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The purpose of this educational portfolio is to enable you to identify and achieve the prescribed learning outcomes of this module, Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice.

The learning outcomes are as follows:

1.  Critically examine the relationship between law, ethics and ethical reasoning in nursing practice in Singapore.

2. Implement and appraise a decision-making process using legal and ethical framework or code of practice

3. Demonstrate critical understanding of values-based practice to a population group to inform future delivery of health care services in Singapore

4. Critically reflect on the way in which healthcare legislation, culture and society influence ethical nursing practice and health and well-being more broadly.

You will be required to provide evidence of achievement for each learning outcome within your portfolio.

Ethical vignette (scenario situation).  Reflect on your everyday practice and try to identify a situation which represented an ethical problem or dilemma. The situation may also involve relevant legal and/or professional issues which it may be appropriate to address.

The chosen situation should be adapted on the basis of the work you have already done for the formative assessment (please ensure you maintain confidentiality/privacy at all times and do not use any patient identifiers).

Learning Outcomes 2, 3 and 4 will be addressed by discussing, analysing and evaluating the research and evidence base that informs the discussion related to the vignette/scenario from an ethical standpoint taking into account relevant legal and/or professional issues as appropriate and with reference to supporting academic literature.

When planning your report section, it may be helpful for you to consider the situation in relation to each participant e.g. the nurse, patient, relatives and other healthcare professionals as appropriate.

In your discussion it will be important to consider the law and ethical issues. We recommend that you use the bioethical principles as your ethical framework and use should also be made of the philosophical theories of   Deontology  utilitarianism and values-based care as appropriate.

Your discussion must be supported with academic evidence.

Portfolio Entry 1

Exploring the Theory and Application of Law and Ethical Reasoning in Nursing Practice

The assignment aims to evaluate the ethical issues abounded in nursing practice. The assignment is defining how the nurses should make ethical decisions either in their daily nursing practices or helping the patient’s family to make the decision making. The paper aims to identify the appropriate ethical decision-making process model for the given scenario.  Mainly the issues are with the confidentiality of the patient, autonomy, quality care, justice, time and cost of care. This paper also defines how a nurse should be prepared to handle these types of issues with the use of the ethical decision-making model. The paper is divided into three main parts. The first part is the scenario situation, the second part is the report of the given scenario, and the third part is the appropriate action to be taken to solve the issues involved in the scenario. In the third part of the assignment, the decisions will be made by the nurses following the ethical law and value of nursing practices.

LE1 Vignette or Scenario Situation 

Defining ethics

Ethics means character which is coming from the word Ethos. Ethics is defined as the code of morals which is done by the people. The Code of Conduct set by the business is also an example of ethics. These ethics are closely linked with professional and personal standard. These ethical principles are helping to deal with in personal and professional life. Ethics in nursing is concern itself with activities in the nursing field. This nursing ethics helps in many principals with medical ethics and it builds respect for autonomy. Based on the Singapore nursing ethics promote people’s autonomy, their value and need, and respect for the patients. working colleagues and responsibility is also part of nursing ethics. Every nurse should maintain their ethics and responsibility. These things can help them to build up their career and also define their personality in front of every person (MAKABE, et al. 2018).

Mr. S, is a 35 years oldsemi-skilled worker from Singapore in the work permit, is admitted in a public hospital in Singapore. He is admitted in the hospital for his fits affecting cancer. His problem is not work-related. The doctors discovered that he has Throat cancer. This thing can be the cause of smoking. In this typical situation, the medical team suggested a biopsy which is followed by the rehabilitation. Mr. S is a migrant person who moves in many places for his work. He is an employee of the Singapore Company which is. There is a request from his work team for special concern about the proper course of action on a work permit. Mr. S is in very serious condition because of this cancer. He was suffering the pain for the last 3 months, but in this typical situation, he cannot control his pain and come to the doctor for the medical check-up. The doctors give him some of the tests. In his biopsy report, the doctors concluded that he has throat cancer(Yau, Tam, Seah&Siah,2018). He is a chain smoker for the last 10 years and smoking is the main cause of cancer. Mr. S can also realized that he has some problems in breathing and the voice is also changing for the last few weeks. He is also losing his weight from 80 to 65 kg. He is also realized the change in the test of the foods. Before going to the doctor, he noticed that the blood is caught up from this throat. Then he decided to consult with the doctors in the local hospital which is in Singapore. But he doesn't want to tell anything about cancer to his wife as he is newly married. He thought that his full family will be helpless after knowing the fact of his disease but some of his office colleagues know about his disease and they also come with him to visit the doctors. His colleagues are very concerned about his problem as he is in the top of his career in this time. He caught success in his career very fast. So his future is bright. Doctors tell them about the huge amount of cost for the operation but don't have enough amount of money for his treatment. Mr. S have the medical insurance as per the employee law that he buy and maintain his medical coverage of at $ 16,000 per year. This amount is very short for his treatment as he is required to provide much more than this amount. His colleagues are recommended to tell in the organization where he is working that the other employees can help Mr. S in his situation. The doctors also suggest him to tell this situation in his home but refuse the proposal every time. I tell his family then can also help him by providing money. Now he is suffering from very high situations. So everybody is very concerned about him as he suffering from the last stage of cancer(Selcuk, et al. 2019).

