In nursing profession, following the ethical and legal framework is crucial to meet the competency standards and eliminate any kinds of misconduct or patient dissatisfaction in the care settings. Thus, I always review my legislative framework of practice, while dealing with patient’s case or inter-professional interaction. In the Singapore health care context, several legislations are being followed by the nursing professionals to maintain the compliance with nursing profession’s liabilities (Anthony and Vidal 2010). For instance, the key legislative frameworks that have impacted on my nursing profession directly include HOTA act 2011, Nursing and Midwifery act and Workplace safety act 2006 in Singapore.
For instance, the HOTA act 2011 has significantly helped me to deal with the patient’s family, who have registered an organ donation after patient’s death. The HOTA act 2011 includes recovery of four organs, namely kidney, heart, cornea and liver, after the death of the patient, to give another organ failure patient a chance to survive. The act provided the opportunity to communicate with patient’s family in a supportive active way, through which they can easily understand the pre-requisite and emotionally supported and encouraged to fulfil all the requirements for organ donation (Carmi and Schneider 2012). The organ donation is a process, which is difficult to carry on by a significant number of patient’s family member, which may affect the paperwork and requirements for the organ donation procedure. In such a context, I was facing difficulties to deal with a patient’s family, whose liver was about to be donated to another patient, undergoing liver failure. In this context, the patient’s wife and son were significantly distress and dissatisfied with the decision taken by the patient prior undergoing brain death followed by a car accident.
I attempted to support the patient’s family with my communication and empathic listening skills. However, it was becoming difficult to make the patient’s family convinced, as they were confused regarding the procedure and the legal consequences. As a result, I started to argue with the patient’s family, as the procedure was being delayed. In this context, my colleague suggested me to go through the HOTA act booklet and make the patient’s family familiar with the act, to secure the procedure. I took help from the Liveonwebsite or MOH’s website to provide more information regarding the medical and legislative aspects of the procedure. I was able to make them understand regarding brain death, once they got the booklet of HOTA act (Smith et al. 2011).
In another professional context, I took help from the ‘Workplace safety act 2006’, which helped me to understand the administrative control and risk assessment procedure. For instance, I experienced a significant incident in this context, where I revealed that one of my colleagues left the bottle of a chemical open in the corridor, which enhanced the risk of slip and trip as well as chemical injury of all the patients as well as other medical staffs in the word. Upon noticing the misconduct, I placed the chemical in safe place and discussed with him regarding the massive issue, though he denied his misconduct. Then, I took help from the ‘risk assessment’ liability of nursing staffs from the ‘workplace safety policy’ of our organization, which was developed on the basis of ‘workplace safety act 2006’ and successfully made him understand regarding the issue (Huber 2013). I reported the issue to the safety team in the workplace and encouraged him to accept his fault and seek apology from the authority.
With the evolution of health care framework worldwide, the involvement of patient and patient’s family have been enhanced consistently in order to enhance compliance of the patient with the treatment and give their decision value in the medical setting. The advance directive is referred to a medical documentation procedure completed by the patient, while still having the ability of decision making regarding how treatment decisions should be made on her or his behalf in the event she or he loses the capacity to make such decisions, following an exploration of patient’s and service provider’s knowledge, hopes and needs (Kjervik et al. 2010).
According to my opinion, this process can be followed for every patient undergoing a chronic situation and have a possibility to lose consciousness during the treatment procedure. This is a legal tool to make the patient and family aware of patient’s medical consequences, while maintaining patient’s his family’s rights regarding medical decision. For instance, a patient experiencing terminal stage of cancer, cardiovascular syndrome, kidney or liver failure or chronic disease AIDs or chronic Hepatitis. Initially, the process should start with an emotional support, while conveying about patient’s possible health consequences in near future and assisting the patient and patient’s family to control emotional distress (Lillis et al. 2010). This procedure should be followed by the provision of in-depth information regarding the procedure its pros, cons and importance in patient’s medical care plan. Finally, the patient and his family would be ensured for positive support through the care process.
Nurses are the key health care professionals, who are liable for providing continuous support to the patient and patient’s family regarding any kinds of care related information provision. Therefore, nurse should have appropriate skills and competence to communicate with patient and family members in such a way that they could understand the required medical procedures. The nurse should initially give patient support to accustom in the health care environment and build self esteem, through developing a strong positive relationship with the patient. Next, the nurse should inform the purpose of all the care procedure and benefits and risks relate to those procedures (Polivka et al. 2008). In case of follow up sessions, it is the accountability of nurses to provide information regarding follow ups. All the documentations and legal procedures are also conveyed by the nursing staffs to the patient. On the other hand, in case of patient’s family, the nurse should attempt to provide all information regarding patient’s current status, health related consequences, distress, financial information, medical procedures, their purpose in patient’s recovery as well as any kinds of misconduct done by any of the medic staffs. Ultimately, provision of this information would build a trust towards the patient’s family and help them to take part in patient’s care team to give their decision for care process.
