Ethics and Law in Mental Health Nursing - Essay Example

?Ethics and Law in Nursing: Mental Health Case Study Introduction Modern health care s give main focus on meeting effective nursing standards. In the changing healthcare scenario, nurses must ensure the applicability of social justice as the most effective way to deliver effective nursing services. The value of social justice evolves from the elements like respect, impartiality, dignity, and tolerance. In the given case, a depressed 47 year old man who is diagnosed with leukemia is currently undergoing ECT treatments in a psychiatric care setting. Since the severely depressed person is refusing to have food or water, nursing staff frame an emergency care strategy to force-feed the patient through an NG tube after obtaining the consent from the patient’s next of kin. This paper will focus on the professional, ethical, and legal implications of the case scenario. Patient analysis Evidently, the patient is under severe depression. An untreated clinical depression may generally last from six to 24 months. Clinical psychologists opine that the chance of recurrence of this disorder is high unless the symptoms have not been resolved properly with treatment. Clinical reports reflect that the condition of major depression often co-occurs with a sequence of other psychiatric problems including lifetime anxiety. Richards (2011), indicates that anxiety symptoms will worsen the depressive illness with a slow pace recovery, increased risk of reoccurrence, greater health problems, and increased suicide tendency. It is also seen that individuals with severe depression may develop cardiovascular diseases if they do not obtain effective treatment on time. In the view of experts in clinical psychology, people with severe depression would not be willing to follow medical recommendations for eliminating the chances of cardiovascular diseases, and this situation may further increase their risk. In short, people suffering from a major depressive disorder must get proper treatment to completely recover from the disorder. Similarly, the individual has been recently diagnosed with leukaemia and it greatly increases his risk as this disease may lead to complications including repeated infections that are potential to reduce the immunity of the patient. Physicians opine that kidney failure and a fall in number of neutrophils will be the common complications of leukaemia. Finally, the case context tells that the patient is currently undergoing an electroconvulsive therapy (ECT) in a psychiatric care setting. The ECT treatment can have a great influence on the patient’s memory, general cognition, and brain structure and hence he may face troubles with normal thinking and decision making. Legal implications From the patient analysis, it is obvious that the patient is suffering from a severe depression and leukaemia and he may also get impacted by the side effects of ECT treatment. However, the patient is not in an extreme critical situation and he has the ability to see and hear events around him and respond to it verbally. Hence, the nursing staff cannot legally plan a nasogastric (NG) tube insertion for force-feeding the patient. According to Nursing & Midwifery Council (NMC), nurses must treat patients as separate individuals and respect their dignity. While stating the significance of treating individual differences, the NMC specifically says that a nurse has to act as an advocate for the patient and assist them to access relevant health and social care information. The case scenario indicates that the person had not been properly informed about why NG tube insertion became necessary for him. Hence the nurses’ practice is the violation of the code of conduct of the NMC. The NMC guidelines for NG tube insertion clearly say that care providers must obtain consent from the patient if he has the ability to express his views. In the given context, the nursing staff obtained consent from the patient’s relatives even if the patient had the ability to express his interests. Hence, the nurses violated the rule of NMC that states care givers must “respect and support people’s right to accept or decline treatment and care”; in addition, patients have the right to refuse NG tube insertion as it relates to their basic interests (Drugs.com). Therefore, the individual’s basic right to avoid NG tube treatment has been curtailed by the unfair decision of the nursing staff. The NMC code of conduct also states that the nurses must ensure that patients who lack mental capacity remain at the centre of decision making process. However, it seems that the nurses in the given case have not taken any initiative to include the patient for decision making. Here, the nursing staff should plan some counseling programs to convince the patient about the complications of his disease and thereby to change his mental attitude towards diet. The NMC policy also specifically mentions that nurses “must respect people’s right to confidentiality”. However, the nursing staff have failed to follow this instruction by planning to force-feed the patient. The nursing staff’s practice was also against the approved guidelines of the General Social Care Council (GSCC), because GSCC specifically emphasises the protection of patient’s rights. The nurses also failed to establish the trust and confidence of the patient and hence hurt the interests of GSCC. Like NMC guidelines, the GSCC also greatly focuses on the dignity and privacy of service users. The GSCC code of conduct requires social care workers (here nurses) to communicate with the service users (the patient) in an appropriate, open, and straightforward way by clearly explaining the causes of various strategic decisions. It also directs the care workers to make sure that their judgment would not cause future conflicts. However, the case clearly points that the nurses have not made any attempt to explain the patient about the seriousness of his current status to mentally prepare him for the treatment. In addition, the nurses’ illegal act may result in future conflicts as they could not meet both NMC and GSCC criteria. The GSCC guidelines also suggest the social care workers to set established processes and procedures to challenge exploitive behaviour and practice. The case tells that the nurses’ practice was exploitive in nature as they just tried to dispose their duties and responsibilities without considering the basic rights of the patient. Moreover, the GSCC guidelines direct the promotion of service users’ independence while protecting them from