Portfolio Entry 2

But the doctor tells them that there is also a chance to recover from this situation if he can collect the amount which is required for throat cancer. If don't operate cancer right now than he cannot even drink water. He is also very upset about this situation and also thought about his family that he is the only earning person in his house. His colleagues are also consulted with the employees to contribute some money for Mr. S’s treatment. He is also much tensed about the next situation. 

Autonomy

Autonomy is recognizing by the person who should not interfere upon the rights of another individual. Keeping all the details of the patients and inform the patients under confidentially which is a must for all health care centers. Mr. S has all the right to keep his conditions and has the right to request the health care team. Mr. S should not affect live a happy and healthy life (Walls, 2015).(need to write more about autonomy)

Beneficence is the standards of display, ways of varieties, sympathy and saving others. In all the health care centers they are trying to provide the best care which demonstrates beneficence by providing the best health care.  Providing beneficence is the most important and must need the thing in the hospitals and this is also mandatory for the nursing board. It also can achieve the maximum benefit by providing the patient's welfare to the best interest. These benefits are not good for all they require compassion and kind nature in actions and care for the patients and culture. Based on the study they providing the benefits to the Mr. S for the best care to continue his treatment. Based on the scenario the responsible health care center the providers are properly educated and guide the patients that the patients are not scared about their disease. The health care center always need to provide the proper treatment to the patients as they don't deal with this situation before, so this is the responsibility of the nurses to take care of the patient to prepare them for the situation which they are going to deal. There is no permanent cure but can minimize the symbols and keep the diseases under control and provide patients with the best comfort (Chan, Hong, Tan,  & Chua, 2019).   

Nonmaleficence is required in every health care center to avoid to harm the patients. This is not concerned about the quality of work but it is always focused to avoid the harm on patients. Friends and health care providers helping Mr. S form the physical and mental outcome. Based on the scenario Mr. S's confidentiality must be maintained by his family. The doctors provide proper education and guidance to Mr. S about the throat cancer and also provide the mental support which he needed in every moment (Selcuk, et al. 2019).

Justice

The word justice is defining the neutral decision in terms of profits and dangers. This is getting an equal decision about anything or any person. Justice demands a similar behavior or treatment for humans and the patients also. Based on the scenario, Mr. S must be treated with respect like other patients (Ishoy, 2016). Though he is a throat cancer patient, he has the right to demand the confidential and continuity of care. In this scenario, Mr. S is needed to be treated with justice by giving the full information about his cancer. 

Nurses are responsible for the legal and ethical situations. They provide appropriate & independent care for patients who require their care. Care is the mandatory work for the nurses. They might help their patients to manage the physical needs and in the prevent illness and treat the condition of health. The nurses need to observe the patient’s condition first then they treat the patient’s according to the relevant information and also remind the decisions which are consulted between the doctors. The nurses always need to follow the instructions of the doctors obediently. According to the code of ethics, the nurses are responsible offering care to the patients but also responsibly handle and manager the families (Greco, Lewis, Sanford, Sawin & Ames, 2019). In nursing ethics, they need to maintain a good relationship with their co-workers it may help in doing their work. They must have the ability to recognize the situation and interrupt. They also have the ethical right to react to the multiple principal and values which is according to the situation within a given field or context. Based on the scenario, the ethical principles will help to guide the health care team to make the proper and important decision in the continuing care of the Mr. S. In Singapore the health care centers are very high quality and they also have the advanced and latest technology which the doctors are applied in proper situations. Ethics focuses on the natural character of any individual (Chan,Hong,  Tan,& Chua, 2019).

