Ethics and Laws Applied in Nursing Profession - Essay Example

Law & Ethics Applied in Nursing Student’s Name Learning Institution Executive summary With the evolution of mobile phone technologies, more and more modern cellular phones continue to be produced. This has been of both benefit and shortcomings in the medical fraternity. For instance, it is easier to record a case that has happened and easily report by showing actually what happened. However, the disadvantage associated with improved technology includes unfair exploitation of such technology by medical staffs who fail to observe the medical code of ethics. To shed more light on medical code of conduct, this essay focuses on Case One whereby a nursing officer who was fascinated by post surgical wound of a road accident victim decided to take photographs of such wound without proper consent from the patient or her relatives. This behavior is totally unethical and against the medical code of ethics provided under Australian Nursing and Midwifery Council national competency standards for nurses. Introduction In the face of modern mobile phone technology, it has been quite easy to record and transmit patients’ photographs. Indeed, the proliferation of modern cellular phones has led to increased unauthorized patient photographing particularly by practicing medical practitioners. This behavior is now accepted as part of our day to day life. Notably, nurses are increasingly using photography to convey messages regarding patients which have proved effective as it enhances clarity of the patient’s condition. Nevertheless, photographing critically ill patients remain a contentious issue as there no clear cut line to differentiate photographs taken in the best interest of a patient and those with the intent of gaining public sympathy considered exploitative and ethically unacceptable by civil society. Certainly, photographing patients for whatever reason carries some ethical implications which should be critically thought about before any attempt to take such photographs. Nevertheless, with such increased use of technology in patients’ management, use of photography in the health facilitates should be balanced between a legal duty to observe patients’ rights and ethical duty concerning confidentiality and privacy of patient health information. This paper discusses ethics and laws applied in the nursing profession with special focus on the ethical aspect of photographing critically ill and unconscious patient. Ethics and Laws applied in nursing profession-Photographing critically ill patients Undeniably, patients’ photography has gained momentum in present times. According to Eckermann, Dowd, et al. (2006), charitable organizations are currently using images of sick and disabled people to influence the viewing members of the public to generously contribute towards their philanthropic cause. In Australia, the Australian Nursing and Midwifery council have stipulated a code of conduct that states any misuse of clinical photography shall be treated as the medico-legal offense in the nursing profession. Clinical photography is part of medical records and nurses should be aware of the health records legislation that obligates them to confidentially maintain patients’ records. The common law governing the maintenance of medical records prohibits the nursing staff from disclosing patient medical information not only to a third party but also the patient. In Australia, the privacy Act (Cwlth) as well as state legislation gives the patient right to take a copy of their medical records (Australian Nursing and Midwifery Council 2006). However, with regard to clinical photography, clinicians should keep in mind their confidentiality obligation, patient rights and that illegal disclosure of such information can lead to legal proceedings against them. Notably, such photographs can provide good evidence that can strengthen plaintiffs’ legal proceedings. Even though some forms of photography are used for clinical purposes, nurses should bear in mind that such photographs are part of medical records and should, therefore, be treated similar to the other patient information. According to Australian legislation, all medical practitioners should understand legislations governing disclosure and use of patient sensitive and personal information. The law allows photographs taken can be shared among health care providers though this provision differs between territories. For instance, in Victoria, the state law provides for such provision. It allows use of such photography for training. However, according to my view, there is still a concern of patient identification by third parties through physical characteristics even if patient names or other specific details are not recorded alongside the image. In this respect, I suggest that medical practitioners should be extremely careful and utmost care should be taken to ensure maximum security and confidentiality. The photographs should only be accessed by nurses involved in the patient’s management and should not be transmitted to any other third parties. However, following Australian laws, patient’s photographs should not be included as part of medical records unless it is such necessary and the patient is not only well informed of the reason as to why such photographs are taken, but also the likely users of such information (Holmes, Thompson, et al. 2007). The patient may consent photography for the purpose of clinical management or for conveying clinical information to the rest of the medical team. Nevertheless, such consent does not include the use of photographs for educating other work colleagues or merely disclosing the extents of patient injury to the rest of the medical team. Therefore, when a patient consent photographs to be taken, then I suggest such consent to include an explanation of purpose in which those photographs will be used and the third parties likely to access such information. Moreover, third parties should be aware of the limitations provided by the patient consent. In a case where the patient is unconscious, the decision to take photographs can be given by the next of kin