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The Falls Risk and Elderly Care

Question:

Discuss about the Ethics, Professional Guidelines and their Relationship to Nursing Practice.

This essay focuses mainly on the care provision given to the elderly or olderpatient who has high falls risk along with related professional and nursing guidelines for the patient’s care. It will also emphasize the law and ethical guidelines for nursing practice of the registered nurse in Australia and will assist in the understanding the important characteristics of professionalism in the practical healthcare setting.

Inadvertent falls are enlisted under the common reason of nonfatal harms for the patient older than 65 years of age. The accidental death of the patient over 65 years of age is commonly caused secondary to the fall associated injuries. Unintentional falls are a rising public health concern that requires being given attention(Abraham, 2011).

Here, a scenario is considered which includes a nurse and one of her colleague who is taking care of an older and confused patient who tend to fall often due to age-related complications and the colleague nurse is unable to take proper care of the patient and so, she tied the patient to the chair with the help of a sheet.

The other nurse who was witnessing this whole scene needs to take immediate actions. The nurse shouldrespond to the patient as early as possible and remove the sheet tied to the body of the patient. Following this the patient investigation is to be conducted to find clues to his future falls causes and vital signs are to be observed.Somerisk factors related to the clinical condition or medical drug use may be indicated with the helpof abnormal assessment values of vital signs such as Temperature, pulse rate, respiration rate, blood pressure, apical heart rate and postural BP, and for diabeticsFinger stick glucose test needs to be performed within 24-48 hours of the initialobservation(Kim, & Kim, 2013).The patient should also be supported with the fall preventative aids, to prevent future falls and nurse should try to establish harmonious relationship with the patient to increase the patient’s trust on the nurse. These all data needs to be handed over to the registered nurse for targeted care delivery to the patient and hence, attaining holistic management and assessment by working in an interdisciplinary group(Moyle, Parker, & Bramble, n.d.). The nurse should ensure that daily need items and essential materials of the patient are in area of reach of the patientto prevent any further fall. They also need to recheck whether the footwear of the patient is in proper condition and any defects in the care setting provided to the patient.The nurse should communicate the risk of fall to her colleagues so as to handle any future fall properly with colleague assistance. The nurse should keep a check on high-risk patients regularly to improve the safety of the patient’s surroundings(Carlson, & Bengtsson, 2014). In this case mentioned above the nurse applied restraints without doctor approval. However restraints can be used for the patient only if there is a standing or written order for it. Nurses and doctors work together to identify and rate on how likely the patient tends to fall and following this they find the best wayto prevent falls from happening(Lach, Krampe, & Phongphanngam, 2011). Nurses use different types of instruments to evaluate the patient’s balance, strength, and ability to move. Giving care(mentally) to the patient is more important than the physical safety. The nurses require meeting thepsychosocial and emotional needs of patients(Beebee, 2013).

Care Provision for the Patient


The main issues, in this case are nurse adherence to ethics and codes, demands, public needs, and expectation (Australian nursing and midwifery board standards) and involvement of specially trained nurses for old aged care settings which were lacking in this case. The nurse needs to understand and to take care of the patient’s dignity, respect and confidentiality of their information. Another one is the absence of the effective care provisions for the elderly secondary to inability to use her skills and knowledge for the betterment of the patient. The nurse should ask for patient consent before restraining the patient to the chair. The nurse should understand the proper and effective use of methods to prevent falls in elders(Fogel, Berkman, & Merkel, 2009).The nurse needs to follow the goals of elderly care are doing no harm to the patient, telling the truth to the patient, and loyalty to the patient. In the scenario given the aged patient should be treated well without any bias based race, religion, or age and allowed to take their decisions.The nurse should educate about the fall prevention methods to the patient family.These issues can be handled by the provision of suitable training to the nurses involved in the care settings and should be made aware ofthe ANMB standards(Dempsey, 2014).

