Nursing Violations of Patient Rights

NURSING AND PATIENT RIGHTS: A LITERATURE REVIEW

Abuse of patients has become a significant issue for health care professionals in recent years (Rhymes, 1991, pp. 803-816). For the professional nurse, patient abuse is not a situation that simply demands the extension of care to the victims. On one hand, health care professionals have a moral obligation to these victims to insure that the victims are removed, to the extent possible, from abusive situations. On the other hand, the professional nurse feels a traditional obligation to protect the privacy of patients and their families. Between these extremes of an ethical continuum, contemporary society is demanding increased accountability from its health care professionals. Health care professionals who fail to report instances of abuse expose themselves to potential legal problems, just as they are if they themselves are the perpetrators of such abuse. This ethical dilemma appears destined to grow in significance.

Typically, when one considers the phenomenon of patient abuse by a professional nurse, the image is one of a nurse in some way brutalizing a patient. Actual abuse of patients by nurses, by contrast, usually occurs within the contexts of (1) refusing care to patients either because of their condition or the type of care required, (2) a failure carelessly or intentionally to assure that patients are fully informed, and (3) medication errors resulting from a nurse's own impairment (Skelly, 1993, pp

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cisions in the surgery setting that affect the patient. In the United States, the Patient Self-Determination Act "mandates that hospitals ensure that a patient's right to make health care decisions is upheld" (Golanowski, 1995, p. 10). The patient's right to autonomy in health care includes operating room procedures affecting the patient. Except in emergency care situations, a patient being prepared for a surgical procedure will be asked to sign a consent form (Brahams, 1993, p. 361). This form includes typically includes permission for the surgeon to perform additional procedures "as the surgeon thinks necessary" based upon conditions that may be discovered during the surgery (p. 361). At issue is whether such a catch-all phrase can actually convey informed consent. One choice is to delay any additional surgical procedures in such cases, thereby exposing the patient to additional risks and inconvenience. Such a choice, however, avoids "the devastating effects on patients presented with an unwanted fait accompli" (p. 361). Many surgeons argue that informed consent should be sacrificed in the name of expediency. Such an approach appears to be defensible, however, only in cases of "genuine emergency that brooks no delay and

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