Legal And Ethical Considerations In Nursing

Suzy Martin is an enrolled nurse who works part time 15 hours per week on a surgical ward at the local public hospital. She has been employed for the past year and has attended all of her mandatory training.

Suzy is currently completing her bachelor of nursing at the local university

Suzy has developed a good relationship with a client Jasmine on the ward, who has been admitted for exploratory gynaecological surgery. Jasmine had a termination many years ago and is now finding it hard to conceive. This evening, Suzy is looking after Jasmine who has returned to the ward after her surgery.

1. Suzy has received a notification from AHPRA that her renewal of registration is now due.
2. Discuss the roles of the two leading nursing bodies (give the full name of each), who are regulatory partners of AHPRA and name the law under which nursing registration is governed.

1. Demonstrate your understanding of the registration standards, by providing 2 examples of requirements that must be fulfilled by Suzy for her renewal to be successful. Use examples of how Suzy might have fulfilled some of that criteria.

1. Discuss the Enrolled Nurse Standards for Practice domain of professional and collaborative practice, and explain 4 ways in which Suzy can ensure that she meets the professional criteria set within it.  

1. Provide an explanation of the history of NSQHS standards; outline at least two (2) examples of those standards and explain the role of the enrolled nurse in providing safe and quality care. (Minimum 200 words)

1. As the shift nears its end, Suzy enters the nurses’ station to complete documentation. Suzy’s colleague Sarah is already there and tells Suzy she has forgotten her password she asks if she can use Suzy’s to complete her notes.
2. What reasonable precautions must an organisation take to protect the privacy of a client? Discuss how using someone else’s password might infringe an organisation’s policy on privacy. Use relevant legislation to support your answer.

1. Your client asks you if she can look at her notes to see what the doctor has written about her operation. Discuss the legislation that relates to the access of medical records in this hospital. Detail any other health professionals you would engage with and the commonalities of the information that the client may have access to.

1. Suzy reads the surgeon’s notes, where it has been written that it is ‘unlikely’ Jasmine will ever conceive naturally. Jasmine asks you to tell her what the surgeon has written.
2. Discuss the ethical dilemma you are in, what resolution you would come to and who else might you involve?

Sarah who has also looked after Jasmine tells you that she had not read the notes thoroughly and that her religion forbids her from caring for Jasmine. (50 words)

On what grounds is such a refusal to care for someone made?

1. Sarah tells you that ‘people’ who terminate pregnancies are the same sort of people that support euthanasia.

Discuss the legality of euthanasia in Australia and the doctrine of double effect. (100 words)

1. Overnight, the registered nurse is busy with several clients. He fails to complete a proper assessment when Jasmine complains of feeling unwell. Eventually the on-call medic is alerted and Jasmine is taken to intensive care for monitoring.  Jasmine’s partner is called and asked whether he is a power of attorney (POA) for Jasmine as she is deteriorating.
2. In what circumstances might a POA be used and what authority might they have?

1. Jasmine’s partner stays at her bedside. He is very distressed as she becomes much sicker and a decision is made to intubate her and put her on a ventilator. Jasmine’s partner becomes very angry and tries to stop the doctors from doing this. Discuss the medical staff’s duty of care and consent.

1. asmine starts to recover over the next few days, she is breathing with the assistance of a ventilator but she remains sedated as she is very agitated and still quite unwell. Jasmine’s partner believes that the sedation (chemical medication) is a form of restraint.

Discuss the nurse’s responsibility in the use of lawful restraint

1. Several weeks later when Jasmine is recovering, she puts in an official compliant to the hospital about the registered nurse who she says ignored her when she felt unwell. A departmental meeting is called with Jasmine and her partner.
2. Discuss the framework developed by the Australian Council for Safety and Quality in Health Care which guides organisations to express regret for an adverse incident. Discuss the philosophy behind the framework.

Duty to Care in Nursing

The NMBA facilitates the nursing and midwifery practitioners’ and students’ registration.