As per the case study, this section of the essay identifies few of the trends and issues that would concern the decision-making processes of the undersign. The key issues of ethical and decision-making domains have been identified in the following manner: 

  • Will the doctors consult the Mr R employers in the decision-making process?
  • What if the employer does not agree to pay the required amount for the treatment?
  • Does the medical team supposed to keep the treatment information confidential?
  • To maintain Mr. S autonomy of maintaining the information confidential, will affect the patient's family and the patients?
  • The decision regarding the disclosure of the patient’s information to the family is morally needed but ethically inappropriate unless the information
  • The various role of the nurses in this scenario and what are the actions to be taken by the nurses in delivery the best care?

Employer’s involvement in the decision-making process or refusal to pay for the treatment:

The responsibility of the medical team is to inform the employer about the initial findings of Mr. S and they should also inform about the further diagnostic tests needs to be done and the type of treatments.  Mr. S is having the right to make his own healthcare decisions. However, the medical team is concerned about the fact that the treatment cost might be too expensive for Mr. S. Mr. S will be charged same as the residents of Singapore, but his medical insurance only $13000 per year. It is clear to the doctors that Mr. S will not be able to pay the additional treatment cost and the medical team needs to involve the employer in the decision making. Now the question arises whether it would be correct to involve the employer in taking the decision. In legal terms, it is the responsibility of Mr. S to provide valid information about the procedure to carry further. The medical team has given many options to Mr. S to choose the appropriate course of action. As the most important medical ethics for doctors are to provide the appropriate respect for the persons or patients. However, the relation between the employer and employees does not give the right to make the medical decision making. Therefore, it is the responsibility of the Singapore doctors to decide to consult Mr. S employer in the decision-making process(Ishoy, 2016).

The employer cannot refuse to pay the medical treatment cost for Mr. S if the medical insurance is not meeting the treatment amount (Editorial Board, 2018). According to the employment of the foreign manpower regulations of Singapore, the employer is solely responsible to pay the treatment cost of its employees. The government of Singapore has given the policy to take action against the employer is they dent to pay the necessary treatment cos

Autonomy & role of nurses:

Autonomy is defined at the rights given to a patient to make decisions about their treatment process. It is to be noted that the decision of the patients is not infringed by the rights of another individual(Ang, Uthaman, Ayre, Lim,  & Lopez, 2018).The patient's information needs to be kept confidential; it is the sole responsibility of the health care team, Ifit not obeyed then there will be an offence. From the above scenario, Mr. S is having the right to keep treatment information confidential and is having the rights to request the healthcare team to keep it confidential. In keeping all these in mind, the healthcare team should also think about the Mr. S right to live a healthy and happy life. Therefore, the health care team must provide various options and sequences of actions to Mr. S to improve Mr. S autonomy in making the correct decision(Woo & Newman, 2019).However, the medical team has been advised to share the throat cancer problem of Mr. S with the patient's spouse to have the proper counseling of the treatment procedure.   However, the breach of the patient's confidentiality is ethically approved in this type of situations. As in this situation, if the doctors will keep the information confidential, it might jeopardize the patient's life and cause a threat to the patient's life(Wong et al. 2017).

Role of nurses is to make decisions and responsibility legally and ethically. So that the nurses can provide appropriate health care to the patients who are in a state to receive proper care. Making ethical and legal decisions to provide the right health care to the patients should be made mandatory by the medical board. Therefore, it is necessary to provide proper health care by following legal and ethical principles. From the above scenario, it has made easy for the healthcare team to make a good decision for Mr. S which will be beneficial for both Mr. S And the family(Fredholm, Henningsohn,  Savin-Baden, &Silén, 2019).

LE3 Action Plan

For the above-mentioned scenario, the action plan will be best described by the Gibbs reflective model. It is a reflection process in a systematic way. It will be following a specific number of steps to get successful results. This design will be the best to evaluate the legal and ethical issues about the given scenario(Greco, Lewis,  Sanford, Sawin& Ames, 2019).The process mainly consists of six parts, they are:

Description: According to Gibbs, the description should include the type of issues faced in the situation. I was in a dilemma, whether to respect Mr. S autonomy to keep his information confidential to provide the required beneficence to the patient's family. If I could know more about the situation I would have handled the situation issues in a better way . I was not aware of the proper legal ethical framework which should be followed by the health care team in this type of situations(Jackson-Köhlin, 2019). 

