Legal Aspects of Settling the Death of a Patient in Respite Center - Essay Example

Law and Ethics Introduction The purpose of this essay is to analyse a case scenario at the Sunnyland Day Respite Center with focus being on the legal aspects of the law and legislations. The paper will analyse the various aspects of the law in relation to the case that resulted in the unnecessary death of the patient. In addition to that, the various ethical issues will also be determined. Finally, it will explore the implications that these ethical and legal issues may have on the enrolled nurse, registered nurse and the family of the patient. Each aspect will be independently analysed and discussed so as to fully understand the arising issues. Consent, Restraint, Assault & Battery Before any nurse, whether enrolled or registered can do anything to another person, there are some legal requirements that they need to understand. The first legal issue is consent. Consent refers to permission to do something. Before a nurse does anything to another person or a patient, it is a legal requirement that the other party or patient agrees and gives permission for such an act to be carried out (Larson, 2003). When the nurse does something against the will of the patient, it is considered to be coercion. More often, a dilemma arises when the patient refuses care that the nurse thinks is necessary. However, in such situations, the nursing guidelines indicate that it is still important to get consent from the patient. In other situations where the patient may be mentally incapacitated, the family or the guardians may give the consent on behalf of the patient. Restrain is the other legal requirement and is greatly related to consent (Engberg et al, 2008). Restraint is any action or device that is designed or intended to prevent free movement of body parts. Some patients require restraint in cases where it may be deemed necessary, such as when the patient gets violent. However, there is a relation between restrain and patient consent. Before the patient is restrained by the nurse using any device or technique, due consideration and consent of the patient must be taken into account. In the Case Study, Mrs. Davis verbally objects to being restrained. Despite this, the registered nurse goes ahead to restrain the patient against her will. This is against the nursing and service delivery guidelines. As a result of the act, Mrs. Davis falls and suffers injuries that later lead to her death. This again leads to another legal issue that relates to patient care. This other legal issue is battery. Battery occurs when physical harm results due to negligence or unprofessionalism on the side of the care giver. It is not a must that the action results in physical injury for it to be termed as battery (Austin et al., 2005). Any act that is done against the consent of the client is referred to as battery. Assault on the other hand occurs when the care giver attempts to do such acts against the patient’s will. Therefore, assault results when there is an attempt to do an act against the wish of the patient while battery occurs when the act is actually done against the patient’s wish. This is what happens when the registered nurse uses force to restrain the patient result in physical injury and eventual death of the patient. Mrs. Davis verbally objects to being restrained and attempts to undo the restraint. In the process her chair tips over, she hits her head on the floor and loses consciousness. This is battery. Duty Of Care, Negligence And Vicarious Liability The nursing scope of practice defines the knowledge, experience and skills that any nurses, whether an RN or EEN requires before he or she performs any role at his place or station of work. In the case study, the registered nurse and the EEN are both initially working within their scope of duty. This is however changed when the RN decides to restrain the patient against her wish. According to The Australian Nursing Federation, before the patient is restrained, the nurse is supposed to report to the doctor or physician in charge before he or she goes ahead to physically restrain the nonviolent patient. Therefore the RN was out of her scope of duty or practice when she carries out the physical restrain without the patient’s consent. Every nurse owes duty of care to the patient within the hospital or health service facility. It is his sole duty of the nurse or any physician to ensure that they provide the best care to the patient. When there is failure to provide the required degree of care that others would consider to be reasonable, negligence arises. Negligence is normally caused by the rush of the nurse to get work done without thinking first. This normally results in injury to the patient and even death. In the Respite Case Study, the RN rushes into deciding that Mrs. Davis should be restrained. She goes ahead to physically restrain her despite the objection from the patient and the EEN. This amounts to negligence because even the EEN was of the opinion that Mrs. Davis did not require the physical restrain. Duty of care and negligence are based on the rule of reasonableness. When one is found to have breached the duty of care, he or she can be sued for negligence. This is what can happen to the RN due to his rush in restraining the patient against her will resulting in death. Vicarious liability means that the employer is accountable to any standard of care that is provided by the employees. In order to be covered by this clause, the employee should remain within their role and duties. Despite the fact that the RN was working within her duties, her actions amount to negligence and are therefore not covered by the vicarious liability clause. Advocacy According to Austin et al. (2005), advocacy involves engaging other and mobilizing evidence to influence practice or policies within the health service sector. It requires speaking against inequality or unreasonableness in the practice. The nurse is supposed to advocate for the rights of the patients so as to ensure that the patient’s well being is maintained. This can be done either directly or indirectly using the set out guidelines that are normally put in place for this purpose. In the Respite Case Study, it was the duty of the EEN to advocate for the rights of the patient. The EEN was convinced that Mrs. Davis did not require physical restrain. Therefore, it is her duty to provide evidence of what transpired that resulted in the death of Mrs. Davis. This will not only ensure equality, but also promote reasonableness in nursing practice. Documentation The objectives of documentation in nursing practice are same in almost all states and countries. The main purpose why documentation is done is to provide clear and accurate information about the patient while under the care of a given health care provider. Every nurse is required to know what the state laws say on the documentation practice as well as the policies and procedures about the practice. In situations where litigation is initiated, the documented information provides a good starting point for carrying out the investigations. Some of the information that the nurses are expected to complete in the Respite Case Study include, the personal details of the patient, the person who reported the death, name