NMBA is in charge of initiating standards, code of ethics and precept for the nursing and midwifery practitioners.

Another role of the NMBA is the assessment of practitioners who have had their training overseas and would like to practice in Australia.

NMBA is in charge of advancing standards, code of ethics and guidelines for the nursing and midwifery practitioners.

Lastly, NMBA manages announcements, grievances, exploration of incidents and overseas disciplinary hearings (nursingmidwiferyboard.gov.au, 2018).

Australian Nursing Federation (ANF)

The ANF advocates for support in nursing, nurses and midwives who face challenges such as: work-related stress, fiscal issues, underfunded hospitals, staff shortages and facilities and inadequate time spent with residents and patients and long working hours

The registration of nurses is conducted under the Health Practitioner Regulation National Law.

Recency of practice

Recency of practice refers the maintenance of an adequate connection with recent practise in the profession(s) since qualifying for or obtaining registration by nurses or midwives. In this context, practise is not rooted to provision of direct clinical care rather it includes professional working in a direct non-clinical relationship with clients, working with administration and research (nursingmidwiferyboard.gov.au, 2018). First, Suzy has fulfilled and surpassed the number of hours needed to be continuous – which is a minimum of 450 hours – because she works 15 hours a week. Also, Suzy will be able to show her recent practise relevant to prescribing and administration of medicines as seen through her attendance to Jasmine.

Criminal History

Suzy is required to disclose her past criminal history to determine if she is suitable and safe to practice in Australia. In doing this, she has to reveal to the NMBA of any previous charges (if any) for offense (s) punishable by one-year incarceration or more and if Suzy has ever been charged for offense (s) punishable by incarceration in Australia and overseas (nursingmidwiferyboard.gov.au, 2018).

The professional and collaborative practice domain pertains to the lawful, moral backgrounds on which nurses (enrolled nurses) respond to their workspace competently. This domain considers enrolled nurses’ roles to prolong up to date and best practice (nursingmidwiferyboard.gov.au, 2018).

Suzy should accept responsibility and accountability for her actions. To uphold this standard, Suzy will have to team up with her supervisor to ensure the delegated roles are within her radar of practice.

Suzy should be able to communicate accordingly and use the required guidelines to report and inform care.

Euthanasia in Australia and the Doctrine of Double Effect

Suzy should practice nursing in such a way that safeguards confidentiality and the respect of her clients and colleagues.

Suzy should also act following the existing laws, procedures, and policies within the nursing practice.

The National Safety and Quality Health Service Standards (NSQHS) were developed and effected by the Australian Commission on Safety and Quality in Health Care in 2012 to guard the citizens against distress and enhance the standards of medical services provided to provide safe and quality care. NSQHS collaborates with jurisdiction, technical experts, stakeholders including practitioners and patients (Safetyandquality.gov.au, 2018).

The following are the examples of some of the NSQHS standards:

1. Patient identification and procedure matching standard which outlines the process and ways to recognize clients and accurately meet their congruence with the definitive treatment (Safetyandquality.gov.au, 2018).
2. Blood and blood products standard which outlines the process and ways for the secure, worthwhile and administration of blood and blood products thus ensuring safety of the clients being given the blood (Safetyandquality.gov.au, 2018).

The role of enrolled nurses in providing safe and quality care:

Nurses are essential in the purveying of quality and safe medical treatment. This aspect, they achieve by carrying out the following roles:

Participating in the organizational processes, and improvement initiatives thus improving the system for the safe and effective provision of quality healthcare service.

Following safety and quality procedures which will fortify that the healthcare administered is safe and of high-quality (Safetyandquality.gov.au, 2018).

The Privacy Act of 1988 dictates the responsibility of an organization on how to manage personal information and how information is handled. The following are some of the precautions that an organization should embrace to uphold this (O’Brien, Bracht, Robson, Xiang, Mirea, Cruz & Narvey, 2015)

To safeguard client’s records and enforce strict recordkeeping system access against unauthorized personnel. This, in turn, will bar unauthorized users from accessing, duplicating and modifying client’s files.

