Application of Law and Ethics Modules in Nursing - Assignment Example

Assignment 1: Application of Law and Ethics modules Section One: Patient Safety According to Anderson et al (2012) patient safety is a fundamental and critical aspect of quality nursing care. The ability of a nurse to be a critical thinker and use the knowledge in delivering nursing care is vital to the wellbeing and safety of the patients. Therefore, in Mrs. McKay-Hall’s case, there was need for all nurses who provided nursing care to the late Mrs. McKay-Hall to ensure her safety. Registered and enrolled nurses have the responsibility of accepting responsibility to ensure their nursing practice and conduct meet the standards of professional, ethical and pertinent legislative requirements (Nursing and Midwifery Board of Australia, 2010). When the late Mrs. McKay-Hall was returned to the ward after the surgery around 3pm on 9th November 2007, the nursing staff provided the appropriate nursing care. This is because the nursing staff completed a frequent observations chart and conducted the observations accordingly. The nursing staff also recorded vital signs accordingly. This is in line with Anderson et al (2012) who explain that nurses are supposed to provide ongoing monitoring of the health status of patients they are responsible for. Nursing and Midwifery Board of Australia (2010) obligates nurses to fulfill duty of care by performing nursing interventions according to the recognized standards of nursing practice and by performing nursing interventions after comprehensive and accurate assessments. Nursing staff in particular the Advanced Skills Enrolled Nurse, Elizabeth Laja took all the required observations and also completed an entry in the Integrated Progress Notes. When nurse Laja noted that the patient’s oxygen saturations had dropped to 83% she was administered with oxygen and her oxygen saturations returned to normal. In addition, nurse Laja carried out accurate assessments. This indicates that nurse Laja fulfilled duty of care to Mrs. McKay-Hall (Nursing and Midwifery Board of Australia, 2010). However, after the readings, nurse Laja did not collaborate with other healthcare team for an immediate action to be taken. Nursing and Midwifery Board of Australia (2010) obligates nurses to collaborate with the interdisciplinary healthcare team for comprehensive nursing care to be provided. When Nurse Laja noted that Mrs. McKay-Hall’s health status was deteriorating fast as per the observations and readings especially the worsening vital signs, she should have taken an action of their informing an RN, Head Nurse or even calling a physician. Furthermore, even though the readings clearly indicated that the deceased’s condition was serious and worsening quickly, nurse Laja claimed that she never detected anything unusual in in Mrs. McKay-Hall’s condition. Here, the nurse did not demonstrate competence during provision of care. More importantly, during provision of nursing care to Mrs. McKay-Hall there was lack of appropriate communication. As per Spencer et al (2010), effective communication during provision of medical care is the key to the efficient functioning of complex clinical settings. Lack of communication between healthcare providers has been attributed to be the major contributor to adverse clinical outcomes (Spencer et al, 2010). In this case, there is no evidence that nurse Laja informed any other healthcare provider regarding the patient’s worsening condition as demonstrated by the deteriorating vital signs. Nursing standards stipulate that nurses should provide professional nursing practice. In relation to this case, later on nurses did not fulfill duty of care towards Mrs. McKay-Hall because they did not perform nursing interventions according to the recognized standards (Needleman, 2009). This is demonstrated where the nursing staff discontinued recording of vital signs on the Frequent Observations Chart even though the changing vital signs warranted frequent observations. Worse still, the nurse who cared for the deceased after nurse Laja’s shift, did not have any records for her care. Even when the patient’s condition deteriorated further, the nursing staff did not indicate this in the Integrated Progress Notes and also the nurses never contacted the physician Dr. Ahmad who was the doctor responsible for the patient. According to Needleman (2009) during provision of care, nurses have the responsibility of observing, assessing and recording symptoms, reactions as well as progress in order to provide the foundation for care planning and intervention. Nurses are in turn supposed to record the observations and assessments but in this case nurses did not have any records for her care. They even never recorded Mrs. McKay-Hall’s deteriorating status. As Leonardi (2012) emphasizes, nursing documentation is fundamental for good clinical communication because appropriate documentation offers a correct demonstration of nursing assessments, changes in conditions as well as