Communication is one of the key determinants of health outcomes and patient’s satisfaction. Thus, to meet the nursing competency standard, the nurses should meet all the criteria for being efficient in communicating with all the care users as well as other care givers for promoting a collaborating practice. In Singapore, there are several cultural traits exist in the population, who have different language and identities. The nursing staffs need to deal with all of the care users with equal efficiency, irrespective of their cultural background, to avoid discrimination (Potter et al. 2010). Thus, it is important for the nursing staffs, to have a strong base on every culture and languages used by the care users, to facilitate the communication in a smooth and effective way. Therefore, being a nurse I have to communicate effectively across different culture, be sensitive and adaptive towards different cultural norms in relation to verbal and non-verbal communication, assess the patient’s needs and interpret or effectively work with an interpreter as well as should avoid assumptions or judgments regarding the patient’s communication style.
In this context, I have demonstrated these skills and competencies related to cultural diversity several times in my professional area. For instance, while dealing with a Muslim female patient, who have undergone a knee replacement surgery. While dealing with the patient and during thorough interaction with the patient, I observed that the patient is feeling uneasy to leave any of her body parts open, instead of arms, as it was one of their cultural traits I also noticed that, while assisting her bathing, she was hesitating. Thus, I attempted to give her maximum independence during her daily living activities and assisted her to cover her body parts all the time. Another incident I faced, when checking her diet chart. I reviewed that the dietician included ham in her diet chart. With my critical thinking skill and diverse cultural knowledge, I identified the restriction of pork in ‘Muslim culture’ and I reviewed the diet chart, while discussing with the patient, to collect her consent; upon revealing that she is restricted to consume pork due to cultural boundaries, I communicated with the physician and dietician to replace ham with chicken; thereby demonstrating effective communication skills both with patient as well as with the professionals (Cherry and Jacob 2016).
Another experience, I have gained in my practice area, while dealing with an older Chinese patient. The patient was in an unconscious status and I needed to take consent from the patient’s family member, i.e. her wife, who is an non-English Chinese and was unable to communicate with the health care staffs and at that time I did not gone through my Chinese language course, thus, was neither able to understand her concern, nor able to make her understand the purpose of the consent. At this moment, I contacted with the professional interpreter, who helped me to sort out the problem and cum down the her.
The health care assistants (HCAs) are the health care staffs, who are usually the beginners and work under different healthcare professionals. In this context, registered nurses have a key accountability to assess and guide these HCA staffs in the health care context. As the experience and knowledge of these staffs are limited, the chance of misconducts in patient care is higher in case of HCAs compared to the other experienced staffs. Thus, it is crucial to regulate and assess their ability to provide appropriate health care services to the patients. The ultimate goal of regulating the health care assistant’s role in Singapore health care framework is to promote patient safety and the quality of overall health care service provided by the health care organization.
It is absolutely relevant to regulate their activities, as their services affect the standard of care potentially. Thus, it is really important for HCAs to know that if they do some misconduct without proper education and training, then they would be held in law accountable for their actions (Dellai et al. 2009). Thus, being a nurse, it is a point to worry, while handing a responsibility over to an HCA; it is because, in Singapore health care system, currently there is no national guidelines to regulate a misconduct help by a HCA, rather the RNs are accountable to make a decision to delegate a job to a health care assistant. Therefore, according to the system, when they are delegating a task to a health care assistant, that means they are depicting that the healthcare assistant is competent enough and they are liable for the consequences of undertaking the task. Thus, based on their competencies, some HCAs are allowed to perform some tasks, whereas others are not.
Currently, HCAs are not regulated, thus, there is no body that they report their concerns. Working within the health care system, they should understand their role, by interacting with the health care team and understand what are their strengths and where do they fit into the system. Therefore, in-depth training can help them to regulate and modify their weaknesses, which would ultimately lead to improved patient care, through the use of most appropriate use of skills in the workforce (Bittner and Gravlin 2009). Therefore, incorporating the regulation of HCAs, it is ultimately contributing to the risk management system of the health care management team. I think safety is a crucial think in the health care system to look for, by all the stakeholders in the health care system, including employer, nursing staffs, HCAs, other health care staffs, physicians as well as patients. Thus, the registered nurses should also responsible for ensuring safety of the patient and the entire health care system, by integrating appropriate regulation and assessment of HCA’s core capabilities and competencies, improving their confidence and compliance with the regulatory systems (Yoder-Wise 2014).
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