Nursing for Ethics and Law

Discuss about the ursing for Ethics and Law.

Introduction:

The aim of this essay is to analyse and assess the case scenario of the Sunny land Day Respite Centre. Additionally, the essay shall also include the law and legislation that exists in the health industry arising from an unexpected death of a patient. The ethical issues in the case study shall be discussed and the implications that could in relation to Enrolled Nurse, Registered Nurse and family members shall be discussed.

Consent, restraint, assault and battery:

Obtaining consent in a health industry is very important. The consent may be obtained in either written form or verbal form. A valid consent is the one that is obtained voluntarily from the patient without any inducement or fraud (Forrester & Griffiths, 2010). Additionally, it is also important that a person from whom a valid consent is obtained have competency to provide the consent knowing and understanding the facts and circumstances of the case (Garity, 2009). In the given case study, Mrs. Davis did not give the consent voluntarily and there is no valid evidence that suggests that the consent was authorised. When patients go beyond their ordinary control, they may be restrained. However, the process of restraining a patient should be authorised by a doctor or used with the consent of the family members. If the person is restrained by not following any of the above-mentioned criteria then it may be said to formation of a claim of false imprisonment (Guo, 2008). Hence, in this case, since the above-mentioned criteria have not been followed it may be said that Mrs Davis was falsely imprisoned.

An additional issue that may arise from the case study as an outcome of the use of restraint is battery and assault. Assault means use of unwanted physical interference and battery means touching a body of a person without their valid consent. Thus, in the given case study, battery and assault were used on Mrs. Davis. 

Duty of care, negligence and vicarious liability:

The principle of duty of care was formulated in the case of Donoghue v. Stevenson in the year 1932.  In this case, Lord Atkin held that there is an obligation on all to utilise his general duty of care and to take reasonable care to foresee injury that has the likelihood to take place. When a person breaches his general duty of care, the liability of negligence takes place. Thus, to determine whether an action, was negligent or not, the presence of the following elements becomes important:

• A person owned duty of care
• Contravention of duty of care
• As a result of the breach of care, a harm was caused to the other person.

Thus, negligence may be established on the part of the doctor or the hospital. The person who makes the claim has the responsibility on establishing that negligence took place on the part of the doctor or the hospital. Thus, in this case also it may be said that the RN was not careful in exercising her duty of care in a reasonable way. While she was using her authority to restrain Mrs. Davis she should have made use of her ordinary sense of care and used in a way that did not lead to injury or harm on Mrs. Davis. Thus, the RN breached her duty of care and was negligent on her methods of controlling Mrs. Davis. In this case, the Respite Centre shall be held vicariously liable for the negligent action of the RN.

Scope of practice (the legal and professional boundaries imposed upon you as a nurse):

The Nursing and Midwifery Board of Australia (NMBA) recognises that nurses acquire and develop special qualifications and expertise throughout the course of their practicing nursing. It is an expectation that nurses shall be competent in the specific area of practice needed to meet the needs of their clients. According to Registration and Endorsement guidelines, nurses who practice as registered nurses should have at least completed 3 years of prior practicing in their area of nursing. It is the duty of a nurse to get authorisation from the doctor if they think that the patient requires attention and more than the requisite (Australian Nursing Federation, 2005). Thus, in this case study, as well, the RN should have used her authority after receiving consent from the doctor; she could have restrained Mrs. Davis. Additionally, it may also be stated in this regard that the RN in the first place should have first considered about the fact whether there was need of restraining Mrs. Davis or not. The EEN questioned the RN about restriction of her movement, as she did not think that Mrs. Davis needed restriction. Thus, it may said that the RN acted beyond her scope of practice while the EEN acted within the scope of practice.

Advocacy (the nurse’s role as an advocate for the client):

In today’s world advocacy has become a central part of ethics in professional nursing practice. The link between nurses acting as advocate of their client is evident in professional organisations such as American Nurses Association (ANA) and the American Association of Critical Care Nurses (AACN). The ANA has laid emphasis on the role of nurse as advocates and encouraged them to take a protective attitude in relation to their patients. The ANA has also stated that the nurses should promote and strive for the protection of health, safety and rights of the patients (Crisp et al., 2013). As per the third provision of the ANA, the nurses have the responsibility of safety and protection of the client along with privacy and confidentiality during the research. In the practice of nursing, nurses should start from the point of strong advocacy as protection (Day, 2006). It is easy to follow the principle of “us against them” as a way of thinking in which nurses start to see themselves as advocates of patients while establishing suspicion of other members in the health care team.

Documentation:

In a health industry, documentation is very important as it ensures that there is continuity of care and it serves as a tool of communication between health care providers. Additionally, documentation also helps in the evaluation and planning of treatment of a patient and creates a record if similar circumstances take place in the future. In the given case study, the description of Mrs Davis should be listed. The description primarily includes the physical description of the patient and the health condition of the patient. The episodes of contact with the RN and EEN should be contained in a written format as part of the documentation process. Medical records should be contained in a legible and informative handwriting. The course of treatment of Mrs. Davis should be included, as part of the medical documentation and it should include details of the ailment of the patient. Additionally, it is part of the legal requirement to maintain medical records as the police officials may ask for the documents as part of their investigating process. The police officials conduct an inquiry depending on the medical records given to them as part of their legal process.

Open disclosure and The Coroner:

Open disclosure means an open discussion of incidents that is an outcome of patient’s harm while they were receiving health care, with the patient, or their family or some other concerned person (Australian Commission on Safety and Quality Health Care, 2013). In the case study, open disclosure is very important, as it will help in identifying the adverse event of Mrs. Davis and will help in assessment to determine the level of response of Mrs Davis. Moreover, it will also help in avoiding speculation and blame and will help in maintaining good internal communication throughout the process.

