Professional And Ethical Nursing Practices: An Analysis

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Nursing Education and Boards

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.

The two leading nursing bodies include the Australian Nursing and Midwifery Accreditation Council (ANMAC) and the Nursing and Midwifery Board of Australia (NMBA). The ANMAC is charged with the role of ensuring that the nursing and midwifery education programs are up to standard (Nursing, 2017). The accreditation involves ensuring that the nursing and midwifery programs are competent and meet quality standards. The NMBA role is regulates the nursing practice by ensuring registration standards and professional codes are set for the nurses and midwifes. This ensures the nursing practice is within the scope and disciplinary matters are dealt with. The nursing registration is governed by health practitioner regulation national law.

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.

Nursing and Midwifery Board of Australia (2016a) refers to continuing professional development where the enrolled nurse seeks knowledge as they continue to practice. Nursing and Midwifery Board of Australia (2016c) recency of practice refers to the nurse seeking renewal should be in nursing practice currently. Suzy has fulfilled continued professional development as she has pursued a bachelor’s in nursing program. Suzy is also involved in current nursing practice where she works part time for 15 hours a week.

1. In January of this year a new set of enrolled nurse standards for practice came into effect. Discuss the domain of professional and collaborative practice, and explain and explain 4 ways in which Suzy can ensure that she meets the standards set within it.  

According to Nursing and Midwifery Board of Australia (2016d) professional and collaborative practice refers to the standard that defines how nurses work while maintaining nursing ethics and ensuring professionalism. The nurse should know the law regarding nursing practice. The nurse practices nursing within the guidelines and hospital protocol. The nurse is aware of the nursing scope of practice and practices within the scope. The nurse works in harmony with other nurses and physicians to ensure patient centred care. Suzy should practice nursing according to the guidelines provided by the hospital. Suzy should consult with the other nurses regarding care of the surgical patients. Suzy raise a report on patient at risk in the surgical ward for example for falls. Suzy practices within her scope of nursing practice

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)

Continuing Professional Development

The National Safety and Quality Health Service standards were developed by the Australian Commission on Safety and Quality in Health Care (2012).  to ensure optimum patient care and quality standardised health care in all the health institutions. The NSQHS standards are implemented to ensure high quality care for the patients while ensuring health care is provided in the best means possible. The NSQHS standard example includes medication safety. This involves ensuring the right personnel orders the right medicine for the patient and it is administered in the right manner while observing for any drug reactions. This is achieved by ensuring hospitals have protocol regarding drug administration, the health care workers document appropriately the patient’s medication, the availability of medications and proper storage, proper handing over of medications from one physician to another and ensuring the patients are aware of the drug’s benefits and side effects. Another standard is preventing falls and harm from falls. The health institutions have put in place strategies to reduce falls, there is an assessment of patients on admission who are at high risk of falls and measures put in place and the patients are engaged in education regarding falls. The nurse’s role is to ensure they follow the right procedures while performing nursing care and identifying any risks that may cause harm to the patient.

2. 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.

1. What reasonable precautions must an organization 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.

According to the Parliament NSW(2002), health organizations are bound by the law to protect the privacy of the patient through the following means. The organization ensures the health care personnel sign an agreement which ensures that the client’s privacy and confidentiality are maintained. The documents of clients are kept secure, consent has to be sought from the client before disclosing their information to third parties(Go,2016). The organization has stipulated rules and protocol regarding privacy and disclosure of the client’s information. Using someone’s password means that third party has access to client’s information without the consent of the client (Nursing and Midwifery Board of Australia, 2010). This leaves the client vulnerable as the password may be shared with other parties. Patient’s records should not be disclosed without their consent and this amount to a criminal act.

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.

According to Parliament NSW (2002), the Privacy principles dictate that a patient has the right to access their medical records and be aware of the information in the records regarding their treatment. The sixth principle states that the patient should have immediate access to their health information upon request. However, the responsibility lies with the doctor who has documented the notes regarding the operation on whether the client should access the medical records. This also depends on how the client would be affected by the information and it may be safe to withhold the information from the client when necessary. I would engage the physician and the registered nurse. The client may have access to the type of operation she will have, and the risks involved in such operations.

1. In detail, outline your responsibilities in contributing to the nursing records of a client.  

Nursing Practice Guidelines and Standards

The nurse responsibilities in documentation include the planning of a nursing care plan that correlates with the patient’s illness (Lavin, Harper & Barr, 2015). The nurse documents the nursing care provided to the client at the end of every procedure. If the client’s condition changes the nurse documents the time it occurred, the signs and symptoms and the physician who has been notified. Any orders received via the telephone are documented according to the date and time and the physician who has given the order. The nurse is also responsible for ensuring the privacy of the records of the client is maintained.

3. 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.
4. Discuss the ethical dilemma you are in, what resolution you would come to and who else might you involve?

The nurse is aware that the surgeon notes will cause Jasmine extreme discomfort while at the same time it is her right to be aware of the condition. Suzy will not disclose the information but will direct her to the surgeon who will give further information (Nursing and Midwifery Board of Australia, 2008b). I will involve the physician and a counsellor.

1. b) Provide an explanation of the term bioethics, include one theoretical concept in your response.

According to (Johnstone, 2015) bioethics refers to the ethical issues raised during research, medical issues such as euthanasia and biology in general. Bioethics involves various fields and is governed by the principles of beneficence, non-maleficence, autonomy and justice. Theoretical concept is sterilizing a woman during caesarean section without her knowledge because she is HIV positive. This is an ethical issue since the woman has been denied her right to raise children of her own while others may argue it benefits her since no future offspring will suffer from HIV.

