNA rudely responded demanding that the
patient was fine and ordered her to quit her whining. A second incident occurred after putting the

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patient in her wheelchair. The CNA attempted to brush her teeth but did so in a very rough
manner, practically choking the patient with her own toothbrush causing the patient to gag
multiple times. During lunch, the patient informed me that she was very hungry because the
CNA had neglected to feed her breakfast. Having known the correct way and skills needed in
caring for a patient, as learned in lab, I came to the conclusion that I needed to do something
about the way the CNA was treating my patient. I felt responsible for my patient as well and
could not continue to watch her being treated so terribly. At the end of the day, I brought my
concerns up to my clinical instructor. I told her everything I had witnessed and who the CNA
was. I was completely unsure of what exactly I should do about it and wanted to put it into her
hands. She told me that I had done the right thing in coming to her and that she would talk to the
charge nurse about it and handle it from that point forward. An alternative response to the
situation would be to go straight to the charge nurse with my clinical instructor. I think it would
have helped if the charge nurse heard the story straight from me that way I could be there if any
problems occurred.
This day had created a situation of moral distress for me. In this situation, I knew what
the right thing to do was and how to correctly treat a patient. However, I felt powerless and felt
as if I could not stand up to the CNA and speak my mind. I was not torn between two ethically
wrong decisions to make; I just needed the confidence and power to do the right thing.
METHOD:
The JMU 8 Key Questions can be used to help evaluate ethical situations. Fairness
involves the questioning of equal and just treatment while outcomes encompasses both the short
and long-term consequences of the patient and/or provider (Alger & Sternberger, 2013). The
correlation between responsibility and rights is considered because when one person has a

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responsibility or duty another person has a right. Character includes questioning ones best self
and determining what virtues to maintain or eliminate. Empathy embraces these positive virtues
and allows one to respond as if they deeply felt for the person. Liberty includes the respect of
ones decisions, actions, and the person as a whole also including ones confidentiality and
consent. The last key question, authority, involves the evaluation of what is expected of an
individual by legitimate authorities often resulting in successful outcomes.
FINDINGS:
Fairness became an issue in this ethical situation when the CNA neglected to consider the
patients dignity. The CNAs overall attitude was one that, in general, did not include fairness
when taking care of her assigned patients. The situation could have resulted in short-term
outcomes such as direct harm to the patient, diminished self-esteem, and negative impact on
bodily care of the patient. Long-term outcomes that could have possibly resulted include further
advancement towards morbidity and mortality. Another possible long-term outcome includes the
nursing home developed a negative reputation. Responsibility is largely a key factor in this
situation because the CNA should have held full responsibility in the care of the patient. The
CNA had the responsibility of not only apologizing to the patient but also taking proper action to
make the situation just. On the other hand, the patient had the right to be responded to
appropriately which included being heard and listened to. One of the components, character, was
completely ignored by the CNA herself in deciding what the treatment of the patient would
entail. However, I evaluated my own character when I took this as a learning experience in how
not to act in the future. I realized empathy played a role in this situation when I was overcome
with a combination of sadness and anger. I empathized with not only the patient but also the
other residents when realizing that others had probably been treated in this same way before.

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First and foremost, the component of patient autonomy that falls under liberty was ignored. The
patients ability to defend herself was compromised and therefore the CNA was able to take full
advantage of the patient knowing that she probably couldnt defend herself. Another aspect of
liberty, confidentiality, was involved when I felt the need to inform the patients family how she
was being treated but decided it would be better to avoid causing them more distress and
allowing the facility to handle it. In terms of authority, the CNA seemed to believe that her
authority was above mine but I didnt allow this to intimidate me. I immediately reported what I
had seen to my clinical instructor who assured me that she would further report this to the charge
nurse.
Provision 3 promotes guidance in patient care by outlining the responsibilities of us as
nurses as we serve as advocates, protectors, and promoters of rights, health, and safety of all
patients (Brown & Finnell, 2015).

CONCLUSION:
In looking back, I realized that I could have gone further and reported the incident to the
charge nurse myself. The benefit of this would have been that she would have heard my personal
account of the situation. In the future, I will still report a situation like this to my clinical
instructor if still a student nurse and then follow up with the charge nurse. If at that point I am an
RN, I will simply go to the charge nurse myself. The JMU 8 Key Questions helped me
understand how to breakdown an ethical situation. They also allowed me to consider different
approaches when making ethical decisions. When looking over Provision 3 of the ANA Code of
Ethics, I was made aware of the fact that it is our duty as nurses to protect patients in all
situations even if it involves taking actions that are challenging (Brown & Finnell, 2015).

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References
Alger, J. R., Sternberger, L., & Goldstein, B. (2013). The madison collaborative: Ethical
reasoning in action Harrisonburg, Va. : James Madison University, c2013.
Brown, C., S., & Finnell, D., S. (2015). Provisions of the code of ethics for nurses: Interpretive
statements for transplant nurses. Nephrology Nursing Journal, 42(1), 37-44.
Gibbs, L. M., & Mosqueda, L. (2004). Confronting elder mistreatment in long-term care. Annals
of Long Term Care, 12(4), 30-35.
Kleinschmidt, K. C. (1997). Elder abuse: A review. Annals of Emergency Medicine, 30, 463-472.
doi:10.1016/S0196-0644(97)70006-4