Feelings:  I was very nervous about that situation. First I decided to respect the autonomy of keeping the treatment result confidential. Then I realize that it is causing harm to the patient's family and the society which was ethically not right. I was scared at that point, to decide that particular situation. I was not sure how much my decision can help the patient’s life and give happiness to society and patients family. And I was nervous about the fact that if my decision will support the ethical and legal standards of the medical committee and my organization ). I was really scared about the results of the particular action taken and was not very sure about it(Grigorovich, Kontos& Kontos,2019).

Evaluation:one great thing that happened to me while making the decisions, it that it made me make decisions based on the legal and ethical standards. It helped to provide the best practices for the patients as a whole. These made me investigate all my action plans are ethically and legally approved. It helped me to gain confidence and increase my knowledge of how to make decisions and solve the issues based on the ethical and legal standard. Few things which I didn't like about the experience is that I was in stress and under pressure. I was lacking behind in terms of having enough confidence and knowledge about the situation. All these lead to immense pressure and my confidence level was low to deliver the best care to the patients (Kaakinen,  Coehlo, Steele & Robinson, 2018).

Analysis: I think the patient needs to be treated on their autonomy. The appropriate respect should be paid to the patient’s autonomy to maintain trust. It will also help to provide the proper health treatments to the patients and will support the patient’s family also. It should be taken care of that the actions must be inclining to protect the patient's life(Reilly &Jurchak,  2017).For doing this, the protocols & legal ethics of the patients is not violated.

Conclusions depending on Gibbs design:I could have personally explained to the patients about the results of the decisions they are making to disclose their treatment information. And many best options to maintain the confidentiality of the patient’s information.I should have properly educated the patients about the negative & positive impacts of sharing the treatment results to their partner and their family(Reilly &Jurchak, 2017). 

By applying the legal& ethical principles in the decision making the process can improve the way of providing healthcare to patients(Martsolf&Sochalski, 2019).Therefore, if in the future I will be facing such situations I will be more confident in co-operating the situation in a better way. I will be able to analyze the situation more accurately with the help of legal and ethical standards. My actions to a particular situation will be based on the ethical code and protocols of the organization. In the future situations like this, I will be educating patients about the various types of opinions they are having and the various consequences of the actions to get the proper way to have a healthy and safe life. While doing all this, the patient’s information or results will be kept confidential(Whelton, 2018).This model is an eye-opener for me to gain knowledge about legal and ethical terms. It helped me to know the ethics and legal standards and the protocols of a particular situation in Singapore.

The future nurses will be having enough empower with the help of appropriate analysis of the ethical standards & legal framework. It will also help the nurses to maintain a good relationship with the patients and their families, and with colleagues(Paulo, 2019).

Conclusion

By the means of this essay, an attempt has been made at adjoining the relationship between the ethical reasoning, law and the ethics concerned with the practice of the nursing activities altogether. I have attempted to accomplish that the in Singapore, the nursing activities are accomplished with the implementation of the ethical framework or the code of ethics as set by the Singapore Nursing Board that looks after the upholding of the events of professional conducts and accomplish the  necessary disciplinary actions against the midwife/nurses in cases of misconduct. They are found to be pretty aligned with the laws and regulation aspects of the same. It is evident from the above discussion that the case study had identified the critical ethical issues in terms of maintaining patient and their families’ confidentiality, ethical considerations about the use of proper terms and conduct, etc. This illustrates the number of barriers and difficulties faced by nurses when accomplishing nursing decisions in the best interests of the patients with taking into account the role of the ethical domains they might be violating. 

References

Ang, S., Uthaman, T., Ayre, T., Lim, S., & Lopez, V. (2018). Differing pathways to resiliency: A grounded theory study of enactment of resilience among acute care nurses. Nursing & Health Sciences, 21(1), 132-138. doi: 10.1111/nhs.12573

Chan, D., Hong, M., Tan, M., & Chua, W. (2019). Older patients’ participation in physical activity during hospitalization: A qualitative study of ward nurses’ perceptions in an Asian context. Geriatric Nursing, 40(1), 91-98. doi: 10.1016/j.gerinurse.2018.07.002

Editorial Board. (2018). International Journal Of Social Research Methodology, 21(6), (ebi)-(ebi). doi: 10.1080/13645579.2018.1525177

