The Patient Care and Medical Investigation - Term Paper Example

Professional, Ethical, & Legal Issues in Nursing Practice Jane Palmer Total Number of Words: 2,033 Table of Contents I. Case Introduction …………………….………………………………. 3 II. Purpose of the Study ………………………………………………… 5 III. Ethical Principles and its Application in the Case of the Elderly Patient ………………………………………………………… 5 a. Autonomy and Informed Consent to Treatment and Care ………………………………………. 5 b. Ethical Issues on Confidentiality ………………………. 6 c. Ethical Issues on Beneficence …………………………. 6 IV. Legal Issues Related to Nursing Profession ……………………… 7 a. Informed Consent …………………………………………. 7 V. Contribution of Ethical and Legal principles to Standards of Clinical Practice ……………………………………….. 9 VI. Conclusion ……………………………………………………………… 10 References ……………………………………………………………………… 11 Case Introduction An elderly female patient at the age of 86 years old was transferred from an unidentified hospital to a community hospital where the student nurse has been assigned on placement. Aside from suffering from a significant weight loss, the elderly patient was admitted after having experienced numerous falls that caused her a fracture on her right hip. As soon as the patient arrived at the community hospital ward, the student nurse was assigned to arrange the needed documentation for the patient’s admission based on the hospital policy and procedure and accompany the patient to a vacant bed. Right after the student nurse introduced herself to the patient, she immediately seeks consent from the patient to be admitted to the ward. Thereafter, the student nurse started working on the patient’s care plan and admittance form. After having read the notes that explains the patient care and medical investigation that was carried out by the unidentified hospital stating the activities of daily care that was delivered to the patient and that the patient needs a minimal hospital intervention aside from the catheter and pain reliever that was kept under control, the student nurse asked the patient with relevant questions pertaining to the patient notes that was given by the unidentified hospital. After the interview, the student nurse has to replace the patient’s identification name band that was attached by the unidentified hospital. While removing the patient’s identification band, the student nurse noticed that the identification band that was attached by the unidentified hospital is ‘red’ indicating that the patient has an allergy. As a general rule, the type of allergy the patient have should be written on the red identification band using a permanent marker pen. In the case of the elderly patient, nothing was written on the identification band. As a student nurse, part of her responsibility is to verify the situation with regards to why the patient was given a red identification band. Being aware of the importance of duty of care in handling patients, the student nurse rechecked the patient’s notes and phoned the ward that handled the patient from the unidentified hospital. The student nurse was told that nobody is aware of any allergies related to the patient nor the red identification band the patient is wearing. Eventually, the elderly patient’s daughter arrived at the community hospital. The student nurse asked the elderly patient’s daughter if her mother had any allergies. The student nurse was told that the elderly patient had a previous allergy to a drug she was given by her G.P. approximately 18 months ago. However, the elderly patient’s daughter could not remember the name of the drug since it was another daughter who lives in New Zealand who was with the elderly patient the time she was admitted to the unidentified hospital 5 days ago. Since the other daughter has already gone back to New Zealand, the elderly patient’s daughter volunteered to call her sister to verify the name of the drug that have caused their mother some allergic reaction. The student nurse decided to get in touch with the elderly patient’s G.P. to ask about the allergy. The G.P. told her he could not recall any allergies related to the elderly patient. For this reason, the student nurse requested the G.P. to check on the patient records. Ten minutes after the G.P. arrived at the hospital, the G.P. checked on the computer. The G.P. noted that the elderly patient had a massive allergic reaction when she was given Trimethoprim 16 months ago. After continuous search for an answer, the student nurse found out that the red identification band that the elderly patient had was given by the paramedics but failed to document anything about the patient’s case. For this study, the researcher will discuss the professional issues as well as the ethical and legal concerns of the case in relation to the practice of nursing based on the NMC code of conduct and other related guidelines set by the Department of Health in relation to nursing profession. Purpose of the Study To enable the student nurse to develop a broader knowledge in determining the importance of nursing ethics and its legal implication on nursing profession by critically analyzing the case scenario provided in this study. Ethical Principles and its Application in the Case of the Elderly Patient Autonomy and Informed Consent to Treatment and Care With regards to autonomy and issues on informed consent, student nurse should at all times follow the guidelines written under the code of standards of conduct, performance and ethics for nurses and midwives published by Nursing & Midwifery Council (NMC). It is also essential to go through the guidelines developed by the Department of Health particularly on the ‘Reference Guide to Consent for Examination or Treatment (2001)’; and ‘Seeking Consent: Working with Older People (2001)’. (NHS, 2006: p. 6, 8) In case the patient is not mentally capable of deciding for his/her own preferred treatment and care, student nurse should immediately refer to the ‘Mental Capacity Act (2005)’ and ‘Seeking Consent: Working with People with Learning Disabilities (2001)’ published by the Department of Health. As part of a legal and ethical health care practice, ‘informed consent’ is a standard operating procedure of health care service rendered to each patient prior to the start of any treatment, physical investigation, or providing personal care for the patient. (NMC, 2008; NHS, 2006; p. 8; DOH, 2001a, p. 2; DOH, 2001b; p. 1) As a generally acceptable nursing practice, each patient has the legal right to either accept or refuse a certain treatment or care based on their personal / religious beliefs or value system – regardless of whether or not the patient’s decision could cause further harm on the patient’s overall health and wellbeing. (DOH, 2001b: p. 3) Based on the case presented in this study, the student nurse complied with the guidelines on informed consent by seeking permission from the patient prior to the elderly patient’s admission to the ward. The same procedure should also apply before the student nurse removed the patient’s identification band. In case the elderly patient refused to give her consent to be treated or be admitted to the ward, the student nurse should respect the patient’s decision at all times. (NMC, 2008) Ethical Issues on Confidentiality The practice of confidentially is equally important in nursing