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According to standard number four (which outlines the communication and collaboration standards), of the state of Texas official standards of practice for registered nurses, the nurse should collaborate the relevant information with the patient, healthcare team members, and if necessary, the patient's significant other(s) with the aim of providing optimal treatment to the patient (Nazek, 2011). This is the nursing standard of practice that applies to this case study. The ICU staff nurse violated this standard of practice by withholding the information about Mr. E's advance directive from Mr. Y and Ms. H who are considered in this case to be Mr. E's significant others. Though, the ICU staff nurse withheld this information as a directive from Dr. K, he/she understood that the doctor's action in proceeding with the treatment course is contrary [url=http://www.mxitcms.com/abercrombie/]abercrombie[/url] to Mr. E verbal objections and his advance directive which declined this form of treatment. The nurse had to reconsider this nursing standard of practice within the context of the existing situation (Nazek, 2011).
The implication of strictly following the above stated nursing standard of practice would involve Mr. E obtaining a less optimal treatment. This is because; the verbal objections expressed by Mr. E are due to his misunderstanding of the doctor's explanation. This may have occurred due to disorientation caused by hypoxia or his developmental retardation. Therefore, if the nurse applies this standard of practice, the consequences would be that Mr. E would receive inadequate treatment, and the nurse-doctor relationship may become strained (as the nurse disobeyed the doctor's [url=http://www.rtnagel.com/airjordan.php]nike air jordan pas cher[/url] instructions), and, this interferes with the cooperative action of the healthcare team. The nurse's decision to overlook this nursing standard of practice would ensure that Mr. E receives adequate and appropriate healthcare; and the nurse maintains a salubrious working relationship within the healthcare team (Nazek, 2011).
The second provision of the ANA (American Nursing Association) nursing code of ethics, states that, primary commitment of the nurse is to the patient, whether the entity defined as a patient is an individual, a group of people, family or a community. This is the most relevant nursing code of ethics that applies to this case study. This provision upholds the primacy of the patient's interest in nursing. The nurse should thus strive to provide the patient with an opportunity to participate in his/her planning care; and ensure that the patient accepts and implements the treatment plan. Intra-professional collaboration within the field of nursing is critical in addressing the patient's needs (ANA, 2010).
The nurse in this case study faced a conflict of interest arising from the need to maintain a working nurse-doctor professional relationship, while at the same time, avoid violation of the second provision of the nursing code of ethics. The nurse did not disclose this actual conflict of interest to Dr. K, because Mr. E's medical condition [url=http://www.moncleroutletosterblade.com]moncler outlet[/url] rendered him incapable of making sound medical decision which the nurse may need to consider. This necessitated the need for the nurse to ask Mr. Y who has legal authority to make medical decision for Mr. E as stipulated in Mr. E's medical power [url=http://www.mnfruit.com/doudounemoncler.php]moncler[/url] of the attorney. The nurse decision to withhold the information about the advance directive from Mr. Y was meant to ensure that Mr. Y makes a medical decision that is compatible with the doctor's treatment plan (ANA, 2010).
Mr. E's objection to being placed in a respirator raises ethical implications when he was finally placed in the respirator. The use of the respirator was contrary [url=http://www.jeremyparendt.com/Hollister-b5.php]hollister[/url] to Mr. E's wishes, but, the doctor overlooked his objections because of the greater benefit that Mr. E would get from being placed in a respirator (Nazek, 2011).
Mr. Y should contemplate on the following ethical consideration before making [url=http://www.jeremyparendt.com/Barbour-Paris.php]barbour pas cher soldes[/url] the decision to authorize the use of the mechanical ventilator for his brother: what was the reason for his brother refusing the use of ventilators? Were his brother's cognitive functions intact when he made these objections? Are there any possible significant adverse effects to his brother's health when he is placed in the ventilator? And finally, Mr. Y must weigh the consequences of the options of placing his brother in a mechanical ventilator, and, preventing Mr. E from dying from aspiration; or declining the use of mechanical ventilator and risk his brother dying from aspiration (Nazek, 2011).
Several factors complicate Mr. E's advance directive. First of all, the advance directive declines the use of the most important medical devices that would save Mr. E's life, and if followed by the doctor, it would lead to the death of Mr. E due to aspiration. Secondly, Mr. E's condition was an emergency, and, any discussion of the advance directive with Mr. E's brother and niece would consume the precious time that determines the outcome of Mr. E disease. Lastly, the advance directive was signed under [url=http://www.mnfruit.com/airjordan.php]jordan pas cher[/url] totally different circumstances that did not predict his current condition (Sidirov, 2010).
The nurse in this case study violated the HIPAA regulation, relating to maintaining the patient information confidential, by discussing the patient's information with three other nurses within a context that did not advance the interests of the patient. The second violation is that the nurse did not obtain consent from the patient before discussing his condition with other nurses. Dr. K violated the HIPAA regulation that requires the attending doctor to disclose information to the patient's significant others. The three nurses from the medical-surgical ward [url=http://www.jeremyparendt.com/Barbour-Paris.php]barbour france paris[/url] violated the HIPAA regulation that requires nurses to obtain the patient consent before discussing his condition (Rothstein, 2011).
The three nurses working in the medical-surgical ward displayed unprofessional conduct during their chat with the ICU staff nurse. The first nurse was [url=http://www.mnfruit.com/doudounemoncler.php]moncler pas cher[/url] not concerned with the patient's interests, the second nurse does not follow HIPAA regulations and the third nurse is ignorant about the advance directive. Within the context of provision 6 of ANA code of ethics, the ICU nurse must report these three nurses to the relevant authorities, for instance, the chief nurse or the hospital administration if the chief nurse is absent, as [url=http://www.lcdmo.com/hollister.php]hollister pas cher[/url] they are compromising the quality of nursing care provided in the hospital. Also, the ICU nurse could use official publications from the Texas standards of nursing practice and ANA code of ethics to inform the three nurses from the medical-surgical ward, the importance of caring about the patient interests, importance of HIPAA regulations in nursing practice and the significance of advance directives (Nazek, 2011).

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