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Commission Accreditation And Quality Measures

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Question:

Discuss about the Commission Accreditation and Quality Measures.
 
 

Answer:

Introduction:

The professional role of nurses is including a wide range of services, which includes medication administration to proper documentation of the patient. Thus, nurses need to follow the standard practice guidelines provided by the medical board and office. In this context, the Nursing and Midwifery Board of Australia has developed the ethical code, standard of registered nurse practices, competency standards for registered nurse in Australia and professional conduct (Butts & Rich, 2012). In this essay the focus is to develop the understanding how law, ethics and professional guidelines guide nursing practice. In addition the essay would focus on the key principles underlying ethical, legal and professional guidelines and codes that underpin the practice of registered nurses in Australia, while developing sills in academic and information literacy. The skills related to the ethical and legal aspects in the Australian Nursing framework would be developed through the analysis of a case scenario.

In this essay, a case scenario has been focused, where a nurse witnessed another nurse, who was looking after an elderly, confused patient with high fall risk. It was revealed from the case scenario that, the nurse found it difficult to take care for her patient safely, thus, she tied the patient with her chair by using a sheet. Though the situation was significantly critical and the nurse was facing trouble to ensure patient’s safety due to the patient’s non-adherence with nurse’s guidelines, which is due to patient age and confusion; it is highly unethical to tie someone up, with the chair, by using a sheet.

 

Being a nurse, one of the key responsibilities to ensure patient’s safety, satisfaction and well being. However, in the case scenario, none of the above mentioned responsibility has been met by the nurse (Goethals et al., 2012). It is because, tying someone up, instead of her taking her consent neither ensure the patient’s safety, nor enhances patient’s satisfaction or well being. Rather tying the patient violates not only the standards of the registered nurses guidelines or professional conduct, but it also violates the human rights, as well as affects the health and well being principles negatively.

However, it has been seen in many cases that physical restrain, like tying patient with bed or chair is done for ensuring safety, but these kinds of incidents may raise a significant ethical issue for both the nurse and nursing home. If it is found to be inappropriate and patient has been harmed, the nurse can be sued by the patient’s family members. In the cases, like the scenario described here, where the patient is confused and consist a high fall risk, an appropriate management plan should be made based on patient’s condition and the decision needs to be taken and supported by all the members in patient’s care team (Jakobsen & Sørlie, 2010). Moreover, the most important thing is collecting patient or patient’s family’s consent, which ensures that the procedure is done for the patient’s well being and patient’s family members are aware and supported the procedure. However, in the case scenario, neither such consent was collected, nor a thorough management plan of the patient was implemented for managing the difficulties the nurse was facing, while dealing with elderly patient. Several evidences suggested that unnecessary use of physical restrain showed a significant harmful effect upon the patient, which can also cause pain or discomfort.

Therefore, the witnessing nurse, after witnessing the situation, attempt to stop the colleague doing the physical restrain to the patient. It can be the scenario that the nurse becomes aggressive and do not attempt to cease the procedure. In this kind of situation, the nurse needs to handle the situation sensitively by making the colleague understand about the negative consequences of the work he is doing. In addition, the nurse should also make her understand regarding the patient’s discomfort and ethical issues related to the case (Aitamaa et al., 2010). However, even after discussion, the nurse is not ready to stop her activity, the witnessing nurse should complain to the nurse manager or the in-charge at that shift. It is because, according to standard 6 of professional nursing standard of nurses by NMBA, nurses should ensure a safe, appropriate and responsive quality of nursing; which is being hampered by the accused nurse’s practice (Nursingmidwiferyboard.gov.au, 2017). Moreover, according to code statement 2 ad 5 of NMBA ethical codes for nurses, “Nurses value respect and kindness for self and others” and “Nurses value informed decision-making”, both of which are hampering in this case (Mohr, 2010).

