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This essay will give you the opportunity to develop your understanding of how law, ethics and professional guidelines guide nursing practice. It will allow you to reflect on the values and characteristics of professionalism in the healthcare setting. Completing this essay will also further develop your academic and information literacy skills.
Select one of the three discussion board scenarios. The chosen scenario of my essay question is:
You witness a nurse perform a procedure on a patient without consent.
As the witnessing nurse what is your immediate action? What must you do following this? Which sections of the Australian National Competency Standards for the Registered Nurse apply here and why? What are the possible legal/ethical implications?
Identify the main issues inherent in the scenario and make appropriate recommendations to address these issues.
It is expected that your essay will address/contain the following information:
The NUR 120 Learning Outcomes addressed by this assignment include:
On completion of this unit a student should be able to:
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The present discussion tries to look into different perspectives of a scenario experienced in an organizational atmosphere, in light of laws, ethical & professional guidelines in nursing practice. This essay critically reflects of an individual’s understanding on how legal framework, ethical and professional code of conduct, and core values of nursing are interplayed and guide an individual or a group of healthcare providers to perform in a certain manner that works best for all the stakeholders.
The present essay is focusing on a scenario where a nurse is witnessing another nurse to perform a procedure on a patient without consent and what the witnessing nurse would do in such a scenario. To analyze the action or steps need to be taken as a witnessing nurse it has been tried to analyze and reflect upon the standard protocols, values and ethics of nursing, and how professional guidelines, legal framework help achieve healthcare providers a quality and integrated approach to build up holistic healthcare service. The essay explores nursing values and ethics, the importance of core value and ethics implementation at work place. The requirement of legal framework and the necessity of developing standards and yardstick in providing quality healthcare are also analyzed. The essay also tries to identify the laws applicable in the present scenario and how practicing in certain guided manner can help an individual in achieving quality nursing care.
Nurses are the bridge between Doctor and patient. They act as the front line caregivers and are of utmost importance in any health care delivery system (Chiarella, 2012). Healthcare delivery is a holistic and integrated process and for the systems to work seamlessly and efficiently the nurses need to understand the legal, professional and ethical guidelines. Nursing values and ethics are built upon recognizing the universal human rights (Gerish & Lacey, 2013). The profession of nursing demands to recognize patients or individual’s basic human rights, and protect the dignity and inherent confidentiality of the beneficiaries. The core value of nursing are intertwined with the values of human rights which emphasizes upon social, cultural, and civil rights that are broadly applied to human beings all over the world (Taylor et al, 2011. Nurses are required to acknowledge and accept the criticality of the relationship between health and human rights, and that respecting and acknowledging human rights one can achieve desired outcome in fostering good health.
In the discussed case study a nurse is performing a procedure without consent. The act can be treated as an unlawful action, a malpractice and a breach of professional and ethical code of conduct of a practitioner. Health is also a fundamental human right, and a nurse need to recognize, respect and promote the basic principles of human rights to the most attainable limit possible. Here it can be seen that basic human right is denied as patient is unaware about the procedure, its pros and cons, cost, and other health related outcomes.
Lack of attention to safeguard and protect human right can have severe consequences on both patient and nurse and other healthcare workers. If the basic human rights are neglected or violated due to lack of care or honesty or unprofessionalism, it may lead to serious medicolegal issue (Consumers Health Forum Australia, 2016). In Australia, the nurses also need to understand the link between human rights and operational framework and promote the culture, value system of the Australian communities. A particular individual or a group of beneficiaries might have different socio-cultural value system which guides their decision making process- a nurse should identify and differentiate so as to respect their value system and diversity of Australian communities (Consumers Health Forum Australia, 2016). Overall it can be said, that all over the world nurses are the primary touch points of any healthcare delivery system, and they need to provide compassionate and culturally responsible, competent care with patient’s dignity and privacy safeguarded.
The preset case is discussed further with the help of professional guidelines, standards and benchmarks of nursing practices laid by Australian Nursing & Midwifery Board, and other legal frameworks.