To bar any staff who is not involved in taking care of the subject client from accessing client’s information.

Educating its staff about keeping their passwords private.

Using someone else’s password is like breaking the trust existing between the professional and the client to another party. This, might poison the confidentiality of the organization – which (confidentiality) is the most aspect in between the organization and its clients – and thus breaching an organization’s privacy policy.

Being an enrolled nurse, it is clear that disclosing to our clients' medical records/reports prohibited and outside the scope of our practice although, an enrolled nurse can still refer their patient’s requisition for the access of their medical records to their supervisor and registered nurse.

The following are laws that relate to the retrieval of health records are:

Right to Information Act, 2009 which provides that one has the right to retrieve documents about themselves (Legislation.qld.gov.au, 2018)

Nurse Responsibility in Lawful Restraint

Information Privacy Act, 2009 which protects the personal information of individuals by State Government agencies; in this case, the hospital (Justice.qld.gov.au, 2018)

Commonalities of the information that the patient may have to retrieve to are: the client’s written reports, pictures, sketches, data on flash drives, video, and audio recordings.

In order to contribute to the nursing records of a patient, a nurse has to fulfil the following responsibilities (Groves, 2014).:

Ensuring that only authorized persons have access to information about the clients. Boards, for example whiteboards in ward rooms, used to record consumer information should only be availed to authorised persons, clients’ files should be stored according to Australian Standards for medical records, passwords for computer files.

Documenting relevant and legible facts and not the things we perceive. Each client has a personal plan of care within which their clinical record holds their assessment, relevant history investigations, diagnosis, treatment and support services required, other service providers, progress, follow-up details and outcomes.

Ensure that each entry begins with a date and time with the recorded ending with a written signature. 

Documentation is an all-inclusive, factual and sequential record of the client’s condition and the treatment and support offered.

This is a truth vs deceptive ethical dilemma. Here, a nurse is usually tone in between telling the truth to a patient and concealing the truth because it is hurtful or discouraging. To handle this issue, one has to use the ethical decision-making process to come up with a resolution. A nurse should, therefore, consider this whole process before making a decision. According to Fry and Johnstone, we can use the following steps for an informed ethical decision-making approach (Groves, 2014):

1. Situation assessment which involves asking questions and information gathering
2. Singling out of the ethical problem
3. Setting moral objectives and planning a suitable action
4. Execution of the noble plan of action
5. Evaluation of the ethical consequences of implemented actions

Suzy will have to inquire from the involved surgeon, a supervisor or a registered nurse if it is suitable to disclose to Jasmine contents of the written notes.

According to Merriam-Webster dictionary, bioethics is defined as a branch of knowledge that is involved with the ethical inference of biological research and applications, especially in medicine.

Bioethics consists of the study of that which is perceived right or wrong in discoveries and techniques. Bioethics outlines the inspection and the modes of study in which the moral and theoretical inferences of specific biological and procedures in medicine, which are related to health within our society and environment. One of the most outstanding theories of bioethics is the metaethical theory which pursues to comprehend the nature of moral assets, statements, attitudes, and decisions. Proponents of this theory posits that a metaphysical explanation of ethics is essential for the suitable assessment of actual ethical concepts and for devising applied ethical decisions (Kuhse, 2015).

NMBA and ANF regulations in Nursing

Denial to engage in the treatment of a client is to be decided through the discussions with a nurse’s immediate superior. Conscientious objection in medicine reveals the rooted religious beliefs that conflicts with someone’s aspect of medical practise. Individual issues, stand and or faith that directly leads to the withdrawal/refusal of treatment and may consequently after that, cause distress, pain or hurt the client is not to be discussed. However, medical practitioners cannot make moral judgements on behalf of patients (Groves, 2014). In this context, Sarah’s refusal to care for Jasmine on religious grounds outlines the concept of conscientious objection.