A coroner is a person whose role is to confirm and certify the death of a person within a given jurisdiction. A coroner may conduct a command of investigation into the manner or cause of death and investigate and confirm the identity of the person who is unknown and has been found dead within the jurisdiction of the coroner. In the given case study, the role of the Coroner would be to investigate into the matter that caused death of Mrs. Davis and whether or not, the RN was negligence that caused death of Mrs. Davis.

In the given case study, as an EEN, I have been presented with a problem that has led me to a dilemma. The RN has suggested me to lie about what happened with Mrs. Davis or else it shall bring trouble for both of them. There are many decision making model that is available in the field of healthcare industry (Cooper, 2012). However, the DECIDE model is recommended for nurses (Allen et al., 2008) and I shall follow the DECIDE model for taking the decision in this situation. The process of DECIDE MODEL includes:

“D= definition of problem

E= Establish the criteria

C= Consideration of the alternatives

I= Identification of the alternative

D= development and execution of plan of action

E= Evaluation and Monitoring the solution”

In the given situation as an EEN my responsibilities included that I should act in a safe and competent manner and act in accordance with the code of professional practice in Australia (McDonald, 2010). Nurses have the responsibility of acting as impartial and provide honest and accurate information in relation to nursing and health care practice (Australian Nursing & Midwifery Council, 2002). Thus, as an EEN I should not be influenced by the RN and should inform the investigating authority about the incident that truly happened with Mrs. Davis. As a nurse, I have the responsibility of building trust and confidence in the profession of nursing. If I do not disclose proper information to the people and the Coroner, people may reduce their belief in the profession of nursing (Australian Nursing & Midwifery Council, 2008a).

Conclusion:

Conclusively, it may be stated that the case reflects complex legal and ethical issues that can take place in a heath care setting when an adverse event takes place. Thus, it is important for nurses to understand the framework and codes, which guide their practice and are aware of the models that help them in taking proper decisions.

References:

Allen, S., Chapman, Y., Francis, K., & O’Connor, M. (2008). Supporting nurses to make ethically sound decisions when nursing aged care residents at the end-of-life: Using the DECIDE model. Singapore Nursing Journal 35(2), 4-11. Retrieved from the CINAHL database https://www.ebscohost.com

Australian Commission on Safety and Quality Health Care. (2013). Open disclosure of things that don’t go to plan in health care: A booklet for patients beginning an open disclosure process. Retrieved from http://www.safetyandquality.gov.au/wp-content/uploads/2013/05/SAQ083_Patient_guide_OPEN_DISCLOSURE_INTERNALS_V5.pdf

Australian Nursing Federation. (2005). Competency standards for nurses in general practice: Scope of nursing practice. Retrieved from: http://anf.org.au/documents/reports/compstandards_nursesingp.pdf

Australian Nursing & Midwifery Council. (2002). National competency standards for the enrolled nurse. Dickson, ACT: Author. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#competencystandards

Australian Nursing & Midwifery Council. (2008a). Code of Ethics for Nurses in Australia. Dickson, ACT: Author. Retrieved from

http://www.nursingmidwiferyboard.gov.au/Search.aspx?q=code%20of%20ethics

Australian Nursing & Midwifery Council. (2008b). Code of professional conduct for nurses in Australia. Melbourne, Australia: Nursing & Midwifery Board of Australia. Retrieved from http://www.nursingmidwiferyboard.gov.au/Search.aspx?q=code%20of%20professional%20conduct

Cooper, R.J. (2012). Making the case for ethical decision-making models. Nurse Prescribing 10(12), 607-611. Retrieved from the CINAHL database https://www.ebscohost.com

Crisp, J., Taylor, C., Douglas, C., & Rebeiro, G. (Eds.) (2013). Potter & Perry’s fundamentals of nursing (4th ed.). Sydney, Australia: Elsevier Australia.

Day, L. (2006). Advocacy, agency and collaboration. American Journal of Critical Care 15, 428-430.Retrieved from http://ajcc.aacnjournals.org/content/15/4/428.full.pdf+html

Forrester, K., & Griffiths, D. (2010). Essentials of law for health professionals (3rd ed.). Sydney, Australia: Elsevier Australia

Garity, J. (2009). Fostering nursing students’ use of ethical theory and decision-making models: Teaching strategies. Learning in Health and Social Care 8(2), 114-122. DOI: 10.1111/j.1473-6861.2009.00223.x

Guo, K. L. (2008). DECIDE: a decision-making model for more effective decision making by health care. The Health Care Manager 27(2), 118-127. Retrieved from http://www.nursingcenter.com/lnc/static?pageid=800371

McDonald, C. (2010). A guide to moral decision making. Retrieved August 6, 2013 from http://www.ethicsweb.ca/guide/guide2010.pdf

Park, E-J. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics 19(1), 139-159. DOI 10.1177/0969733011413491

Queensland Government. (2012). Open disclosure program. Retrieved 7 August, 2013 from http://www.health.qld.gov.au/psq/od/webpages/od_homepage.asp

Queensland Nurses Union. (n.d.). Advocacy factsheet: Recognition that nurses are well-placed advocates for patients and their families. Retrieved 7 August, 2013 from http://www.qnu.org.au/__data/assets/pdf_file/0012/214104/NFYFL-Factsheet-Advocacy-FINAL.pdf

Queensland Nursing Council. (2008). Scope of practice – framework for nurses and midwives. Retrieved from http://www.health.qld.gov.au/parrot/html/documents/nursingscprac.pdf

TAFE Queensland. (2014). HLTEN509B Apply legal and ethical parameters to nursing practice [Study topics and presentations]. Retrieved from the TAFE Queensland Gold Coast: http://my.tafe.qld.gov.au