Professional, Ethical And Legal Considerations For Nursing Practice

One of your closest friend's mum is admitted to the clinical area where you are currently on placement. Your friend approaches you whilst you are out socialising and askes specific questions about her mum and the long-term effects of her condition. You explain to your friend that you cannot disclose any information regarding her mum. She becomes very upset at your response and appears emotionally distressed. There is nobody with you, who you could ask for support at this moment hence, you feel conflicted with your decision to withhold information from your friend. With reference to two of the professional values from the practice-based assessment (PAD).

Critically analyse and evaluate the impact of your action with specific reference to the professional, ethical and legal considerations in relation to your role as a pre-registration student nurse.

The nursing practice is broad; from patient care to research and education. The various aspects of nursing practice are regulated by various legal, ethical and professional codes and standards. All nurses are included in the register when they commit to abide by the requirements of the profession which are stipulated in the codes and standards. Adherence and compliance to these regulations are enforced by a professional regulatory body. The nursing and midwifery council is mandated with this task in the UK (Osborne, 2015). Their legal standards are those which are those whose adherence is required by a law to be undertaken. A failure to comply attracts a punitive action following a criminal proceeding.

 Professional codes are not necessarily a requirement of the law. They are stipulated by the professional body for its members. A deviation from the expectations subjects an individual to disciplinary measures through a professional tribunal that analyses their conduct. According to Feo, Rasmussen, Wiechula, Conroy, and Kitson (2017), this is done by considering their professional expectations with reference to their skills and qualification. Ethical requirement derives the expectations of the values and virtues gained in practice. It also has demanded some level of professional judgement. Ethical requirements may be a legal requirement or just an expectation of the professional body. Personal values in practice are the main consideration.

In the case scenario, professional values of confidentiality and communication are the main concern. These are important aspects of a nurse-patient interaction. They are the basis of building a rapport and trust upon which nursing practice happens. These values cut across the legal, ethical and professional requirements in practice. These two basic components of nursing practice are comprehensively discussed below.

According to the nursing and midwifery council (2015), the nurse owes the duty of confidentiality to all those receiving their care. Patients have a right to privacy and confidentiality (Moss, 2017). When a nurse takes up the responsibility of care, they are obliged to treat the patients with utmost level confidentiality. They enter into an agreement of non-disclosure which must be respected. A breach of this agreement is punishable by law and the regulatory body. Confidentiality is argued to be the most important value for any health professional. Care can only be provided when the patient discloses all the necessary information to the care provider during history taking (Griffith, 2015). The course of interventions is based on the acquired information. If the patients withhold some information, a care plan that is formulated may miss some very vital details which may have some far-reaching consequences to the patient. This may range from the prescription of the wrong drugs or prescription of drugs in lower quantities than the required doses. Some studies have shown that healthcare providers have spent so much time and resources treating the symptoms rather than the root cause of a problem. The root problem could have otherwise been detected in the process of history taking.

Legal and Ethical Requirements for Confidentiality

Taking a good history is influenced by the level of trust a healthcare provider inspires from their interaction with the patient. Patient integrity is a major concern to them that does not influence their health-seeking behaviour but also their adherence to the treatment regimen. The success of nurse-patient interaction is pegged on the level of confidence (Gilbert, Rickert & Aalsma, 2014). It is one aspect that cannot be substituted.  The issue of confidentiality has some legal and ethical requirements surrounding it. In law, the aspect of confidentiality is a key factor in patient care. There is no single law that has been formulated to address the issue of confidentiality (Ferguson, 2016). The sources of these laws have been judicial precedents following cases that touched on the matter. For instance, in the case of Hunter v Mann (Carr, 2015), the court ascertained that a doctor is bound by duty not to voluntarily disclose, information, which they have gained in their professional capacity from the patient, without their consent. This law addresses the nurses and all other healthcare providers involved in care provision.

The law protects the dignity and autonomy of individuals (Monrouxe, Rees, Dennis & Wells, 2015). Confidentiality is necessary to uphold this human right (Michalowski, 2017). Medical information is recognized as private and the law requires its protection. Handling of patient data is done to in confidence and by only those authorized. Consent is sort in case the information is to be shared. In the case scenario, being a nurse, the duty of responsibility has to be upheld at all times. Patient information, concerning their course of treatment and prognosis can be disclosed to other people only when consent has been sought from them. Without a consent, it is prohibited to do so. The information that is being sorted in the case scenario is identifiable to the patient; thus should be held handled with strict confidentiality.