Value and ethics in nursing practice go hand in hand and yet they are sometimes confusing and overlapping in nature. In order to promote health and achieve desired outcome it is important to uphold patient’s dignity and confidentiality, but in real work scenario values may face a conflicting situation (Faden & Beauchamp, 2014). It is of utmost important to think rationally and opt for an ethical solution. An ethical guideline or framework in such scenario might relieve the complexity of the scenario. It is important for nurses to act in a recognized legal and ethical framework to avoid such conflicts. Professional guideline helps in making ethical and value based decision, and also supports the best attainable solution in any given scenario. A nurse need not only educate him or herself about medical knowledge but also should be updated on legal, professional and ethical framework and competency level (Nurses & Midwifery Board, Australia, 2016). Professional guideline helps in creating a safe and professional environment for both caregivers and beneficiaries.
A standard can be deciphered as a norm or an expected level of performance that can be achieved, measured and compared with actual performance level. Standard in healthcare delivery is of utmost important since health is intangible and to provide quality care the caregivers should be achieving the minimum level of performance. Standard helps in measuring performances by acting as a yardstick. Performances can be measured and compared against the set standard and methods and guidelines can be developed to improve efficiency of the health worker and healthcare delivery system.
The “Nursing & Midwifery Board (NMBA)” of Australia has developed standards for professional and registered nurses under “National competency standards for the registered nurse” during 1990s. The competency standards set by NMBA has undergone periodic review, modification and has been revised multiple times since its inception, so as to act in the best interest of healthcare providers, patients and all major and minor stakeholders of health care delivery system. Periodical rectification was also a part of maintaining consistency with the legal & political scenario to make it more relevant and contemporary in nature (Ralph, Birks & Chapman, 2013). The standards, while are based on broad principles, are also made dynamic, in accordance with the legislative requirement, and congruent for the nurses practicing in a health care delivery platform.
The competency standards set by Nursing & Midwifery Board of Australia (Competency Standards-NMBA, 2016) is organized into four different domains as follows.
Professional Practice Standards -are related to the knowledge, accountability, and responsibility of a practicing nurse. It requires a clear understanding of legal, ethical, and professional guidelines and ensures that legislative directives are followed accurately in order to protect rights of individual and groups while a part of health care delivery system.
Critical Thinking & Analysis - are self-reflecting appraisal tool. This emphasizes on professional development, enhancing knowledge and skills, and reflecting those in professional practice. It puts evidence based practice in forefront and helps the nurses in understanding the scenario to make better decisions.
Provision & Coordination of Care- A nurse need to assess patient’s condition as well as assessment of individual or groups and accordingly coordinating for an organized, seamless timely service by the healthcare delivery people and system.
Collaborative & Therapeutic Practice- It reflects on the importance of nursing care and how it is an utmost crucial part of interdisciplinary health care delivery system. It also focuses on building and nurturing professional relationships with patient and co-workers of health system.
Implementing Operating Protocols
To implement the standards designed and developed by NMBA the four categories of standards are described by the help of indicators. These indicators specify the various aspects of a standard, and explicitly describe how the standard can be achieved. To implement the protocols the nurses should carefully examine the indicators and perform their duties in accordance with the guidelines these indicators encompass all the aspects of four domains of standard- workplace behavior, personal development, professional ethics, legal aspects and value based framework. A careful and optimal establishment and implementation of standards helps in achieving standard operating protocol (Gastmans, 2013). It is wiser and easier for any health care delivery set up to follow a set of protocols which invariably becomes the organization’s discipline and culture and reflect the core value of the organization.
The present case study, as it has been discussed before, shows a nurse is performing a procedure on a patient without consent. The standard laid by NMBA strictly mandates the importance of an informed consent in the first domain of standards, i.e. Professional Practice Standard. In the professional practice standard domain, indicator 2.4 has an objective element which lays clear instruction regarding “informed decision”. It clearly says, a nurse should, “be protecting individual and group rights and help making informed decisions” (NMBA, 2016). In the domain of collaborative & therapeutic practice, in indicator 9, the standards clearly mandates for participative and informed decision making procedure by all healthcare stakeholders, i.e. all the healthcare providers and patient. Under the same domain of collaborative & therapeutic practice indicator 10 also says about communicating nursing assessment to all relevant healthcare stakeholders, i.e. service providers and beneficiaries (NMBA, 2016).
In recent time laws and legislative directives forms an important part in guiding healthcare delivery system. To achieve seamless and holistic healthcare delivery system healthcare workers must be aware of the recent developments in medico legal laws (Parahoo, 2015). As a registered doctor a nurse will be held responsible for his or her actions and decisions, which will have both legal and professional implications. Concern related to healthcare litigation is increasingly growing, and patients are becoming aware about their rights and subsequent legal course of action (Storch, 2011). A careful and thorough understanding of legal laws related to professional nursing practice is crucial as an accountable and responsible registered practitioner.