or any other close relative. The Australian nursing code of ethics is very categorical where any form of photography is not directly related to the patient’s care. It provides that proper consent must also be obtained. Further, the code requires that where such photographs are to be used in public, written consent must be obtained irrespective of whether the photographs are to be treated as anonymous. Nevertheless, the Australian nursing code states that where consent cannot be obtained from the patient due to his/ her condition, such photography should be taken without negatively affecting the patient’s interest and proper authorization should be obtained from either parents or any other close relative. Nonetheless, where incapacitation is temporary, consent must be sought from the patient as soon as she regains capacity. Since all the photography form part of the medical record, the code provides that no any identifying material should be publicized without the express consent from the patient (Kerridge, Lowe, et al. 2005). The patient should be made to properly understand the material in question, and that once in the public domain, it is unlikely to withdraw it from circulation. Further, the code provides that any form of consent does not provide blanket permission, and as such, it should be periodically reviewed with an option of limiting future accessibility or complete withdrawal from circulation. However, in the event of withdrawal, the law provides that all copies including the master copy should be destroyed, and only the material that is part of the patient record should be maintained. Nurses should also take note of the privacy amendment bill which may have an impact in handling of electronic medical information. In addition, nurses and other medical practitioners should appreciate the dynamism of law relating to this area and should, therefore, keep abreast with changes in legislation while drafting industry practices and policies. Basically, there is no one single way through which patient photography can be claimed as fully ethical. I agree with both federal and state laws that consent must be well informed and should result from comprehensive discussion with the medical practitioner which should be devoid of coercion. As echoed by Holmes, Thompson, et al. (2007), a lawful consent should be more than a functionary signature at the bottom of a pre-prepared pro forma. Even where the patient is unconscious, the most reasonable way of supporting the patient’s autonomy is by obtaining informed consent, which is purposeful and preferably consented in writing before taking the photographs. However, the patients should be allowed to revoke their consent any time they feel like. The obligation and rights of the patient could be extremely difficult to observe, especially in this era of advanced mobile phone technology as nurses can freely take patient photographs especially when unconscious without their knowledge and consent. As echoed by Fry & Johnstone (2008) the Australian medical fraternity and the legal profession continues to face an uphill task due to evolving mobile phone technology which has led to increased clinical photography and electronic data sharing, particularly through social media, which is totally against the patient’s rights to confidentiality and privacy. According to the Australian Nursing and Midwifery Council (ANMC) national competency standards, every nursing practitioner must demonstrate professionalism, legal and ethical responsibilities in the course of their practice. This code of ethics has been developed for all nurses including nursing students, nurses and those in management. Notably, the code of conduct outlines the nursing profession's commitment to respect of patients’ rights such as promoting, upholding and protecting the rights of both recipients and providers of nursing health care. In addition, it identifies the ethical values and standards that the nursing profession is committed to, provide a reference point from which to reflect the nurses’ conduct and finally provide guidance on the ethical decision making and practice. Basically, the nursing profession acknowledges the universal human rights and the moral responsibility to uphold the dignity of every patient. This includes respecting, recognizing and safeguarding patient rights. In this respect, I support the generation and management of patient medical information with the utmost integrity and professionalism. All patient information being recorded should be relevant to health care and treatment of a patient and not for malice. According to ANMC, ethical management of patient information includes respect of people’s privacy and confidentiality while at the same time observing safety. It is essential to note that personal information including photographs taken should only be shared with any third party with lawful authorization. I support the nursing code that requires all nurses to comply with the conditions governing disclosure of patients’ information. Firstly, all nurses should understand that it is unethical to photograph an unconscious patient without written consent and where authorized, it is also against the law to share such photography with third parties (Johnstone 2008). In this regard, a nurse should preserve every patient right and not to compromise or disadvantage the safety and privacy of a patient. Ethical patient information management requires nurses to only maintain patient information and record for the provision of quality health care. However, it is unethical for any nurse practitioner to divulge patient information including photographs of unauthorized people. Patients’ photographs have proved important in medical education. However, in such cases where patient’s photographs are taken for learning purpose, their identities should not be revealed. Patient photography has been one way process that benefit clinicians only who reaps handsomely with little attention being paid to patients whose photographs are taken. Patients are usually seen as unusual findings rather than people living and having feelings. According to my research, many nurses