An intoxicated alcoholic female patient was brought into the hospital. Two female registered nurses and other personnel applied physical restraints to the patient since she behaved in an assaultive and combative manner. The patient would not let go of one of the nurse's hands and her fingernails were puncturing the hand. The other nurse administered a painful pinch to the patient on the inside of her upper arm to get the patient to release her grip. Both nurses were fired for patient abuse. The case was brought to the Court of Appeals of Arkansas in 1996. The court ruled that the nurse did not administer intentional patient harm or intentional disregard of professional nursing standards and that the nurses should not have been fired. At the worst the act was viewed as an indiscretion or good-faith error in judgement (Legal Eagle Eye Newsletter, 1997).
Three ethical issues involved in this case include the following:
1. Responsibility and Accountability for Nursing Judgment and Action. The nurse has the responsibility to identify any ethical or legal dilemmas, and is accountable for the seeking of resources to formulate appropriate decisions. In this case the nurses had the responsibility to identify the priority of care and provide appropriate care. Since the patient was displaying combative behaviors and was intoxicated with alcohol, physical restraint was identified as appropriate to prevent further self and other-inflicted injuries. The nurse must assume responsibility and accountability for their actions and judgment and must consult appropriately when necessary. In this case the two nurses consulted each other as well as other hospital professionals in the decision to use restraints and assist each other in releasing the patient's grip (Constantino, Boneysteele, Gesmond, & Nelson, 1997).
2. Autonomy versus Beneficence. The loss of decision-making for the patient results in a loss of autonomy and this mu...