Sharing information with friends and relatives is also guided by the principle of confidentiality. The patient should consent to disclosure of information to them (Dheensa, Fenwick & Lucassen, 2016). The law has a provision where a patient can give the power of attorney to a family member or attorney to make decisions concerning their care if they are incapacitated. Such an individual will be granted the right to access their information in order to make an informed decision. By signing the legal documents granting such powers, the patient will have consented to disclosure as per the terms and conditions governing the relationship. In the case scenario, it would only be possible to provide the information with the friend required if they had such powers of attorney or if the mother consented to such an action.

Case Scenario and Analysis

The law also provides some statutory provisions where confidentiality can be breached (Ley & Hayes, 2018). In the case of the notification of an infectious disease, a health practitioner is required to inform the necessary authorities for action without necessarily having to ask for consent. The circumstance is viewed as the best move for the public interest. To protect other people from infection, the authorities should be notified. A court may be issued requiring disclosure of such information (Gerrard, 2018). If the court finds it necessary to retrieve such information, a nurse may be subpoenaed to testify and shed light on a matter in a particular case. The case scenario above does not fit the above requirements and thus disclosure confidentiality cannot be breached.

The scenario poses an ethical dilemma while trying to uphold the principle of confidentiality. Respect of autonomy of the patient is mandatory even if the patient will not know it even if it was breached. It is possible that the friend's mother will not know that the information was not breached. Legally, the issue would be punishable if the issue is brought before a court or medical tribunal. Ethics focus on the actions of the healthcare provider. What is considered professionally correct even if it may not be a requirement of law.

In confidentiality, a nurse will be required to view the consequentialism of their actions (Lunt, 2016). Their clinical judgement should guide their decision. The disclosure may break the trust that the patient has in the healthcare provider. This may result in the withholding of vital information that may be essential for the further provision of care. Inpatient care, the relatives and friends are equally affected if a friend or relative is suffering. It is understandable when there is a conflict of interest when a family member or friend expresses their needs and one feels that they can meet them. However, the principal duty of a healthcare provider is to the patient (Hébert, 2015). Once they agree to take care of them, they assume the duty of care to that patient. Any action that may undermine the autonomy of the patient is avoided at all costs. The ethical decision, in this case, is to seek the patient's consent on disclosure of information.

 Communication is a deliberate sending and receiving of information. All the patient-nurse interactions are founded on the ability to pass and receive information (Rowe, 2017). The patient can give an account of their health when consulted while healthcare providers can explain the treatment plans and options available. Communication is important in creating a rapport between the patient and the care provider. Essentially the relationship is completely based on communication. Thus there has been a lot of emphasis on communication as a very essential interpersonal skill among healthcare providers (Fitzpatrick, 2018). A nurse is expected to have good communication skills for effective interaction with both the colleagues and the patients. Some of the good communication skills include being a good listener. The simple rules of turn-taking enable the nurse to allow the patient to express themselves without interruption. The use of open-ended questions is a way of encouraging the patients to communicate and making them make a decision free from bias. Compassion and empathy are expressed by the use of use of kind words. Trust can be built and maintained through communication and giving assurance to the patients (Brashers, Phillips, Malpass & Owen, 2015). In a healthcare team, effective communication is necessary for interaction between the different professionals in the team.

Conclusion

Communication has been a matter of great emphasis in both training and practice. Patient education is the hallmark of preventive medicine (Alligood, 2017). The nursing and midwifery council has set out the important considerations for an effective patient education program. The information should be clear, intelligible and accurate.it should be in a way that the patient can easily synthesize and understand. It is the duty of the nurse to explain to the patients about their condition in a way that they can easily understand. The nurse is expected to customize the education to suit the suit the needs of the patient keeping in mind their level of understanding and level of education. In establishing a patient-centred care plan, patient education is important in order to encourage their participation

Current trends in healthcare are being directed towards a patient-centred approach in care. The patient is made aware of all the treatment options they have, the expected outcome and the complications associated therewith. Communication enables the health provider to explain the contents of an informed consent (Kurtz, Draper & Silverman, 2016). It may enable them to make decisions in anticipation of the expected outcome. For instance, in the case scenario, during her patient education, the mother should have been informed of the expected outcome and those that should be contacted to provide support. they could also decide who to make decisions in case they are unable to do so. Passing such information to the patient will empower them and make them feel in control. They can make arrangements and make decisions about their care and the people that should be involved.