The sections of the Australian nurses whose practices will apply here are gerontological nurses as they are specialized in the provision of treatment and care of the older people and their age- related illness or risk factors related to cognitive, physical, and psychosocial alterations are essential requirements for nursing care of older adults. They assist the older adult patient to maintain activities of daily life.Registered nurse strictly follows and understands the code of ethics provided by Australian nursing and midwifery board(Terry, Stirling, Bull, & Fassett, 2015).The 'Registered Nurse' is a nurse who has completed the course approved by AMBA and who utilizes her nursing skills and critical judgment of nursing to meet the health needs of the patient to provide them best care(Halcomb, Stephens, Bryce, Foley, & Ashley, 2017).The registered nurse shows know-how in thedelivery of nursing care as defined by National Board standards and codes, informative preparation, applied legislation and situationof care. The registered nurse takes action independently as well asinterdependently, assuming responsibility and accountability for their actions.The registered nurse plays a role of leader in the management of health and nursing care within various carecontexts to provide optimal health results. This includes applicable referral to, and meeting with, other pertinenthealth professionals, facility providers, and maintenance services(Edmonds, Cashin, & Heartfield, 2016).


The legal, ethical, and the professional issues in the case are the patient’s autonomy (the independence of a patient to carry his activities and to take informed decisions) and right for the informed consent which were violated when he was tied with a sheet into his chair. Hence, according to the autonomy right of standard ethics, the nurse should take care of what the patient wants and no nurse has right to deny this. According to the right of informed consent,  the patient can say that he was not asked for his consent to this action so, informed consent is the legal and ethical duty of the health professional and the nurse to take from the patient(Joana, Rosa, & Bruno, 2013). There is no need for informed consent in cases where the patient is unable to express his needs.Abiding these rights will consequently help in the establishment of trust and harmonious professional relationship. The legal and ethical implications arise when nurses breach or unable to follow their ethical duties and responsibilities("Medicines Australia Code of Conduct: breaches,” 2015).In the above mentioned case, the nurselacks the right standards of practice and respect of patients’ rights("Implications of the Affordable Care Act on Nursing Regulation and Practice,” 2014). Nursing in Australia is bound to standard code of ethics defined by ANMB. Ethics is a branch of philosophy that handles questions about the morality and concepts such as evil or good, wrong or right, virtue or justice.The nurse should act ethically to maintain standards of practice and should respect the rights of the client(Halcomb, Stephens, Bryce, Foley, & Ashley, 2017).

Professional Issues in Nursing Care of Elderly


The key ethical principles of nursing practice are respect for individuals, their autonomy, justice, veracity, nonmaleficence, fidelity, andbeneficence. Respect for patient, irrespective of caste, creed, race or age. Respect for autonomy is also called as personal independence. The right to justice is delivery of equal service and care of all the patients(Mason, 2017). Veracity is the rule to tell the truth to the patient and nonmaleficence is to do no harm to the patient.  Accountability or fidelity is the willingness of the care provider to stay loyal with the patient. The law followed by the registered nurse in Australia is a Health Practitioner Regulation National Law (ACT) 2010. The national standards of practice for registered nurse are as follows: Professional Practice: The codes in this guide the registered nurse to take action according to the health law and legal requirement of the medications. It helps to aware the nurses about the legal implication of the nursing intervention made for the patient and also the way to identify legal implication(McElroy, 2011). It also explains the nurse about the effect of the legislations and unprofessional practices as it relates to the breach of patient’s confidentiality and their privacy. It aims to deliver optimal care to the patient and guides to avoid unsafe practices for prevention of recurrence of bad outcomes.The competency standards also guide the nurses in critical analysis and thinking and train them on the use of clinical research and its implication for appropriate decision making.Delivery and coordination of care plan described in ANMB to assist the health care professionals to, plan, implement, evaluate and do an assessment of the patient for optimal care provisions. The last one is therapeutic andcollaborative practicewhich relates to the way to establish good relationship with a patient and the healthcare teams(Phelps, Hyde, & Planchon Wolf, 2015). RN(Registered Nurses) follows practices, according to Australian nursing code and ethics defined by ANMB. It includes equal nursing care for all people. Nurses should value kindness and respect for self and patients. They believe in the provision of quality nursing and care for all individuals. RN gives importance to informed making of decisions. The nurses believe in the safety of health and nursing care and also ethical management of patient’s data or information. Registered nurse believes inan economically, socially, and ecologically workable environment for promotion of wellbeing and health to the patient. The reasons for the codes of ethics for nurses are to distinguish between the unsafe practices and basic ethical standards of care to which profession of nursing is committed. It provides a reference basis from they can follow and guide their conduct and others. It also denotes the community human rights standards and value of ethics expected from the nurse.The nurses must demonstrate integrity and professionalism and carry out their work within standard professional, ethical and legal frameworks. The code of ethics is crucial to be followed by the registered nurse and if they breach this ethical code, then their nursing license will be taken away or canceled.Healthcare provisions will endure to face alterations and advancements; however, professionalism and an emphasis on patient satisfaction will always act as the heart or soul of this healing profession(Halcomb, Stephens, Bryce, Foley, & Ashley, 2017).

