Legal and Ethical Principles in Nursing: Case Study Reflections

Introduction 

• Background sentence - What is the context?
• Focus sentence - What is the main message/argument? E.g., take this from the main themes in the task question - legal and ethical principles and requirements

• Overview sentences x 3 - What will the written piece cover? E.g., introduce key regulating bodies that relate to the profession of nursing and midwifery.

• Summary sentence about legal and ethical decision-making processes.

Case 1: Separate developed

Case one involves a student registered nurse being asked by a mentor to attend a surgical theatre in a regional hospital. The ethical dilemma is that the patient refuses consent. The ethical and legal importance of patient autonomy and consent is the primary consideration in the case.

The ethical considerations pertaining to this case can be viewed through the prism of two core fundamental ethical principles: autonomy and non-maleficence (McDonald & Then 2019). Autonomy defined as the patient’s ‘right to decide’, is a central tenant of medical ethics, and is a cornerstone for health care law. Respecting the patient’s decision for a student not to attend theatre must be upheld, even if healthcare professionals disagree. Non-maleficence is defined as the duty to do no harm. Despite the mentor’s request and potential learning opportunities, the student registered nurse must not exploit patients and is required to report to appropriate authorities when necessary (McDonald & Then 2019).Informed consent and decision-making are essential components of patient-centred healthcare. APRHA defines informed consent as ‘a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved’ (Australian Health Practitioner Regulation Agency [AHPRA], 2020). According to Australian common law, informed consentcomprises three key principles: patient competency, voluntary and fully informed decision-making (Australian Law Reform Commission, 2014). As the patient meets these conditions, their request constitutes informed consent. Consent may be given in writing, orally or be implied; however, Queensland Health requires ‘as a minimum, written consent be obtained for all healthcare’ involving student participation in at-risk operations (Queensland Health, 2023). The code of conduct (Nursing and Midwifery Board of Australia (NMBA) 2018), 2.3 (d) states that informed consent must be obtained before involving people in teaching. Whilst student registered nurse involvement is encouraged, students and practitioners must respect the patient’s right to refuse consent in clinical teaching without compromising the nurse-patient relationship (Queensland Heath, 2023). Legal implications if the student were to enter the theatre without patient consent would be significant. By breaking the code of conduct and code of ethics the student registered nurse is thereby breaching the Health Practitioner Regulation National Law Act (2009) (Qld). By breaching the consent law, the health practitioner is in violation of the Australian Charter of Healthcare Rights (ACSQHC 2019). Criminal charges are unlikely in this case, as the medical officer would be conducting the surgical procedure with the reasonable belief that they are acting lawfully (Criminal Code Act (Qld), 1899). However, the patient may seek retribution for emotional distress caused by having their wishes ignored. Under vicarious liability, this would see the facility held liable (Ellis v Wallsend District Hospital, 1989) Additionally, the Registered nurses involved may face disciplinary action by regulatory boards. In extreme cases the student and mentor’s actions may constitute unintentional assault and even negligence, thereby violating the Civil Liability Act (2003) (Qld). Maintaining a respectful relationship between the student, mentor and the hospital staff promotes a safe and effective health care environment. The International council of Nurses (ICN) code of ethics addresses the importance of respecting all people and their decisions. ICN (2021) s2.1 highlights the requirements for nurses to demonstrate responsibility and accountability for ethical nursing practice. The social construct established in health care creates ethical distress due to the power imbalance between students and mentors. This concept creates a difficult environment for students to speak up and challenge authority (Pattni et al. 2018). Despite this fear, students are often required to challenge authority and must deal with the fear of retribution whilst simultaneously showing respect for a senior mentor. Given that the ethics, laws, and policies clearly converge to support patient autonomy, the student's response should be not to attend theatre. Regardless of whether the patient becomes aware, the student registered nurse’s attendance would have potential disciplinary and legal ramifications for not only themselves but for the consenting mentor and the governing hospital. The clinical placement guide for the University of the Sunshine Coast states that students must abide by the codes of conduct of their professions whilst undertaking clinical placements (University of Sunshine Coast [UniSC], 2022a). As the student would comply with applicable codes, standards and legislation, the universitywould back the student's decision and ensure they receive no penalties for going against the direction of her mentor. Students can ‘report suspected unethical conduct by a colleague to appropriate authority’ (AHPRA, 2020) and can make voluntary notifications under certain circumstances. Although these conditions arguably do not meet the requirements, another healthcare member may consider reporting theincident to the facility or Health Ombudsmen, under the Health Ombudsmen Act (2013). The student registered nurse must respond to this case to the highest ethical and legal standards. An ideal response from the student registered nurse could involve direct communication to the mentor stating that they feel uncomfortable entering the theatre but would be grateful for other opportunities to attend after the patient had consented. This would directly align with the Code of Conduct (NMBA 2018), 1.2 (c), which highlights that nurses should not participate in unlawful behaviour and 2.2 (d) nurses should advocate on behalf of the person where necessary. Directly communicating with the mentor and abiding by the law and ethical codes will maintain professional accountability by actively doing what is best for the patient.

