The law as an Integral Part of Nursing Practice - Essay Example

Dear Lin, Please request and ise your to just remove what needs to be removed, then SPECIFY which we need to ADD because I cannot exactlypoint out what your tutor means. I am already following the original content of the Instruction to use GIBBS cycle essay on the four domains of nursing… Please Place Title Introduction The law is an integral part of nursing practice and it is increasingly being used to regulate nursing practice and to impose new obligations on all health professionals in the interests of public safety. The scope of practice for each nurse is based on the individuals education, knowledge, competency and extent of experience. The primary intent of the legislation is public safety. Using the Gibbs (Gibbs, 1988) Cycle as format of this essay, I shall first describe what happened, reflect on my feelings and emotions, reflect upon practice placements as well as discuss developments in the four (4) domains: professional or ethical practice, care delivery, care management, and personal or professional development relating to learning outcomes for NMC 2004, giving details about what was good and bad about the experience, analysis of what sense I can make to the situation, and conclude what else could I have done. The discussion will be focused on the particular aspects of my practice and will provide indications to the learning and achievements in the process as well as areas that need further development   In a step-by-step process, I will describe the events or activities that happened as they exactly went under description. Description of feelings will follow that shall give the personal view and emotion that I went through as a student undergoing the whole process or activities, prior to the evaluation of experience that shall give an in-depth presentation of how the events and activities commenced. After careful evaluation, I shall present an analysis of the whole activities or events giving rationale and reasons why these occurred or what can be expected.   After the Analysis, I will present general and specific conclusions derived from the whole activities or experience that will then lead to outlining of personal action plans. Gibbs Cycle is circulatory and goes back to the whole process with an indication that improvement goes along the way towards perfection of practice or process. Practice Placement Description and Feelings In my practice placement, I have experienced all of the four domains of nursing practice as professional and ethical practice, care delivery, care management and personal and professional development. Definition for "Registered Nurse" (RN) or "Registered Professional Nurse" in a general view since there are now more non-UK and non-EU nurse professionals in the United Kingdom goes, “are professional nurses who often supervise the tasks performed by Licensed Practical Nurses, orderlies, medical assistants and nursing assistants. They provide direct care and make decisions regarding plans of care for individuals and groups of healthy, ill and injured people. Some nurses may have a Bachelor of Science in Nursing degree, which makes specialising in fields such as psychiatry (psychiatric nurse) or anaesthesiology more feasible, but in many states the Associate of Science in Nursing is the entry-level degree for those entering the profession. Regardless of degree, they have many hours of clinical experience,” from the Ask.com (2006). With the purpose to inform professionals of required conduct in the exercise of their accountability and practice, as well as inform the public about what to expect from registered practitioners, the nursing standard (NMC, 2002) provided for the Code of professional conduct so that nay registered nurse is expected to be accountable for their practice in caring for patients and clients. Specifically, they must respect the patient or client as an individual, obtain consent before giving any treatment or care, protect confidential information at all times, cooperate with the team members, always trustworthy, and must act to identify risk to patients or clients as shared by the United Kingdom health care regulatory bodies. As a health professional, registered nurses must protect and support the health of individual patients and the wider community, act in justified ways that win the trust and confidence of the public, and uphold or enhance the desirable reputation of the profession. In like manner, a registered nurse is accountable for the practice, so that a nurse is answerable for all actions or omissions “regardless of advice or directions from another professional,” (NMC, 2002). Nurses have a duty to care for patients and clients that are entitled to receive safe and competent care and must adhere to the laws of the country in which the nurse is governed under. In respecting the patient or client as an individual, the nurse is expected to recognise and respect the role of patients and clients as partners under their care. That the individual patients can contribute in this partnership so that preference of the client must be considered “within the limits of professional practice, existing legislation, resources and the goals of therapeutic relationship,” (NMC, 2002). In addition, NMC pointed out that the nurse is “personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs.” The nurse must be at all times “maintain appropriate professional boundaries in the relationships you have with