NRSG370 Clinical Integration

Online module tasks are designed to enable students to demonstrate understanding of the specialty practice environment in terms of roles and responsibilities, rights, communication processes and the meaning of illness for patients. The modules include the critical analysis of an issue of safety, confidentiality and a reflection on personal perceptions and meanings of health, illness, dying and death to consolidate learning about the specialty practice environment.

Distinguish the roles and responsibilities of a nurse in the selected specialty practice area.

There may be specific legal obligations associated with your specialty area of practice.
Talk to experienced nursing staff, lecturers or tutors about legal obligations specifically related to your chosen specialty. It may not necessarily be mandatory reporting issues, but be related to other issues. Areas to explore may be confidentiality issues when a person is cognitively impaired or underage, has a positive HIV status and is sexually active, and so on. For this section you can think outside the square about legalities of what nurses can and cannot do.
Identify one aspect of your legal obligations related to your specialty and write a short paragraph on how you would ensure you honour your legal obligations while working in this area.

Introduction

Clinical Cardiology nurses are registered nurses that work with any medical conditions related to the heart for example congestive heart failure. They help cardiologists to diagnose as well as treat heart – related conditions that affect the circulatory and also the pulmonary system (Mudaliar, 2017).. They are mainly involved in research work, educating patients, as well as offer preventive measures; and keeping medical records of patients (Omboni, & Tenti, 2018).

Among many others; the main roles of registered nurses are that; they should be competent in their work; they should demonstrate independence and interdependence; they should be responsible and accountable for all their actions; and they should  ensure that there is coordination with nursing and healthcare and the different ways of care ;to ensure that patients are referred to and consulted with the right people(Nursing and Midwifery Board of Australia – Home,2018).

Clinical cardiology nurses have legal responsibilities and a code of ethics that guide their profession. The legal obligation of clinical cardiology nurses are to respect their profession and their patients and not to take into possession any property that may belong to the patient and to act in accordance with all authorities and legislation that involves the  administration .(Karabakir & Cetin, 2016).

Legal and ethical issues: Medical Negligence

There are very many legal issues (read nrsg 379 clinical integration) that rotate the medical surgical department that highly affect nurses in their day to day activities majorly medical negligence. It is when a nurse fails to take reasonable responsibility to prevent loss or injury to another person. There are various aspects of medical negligence. One of them is failure to take history. When a nurse fails to take history of the patient, they may end up treating them inappropriately. For instance a nurse may fail to note a patient who has had high blood pressure, yet this is vital information when conducting a heart surgery. Another aspect is failing to perform medical examinations and writing reports. Nurses also fail to undertake medical examinations and write reports. In such cases, high risks will be involved in treatment as it is not known whether the blood of the patient is infected leading to injury of the patient. Medication is another aspect that involves giving wrong prescription and medication leading to poor treatment. Medical negligence can be intentional and unintentional; all in all it has its own consequences such as suspension and even loss of license. However nurses cannot be held accountable when a treatment fails and that the failure was a possible outcome in part of the treatment. It is thus proper that nurses follow the correct procedure and be keen to avoid such consequences. (Team, 2018).

The main difference between a clinical nurse specialist (CNS); advanced nursing practice (ANP) is that the CNS  nurses are focused  on improving the healthcare of the patient at the bedside and are experts whereas nurses in ANP focus more on prescribing medication to patients. (Edmonds, Cashin, & Heartfield, 2016)

Physical and emotional safety

 Nurses  at work experience both physical and emotional constraints at work. In their day to day activities they could experience injuries as a result of carrying heavy machinery, lifting weighty patients and piercing themselves accidentally while administering medication putting them  at a risk of getting infections. Some of the emotional plights they experience are majorly stress from physicians and immediate relatives of the patients. They are also subjected under a lot of pressure especially in emergent crises which eventually affects their judgment as well as how they make their decisions. Nurses should be protected from physical injuries by providing them with protective clothing and employing more staff to help in strenuous duties. Their emotional and well being should be kept into consideration and they should be awarded leave at work so that they are able to rest (Kelly, 2014).

The rights of patients were created in 1948 under the Universal Declaration of Human Rights. It recognizes “the inherent dignity” and the “equal and unalienable rights of all members of the human family”. This organization has been at the forefront to ensure that International Laws have enshrined rights of patients in the medical sector that ensure their dignity is preserved (Murad, Atta-ur-Rahman, & Bian, 2017).

When it comes to the doctor – patient relationship, it is required that communication should be purely open, by providing the patient with the truth. Research has shown that most patients desired to be told everything concerning their health. It has been found that patients could sue doctors even for very minor mistakes that they were not told and thus it’s key to inform patients (Nursing Council of New Zealand, 2012).

In signing the consent, the patient should be aware of his rights as; that he has the freedom from force, overreacting, deceit and any other form of constraint has the right to withdraw or refuse without the physician influencing the patient’s healthcare and he has the right to ask any questions that in order to negotiate about the treatment process. (Boyd, 2014).