Case 2 : Separate developed 

• Should follow a similar format to case 1

Conclusion 

• Should summarise the main points and topic of the task

Assessment Summary and Approach

The assessment required students to critically evaluate two case studies in nursing practice by applying legal and ethical principles to real-world scenarios. The key requirements included:

• Writing an introduction that outlines the context of nursing ethics and law, with a focus on regulatory frameworks and decision-making processes.

• Developing Case 1 and Case 2 (each approx. 850–900 words) where students explored ethical dilemmas through principles such as autonomy, beneficence, non-maleficence, and justice.

• Referencing relevant legislation, codes of conduct, and professional guidelines (e.g., NMBA, AHPRA, Australian common law, hospital policies).

• Highlighting the role of informed consent, patient autonomy, accountability, and professional responsibility.

• Concluding with a concise reflection that summarises key findings and learning outcomes.

Mentor’s Step-by-Step Guidance

1. Introduction: The mentor first guided the student to establish context by linking nursing practice to ethical and legal principles. The focus was on identifying the importance of patient autonomy, informed consent, and regulatory compliance. The student was encouraged to introduce governing bodies (e.g., NMBA, AHPRA) and outline how ethical decision-making shapes safe practice.

2. Case 1 – Patient Refusal of Consent: The mentor assisted the student in breaking down the dilemma. The student was guided to analyse the situation using the principles of autonomy and non-maleficence, linking them to legislation and professional codes. The mentor emphasized balancing learning opportunities with respecting patients’ rights. The student developed arguments about the legal consequences of breaching consent and the ethical implications of disregarding autonomy.

3. Case 2 – Parallel Ethical Dilemma: Following a similar structure to Case 1, the mentor encouraged the student to apply ethical frameworks systematically, ensuring that each decision was justified with professional codes and legislation. The focus was on developing a clear, logical argument and showing critical thinking when resolving ethical conflicts in practice.

4. Conclusion: The mentor guided the student to summarise both cases by restating the importance of legal compliance, ethical integrity, and professional accountability. The student reflected on how nurses must make decisions that prioritise patient-centred care, even in the face of authority or pressure.

Outcome and Learning Objectives Achieved

The final outcome successfully addressed all assessment requirements. The student was able to:

• Apply ethical principles and legal frameworks to complex nursing scenarios.

• Critically evaluate dilemmas involving consent and autonomy.

• Reference governing bodies, legislation, and codes of practice to support arguments.

• Demonstrate professional accountability and advocacy in decision-making.

• Strengthen academic writing skills by structuring arguments logically and cohesively.

The assessment helped the student meet learning objectives around professional standards, ethical conduct, and reflective practice, ensuring readiness for clinical decision-making in nursing.

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