pertinent patient information in order to support the multidisciplinary team to deliver excellent medical care. In nursing documentation is an evidence of care and is a fundamental professional and medico legal aspect of nursing practice (Leonardi, 2012). Still, nurses are supposed to deliver care that conforms to the standards of nursing practice and to follow the stipulate policy procedures (Leonardi, 2012). In this case, nurses did not follow the stipulated policy procedures and this against professional nursing practice. For example RN Jodi Windram was responsible for the care of Mrs. McKay-Hall but never called medical emergency even though the patient’s vital signs had deteriorated to an extend of the pulse rate increased to 130 beats per minute yet the hospital’s policy was that pulse rate above 130 met the emergency calling criteria. Austin (2008) stipulates that after a nurse performs assessment and makes nursing diagnosis, a nurse should continue evaluating patient’s condition and communicate the worsening signs and symptoms appropriately (Austin, 2008). As mentioned before, communication aspect clearly lacked during provision of nursing care to the patient. Not only was communication lacking in form of documentation but also there was also lack of communication from the nurses to the other healthcare providers including the respectable physicians. For instance, in spite of the patient’s vital signs continuously deteriorating, the nursing staff did not notify the medical emergency. There were also instances where the nursing staff never made any documentation or recorded the patient’s progress and health condition. Austin (2008) emphasizes that nurses are supposed to inform and communicate to the respective doctors regarding their patients’ current or changing conditions and also communicate with other healthcare providers at every point of patient care. Likewise, nurses are supposed to keep accurate documentation and do it promptly. Accurate and prompt documentation during provision of nursing care is important because medical records are legal documents in accordance with the state laws and regulations and also documentation is a way of communication between healthcare providers that ensures continuity of care (Leonardi, 2012). Clearly nurses did not provide professional nursing care to the patient. There are some instances where very important clinical information was not recorded and documented and also communication by the nurses was very poor. In spite of Mrs. McKay-Hall’s condition deteriorating very fast, none of the nurses made an effort to inform the medical emergency team. The poor nursing care compromised the patient’s safety. Section Two: The Tort of Negligence Negligence occurs when a nurse fails to act as a reasonable rational individual would do under the same/similar circumstances, which causes harm to the patient. Elements of negligence include: duty; breach of duty; causation as well as injury and damages (Delk, 2012). Duty Duty refers to the legal duty to abide by to the set standards of care. Nurses are professionals and hence they are held by to higher standards of care in performing their duties to patients when compared to standard of care lawfully enforced on ordinary individuals. This higher standard is only applicable to the actions that are directly related to nurses’ professional nursing duties (McGowan, 2011). The nurses owed duty of care to McKay-Hall. For instance, Registered Nurse Jodi Windram owed duty of care to the patient. This is because as the proceedings indicate, RN Jodi Windram was responsible for Mrs. McKay-Hall’s treatment on the afternoon/evening shift of 11th November 2007. Likewise, RN Gloria Kuyper owned a duty of care to the patient. Nurse Kuyper was responsible for Mrs. McKay-Hall on the night shift of 11-12th November 2007. Breach of Duty A nurse breaches duty when he/she fails to abide by the set standards of care. Deviating from the established standards encompasses negligence (Delk, 2012). In this case, nurses had a duty of abiding to the predetermined standards of care when providing nursing care to Mrs. McKay-Hall and thus failure to conform to the standards constituted negligence. Nurses Windram and Kuyper breached duty when they failed to call medical emergency in spite of the hospital policy standards stipulating that medical emergency should be called when the patient had very high pulse rate and respiratory rate. Another example of breach of duty is when Nurse Kuyper failed to increase the frequency of observations in spite of the Mrs. McKay-Hall’s observations being outside the normal range yet in such a case nurses are supposed to complete frequent observations chart. Nursing and Midwifery Board of Australia (2010) obligates nurses to fulfill duty of care by performing nursing interventions according to the recognized standards of nursing practice and hence the nurse breached the duty. Causation Causation refers to the link between the negligent action and the harm or damages. In this