 


Considering all of these standards of practices and analyzing the negative impact of the case upon the quality of services provided by the hospital to the patient, the management should be informed by the witnessing nurse immediately after discussing with the nurse. The incident should also be documented. Next to this step, the nurse should assist the management to undertake adequate legal action for breaching the ethical codes and professional standards as well as for attempting to harm a patient, without taking consent from either patient family or any members of the multidisciplinary team (Kontio et al., 2010). After that, the team should cease the procedure to be continued by the nurse. Another important thing that should be done in this case is informing the patient’s family regarding the incident and apologizing for the misconduct done by the nurse.

After informing the case to the top management, the accused nurse should be asked regarding the case, for the sake of a thorough and professional investigation and the nurse’s opinion should be taken. Here, the nurse would be asked for what was the reason for her action, what were the constrains she was facing and what ethical issues she raised in the hospital. The nurse would be asked for seeking apology from the patient’s family as well as the hospital authority for the misconduct. The nurse would also be advised for not taking such step in future. Moreover, she would be allocated for proper training and compensation for her activity would be provided to her. In this context, a proper inquiry should be done by the medical board, where medical professionals from the other health care organizations would take part in the investigation to reduce the chance of biasness (Goethals et al., 2013).

Being the witnessing nurse, immediately after the incident, lesson would be learnt, regarding the negative consequences that can occur, when a nurse does not follow the ethical and legal framework of the health care services.

“Registered nurse standards for practice” have been developed for ensuring safe and high quality health care services provided by the Australian registered nurse. The case scenario revealed that the accused registered nurse, who tied the patient with chair, did not meet these standards. In this guideline, standard 6 discusses RN’s role in “providing safe, appropriate and responsive quality nursing practice”, where in 6.5 standards, it has been depicted that RN “practices in accordance with relevant policies, guidelines, standards, regulations and legislation” (Nursingmidwiferyboard.gov.au., 2017). Therefore, in the case scenario, the accused nurse has not met this standard of practice for RN, as she did not follow the hospital policy, guideline and NMBA standard as well as violated human rights related legislation. On the other hand, according to standard 6.6, “RN uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards” (Nursingmidwiferyboard.gov.au., 2017). This standard has significantly followed by the witnessing nurse, as she attempted to reduce the risk of the misconduct by advising the accused nurse and reported the issue to the higher health care management staff to take immediate action, as she understood the actual risk related to the system and the practice is opposing the expected standard. Therefore, standard 6 can effectively be applied in the case scenario.

 


In addition, According to the code statement 2 and 6, RN should promote respect and kindness for self and other as well as RN should create a culture of safety in the nursing and health care framework. However, in the case scenario, the accused nurse has not met these ethical codes, as she failed to establish a safe environment for the patient and attempted to violate patient’s rights. This is how the “code of ethics for RN” is applicable in the current case scenario. On the other hand, according to National competency standards for RN, nurse should “comply with relevant legislation common law, fulfils the duty of care, recognizes and respond to unsafe or unprofessional practice, practices within a professional and ethical nursing framework” (Nursingmidwiferyboard.gov.au., 2017). In the case scenario, the accused nurse was unable to fulfil her duty and comply with the legal and ethical framework” as she attempted to tie her patient in an unprofessional way to manage the patient’s fall risk related issue, which could harm the patient and violated the patient’s right. Therefore, it can be said that ethical and professional standards of registered nurse practice were not met in the case scenario practice, indicating a legal or ethical implication.

While investigating the legal and ethical implication of physical restraint, the Joint Commission standards need to be reviewed. JC Standard PC.03.05.01 states that restraint can only be used when it can be clinically justified or warranted by patient behaviour, threatening the physical safety of the patient, staff or others. However, none of the above criteria was found in the case scenario, thus according to this legal standard, restrain was not applicable in the case scenario, indicating it a professional, ethical and legal misconduct. JC standard PPC 03.05.05 states that restraint should be used based on an individual order; however, there were no evidence of order provided by physician or a member of multidisciplinary team. According to JC Standard PC.03.05.15, organization should have proper documentation of the restraint usage, which was also not done by the accused nurse prior implementing the practice upon the patient (Wagner et al., 2012). Therefore, analyzing JC standards, it can be interpreted that these legal standards were not met by the accused nurse, while doing the misconduct in the hospital framework.

