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Ken is a health care worker who has been working in the supported living facility for individuals with severe learning difficulties. He has been working in the unit for the last 2 years. Mark is a 35 year old male client who was brought to the facility an



Ken is a health care worker who has been working in the supported living facility for individuals with severe learning difficulties. He has been working in the unit for the last 2 years. Mark is a 35 year old male client who was brought to the facility and he has severe learning difficulties and he cannot communicate verbally but he uses Makaton to communicate. Mark came with long finger nails and he was scratching himself. So ken become concerned as he viewed it as dangerous to the client and decided to cut the nails. Ken saw it as a personal need and therefore, he did not consult the client. This action developed a need initiate disciplinary action against Ken because the rights of the client were violated and also he did not seek permission from the client and he never even consulted from other members of the team. On the other hand, Ken claims that he did it to serve the interest of the client.

The persons involved in this case is the manager, the client and the health care worker (Ken) who was providing care during the time. The situation actually occurred at the health facility as care was being delivered as the normal routine to the client. The care services in the hospital are usually delivered to the clients as the need arises and therefore, cutting of nails to Ken was a need to prevent the client from injuring himself and also reduce the risk for developing complications.

In this situation, there are conflicts that arise because Ken did not get the permission from the client to cut the nails and on the other hand he claims that he did that to serve the interest of Mark, beneficence and autonomy of the client are conflicting. It is a dilemma whether to initiate the disciplinary action or not. I think the client rights were violated but the fact that the health worker was doing that to protect the client from complication that may arise from scratching, it serves to protect the client and it is not wrong to me.

The client interest were served in this situation and the fact remains that, the client was unable to communicate well. Also due to the learning difficulties that the client experienced, he might not have been in good position to understand the dangers the nails posed to his health. For this situation it was necessary to consider the care provider decision was beneficial to the patient and therefore not initiate the disciplinary action. This a decision made me happy and I can rate it at 8 in a scale of 0-10. This is because patient centered care is very beneficial to the client and prevention of risk that comes in with impaired skin integrity was part of it. Am happy for the decision I made because it was not necessary to punish someone who did patient-centered care but still I wish he consulted with the rest team members.


The consequentialism which is in the class of the normative ethical theories describes the consequences of the individual conduct as the basis of making judgment as right or wrong (Kagan, 2018, p.8). In this situation the health worker claimed that he was doing it for the purpose of the client and thus he was protecting the client from risk for developing complications that might have aroused if he continued scratching himself without an action being taken.

As a nurse, it is always important to respect the principle of autonomy and thus respecting the rights, values and choices that the client makes doing their own care (Butts and Rich, 2019, p.26). The client can refuse treatment or even choose not to do us instructed and that is their own choice. It is therefore necessary to consider this and educate the client on the importance and all the care you intend to give him/her to enable them make informed decisions (Bastable, 2017, p.12).  They can also be involved in their own care and therefore, it promotes understanding.

In this situation the client had severe learning difficulties and therefore it will would have been hard to explain to the client the risk for infections he was exposing himself to because he might not have understood it earlier before harm had already occurred. This situation required fast intervention and the time for consulting might not have been very necessary because the client could have hurt himself more so the health worker cut the nails to protect him.

In addition, it is also necessary to respect the client not only in the clinical setting but also in all situations of life. Respect all the client irrespective of their health status, ethnicity, age and even their race (Kreitzer, 2015, p.23). This will make patient feel they are being cared and also their rights are being respected. They will make them feel that they are worthy and thus will they will want to associate more and also be involved in their care. In the Mark situation the healthcare worker did not bother to ask him what he wanted or involving him in the decision to cut the nails which was then bad practice.

The nurse should also consider the principle of non-maleficence and therefore, provide care that does not bring harm to the client. In their normal duty, the health care worker should consider providing care by avoiding deliberate harm, this might occur as a risk during the normal delivery of the nursing action (Mitchell, 2017, p.67). If the nurse exposes the nurse exposes the client to risk during the normal care provision and the risk occurs, that is deliberate. The client might not be aware of the dangers but doing things without consulting might have hurt the client.

It was also necessary to provide care that will benefit the client by balancing the benefits and the risk of harm. It I very clear that the client actions were dangerous to him and thus he could not be left alone to continue due the scratching but it was only necessary to cut the nails to eliminate the risk of infection he was exposing to himself (Griffiths et al., 2016, p.34). The best help the client would have received is cutting the nails to prevent the risk and that was what was done by this situation the principle of beneficence was considered.

The nurses autonomy should also be respected in this situation. This is because the nurse at that point saw the danger of the nails and he made his decision to cut the nails on the basis of protecting the client from harm. It was not necessary for the nurse to consult other individuals because this was not something complicated and the fact that the nurse understood the situation of the client (Butts and Rich, 2019, p.32). It was the best decision to make at that point in time to prevent further damage which might have occurred.

As a nurse, it is also important to practice with good considerations on application of the available evidence (Dean, 2017, p.13). The nurse should ensure that all the care or information that is being provided to the client is evidence-based and it is therefore, important for the nurse to improve his/her knowledge and skills to enable her provide care that is safe and effective to the client at all time.