profession. (NMC, 2008) The student nurse should always discuss with the patient the need to share their personal information with other health care agencies. (NMC, 2008) Even though it was part of the nursing student’s responsibility to conduct an investigation as to why the elderly patient was wearing a red identification band, it is but ethical on student nurse’s part to seek the elderly patient’s consent before contacting anyone from the unidentified hospital regarding the red identification band and/or disclose the patients’ confidential records of the elderly patient under any circumstances. Ethical Issues on Beneficence The law of beneficence demands nurses to do only good actions which may contribute to the welfare of the patients. Concerning the principle of beneficence, it is important that any decisions made by the student nurse on behalf of the patient should be for the greatest benefit or best interests of the patient. (Mental Capacity Act, 2005; DOH, 2001b; p. 9) The fact that the student nurse was determined on knowing the medical history of the elderly patient based on the red identification band the patient was wearing is a positive sign that the student nurse was making a quick decision based on what is best for the elderly patient’s health and treatment. Legal Issues Related to Nursing Profession Informed Consent As a general rule, informed consent should be given voluntarily by patients above 18 years of age. (DOH, 2001a: p. 4; DOH, 2001b: p. 7) Since the patient in this case is 86 years old, there is no need to seek approval from anyone related to the patient except when the patient is medically proven to be mentally incapable of deciding for her own care and treatment. The practice of informed consent is basically a part of the general legal process when health care professionals provide a major intervention related to the health care service provided to the patients. (DOH, 2001a; p. 8) Based on the principle of informed consent, the elderly patient has the right to be informed about the health care treatment or physical inspection that will be provided by the student nurse or anyone from the healthcare team regardless of the patient’s physical and mental health condition. As a professionally acceptable practice, the student nurse seeks the personal consent of the elderly patient to be admitted at the ward. Even though the case did not state whether or not the student nurse seek the elderly patient’s consent prior to phoning the health care practitioners who attended to the patient at the unidentified hospital, the NMC code of nursing profession (2008) states that student nurses should always respect the patient’s confidentiality and collaborate with health care professionals who have been responsible in caring or treating the elderly patient. Legally speaking, the student nurse have already violated to principles of informed consent in case she did not personally informed the elderly patient about the phone call even if the student nurse’s action was for the benefit of the patient. In case this principle was violated by the student nurse for any reason, the elderly patient or the patient’s daughters could file a legal action against the student nurse and/or the rest of the health care professionals that has a direct obligation in handling and monitoring the performance of the student nurse. (DOH, 2001a; p. 2) In some cases, the entire group of health care providers may also be held liable for the particular violation of their staff. (DOH, 2001a; p. 2) Given that the elderly patient refused to be admitted at the wards or receive any form of treatment and care from the student nurse or any of the health care practitioners, it is important for the student nurse or health care practitioners to record all cases wherein a patient decided to refuse certain treatment and care in order to avoid any future miscommunication which may result to the filing of legal cases. (Rodden & Bell, 2002; DOH, 2001a: p. 6; DOH, 2001b: p. 3) Contribution of Ethical and Legal principles to Standards of Clinical Practice The basic principles of nursing ethics – as the standards of clinical practice, is commonly used in developing and implementing guidelines used as a legal basis and justification for an act of negligence or malpractice. Therefore, nursing code of ethics such as: (1) autonomy; (2) beneficence; (3) confidentiality; (4) informed consent; (5) justice; (6) non-maleficence; (7) respect for the patient; and (8) veracity among others (NMC, 2008; Bailey, 2007) combined with the legal issues related to nursing profession serve as a professional guide for all nurses. Conclusion To avoid facing legal charges for the grounds of malpractice and/or negligence, student nurses should be aware of the basic ethical guidelines and legal issues related to nursing profession. In case the student nurse is not familiar or is unsure about a specific nursing practice scenario, it is advisable for student nurses to seek legal advice from the experts. It is professionally acceptable for the nursing student to follow the guidelines on informed consent prior to admitting the elderly patient to the community hospital ward. Upon phoning the health care professionals from the unidentified hospital where the elderly patient was first admitted prior to the hospital transfer, the nursing student should have informed the elderly patient regarding the need to call the other hospital to verify the history behind the red identification band the patient was wearing as well as other diagnosis information related to incidence of patient’s allergies. Decisions made on the part of the nursing student strongly signify an act of integrity in terms of having a strong commitment to her chosen profession. In case the student nurse did not exert effort in tracing the history behind the red identification band the elderly patient was wearing, there is a higher risk for the patient to face unnecessary health consequences or adverse effects from her future medication. *** End *** References: Bailey, G. (2007). NASW Standards for Social Work Practice in Palliative and End of Life Care. Retrieved June 11, 2008, from National Association of Social Workers: http://www.naswdc.org/practice/bereavement/standards/default.asp DOH. (2001a, March). Retrieved June 11, 2008, from Reference Guide to Consent Examination or Treatment: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019079.pdf DOH. (2001b, November 21). Retrieved June 11, 2008, from Seeking Consent: Working with Older People: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009325 DOH. (2001c, November). Retrieved June 11, 2008, from Seeking Consent: Working with People with Learning Disabilities: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4067019.pdf Mental Capacity Act. (2005). Retrieved June 11, 2008, from Mental Capacity Act 2005: http://www.dca.gov.uk/menincap/legis.htm NHS. (2006). Dementia: Supporting People with Dementia and Their Carers in Health and Social Care. pp. 1 - 27: National Institute for Health and Clinical Excellence and Social Care Institute for Excellence. NMC. (2008). The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. Nursing & Midwidery Council. Rodden, C., & Bell, M. (2002). Record Keeping: Developing Good Practice. Nursing Standard , 17(1):40 - 42. Read More