are not aware of the existing nursing code of ethics that require them to obtain proper consent before taking patient photographs just as is the case for any other medical procedure. According to the ANMC code of standards, patients hold their trust on nurses for both their well-being and their lives. As such, all nurses must accord their patients concern and first priority by respecting their privacy, dignity and maintaining the confidentiality of all patient information. According to the case, I agree the nursing officer could have been fascinated by the patient surgical wound after the tragic road accident and may have decided to take photos for further research. Even though observation research has in the past been heavily criticized for lack of objectivity and poor reliability, it is less costly and, therefore, has advanced significantly as one way of collecting data. However, the nursing student should be aware of the nursing code of ethics stipulated in ANMC guiding standards that require photography as a method of data collection to have informed consent. In this respect, the officer must have acted unethically and against the law by taking advantage of the patients’ state to take her photographs. The standards continue to state that research projects involving photography should be closely monitored, and necessary protocol should be put in place to provide useful and objective data that could lead to improved patient care. All projects involving patient photography should be presented to the ethics committee for approval. Further, the committee before giving approval should seek relevant approval from doctors, nursing managers, patients and in some situations relatives. More importantly, the ethics committee will also require to be fully convinced that taking patient photographs will not in any way interfere with patient treatment or nursing care. Nevertheless, the patient, doctor or relatives reserves the right to withdraw their consent at any given time without giving any explanation. Where, photographs are taken for research purpose, the nursing code of ethic stipulates that such photographs should be securely stored and should only be used for the purpose connected to the research project. However, the code also recommends the use of masking device to hide the identity of the patients whose photos are taken. It goes forward to emphasize that accessibility of such photographs should only be granted specifically to those involved in the research project and upon project completion; all such photographs should be destroyed to maintain the confidentiality of the patient (Johnstone & Kanitsaki 2007). On the other hand, patient photographs could be taken for documentaries. Documentaries are famed with arousing public sympathy and raising general publicity especially on the rise of road carnage. For this reason, the nursing officer could have been motivated to take the photograph with the intent of raising public awareness of the dreaded outcomes of road accidents. Notably, some documentaries put the viewers in such voyeuristic and tear jerking positions that are sensational and at times negatively affect the viewers. However, I wish to remind that every time an individual seeks to take patients photographs for whichever purpose, proper authorization must be followed to avoid impinging on individual privacy and confidentiality. Photographing very sick and unconscious patients without proper consent should be deplored. Although relatives may consent taking of unconscious patient photographs, care should be given as to whether this will be in the best interest of the patient as described in the individual privacy and confidentiality Act. Unconscious patients cannot give consent, and as such they are potentially at greater risk of exploitation by relatives and research companies. In addition, the desire of some relatives to see their patient appearing in public may cloud their common sense when making informed decisions. Relatives may be made to understand that refusal to take patient photos could render them appear churlish and unhelpful in the society. Conclusion In conclusion, recent studies have shown photography can improve medical practice through research and raising public awareness. In this regard, I suggest utmost care to be taken to ensure that patient right is not overstepped and that such confidential and private materials are not abused or exploited. Basically, where photographs are used for studies, care must be taken to take account of the issues surrounding informed consent. Patient photography can be useful in informing the general public on health topics and other matters of public interest. However, such photographs should not be used for other sensational and dramatic purposes. There should be elaborate protocols to be followed when taking patient photographs either in preparation of documentaries used to enlighten members of the public or raising funds for charitable organizations. Nevertheless, according to the case, collecting medical information by photographing post-surgical procedure case is tantamount to infringement of individual rights and not in the best interest of the patient. References Eckermann, A. Dowd, T. et al. 2006. Binan Goonj: Bridging cultures in Aboriginal health. Marrickville: Elsevier publishers. Fry, S. & Johnstone, M. J. 2008. Ethics in Nursing Practice: A guide to ethical decision-making. Ed: 3. London: Blackwell Science/International Council of Nurses. Holmes, C. Thompson, F. et al. 2007. Review of the Code of Professional Conduct for Nurses in Australia and the Code of Ethics for Nurses in Australia; and the development of a Code Transcultural Nursing. 18.3: 247–56. Johnstone, M & Kanitsaki, O. 2007. An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context. Journal of Professional Conduct for Midwives in Australia and a Code of Ethics for Midwives in Australia. Townsville: James Cook University. Johnstone, M.J. 2008. Bioethics: A nursing perspective. Ed: 5. Sydney: Elsevier publishers. Kerridge I, Lowe M, et al. 2005. Ethics and Law for the Health Professions. Ed: 2. Annandale: The Federation Press. Read More