However, in this case !as in all cases) the nurse might instead consider doing the right thing 2' ± that is, she might not simply follow the regulation course, but first take the trouble to analyse the situation for herself, and then act according to the result of her own reasoning. Of course, if she decides that she must advise V and R that she cannot help them, and that they must attend the nearest accident and emergency hospital, then the practical outcome will be the same. However the nurse herself will have thought more thoroughly than if she had merely obeyed the rules, and may well feel more confident !and more in charge) as a result. But how is she to carry out this analysis? How might she structure her thinking if she decides todo the right thing 2'? N does have the option to help the injured
person, but if she does so she might well place herself at greater personal risk than
if she were simply to turn V and R away. As stated in section 8.7, once N opts to render care and assistance to V, then a duty of care arises and the question then relates to the applicable standard of care. It is clear that liability may result from negligent treatment or advice rendered by N or any failure of communication in providing V with emergency treatment.' So what should N do? Certainly,doing the right thing 2' is the more complicated ± and potentially
more fraught ± option. What factors should the nurse take into account? How
might she begin to think clearly about this case? If she does decide to deliberate on
the situation she must do so quickly, and under considerable emotional pressure ±
neither of which are conducive to clear reasoning. Given this, the nurse might find
it helpful to organise her thinking under three distinct headings :context, out-
comes and obligations.
Context
Firstly, N must assess the risk. `Risk', of course, is a general term which might be
interpreted in several ways. The nurse might, for instance, think about:
. the risk to the injured party !if he is not instantly helped how will he be
affected?);
. the risk to her conscience !what if she begins to help and the patient dies ± or
what if she does not help and the patient dies?);
. the risk to her future career, and so on.
She must also, prior to any further deliberation, decide whether any intervention
she could make would do any good. If it would not, and if it is clearly better that V
attends a working clinic, then obviously that is where he should go. If, on the other
hand, she decides she could give some help, she must also work out howeffective
she would be and howcertain she is of her judgementabout her effectiveness. Also, if
there are other patients whom she might be helping instead of V, she must
consider whether she should assist them before she turns her attention to V.
The context, in this case as in most cases which nurses have to deal with, is one
of uncertainty. N simply does not know for sure what the outcome of any of her
options will be. Because of this it is very important that she reflects, in the abstract,
on herpriorities.
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