However, the nurse also has a responsibility of care. They should be cautious of the mental health of an individual and the overall impact of the information on the patient recovery (Fitzpatrick, 2018) Balancing the duty of care and the right to information poses a challenge to a nurse. In such a situation, the nurse will have to critically judge the situation and arrive at a decision. They should be aware of how and when to break down some critical information to the patient. A support structure which may involve the relatives and friends may be important.

 In the case scenario, the concerned nurse should take up the responsibility of the explaining to the patient about consenting to family members accessing the health information. The process will include explaining to her the right to autonomy and confidentiality (DoH, 2015) and how her consent will be necessary for the family members to gain information on her progress. However, they should inform them that their decision would be without coercion. In any case, her decision will be honoured. Proper communication of the issue at hand will enable her to gain all the necessary facts for her to make the decision (Herring, 2015). The issue of consent has both legal and ethical connotations. Legally a consent will give permission for the healthcare provider to share information with those close to the patient. The friend's mother should be consulted on the information to be shared so that they can consent. Ethically, it is prudent to recognize that those individuals close to the patient play a very significant role in their recovery. Some information is very sensitive to the patient and they should agree if it is to be shared and specify to whom it should be shared. Communication is what will enable a healthcare provider to identify the wishes of the patient and consequently honour them.

Sometimes, in viewing the patient’s condition, the nurse may feel that the course of the recovery may be influenced by those around them. In cases of terminal illnesses, it is usually advisable to improve the quality of life of the patients by allowing them to spend some time with their loved ones. However, this may not be the wish of the patient as some of them would not want their loved ones to see them in such a condition. In the case scenario, the condition of the patient or their wishes has not been expressed. The situation described above poses as a conflict of interest in the discharge of duty.

The healthcare provider has a duty to listen to the concerns of the relatives and family members (Al-Jawad, Winter & Jones, 2017). They should weigh the impact of the information and the therapeutic benefits that would be drawn from giving the information to them. They have a duty to tell the patient what the close relatives and friends would wish to know regarding the condition. However, they should honour the wishes of the patient at whatever cost. Sometimes the patient may have particular directives to the healthcare provider not to disclose information to some individuals. If those individuals they had been requested not to disclose that information ask, they should listen to them. However, they should judge whether the patient will consider it as a breach of professional confidentiality (Sokol, 2015). In the case scenario, it is the duty of the nurse to explain to the friend's mother that the friend wanted to have to get some information about their health. They should then explain to them the essence of providing such information to her, then let them make their own decision regarding the issue.

As a Pre-registered nurse, complying with the codes of professional and ethical conducts is the only way to acquire a practising license. Communication and confidentiality are critical in nursing care. In the case scenario, it's a matter of professional and ethical standards in patient care. Practising to abide by them is the only way to ensure professionalism and promotion of patient rights and dignity. Consulting with superiors on such conflicting issues will be a way of seeking assistance on issues they may need support.

Conclusion.

The conduct of nurses is tightly regulated by professional and ethical codes. By the virtue of being a nurse, one is expected to abide by the regulation to ensure safe practice. The code prioritizes on the interest of the people. It considers needs and the safety of the people paramount. They ensure an effective practice and promote professionalism and trust. These are key concepts in the provision of care and building a fruitful professional relationship. Punitive actions accompany individuals who violate the regulations. Criminal proceedings may be initiated if the act committed is prohibited in the law. Professional violation, in most cases, if not criminal, is dealt with by the regulatory professional body. The principle of confidentiality cuts across both law and professional codes. A punitive action following the breaking of confidentiality may be handled both in the court of before a professional body tribunal formulated to analyse the conduct of a professional. In the case scenario, the disclosure of patient’s private information without prior consent would be punishable. Confidentiality is an ethical principle that defines the nurse-patient interaction (Laurie & Porter, 2016). 

Communication is also a major component of a therapeutic relationship. Good communication skills have a bearing on the success of the interaction (Hargie, 2016). Barriers to communication, such as poor listening skills, have been implicated with the majority of the medical errors. Patient education falls in this category. It has been championed as one of the most effective ways of developing a patient-centered approach in care. consultations with the patient can be made and decisions discussed and arrived at with the health care provider. in the case scenario, communication was important in expressing the wishes of the friend to the mother and receiving a feedback for the same.

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