patients and clients. You must ensure that all aspects of the relationship focus exclusively upon the needs of the patient or client,” (NMC, 2002). The nurse is also expected to promote the interests of patients such as assisting in gaining access to health and social care, information and support for their needs. They “must report to a relevant person or authority, at the earliest possible time, any conscientious objection that may be relevant to your professional practice. You must continue to provide care to the best of your ability until alternative arrangements are implemented.” In obtaining consent prior to giving treatment or care, the RN is best advised that “All patients and clients have a right to receive information about their condition. You must be sensitive to their needs and respect the wishes of those who refuse or are unable to receive information about their condition. Information should be accurate, truthful and presented in such a way as to make it easily understood. You may need to seek legal or professional advice, or guidance from your employer, in relation to the giving or withholding of consent,” (NMC, 2002). The RN “must respect patients’ and clients’ autonomy - their right to decide whether or not to undergo any health care intervention - even where a refusal may result in harm or death to themselves or a foetus, unless a court of law orders to the contrary. This right is protected in law, although in circumstances where the health of the foetus would be severely compromised by any refusal to give consent, it would be appropriate to discuss this matter fully within the team, and possibly to seek external advice and guidance,” (NMC, 2002). The valid consent is further ensured to be implemented by a legally competent professional, given voluntarily and the patient must be informed.” The RN must at all times, “presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can use it to make an informed choice,” (NMC, 2002). Also, they must bear into mind that, “Those who are legally competent may give consent in writing, orally or by co-operation. They may also refuse consent. You must ensure that all your discussions and associated decisions relating to obtaining consent are documented in the patient’s or client’s health care records,” (NMC, 2002). In cases where “patients or clients are no longer legally competent and thus have lost the capacity to consent to or refuse treatment and care, you should try to find out whether they have previously indicated preferences in an advance statement. You must respect any refusal of treatment or care given when they were legally competent, provided that the decision is clearly applicable to the present circumstances and that there is no reason to believe that they have changed their minds. When such a statement is not available, the patients’ or clients’ wishes, if known, should be taken into account. If these wishes are not known, the criteria for treatment must be that it is in their best interests,” NMC (2002). Even mentally incapacitated clients or those detained under statutory powers, obtaining consent applies so that even if directly involved, the psychiatrist may be involved and that the RN must be aware of all “circumstances and safeguards needed for providing treatment and care without consent,” (NMC, 2005). When unable to give consent such as in emergency cases where treatment is necessary, the RN may provide care without consent but RN must demonstrate that the action is for the patient’s best interest (NMC, 2002). All competent adults provide consent for themselves whilst in cases of children below 16 (England and Wales), 12 in Scotland, and 17 in Northern Ireland, parental consent is important (NMC, 2002). The individual involved in the performance of care must be the one to obtain consent, unless a trained staff may perform it for another. Use of complementary or alternative must be ensured as safe and for the interest of the patient but must be discussed with the team as part of the therapeutic process and that patient must also consent to its use (NMC, 2002).Cooperative work within the team with respect for all individual members without discriminatory acts is expected and the “team” is defined as the patient or client, client’s family, informal caregivers, health and social care professionals in the National Health Service, as well as independent or voluntary sectors (NMC, 2002). When working as a member of a team, the RN remain accountable for all professional conduct, care provided and any omission on RN’s part and in delegating care delivery to those who are not (yet registered, it must be ensured that the act will not compromise existing care and that even in delegation, the RN is accountable (NMC, 2002) so that supervision is still necessary. RN is also dutybound to cooperate with internal or external investigations. I learned that controlled drugs are kept in a double lock cabinet on a wall. Two trained nurses have to sign and give date, time and amount of drugs given prior to release of drugs, and also, both nurses have to witness and supervise medication being given to patients. These drugs are checked twice a day by two staff members and if a controlled drug is missing, I had to notify the pharmacist in-charge in investigation and finding the drug. I also learned that other medications were kept in a locked trolley, and during rounds, any drugs found cannot be administered to patients. These are discarded in a sharp bin for proper