1. c) 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.

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

According to (Nursing and Midwifery Board of Australia, 2008a) the nurse has the right to refuse to care for someone if they feel that it places them in a dilemma in terms of religious, and ethical beliefs. The board states that the nurse should be given support and no discrimination against them.

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.

Euthanasia in Australia is not legal. However, in Northern Territory euthanasia was made legal in 1995 according to the rights of the terminally ill III act (Ryan, 1996). This was however repealed in 1997 after the Euthanasia Laws Act was passed by the government. The Euthanasia Law Act states that the legislative parliament doesn’t have the act to make laws regarding euthanasia. The doctrine of double effect regarding euthanasia states that the effect of a terminally ill client being subjected to drugs leading to their death causes relief of pain which is a benefit but also causes death which is an unwanted effect.

4. 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.
5. In what circumstances might a POA be used and what authority might they have?

Patient Privacy and Confidentiality

POA is used when a patient is incapacitated meaning they are in coma due to deteriorating medical condition or a head injury from an accident and one is unable to make decisions regarding their treatment. The power of attorney makes decision on behalf of the client regarding their treatment (Lucky, 2017). This includes refusing treatment such as blood transfusion, medicine, surgery and use of life support machines. However, the POA cannot refuse lifesaving treatment, palliative treatment such as analgesics which reduce the pain or allow organ transplant or permit pregnancy termination.

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.

The nurse is obliged to provide lifesaving care to Jasmine which includes intubating her which increases her oxygen saturation. The medical staff are also obliged to explain the procedure to Jasmine’s partner and demystify it while seeking consent regarding the intubation. This eases the tension and ensures the consent is sought to prevent legal repercussions (Kozier, 2008).

1. Jasmine 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

A nurse uses restraint to ensure the safety of the patient (Mohler & Meyer, 2014). Physical restraint involves limiting body movement by applying a device. This is used when the patient is violent and can cause harm to themselves. It is also used when the patient may remove the invasive devices such as urinary catheters or intravenous lines. Chemical restraint is when a drug is given to ensure the patient doesn’t move. The nurse should ensure the safety of the patient while using any restraints as they may cause harm. A restraint should be used for the shortest time possible. The nurse should explain to the family of the client why the restraint is used.

5. 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.
6. 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.

According to (Australian Commission on Safety and Quality in Health Care, 2013) the framework involves the need to realize the incident has occurred and prevent further harm while ensuring privacy of the client and healthcare personnel. Provide the client and family an open forum to discuss the incident (open disclosure). Listen to the grievances raised during the open disclosure while offering support. Offer follow-up regarding the investigations of the incident and ensure documentation. The framework aims at openness when healthcare doesn’t work as plan.

1. Outline the elements of the framework.

According to (ACSQHC, 2013) open and timely communication which refers to the role of the organisation planning the disclosure of the incident as soon as possible without concealing any information. The second element is acknowledgement which refers to accepting and dealing with the incident that has occurred. Apology to the patient and the family regarding the incident that has occurred. Supporting the patient and the family while meeting their needs by keeping them informed on the updates regarding the incident. Systems improvement and clinical risk management which involves setting and reviewing policies on such incidents. Good governance which ensures the management oversees monitoring and reporting to negate such occurrences. Confidentiality regarding any information of both healthcare worker and the patient.

References

Australian Commission on Safety and Quality in Health Care. (2012). National safety and quality health service standards. Retrieved from https://safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf  

Australian Commission on Safety and Quality in Health Care. (2013). Australian open disclosure framework: Better communication, a better way to care. Retrieved from https://safetyandquality.gov.au/wp-content/uploads/2013/03/Australian-Open-Disclosure-Framework-Feb-2014.pdf  

Go, A. (2016). PRIVACY ACT 1988-SECT 95AA.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

Kozier, B. (2008). Fundamentals of nursing: concepts, process and practice. Pearson Education.

Lavin, M. A., Harper, E., & Barr, N. (2015). Health information technology, patient safety, and professional

nursing care documentation in acute care settings. Online J Issues Nurs, 20(6).

Luck, T., Rodriguez, F. S., Wiese, B., van der Leeden, C., Heser, K., Bickel, H., ... & Wagner, M. (2017).

Advance directives and power of attorney for health care in the oldest-old–results of the AgeQualiDe study. BMC geriatrics, 17(1), 85.

Möhler, R., & Meyer, G. (2014). Attitudes of nurses towards the use of physical restraints in geriatric care: a

systematic review of qualitative and quantitative studies. International journal of nursing studies, 51(2), 274-288.

Nursing and Midwifery Board of Australia. (2008a). Code of ethics for nurses in Australia. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx  

Nursing and Midwifery Board of Australia. (2008b). Code of professional conduct for nurses in Australia. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx  

Nursing and Midwifery Board of Australia. (2010). A nurse’s guide to professional boundaries. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx  

Nursing and Midwifery Board of Australia. (2016a). Registration standard: Continuing professional development. Retrieved from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-professional-development.aspx  

Nursing and Midwifery Board of Australia. (2016c). Recency of practice [Fact sheet]. Retrieved from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Recency-of-practice.aspx  

Nursing and Midwifery Board of Australia. (2016d). Standards for practice: Enrolled nurses. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Nursing, A. (2017). Australian Nursing and Midwifery Accreditation Council Registered Nurse

Accreditation Standards: Australian Nursing and Midwifery Accreditation Council.

Parliament, N. S. W. Health Records and Information Privacy Act, 2002.

Ryan, C. J. (1996). Euthanasia in Australia—The Northern Territory rights of the terminally ill act.