of employee present at the death scene, the name of the person who certified the death, probable cause of death and a probable mechanism of death. The Coroner A coroner is an officer working for the government whose duty is to certify and confirm death that has taken place within his or her jurisdiction as dictated by the laws of the land (British Columbia Coroner Service, 2012). In addition to the confirmation and certification of death, the coroner may also carry out required investigations in order to unravel the cause of death or to determine the identity of an unknown person who has died in the coroner’s jurisdiction. According to Forrester & Griffiths (2010), there are three main duties of the coroner. The first duty is the identification of a deceased individual. The second duty is the determination of cause of death. This is done through the determination of the mechanism of death. It involves a review of the last actions or events that took place before the victim died. The final major duty is the determination of the manner in which the victim died. This may be done through an autopsy, which will be done by a certified pathologist (Forrester & Griffiths, 2010). The coroner will be responsible for all the properties of the deceased until the family or relatives of the victims are identified. In the Respite case study, the coroner will carry out two major duties. The first duty will be the determination of mechanism of death, where he or she will review information on the last events prior to the death of Mrs. Davis. The second duty will be to determine the probable cause of death. The coroner may decide to call for an autopsy in order to determine the cause of death. Open Disclosure Open disclosure is a term that is used to refer to the open discussion that is normally initiated by the patient or the family members and relatives of a patient about a given incidence or occurrence. The Australian Open Disclosure Framework provides a consistent framework or basis for communication that is needed after an incidence that has resulted in harm or death during the provision of health care service (Australian Commission on Safety and Quality in Health Care, 2003). This is necessary so as to put patients in the central of health and safety matters. The service care providers are required by the law to disclose information leading to an unexpected healthcare outcome to either the patient or the family members (Tysall, 2012). In the Respite case study, this is no exception. Despite the RN telling the EEN not to disclose any information, this is against the legal and practice standards and guidelines. The RN and the EEN are required by the law to provide and reveal all the information on the events that led to the death of Mrs. Davis. The act of keeping such information away from the management, the coroner and the family members is therefore against the law and against the health care practice guidelines (WHO, 2009). Using a decision making model for ethical dilemmas’ The Power to Influence Patient Care’ In determining the care that is suitable for a given patient, there are ethical considerations that the nurses should not forget. In such situations, several forces may influence the type and nature of the decisions that are made by the nurses (Parker, 2007). In making such decisions in a case of dilemma, it is important for the nurses or the health care provider involved to think critically about the skills and ethical principles involved (Parker, 2007). In addition to that, the relationship with the patient as well as communication skills should also be considered. This makes the nurse or the health care provider arrive at the decision which is ethically suitable for that particular situation (Parker, 2007). Ethical approach is derived from nurse’s understanding and skill which are significant forces that can deliver the power to impact patient care in an. The health care practitioner’s power is essential to the nurse’s understanding and experience. There is no other approach for the esteem that is made by a nurse who gives steady, exceptional, complete care. Practice is power that attributestoa character for excellence. Consistence by nurses who reads current professional concepts and distributes evidence-based on the findings with team members so as to advance their nursing understanding and skills, reinforces the practice and impacts the actions of others, hence improving patient care. (American Nurses Association, 2001). In regard to the case study the ethical judgment making process, should have been developed and used in addressing a Mrs. Davis case. A consistent patient like Mrs. Davis have rights and should have been acknowledged to make individual decisions regarding health care, with the refusal of being reinstated. This plays a crucial part in communicating and accepting the wishes of the Mrs. Davis, even when doing so may have been against the opinion of JN Jolie. The power in me to commit to the health body and unit by practicing as a good role model, reformers, critical thinker, and raconteur for the health care while individual power explains to conscious, planned, and lenient decision making concerning ethical situation which prohibits me not lie. According to my work and personal ethics, I could have acted differently regarding the issue in the case study. First, knowing very well Mrs. David did want to be restrained, I could have faced JN Jolie at that particular moment, tell her to respect Mrs. Davis decision, and then further remind her the ethical code that defines a restrain issue, and maybe she could have thought about it and the accident could have been prevented. Additionally, since am aware that nurses should be accountable for their actions and answerable to their practice, I could have defied her suggestion and implication to lie, tell her to report herself to the management and explain exactly what happened. If she doesn’t, I would have gone and report her myself to the hospital senior management.Thus, determining the extent that I will uphold justice to promote human rights and fairness in Mrs. Davis case. Conclusion This essay has highlighted legal and ethical issues in nursing health care. Nurses must practice autonomously, caringly, proficiently and safely, and must maintain self-esteem and support health and well-being. They must evaluate and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where needed, they must be able to offer safe and effective instant care to all people prior to accessing or referring to someone else opinion, irrespective of their field of practice. Regardless of the second party opinion, the nurse has a legal and ethical obligation to respond to the request for care. In general, the nurse should see the patient to evaluate health needs and determine the level of care required. References American Nurses Association (2001).Code of Ethics for Nurses With Interpretive Statements. Washington, DC: ANA. Austin, W., Lemermeyer, G., Goldberg, L., Bergum, V. & Johnson, M. S. (2005). Moral distress inhealthcare practice: the situation of nurses. HealthCare Ethics Committee Forum, 17, 33–48. Australian Commission on Safety and Quality in Health Care (2003).Open disclosure Healthcare Professionals Handbook, page 3. 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