medication identification and disposal. Other patients who inquire about other patients are not given information. All handovers, meetings, discussions with patients and staff were held in closed door with minimal disruption. If a multidisciplinary team is involved in a meeting, one person will take control of meeting as chair and will bring the meeting to order, propose avenues, treatments and recommendations after hearing from all involved. In a case of arranging a termination of pregnancy with a young school girl, nobody from the medical team should inform mother of daughter’s decision to have the termination. If a person does not speak same language, an interpreter must be engaged who is non biased and neutral. Ask interpreter for proper relation of patient’s communication verbatim. When surgery is needed, patient signs consent form and ensure that interpreter signs relevant section. This cannot be designated to family members, friend, or peers. Muslims, Jewish people do not eat pork. When nursing a patient who is not able to complete own menu. Order what he would like to eat. Bear in mind about the pork and engage assistance of visitors of his for this purpose. Under care delivery, I had no prior knowledge of before module 2 placement that during internal examination on female patient, I can ascertain if she has had vaginal delivery previously. Also, by washing the hands correctly and applying universal precautions such as protective gloves, aprons, and eyewear, I am preventing the risk of infection being passed on. Under care management, in a Radiotherapy undergone for several weeks during Mondays to Fridays at 10 minutes daily, certain areas are targeted. I learned that healthy cells are damaged, or destroyed in process although I cannot exactly recall ratio of healthy against cancerous cells destroyed. Before placements 1 and 3, I was not aware that women who are given chemotherapy experience hair loss or going bald, unable to conceive or have early menopause. Neither was I aware that women who have been diagnosed as having BRCA 1/2 experience further problems which affect every aspect of their life such as application for a mortgage will be denied, no insurance company will cover them, maybe easily denied or rejected when applying for employment due to being unable to fulfill role. They could not be relied upon for clinic radiotherapy appointments and admissions. When taking a temperature, I was able to perform this correctly. I did not understand or have knowledge of what was happening within the internal environment such as hypothalamus, negative feed-back, meninges. As high temperature may be a negative feed-back, it will not right itself and intervention is required such as removal of excess clothing, introduction of fan, aspirin – interlukin. Previously, if I had a patient who had blood in the urine, I would not have then known to be of several probable causes such as kidney stones, tumor, trauma, cystitis, or monthly period. When observing an anesthesiologist during visit to a patient prior to surgery, I am able to understand why he asks the questions and I gain further knowledge such as the grade A.S.A 1, 2, 3 to detect if it will be a smooth intubation or a more challenging one and also asking the patient if they have experienced reflux - cardiac sphincter. If during previous surgery, have they ever experienced being awake during surgery or shock. One muscle relaxant suxamethonium has been found to cause shock in some patients. When caring for a patient after returning to the ward from surgery noted opiod sensitivity, which although I had heard off previously I had not easily understood. And under personal or professional development, understanding patient’s verbal, non-verbal or written consent is necessary before any treatment or procedure. It is also very important that the proper patient identification is establish prior to attaching correct wristband with the correct details in order to maintain safety. During the placement, I also learned that the patients’ notes were kept in a locked trolley at all times to maintain confidentiality and privacy of patients. The patients’ records are also closed in the nurses’ station so that those who are not allowed to see them are not privy. Both patients and peers must be kept safe at all times in a well-lit, well-ventilated, convenient and welcoming environment. Before performing any procedure I must ensure the environment is safe at all times. If cot sides are attached to bed, I must find out if they function properly. The same applies with brakes on the bed as patients may fall out of beds due to improper judgment of size, or disorientation as result of medication. That is why cot-sides should be put up and brakes are applied. In treating a chronically ill patient, I learned that it is better and proper to ask him closed questions as open ones would clearly distress him more. One experience that stood out in my experience though, is when I encountered a porter who was nasty and rude even in front of patients where he openly discussed how his fellow professionals in the team were not as competent as he expected them to be. In this particular area, the patient, who was under my care, got upset and cried afterwards in her room. These are all my experiences during the placement which I could relate well to the four nursing domains. Evaluation Under the Professional or Ethical practice, I was able to understand as well as relate well with the function in