danger or harm. In total, the nurses will not be free from the legal implications arising out of their illegal practice. Ethical implication From scrutinising the case context, it seems that the care plan framed by the nurses is ethically recommendable. From the patient analysis session, it seems that the individual refuses to have food or drink. Since timely food consumption is essential for the maintenance of a healthy body, any medication method will not be effective for the patient unless he is willing to adhere to the food pattern suggested by the nursing staff. Hence, it is clear that if the patient’s current state is continued it may end up in dangerous complications or even death. The primary responsibility of a nurse is to work with others to promote the health and wellbeing of individuals under care. Although a counseling program may be capable of changing the patient’s mind, the time taken for the intended result may adversely affect the clinical condition of the patient. Hence, the nursing staff ethically acted for ensuring patient safety. According to the NMC code of conduct, nurses must be able to prove that they have acted in someone’s best interests if they have provided care in an emergency situation. The nurses have obtained consent for NG tube insertion from the patient’s next of kin and the practice shows that the nursing staff sincerely wished the wellbeing and fast recovery of the patient. The NMC guidelines recommend that nurses have to deliver care based on the best practice available. Although nurses were legally obliged to obtain consent from the patient in the identified scenario, the best available evidence drove them to act against this policy. The NMC code of conduct clearly says that nurses must ensure any suggestion they put forward is evidence based while they are advising healthcare products or services. It also adds that nurses have to keep their knowledge and skills updated for delivering effective and safe care while working without direct supervision. This case relates to an emergency care management where a nurse must give more emphasis on patient safety rather than widely accepted conventional practices. There are some other real life situations where nurses may be forced to suggest care plan for the patient without his/her consent. For instance, a person who has lost his legs or hands in a road accident would not be ready to live his remaining life as a disabled person and therefore he may not cooperate with nursing staff and their strategies. Under such a situation, nurses may be driven to force-feed the patient as they always aim the patient safety rather than man-made nursing code of conduct. The given case is a similar situation, because the individual is really worried about his present life issues especially, the recently diagnosed leukaemia. Moreover, the GSCC code of conduct instructs the care providers to follow risk assessment policies to evaluate whether the behaviour of service users threatens themselves. Professional implications Various nursing theories including Modeling and Role Modeling (MRM) theory describe the professional code of conduct of nurses. In the view of Peterson and Bredow (2008), the MRM theory purports some ideologies about people and their health, environment, and nursing practices. The modeling aspect of the MRM theory advises nurses to explore patients’ psychological nature and to appreciate its value and significance (p.235). Through this process, the nurses would be able to assess the client’s world from the view point of the client. In order to effectively deal with this process, the nurses must recognise that each person has his own unique characteristics. Therefore, the respect element plays a vital role in this modeling phase. In order to deal with the patients in an effective way, the nurses must be conversant with their mental attitude which is the key element in determining the health condition of a patient. According to NMC, as a professional, a nurse is personally accountable for her actions and omissions in her practice and she must always be able to justify her decisions. From the case background, it is clear that the nursing staff fully complies with the NMC’s professional code of conduct. Although the nursing staff failed to cop up with the legal procedures associated with the NG tube insertion, they had sufficient reasons to justify their decision. The NMC also influences nursing staff to deliver a high standard of practice and care at all times; the case tells that the nurses could show efficiency in responding to the situation. The GSCC guidelines also demands nurses to demonstrate efficiency and effectiveness while managing a critical situation. Outcome of the case study This case throws light to different legal and ethical issues faced by nursing staff while framing a care plan. Although NMC and other nursing guidelines aim at the effective delivery of nursing care services and patient safety, sometimes they may not bear desired outcomes. In the given case, if the nursing staff had strictly followed legal procedures associated with NG tube insertion, the patient would have developed further complications. Therefore, even though the decision of the nursing staff was against the accepted code of nursing conduct, it could be recommendable on a professional and ethical perspective. It is advisable for the nursing staff to use their knowledge and skills giving first priority to patient safety when they confront with similar situations in future. Conclusion Although the case discussed involves different legal, ethical, and professional implications, it points to the fact that sometimes nursing staff may be forced to omit established codes of practice to ensure patient safety. Every nurse can go beyond the framework of written practice codes if they can justify that such a practice was necessary to ensure the patient safety. References Drugs.com, n. d., ‘Nasogastric intubation: What you should know’, Viewed 11 October 2011, General Social Care Council 2002, ‘Codes of practice: For social care workers and employers, Employers of social care workers’, Viewed 11 October 2011, Nursing & Midwifery Council 2008, ‘The code: Standards of conduct, performance and ethics for nurses and midwives’, Viewed 11 October 2011, Peterson, SJ & Bredow, TS 2009, Middle Range Theories: Application to Nursing Research, Wolters Kluwer Health, Lippincott Williams & Wilkins, USA. Richards, D 2011, ‘Prevalence and clinical course of depression: A review’, Clinical Psychology Review, pp.1-41, Viewed 11 October 2011, Read More