Moreover, according to section 69 of the mental health act 2001, a patient cannot be placed over a physical restraint or speculation until it is crucial or as a last option. It is the liability of the professional to ensure the necessity of physical restraint, whether it is necessary or not and for doing this thorough evaluation and re-evaluation should be done by more than one professional (Ramsay, Roche & O'Donoghue, 2013). The law also says that the consent of the patient’s family should be obtained, for using the restraint as a tool of patient’s well being. However, if consent was not taken and the process was not done properly, many legal challenges can be raised. It also states that any nurse using physical restraint should adhere to the Mental Health Commission rules in this context. However, law of false imprisonment protects a patient from an illegal restriction in his or her freedom of movement, which is applicable to the unlawful restraint of liberty, which has been noticed in the case scenario. Therefore, an unlawful action could be alleged by the patient’s family; however, only relevant policy adherence or proper authorization documents for understanding restraint action can rescue the nurse from the compensation for the illegal conduct.

 


None of the above mentioned criteria has been fulfilled by the accused nurse. Therefore, for the unethical practice, the nurse can be suspended from her job by the hospital authority, or she can be given a warning for such misconduct along with penalty (Mohr, 2010). Moreover, in case of legal allege by the patient’s family, the nurse can even be sued from her job.

The registered nurse need to adapt the key skills and competencies required to fulfil her role effectively. In the Australian health care framework, in addition to follow the standards of practices, the nurse need to follow all the ethical codes and the legal policies built by the Australian medical and health care board. In this essay, an ethical issue regarding RN’s role has been focused for understanding the role of RNs in adhering with the professional standards, ethical codes ad competencies. The essay evaluated the case scenario by demonstrating possible steps taken by witnessing nurse, the application of registered nurse standard for practice and the legal-ethical impaction of the case. The essay helped in developing a critical and reflective approach to the legal and ethical nursing practice.

 

Reference List

Aitamaa, E., Leino-Kilpi, H., Puukka, P., & Suhonen, R. (2010). Ethical problems in nursing management: the role of codes of ethics. Nursing ethics, 17(4), 469-482.

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.

Goethals, S., de Casterlé, B. D., & Gastmans, C. (2013). Nurses’ decision-making process in cases of physical restraint in acute elderly care: a qualitative study. International journal of nursing studies, 50(5), 603-612.

Goethals, S., Dierckx de Casterlé, B., & Gastmans, C. (2012). Nurses’ decision?making in cases of physical restraint: a synthesis of qualitative evidence. Journal of advanced nursing, 68(6), 1198-1210.

Jakobsen, R., & Sørlie, V. (2010). Dignity of older people in a nursing home: narratives of care providers. Nursing Ethics, 17(3), 289-300.

Kontio, R., Välimäki, M., Putkonen, H., Kuosmanen, L., Scott, A., & Joffe, G. (2010). Patient restrictions: Are there ethical alternatives to seclusion and restraint?. Nursing Ethics, 17(1), 65-76.

Mohr, W. K. (2010). Restraints and the code of ethics: An uneasy fit. Archives of psychiatric nursing, 24(1), 3-14.

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 23 April 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Ramsay, H., Roche, E., & O'Donoghue, B. (2013). Five years after implementation: A review of the Irish Mental Health Act 2001. International journal of law and psychiatry, 36(1), 83-91.

Wagner, L. M., McDonald, S. M., & Castle, N. G. (2012). Joint Commission accreditation and quality measures in US nursing homes. Policy, Politics, & Nursing Practice, 13(1), 8-16.

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