accordance with the legislation and common law practice affecting nursing practice as can be observed by mentor. With proper guideline and instruction, I was able to demonstrate my knowledge in the legislation of common law pertinent to nursing practice within the requirement for medication of patients, and legal implication of nursing intervention. My actions can be reflected of awareness of legal implication since I am answerable to both the patient and the public. According to Benner (1984), the domains of nursing are basically helping, teaching-coaching, diagnostic and patient monitoring, managing rapidly changing situations, administering and monitoring therapeutic interventions, ensuring quality of health care, and organizational and work-role competencies. His domains outline problem solving and describe what it is that nurses have to do. The domains of nursing provide a theoretical framework for guiding nursing care that includes assessment, diagnosis, planning, intervention, and evaluation in the implementation of nursing practice (Benner, 1984). I can personally regard the positive aspects of my performance as punctual, smart in appearance, respectful, and maintains dignity at all times. I also have the ability to retain information, use communication and practical skills in demonstrating knowledge beyond what is required. I have always been punctual, eager to learn, have full attention to details, ensure clean and safe environment, as well as communicate effectively with colleagues and mentors. I work well, contribute to the team work, and I am polite, with a friendly calm approach. I continue carrying out safe practice, sought assistance when needed and made the most of placement requests. I also visited other departments, and have gained further experience while employing the universal precautions as required always in smart appearance I effectively worked as part of a team with members of the public. I have displayed proper knowledge, while my skills were able to relate to research and evidence of reading. I had performed all tasks safely, competently and confident. I also require minimal supervision when planning care. I have gained the ability to “pick up” details which requires some form of intervention and I am able to prioritize and work well even when staff shortage occurs. I also openly admit that I need to improve eye level response, as well as familiarize myself with medication that can be administered and those that cannot. I also need to know more about administering humidified oxygen therapy. I need more experience in observing a patient who is needs nurse care service and in providing care thereafter. I also need to familiarize myself with more data about symptoms to identify illness from symptoms that are presented by patients. Similarly I find it necessary to be well aware of all relevant laws that apply to out-patients and in-patients Not to oversee the importance of community support, I also aim to learn more about networks that are available to the patients, especially for the outpatients and those who are in real need of health and social care support. I need to be aware of correct diagnosis and the effect misdiagnosis can pose on the patient while I also want to ensure I make the most of placement when working in unfamiliar areas. Other than the mentioned above, I also desire to know more about the different types of care offered to out-patients as more and more patients now require home-care. Analysis With the institution, I was able to discuss with a charge nurse details regarding health promotion. We also discussed about the relevance of health of a nation socially and economically. When administering subcutaneous injection, I informed him that I am accountable to the members of public, fellow peers and society. While he is already professionally accountable as he is a registered nurse, I was not since I have not yet registered. Prior to arriving on the ward, I have read additional materials regarding nurse care. During the discussion, I was able to show understanding and relate to what was being presented at that time. I also assisted the doctor with procedures, anticipating what would happen to the patient afterwards. Certain signs and symptoms presented by patient which I could relate to previous reading were already familiar. These things are very important in the nursing practice with the four domains because there is a reminder of the important things not only to keep in mind while in practice but also practice for improvement and perfection. Likewise, I was able to evaluate that I may need to develop confidence as sometimes there are issues I was unsure of but whilst I had the skills and knowledge to undertake certain skills, that is, care planning, a little prompting is required. In Module 2 I performed at the level expected for a module 2 student, identifying my own development, and always maintaining safe practice. Overall, I am a safe-practising student nurse who sought assistance where necessary. I had been a good and valuable member of ward teams and can work and fit in as a team member. I also demonstrated good communication, that is, assertiveness and listening skills which are essential for good patient care. I was pro-active in achieving my learning outcomes and put a lot of effort into placement. Under this practice, the four domains of nursing practice are covered as professional or ethical practice, care delivery, care management, and personal or professional