Euthanasia has not been legalized in Australia. However, Australian states can legislate on the issue. For instance, the Voluntary Assisted Dying Bill, 2017 was passed in the state of Victoria and will come into effect in the mid-2019. It is debated that people have the right to die with dignity and this should not be stripped from them. Euthanasia is therefore regarded as murder.

The doctrine of double effect advocates for acting supportively right (good), even though it has a bad ethical side effect but remains morally acceptable so long as the unfortunate side effect is not intended (De Leo, 2015).

Power of Attorney (POA) is a lawful arrangement, undertaken by deed, which grants an individual (“the donee,” usually the attorney) the capacity to act for another individual (“the donor”). The attorney can acquire broad lawful power or restricted legal capacity to make lawful decisions about the donor’s property, medical or finances. POA can be used to a person whose condition is worsening and gives someone of their choice to make life changing decisions on their behalf. That is when they are not in a capacity to make such decisions (Bamford et al., 2013).

The doctrine of necessity is the basis on which extra-legal actions by state actors, which are designed to restore order, are found to be constitutional. Therefore, in this context, the medical staff may intubate Jasmine and put her in a ventilator without consent from her partner because communication between them and Jasmine’s partner is not fruitful and this might cost her life. Under the doctrine of necessity, it is thus necessary to proceed with intubation in a bid to save life (De Leo, 2015).

The responsibility of using lawful restraint holds that the decision must be made by healthcare practitioners and must be documented and reviewed frequently. To decide on the use of restraint, the nurse should take the patient’s need and rights into consideration. It involves a process of supplication, evaluation, team involvement and agreement within an ethical and lawful framework. The enrolled nurse should follow the registered nurse’s directives. The restraint decision, therefore, involves precise evaluation of the dangers posed by a client’s conduct either on themselves or others around them (Groves, 2014).

The Australian Open Disclosure Framework (2014) was developed by the Australian Council for Safety and Quality in Health Care. Open disclosure framework is used by healthcare providers in the acknowledgment and utterances of regret for the occurrence of an unpropitious event in which might have harmed a client while receiving treatment (Groves, 2014).

It aims to cultivate national progressive communication and rendering encouragement to the affected individuals.

Open and timely discussion

Acknowledgement and apology

Expression of regret

References

De Leo, D. (2015). Australia revises its mortality data on suicide.

Factsheets, Blood and Blood Products in Australia. National Blood Authority Australia, 2009.   (Accessed 29 March 2011, at: https://www.nba.gov.au/pubs/factsheets-blood  products.html.)

Groves, W. (2014). Professional practice skills for nurses. Nursing standard, 29(1).

Justice.qld.gov.au. (2018). [online] Available at:     https://www.justice.qld.gov.au/__data/assets/pdf_file/0005/206888/Review-of-the-  Information-Privacy-Act-2009-Privacy-Provisions.pdf [Accessed 23 Sep. 2018].

Kuhse, H. (2015). Bioethics: an anthology (Vol. 40). John Wiley & Sons.

Medicalboard.gov.au.gov.au (2018). [online] Available at: https://www. medicalboard.gov.au [Accessed 23 Sep. 2018].

Nursingmidwiferyboard.gov.au (2018). [online] Available at: https://www.   nursingmidwiferyboard.gov.au [Accessed 23 Sep. 2018].

O’Brien, K., Bracht, M., Robson, K., Xiang, Y. Y., Mirea, L., Cruz, M., & Narvey, M. (2015). Evaluation of the Family Integrated Care model of neonatal intensive care: a cluster randomized controlled trial in Canada and Australia. BMC pediatrics, 15(1), 210.

Safetyandquality.gov.au. (2018). [online] Available at: https://www.safetyandquality.gov.au/wp-  content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf [Accessed 23 Sep. 2018].