On the other hand, the non-consequentialism type of the normative theory is the ethical theory that denies that the degree of wrongness or rightness of a conduct is determined solely by the good or bad consequences it has (Gluchman, 2018, p.53). It this situation the action of the healthcare provider to cut the nails of the client without consulting might not be the right thing at all. He did not ask the client why he was doing so and therefore he never knew what made the client to scratch himself but he just made that decision to cut the nails.

The client rights have to be respected and their decision making should have been put into consideration before making the decision to cut the nails. The nurse clearly assumed the client has learning difficulties and therefore was not in good position to make informed decision, this denied the client his own right.

Furthermore, the client could not have made the right choices maybe because he could not understand the danger behind it but it is important also to consult the rest of the team members. For example those who are more experienced or the individuals who had greater seniority. The decisions of the team members and their individual contributions good have helped in making better decisions and the health worker could not have been exposed to risk for disciplinary action.

Care delivery to the client always focuses on the patient and thus all the intentions that the nurse has should always focus on meeting the needs of the client. All the rights have to be respected even though the client had a problem (Rowe, 2017, p.20). The action that was performed without consent was a breach of the patient rights and thus it is right to initiate action against the healthcare provider who performed the action of cutting nails.

The codes of conduct require the healthcare provider to involve the patient and ensuring that all the information he or she provides is maintained as confidential (Dean, 2017, p.13). It is also important to ensure that, the dignity of the client is maintained during the process of care delivery. It was therefore necessary for the nurse to understand the patient and do the necessary such as trying to explain to the patient the dangers before actually performing the action.

Effective practice was also necessary in this situation. Proper communication could have been done because the client used Makaton to communicate, so to facilitate understanding with the client, the nurse could have employed other services such as use of translator to facilitate proper communication (Ellis, 2017, p.16). The health care provider should also be keen all the time to detect misunderstanding and thus keep mistakes to the minimum or even reduce the incidences of client dissatisfaction that may arise due to miscommunication (Nind and Hewett, 2012, p.214). All the time.

The nurse also needs to be accountable to the decisions they make by taking responsibility of their action. Performing of activities and making of decisions that are within the scope of competence is important in ensuring that the nurse does not do something beyond his/her abilities. This ensures that the care provided to the client is of good quality and will promote health of the client.


The ethical theory of consequentialism made me happier on the way it analyzed the situation and considered that the consequences are the one to decide if the situation is wrong or right and therefore. The consequence of the situation that came out in the case of Ken is that, the client would not expose himself to risk for infection related to impaired skin integrity because the nails he used to scratch himself were already cut. The benefit thus was to the client. This followed and strengthened the decision I made not to initiate the disciplinary action because he was acting for the interest of the client health.

The other ethical theory on non-consequentialism did not make me that happy because of its emphasis that it is not always right that when the consequence is right, the action was also right. The decision I made mainly focused on the patient outcome and this theory does not consider that. The actions of the care provider to me were actually to benefit the patient and it was very agent to cut the nails to prevent further damage that might have occurred.

If I was in the same situation I will definitely make the same decision again, because all the decisions that the nurse did was for the benefit of the patient. The nurse should not be disciplined because, preventing the risk was actually a priority than consulting and considering that the client had severe learning difficulties, it was the best decision to me in this case.



Butts, J.B. and Rich, K.L., 2019. Nursing ethics. Jones & Bartlett Learning.

Bastable, S.B., 2017. Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.

Dean, E., 2017. Unlocking the NMC code of conduct. Emergency Nurse (2014+), 25(2), p.13.

Ellis, P., 2017. Understanding ethics for nursing students. Learning Matters.

Gluchman, V., 2018, May. Theories of Professional Ethics. In Proceedings of the XXIII World Congress of Philosophy (Vol. 12, pp. 137-141).

Griffiths, C., Barker, J., Bleiker, T., Chalmers, R. and Creamer, D. eds., 2016. Rook's textbook of dermatology. John Wiley & Sons.

Kagan, S., 2018. Normative ethics. Routledge.

Kreitzer, M.J., 2015. Integrative nursing: Application of principles across clinical settings. Rambam Maimonides medical journal, 6(2).

Mitchell, V.J., 2017. Ethics and mental health nursing. In Psychiatric and Mental Health Nursing (pp. 37-46). Routledge.

Nind, M. and Hewett, D., 2012. Access to communication: Developing the basics of communication with people with severe learning difficulties through intensive interaction. David Fulton Publishers.

Rowe, G., 2017. VALUES AND ETHICAL FRAMEWORKS IN HEALTH AND SOCIAL CARE. The Handbook for Nursing Associates and Assistant Practitioners, p.20.

Zuriguel Pérez, E., Lluch Canut, M.T., Falco Pegueroles, A., Puig Llobet, M., Moreno Arroyo, C. and Roldan Merino, J., 2015. Critical thinking in nursing: Scoping review of the literature. International journal of nursing practice, 21(6), pp.820-830.

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