development. I had been expected to undertake and demonstrate respect for and promote the rights and choices of individuals and groups. Rationale: Practises in accordance with nursing code of ethics, Individuals or groups to whom care is provided are accepted regardless of race, culture, religion, age, gender, sexual preference, physical or mental state. That I work effectively as part of a team. Rationale: Responsibility and Accountability for own actions within nursing practice, Since health care management is undertaken usually by a team of professionals such as doctors, nurses, social worker, other health professionals, I must consult with an experienced registered nurse when nursing care requires expertise beyond my own scope of competence, and also consult other health care professionals for appropriate actions to be undertaken specially when there are unclear or not understood decisions to make. That I maintain the privacy and dignity of patients and clients. Rationale: Maintenance of an environment which promotes safety, security and personal integrity of individuals, to identify situations which may threaten the dignity/integrity of individual, measures are implemented to maintain dignity during periods of care. I maintain confidentiality at all times. Rationale: Conducts nursing practice in a way that can be ethically justified, confidentiality of records and interactions with others is maintained, discussions concerning individuals are restricted to settings, learning situations and relevant members of health care team. That I provide appropriate care for patients/clients regardless of age, culture, religion, disability, gender, race or sexuality. Rationale: Protects the rights of individuals in relation to health care, strategies for the promotion and protection of individuals rights are identified and adhered to, the rights and social bias of individual are taken into account when providing care, the right of other to their opinions is respected. That I demonstrate effective communication and interpersonal skills. Rationale: Communicate effectively with individuals and families, a range of effective communication techniques is utilised, language appropriate to context is employed, attempts are made to establish alternative communication methods where the individual is unable to verbalise, information is systematically recorded in an accessible and retrievable form. That I provide care safely and effectively at the expected level of achievement. Rationale: Acts to enhance the safety of individuals at all times, relevant principles are applied to ensure the safe administration of therapeutic substances, standard for infection control are adhered to. That I request and use help and refer to other members of the multidisciplinary team appropriately. Rationale: Responsibility and Accountability for own actions within nursing practice, consults with experienced registered nurse when situation is judged as beyond own scope of competence, appropriate members of the health care team are consulted when required. That I act in a professional manner and practise in accordance with the NMC Code of Professional Conduct. Rationale: ethical aspects/ dilemmas of nursing care in the work setting are identify and explained. That I have insight into my own performance and I am able to identify learning needs. Rationale: recognise own knowledge base/scope of competence, decisions are made about care within scope of competency without consulting with senior staff. I settled well onto the ward, is highly motivated and enthusiastic learner. I also know my limitations and when to seek assistance from the appropriate senior staff. Punctuality toward times and also carrying out tasks promptly. And although these may be considered positive, there are also areas I need to develop such as build up more confidence in approaching other members of the multi-disciplinary team. Maintaining eye contact as part of an essential communication tool. I must settle in the ward as part of the team, my actions demonstrate genuine concern for patients I care for with safety. During this placement, in addition to the learning outcomes in the Practice-Based Assessment, I would like to practise the clinical skills from the Schedule on how to look after a patient returning from the theatre, monitoring drain and catheters recording on fluid balance chart, aseptic techniques, dressing of wounds, care for patient pre and post-op urinalysis, manual blood pressure, administer anti-coagulants s/c injections, prepare and assist during screening. After a period of time, I also aim to be able to prepare slides for staining and develop further my skills, working as part of a team and team from each experience. I have discussed this with my mentor and it has been agreed that I will be allocated a patient to follow through theatre, recovery and post-operatively and manage the care required wider supervision, that is, catheter care; urine output, fluid balance care plans etc. I will also have the opportunity to practise administering subcutaneous injections under supervision and reflect on this. Most patients will require wound dressings done therefore I will be given the opportunity to practise this. That I will spend a day at the Sexual Health Centre with Health Advisors to look at “fraser guidelines” and legislation specific to sexual health and to look at other agencies commonly referred to from Sexual Health. Conclusion Reflecting on the experience