Fredholm, A., Henningsohn, L., Savin-Baden, M., &Silén, C. (2019). The practice of thresholds: autonomy in clinical education explored through variation theory and the threshold concepts framework. Teaching In Higher Education, 1-16. doi: 10.1080/13562517.2019.1567486

Greco, S., Lewis, E., Sanford, J., Sawin, E., & Ames, A. (2019). Ethical Reasoning Debriefing in Disaster Simulations. Journal Of Professional Nursing, 35(2), 124-132. doi: 10.1016/j.profnurs.2018.09.004

Grigorovich, A., Kontos, P., &Kontos, A. (2019). The “Violent Resident”: A Critical Exploration of the Ethics of Resident-to-Resident Aggression. Journal Of Bioethical Inquiry, 16(2), 173-183. doi: 10.1007/s11673-019-09898-1

Ishoy, G. (2016). The theory of planned behavior and policing: how attitudes about behavior, subjective norms, and perceived behavioral control affect the discretionary enforcement decisions of police officers. Criminal Justice Studies, 29(4), 345-362. doi: 10.1080/1478601x.2016.1225362

Jackson-Köhlin, D. (2019). Women’s Health Care for Incarcerated Women. Advances In Family Practice Nursing, 1, 131-141. doi: 10.1016/j.yfpn.2019.01.001

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.

MAKABE, S., KOWITLAWAKUL, Y., NURUMAL, M., TAKAGAI, J., WICHAIKHUM, O., & WANGMO, N. et al. (2018). Investigation of the key determinants of Asian nurses’ quality of life. Industrial Health, 56(3), 212-219. doi: 10.2486/indhealth.2017-0066

Martsolf, G., &Sochalski, J. (2019). The Need for Advanced Clinical Education for Nurse Practitioners Continues Despite Expansion of Doctor of Nursing Practice Programs. Policy, Politics, & Nursing Practice, 152715441988231. doi: 10.1177/1527154419882310

Paulo, N. (2019). Moral Consistency Reasoning Reconsidered. Ethical Theory And Moral Practice. doi: 10.1007/s10677-019-10037-3

Reilly, K., &Jurchak, M. (2017). Developing Professional Practice and Ethics Engagement. Nursing Administration Quarterly, 41(4), 376-383. doi: 10.1097/naq.0000000000000251

Reilly, K., &Jurchak, M. (2017). Developing Professional Practice and Ethics Engagement. Nursing Administration Quarterly, 41(4), 376-383. doi: 10.1097/naq.0000000000000251

Selcuk, A., Yap, K., Wong, C., Yang, J., Yong, P., Chan, S., &Teng, C. (2019). A Point Prevalence Study of Antimicrobial Use and Practice Among Nursing Homes in Singapore. Drugs & Aging, 36(6), 559-570. doi: 10.1007/s40266-019-00651-2

Walls, P. (2015). Evidence-based Practice in Nursing Ellis Peter Evidence-based Practice in Nursing 168pp Second edition £18.99 Sage/Learning Matters 9781446270905 1446270904. Nurse Researcher, 22(6), 41-41. doi: 10.7748/nr.22.6.41.s3

Whelton, B. (2018). Nursing Ethics and Professional Responsibility in Advanced Practice Pamela J. Grace PhD, MSN, RN Burlington, Massachusetts: Jones and Bartlett Learning, 2018. 3rd edition, 447 pages, including glossary and index. $72.92 soft cover. ISBN 9781284107333. Nursing Philosophy, 19(2), e12207. doi: 10.1111/nup.12207

Wong, A., Ong, S., Matchar, D., Lie, D., Ng, R., Yoon, K., & Wong, C. (2017). Complexities and Challenges of Singapore Nurses Providing Postacute Home Care in Multicultural Communities: A Grounded Theory Study. Journal Of Transcultural Nursing, 29(5), 402-409. doi: 10.1177/1043659617736884

Woo, M., & Newman, S. (2019). The experience of transition from nursing student to newly graduated registered nurses in Singapore. International Journal Of Nursing Sciences. doi: 10.1016/j.ijnss.2019.11.002

Yau, X., Tam, W., Seah, H., &Siah, C. (2018). An exploration of factors influencing inpatient nurses’ care behaviour in an acute hospital setting. International Journal For Quality In Health Care, 31(6), 473-479. doi: 10.1093/intqhc/mzy199

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