Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: A sergeant who is a patient has behaved inappropriately using offensive language towards a junior soldier admitted for a mental health crisis.  A soldier visiting witnesses this and reports it to you.  What should you do as a Corporal?  What are the ethical issues?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics of professional behaviour, promoting professionalism and upholding the reputation of the profession when informed of inappropriate behaviour by a patient on a vulnerable patient in a health crisis. It also involves the protection of the patient, who is in a vulnerable position. In addition, it is about taking the visiting witness account seriously and dealing with it appropriately and proportionally.

Step 2 – ANALYSE

Patient: 2 principles of beneficence and non-maleficence apply. The patient is vulnerable due to having a mental health crisis and has the right to be treated with respect and dignity without facing any inappropriate and offensive language by fellow patients. Equally, any patient should feel protected and safe in any healthcare environment and be free from harassment, bullying or victimisation.  

Clinical: given the patient’s mental health condition, the patient is vulnerable and the priority would be to ensure their condition does not worsen due to the offensive language and is stabilised.  Following clinical assessment, it might be worth treating the corporal away from the sergeant so that they feel safe in a different area or alternatively, removing the Sergeant away from the Corporal.  It will be a professional judgement call as to whether both can stay in the same physical vicinity given the environment. This may be challenge on an operational tour. It might be worth exploring why the sergeant has targeted the Corporal in this way and whether they are known to each other – is there something else going on?

Legal: The International Council of Nurses Code of Ethics is at: https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf . The code says that the nurses need to be responsive to their patient’s needs, and communicate any inappropriate behaviour (this includes patient on patient) to their supervisors.  Nurses must provide and ensure to the best of their ability, a safe environment for all their patients. In addition, nursing codes of practice state that the primary function is the protection of the patient.

Societal/Military: to hold ethical values the female nurse should display a personal commitment to the standards of practice and behaviour set out in their regulatory code (of whatever country) and the International Code of Ethics. She therefore has a duty to challenge the behaviour of a patient on another patient if their behaviour is offensive and causing distress to that fellow patient.

All nurses are bound by a professional code. In the United Kingdom, the Nursing Midwifery Council (NMC) that regulates all nurses, nursing associates and midwives’ states that the professional standards of practice and behaviour of registrants includes; privatising people, practising effectively, preserving safety and promoting professionalism and trust. As in all nursing regulatory bodies the primary function is for the protection of the public and the reputation of the profession and such behaviour by the sergeant needs to cease and be addressed.

The corporal ought to report this to their immediate line manager who they are on duty with if they feel they cannot challenge the sergeant themselves. Whoever ultimately addresses the sergeant’s behaviour needs to provide leadership to make sure other patients well-being is protected. There must also ensure that they have the knowledge, skills and confidence to ensure a safe environment; and understand how to raise any concerns that could compromise patient safety.

It also worth considering informing the Regimental Sergeant Major about the Sergeants inappropriate behaviour. 

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

This scenario considers the behaviours of a Sergeant who is a patient making offensive comments to a vulnerable patient a corporal of a lower rank and potentially making their condition worse. The patient needs protecting and reassuring and the Sergeants behaviour needs to be addressed to prevent further episodes.  

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

The corporal who the visitor reported the incident to, if they are a registrant, may feel equipped, confident and empowered to challenge the Sergeants behaviour. However, they may feel that military rank structure prevents them from doing so and that they are more comfortable informing their line manager to address the issue. Irrespective of this, the priority is to ensure that the patient who is having a mental health crisis is protected and does not suffer harm by both the sergeant and any failure to address the Sergeants behaviour.

References and Further Reading

International Council of Nurses (Revised 2021), The ICN Code of Ethics for Nurses at Code. Available at ICN_Code-of-Ethics_EN_Web_0_0.pdf; accessed 24 August 2023

Nursing Midwifery Council: Future nurse: Standards of proficiency for registered nurses. Available at future-nurse-proficiencies.pdf (nmc.org.uk); accessed 24 August 2023

Nursing Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates - The Nursing and Midwifery Council (nmc.org.uk) accessed 24 August 2023

Nursing and Midwifery Board of Australia. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx; accessed 24 August 2023

Contributor - Lt Col Janet Kelly VR RGN RM DIpHSM MA (HRM) LLB (Hons) PGHCE PhD. Senior Lecturer in Midwifery, Healthcare Law & Ethics; University of Hull. Chair for the Nursing Midwifery Council's Fitness to Practise Conduct and Competence Committees (2013 to 2021). She has served as a commissioned officer in Queen Alexandra's Royal Army Nursing Corps both as a regular and reservist for over 30 years and is now at the rank of Lieutenant Colonel.