further, I knew I did not at any time place the patient, or myself in danger, nor did I demonstrate bad practice. If I had asked a neutral observer to evaluate my action and give me feedback, he would probably have stated that I performed very well indeed, considering what had been presented. Yet this still did not stop me feeling the way I did. Normally I do not need praise, reward or support in fulfilling my work; yet that day I felt that I could have run out of the building had sister not shown me her warm, genuine and very natural concern. Reflecting further, the experience that I am sharing now validates the psychoanalytical theory of Sigmund Freud who found through his work that we have a conscious, pre-conscious and unconscious level which exists within the human mind. Also, I have concluded through experience that I voice concerns to other people when they are not in orderly manner – stating to them that, like me, they are a professional and a valuable team member and has a duty of care which they should extend to each patient, respecting each individual, preserving their dignity at all times. They should provide individual care regardless of age disability, gender, social, cultural, economical background as stated in the Nursing and Midwifery Council Code of Professional Conduct 2002. Like me, others in the team are also expected in a professional way, ensuring each patient does not experience stress, emotional upset and vulnerability. That our actions reflect not just on one but also on the trust and other team members. In view of all the lessons, mentoring, actual assistance and care provided when it comes to Profession / Ethical Practice contained the competencies that relate to legal and ethical responsibilities, including the demonstration of a satisfactory knowledge base, being accountable for practice, functioning in accordance with legislation affecting nursing, and the protection of individuals and groups rights. On Critical Thinking and Analysis, my experience further taught me that this domain teaches competencies relating to self-appraisal, professional development of self and others, and the value of research. The reflection on practice, feelings and beliefs and the consequences of these for clients is an important professional benchmark especially for nursing aspirants or health care providers. Also the Management of Care contains the competencies that relate to the assessment of patient or client, the planning, implementation and evaluation of care. Under Enabling, I have learned competencies important for establishing nurse and patient relationship. That this domain also integrates the maintenance of safety, skills in interpersonal and therapeutic relationship, and communication, as well as the organizational skills to ensure provision of care. Action Plan: With careful analysis and consideration of all that transpired in the placement and all chosen activities or experiences, I have resolved to do my action plan to reflect on aspects of performance, complete my performance mostly unsupervised, realise dangers quickly, apply common sense throughout my work or duty, communicate effectively with fellow professionals and clients, demonstrate caring skills more often, understand expectations of others, carry out appropriate actions, and relate practice with theory. By following closely to the above, I hope to achieve satisfactory results in most of my performance, especially when I am already a health care provider. That furthermore, it was not appropriate time or place to talk about matters that affect professional image with a colleague in front of the patient. That we should reflect on our performance throughout and initiate the necessary changes for future practice ensuring that each patient is given the correct care which they are entitled to and deserve. For patients, they should also voice ones concerns that they should approach things slowly; there is no need to rush and that by trying to achieve things quickly accidents may occur; and that they may cause injury to themselves or the wound site. I have resolved, for my own professional and personal improvement not to presume, observe each case that presents as a genuine human experience throughout my practice, avoid questioning others actions throughout, utilise every opportunity to learn allowing professional development, gain further understanding of ones capabilities and limitations, and to improve my technique skills. This, I believe could help me understand better my importance as a professional and health care provider. References Ask.com. (2006). “Nurse”. Ask Corporation. Benner, Patricia. (1986). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Cullis T. Dolan L and Groves D, (1999) Psychology for you. Cheltenham, Stanley Thornes (Publishers) Ltd. 1999. Hogston R and Simpson P M, (2002) Foundations of Nursing Practice Making the Difference 2nd Edition. London: Palgrave Macmillan. Nicol M, Bavin C, Bedford-Turner S, Cronin P and Rawlings-Anderson K, (2003) Essential Nursing Skills 2nd Edition, Edinburgh: Mosby. 2003. Nursing and Midwifery Council (2002). “Code of Professional Conduct.” April. Russell, Phil. (2002) “Social Behaviour and Professional Interactions” from Foundations of Nursing Practice Making the Difference by Richard Hogston and Penelope M Simpson 2nd Ed. Palgrave Macmillan London. Virtual Tutor Workbook, Institute of Health Sciences, St. Bartholomew School of Nursing and Midwifery, City University London Read More