case, the nurses contributed to Mrs. McKay-Hall’s harm through proximate cause. Proximate cause indirectly causes the harm because of other contributing factors (Reagan & Hacker, 2012). In this case, nurses such as Nurse Kuyper and Nurse Laja’s actions of failing to communicate and inform the medical emergency regarding the patient’s deteriorating condition contributed to Mrs. McKay-Hall’s harm because had they reported the appropriated medical procedure would have been started and this would have prevented infection as well as prevented deterioration of her condition. Damages Damages refer to the physical result of harm that occurs due to the negligent act (McGowan, 2011). For there to be a successful litigation due to a nurse’s negligence, harm must have occurred to the patient. In this case, harm occurred to Mrs. McKay-Hall. Therefore all the four elements of negligence have been met and hence a claim of negligence can be substantiated. Section 3: Ethical Analysis Ethics are very important in nursing practice because they ensure that nurses treat patients appropriately (Fouka, & Mantzorou, 2011). Generally, nurses in all scopes of practice experience various ethical issues when providing nursing care. Beneficence Beneficence is doing what in the patient’s best interests and thus it requires a nurse to take action that benefit the patient and prevent harm (Fouka, & Mantzorou, 2011). In this case, Nurse Laja upheld the principle of beneficence because she performed all the required observations and also completed entries in the Integrated Progress Notes. In addition, when the patient’s oxygen saturations had dropped to 83%, the nurse administered her with oxygen and her oxygen saturations returned to normal. All these actions were meant to benefit the patient and hence the principle was upheld. Nurse Laja also administered the patient with morphine when she complained of “shoulder tip pain”. Nonmaleficence Nurses should remain competent in their nursing practice to avoid causing harm to patients. Nonmaleficence includes nurses reporting any suspected abuse (Fouka, & Mantzorou, 2011). In this case, nurses did not uphold this principle. For example, Nurse Laja did not demonstrate competence during her nursing care provision. In spite of having taken readings and observations, she never reported because she did not detect anything out of the usual in Mrs. McKay-Hall’s condition. Had she been competent enough she would have detected that the patient’s deteriorating vital signs were an indicating that the patient’s condition was worsening and thus Mrs. McKay-Hall needed immediate medical attention by the medical team. Similarly, other nurses did not report the patient’s worsening condition to the medical emergency. Lack of this competency ended up contributing to the patient’s harm and thus this principle was not upheld. Fidelity This principle represents aspects such as dedication, loyalty, truthfulness, advocacy in addition to the fairness to patients (Fouka, & Mantzorou, 2011). Nurses are supposed to keep their commitments, whose basis is their virtue of caring abuse (Fouka, & Mantzorou, 2011). In this case, nurse did not uphold this principle because they ignored some nursing aspects such as reporting and communicating the patient’s deteriorating status to the appropriate healthcare practitioners and emergency team for the suitable action to be taken. Lastly, the patient had the right the correct treatment as per standards and the nurses should have handled the family of the patient empathetically and with respect rather than being rude and throwing their hands when the patient’s sister tried to seek clarification from them. References Anderson, D., St. Hilaire, D., Flinter, M. (2012). Primary Care Nursing Role and Care Coordination: An Observational Study of Nursing Work in a Community Health Center. OJIN: The Online Journal of Issues in Nursing. 17(2). DOI: 10.3912/OJIN.Vol17No02Man03. Austin, S. (2008). Seven legal tips for safe nursing practice. Lipcott Nursing center. 38(3):34 – 39.  Delk, K. (2012). Occupational health nursing interventions to reduce third-party liability in workplace injuries. Workplace Health Saf. 60(3) p107-9. Fouka, J., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3-14.  Leonardi, B. (2012). Professional Documentation: Safe, Effective, and Legal. RN.com. McGowan CM. (2011). Legal aspects of end-of-life care. Crit Care Nurse. 31(5) p64-9. Needlema J. (2009). Guideline responsibilities for direction and delegation of care to enrolled nurses. Los Angeles: University of California. Nursing and Midwifery Board of Australia (2010). National competency standards for the registered nurse. Nursing and Midwifery Board of Australia. Reagan J & Hacker C. (2012). Laws pertaining to healthcare-associated infections: a review of 3 legal requirements. Infect Control Hosp Epidemiol. 33(1): 75-80. Spencer R, Logan P & Coiera E. (2010). Supporting Communication in the Emergency Department. NSW: University of New South Wales. Read More