The laws related to healthcare are basically set standards so attain a minimum standard in service by the professional. These laws are certainly met by the standards developed by NMBA. Adhering to those standards one achieves to be practicing with required level of competency and a fair understanding of the laws (Tuckett, 2014). As a registered nurse one should abide by the legal requirements such as-respecting the patient as an individual, respecting patient’s family and their wishes, protecting privacy of the patient and uphold dignity, and help patients to make choices of his own by obtaining informed consent before any procedure. Unlawful practice such as performing a procedure without consent is a crime as per the law, and breach of professional ethics as per the standards.
Informed consent is the key to attain a participative decision while providing service to a beneficiary of the healthcare system. It serves as an agreement between two parties-the healthcare provider & the healthcare consumer- which helps in upholding patient’s right to choose or refuse a particular treatment (Faden & Beauchamp, 2014). It also helps in attaining participative decision. The job of informed consent is to make patient aware about the choices of treatment in the present condition of his health, an explain to him the pros and cons, side effects, cost and other relevant information dissemination required to make is own choice regarding the treatment ( Consumers Health Form, Australia, 2016).
Not following the rules of informed consent invariably denies basic right of a consumer of healthcare. To make a decision about one’s self health after having been well informed about the treatment choices is a basic human right, denial of which makes a person exhibiting unlawful practices (Chiarella, 2012). The result of not taking informed consent can have detrimental effect on the health of the particular consumer in question, results in malpractice, medical negligence, and further legal course of action.
The national organization looking after benefits of Australian Healthcare beneficiaries is “The Consumer Healthcare Forum of Australia (CHF)”. CHF works for betterment of healthcare delivery system by ensuring that Australian consumers of healthcare gain a safe, timely and quality service. Both CHF and NMBA have provisions where informed consent might have to be compromised. Such special circumstances can arise during a life emergency, a trauma, or accident injury, a cardiac arrest, or a stroke etc. Informed consent is only possible when the patient is capable to understand the information shared with him, and is capable to make his decision (NMBA, 2016). If the patient is a minor his family can take the decision for him, but if the child is capable to make choice he or she should be involved in the decision making procedure. If the patient is physiologically or psychologically incapable that is have diseases like paralysis or dementia or other neurological disorder his or her family must be involved in making health choices for him. The patient must be informed after the procedure whenever he is capable to understand the same (Consumers Health Forum Australia, 2016).
The nurse can check whether patient is awake or conscious on whom the procedure is being performed. He or she can stop the procedure depending upon in which level the procedure has been performed already. The witnessing nurse should check with the performing nurse whether she is following doctor’s advice, and if the decision has been taken on an emergency situation or on a patient who is not able to make is own choices or incapable under the present circumstances. If the patient is not capable, or the procedure is an emergency of life saving one, the witnessing nurse can further assess whether the decision was conveyed to family members, and whether the decision was a common decision achieved by multiple and all relevant healthcare providers. If the decision is not communicated to the other healthcare providers, it has to be communicated on urgent basis and assess the patient’s condition further. It is important to assess the severity of the treatment performed on a patient to minimize further collateral damages (Tuckett, 2014).
If the patient was capable to receive information to make his own choice related to the procedure, certainly the nurse is performing an unlawful practice and breaching the standards required to maintain. The incident has to be reported in an incident report form and the incident needs to be communicated to immediate supervisors In this scenario the patient and patient’s family needs to be informed about the importance of the procedure performed and all information related to pros and cons of the procedure needs to be communicated (Gerrish & Lacey, 2013). The nurse, who performed the procedure, should be monitored to prevent recurrences of the same. All the healthcare providers should act in unison to minimize the damage caused (if any) to the patient.
Nursing is perhaps the most important profession in the arena of healthcare delivery system as they are the primary touch-points and care givers. In light of the above discussion it can be concluded that the noble profession entitles one with immense responsibility. A practicing nurse is as accountable and responsible as a consultant for his or her performance, actions, behavior and decisions. The standards and legal framework help the nurses to safeguard their own rights and the ethical and value based approach to promote god health is equally quintessential to achieve professional success and delivering quality, equitable and timely service to all. Further it can be said that for a healthcare delivery system to work seamlessly, an integrated approach must be taken where all participants of health care system work in a holistic manner.
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