Legal and Ethical Issues

Conclusion

 Understanding of ethics, law, professional guidelines and their connection with the nursing practice is imperative for the registered nurses and other associate nurses. As they guide the nurse to provide best and optimal care to the patient. In this report a case of an elderly confused patient was given who has high falls risk to develop a practical thinking approach in nurses to make them learn about the associated problems in nursing care and the path they can follow to take right decisions keeping in mind the standard code of ethics and conduct provided by the ANMB. The study of case helps in making them aware of the actions to be taken by a nurse for fall prevention. It also increases the knowledge about the use of restraints at a suitable time with the approval of a doctor and also helped in learning the approach to provide care without breaching the code of ethics and hurting the rights of the patient(Moyle, Parker, & Bramble, n.d.). The right of the patient to have respect (social) and moral (informed consent and right tohave autonomy) aspects of patient safety must be carefully consideredin the nursing care.

References

Abraham, S. (2011). Fall Prevention Conceptual Framework. The Health Care Manager, 30(2), 179-184.

Beebee, J. (2013). When restraint becomes necessary. Learning Disability Practice, 16(1), 9-9.

Carlson, E., & Bengtsson, M. (2014). The uniqueness of elderly care: Registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care. Nurse Education Today, 34(4), 569-573.

Dempsey, D. (2014). Refusing treatment: practical, legal and ethical issues. Nursing And Residential Care, 16(8), 454-458.

Edmonds, L., Cashin, A., & Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards. International Nursing Review, 63(2), 162-179.

Fogel, J., Berkman, C., & Merkel, C. (2009). Efficient and Accurate Measurement of Physical Restraint Use in Acute Care. Care Management Journals, 10(3), 100-109.

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal Of Advanced Nursing.

Implications of the Affordable Care Act on Nursing Regulation and Practice. (2014). Journal Of Nursing Regulation, 5(1), 26-34.

Joana, S., Rosa, C., & Bruno, F. (2013). Incidence of falls and risk assessment in institutionalized elders. European Geriatric Medicine, 4, S59-S60.

Kim, M., & Kim, J. (2013). Effects of the Fall Prevention Education Program (FPEP) for Caregivers in Elderly Care Facilities on Fall-related Knowledge, Fall-related Burden, and Caring Behaviors for Fall Prevention. The Journal Of The Korea Contents Association, 13(11), 778-790.

Lach, H., Krampe, J., & Phongphanngam, S. (2011). Best practice in fall prevention: roles of informal caregivers, health care providers and the community. International Journal Of Older People Nursing, 6(4), 299-306.

Mason, D. (2017). Professionalism in Health Care Organizations. JAMA, 317(12), 1203.

McElroy, A. (2011). Fundamental Aspects of Legal, Ethical and Professional Issues in Nursing – Second edition. Nursing Standard, 25(42), 28-28.

Medicines Australia Code of Conduct: breaches. (2015). Australian Prescriber, 38(6), 216-216.

Moyle, W., Parker, D., & Bramble, M. Care of older adults (1st ed., pp. 55-59).

Phelps, S., Hyde, L., & Planchon Wolf, J. (2015). Introducing Information Literacy Competency Standards for Nursing. Nurse Educator, 40(6), 278-280.

Terry, K., Stirling, C., Bull, R., & Fassett, D. (2015). An overview of the ways nurses understand and utilise the existing Australian Competency Standards for Registered Nurses. Collegian.

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