The law and ethics state that the doctor – relationship should remain confidential at all times; unless the physician has been given the authority by the patient. If the information that is to be released is warranted; then it should be put down in writing and formally executed. However, there are a few exceptions when it comes to confidentiality, which are; when the patient is at risk of harming others and themselves, the physician has the right to protect the victim and inform the law enforcement officers. (Drozdowska, 2010).

Abandonment occurs in cases majorly where there is a workers’ strike. However, it is said that as long as the doctor and the patient have signed the agreed and informed consent, the doctor is supposed to give the patient all the medical attention that they require to the point of recovery. Physicians can be sued for negligent abandonment if any of the above occurs without informing the patient. However, doctors have the right to choose the patients that they care for. (Drozdowska, 2010).

Right to refuse care

It is well known to patients and physicians that all patients have the right to access to healthcare; although patients have the right to withdraw in cases that they fully understand the risks that will come with the decisions they make. However, in this matter there are a few exceptions; which include; that patients who are not mentally stable may require a person who has been legally appointed to take care of them and make for them informed decisions. As much as this right exists; parents and guardian are not allowed to deny infants access to medical care (Nursing Council of New Zealand, 2012).

The rights of carers include; That privacy and confidentiality from their side should be maintained; They should be recognized by health professionals as the cares of the patients, They have the right to work outside the home and they should get immense support from their employers; and lastly they have the right to appeal to any decisions that have been made in an unfavorable manner (Glazer& Fitzpatrick, 2013).

In providing care to the patients, the patients should be able be bluntly honest to the carers about their medical history and anything concerning their health. They should keep in mind that the information should only remain between the patient and the carer; otherwise they could be sued if information is found to be leaked (Glazer& Fitzpatrick, 2013).

Very many cardiovascular patients have come out to reveal their experiences to encourage other patients who have been going through the same conditions, as well as educate the general public on matter relating to cardiovascular diseases. The following is a brief and true story that has proven to have provided so much insight to not only patients but the public at large. 

Case

Jim, a fifty three year old and a singer began to feel light headed and had ignored this for a while until one day when he felt dizzy and placed his head between his legs and an employer who passed by  was able to notice that his head was turning ashy in color and called for an ambulance. Upon arrival to the hospital, it was said that his heart was in good condition, however, there was less blood flowing into the brain and thus was told that he would have carotid endarterectomy to prevent the occurrence of a stroke. Right before his operation his doctor came to discover that Jim was a singer and thus they both agreed not to undergo the surgical way that would involve removal of his vocal cords; so the surgery done was sole for him and the next day he was able to continue with his everyday activities (Personal Stories 2018).

Using Jim Sparacino as a case study, it is observed that the doctor was able to accommodate Jim’s request, on the fact that he heavily relied on his vocal cords since music was what brought for him food to the table. The physician was kind enough to educate him on the alternative method which proved to be very successful. It’s quite clear that the doctor-patient relationship in this case was very exceptional. Would other doctors be kind enough to demonstrate this level of competency in their work?

The theory behind the kind of operation that Jim was done is that a catheter was inserted in the groin in an artery to reach the neck of the patient; then a balloon is inflated so as to ensure that the plaque is compressed and a stent is inserted to prevent the plaque from expanding again(Kaya, 2018). The previous method that was discussed involved moving of the vagus nerve which would ultimately lead to the destruction of the vocal cords.

The doctor was kind and ethical enough to consult the patient before taking any move. The patient being a singer was very protective of his vocal cords; and thus they would be damage if the doctor was to move the vagus nerve. The fact that he used the carotid endarterectomy was very favorable to the patient.

Conclusion

In conclusion, it is highly advised that doctors should set good examples in their profession by being ethical and following the guidelines. It is also key to have a good doctor – patient relationship where the rights of both parties are preserved and their responsibilities performed accordingly as this will reduce the number of unsuccessful operations in future.

References

Kaya, K. (2018). Sudden Cardiac Death: Coronary Artery Spontaneous Dissection. International Clinical Pathology Journal, 6(1). doi: 10.15406/icpjl.2018.06.00152

Personal Stories (2018) Jim Sparacino: Knowing the Options for Stroke Prevention Has Jim Singing a New Tune, Retrieved 29 Aug. 2018 from https://www.secondscount.org/personal-stories/personal-stories-detail-2/jim-sparacino–knowing-options-stroke-prevention-h-2#.W4XKdyQzbZ5

Boyd, C. (2014). Care skills for nurses. Chichester, West Sussex, UK: Wiley Blackwell.

Drozdowska, U. (2010). Patients’ rights protection model in the Patients’ Rights and Patients’ Rights Ombudsman Act of 6.11.2008. Bia?ostockie Studia Prawnicze, 8, 239-253. doi: 10.15290/bsp.2010.08.17

Edmonds, L., Cashin, A., & Heartfield, M. (2016). Comparison of Australian specialty nurse standards with registered nurse standards. International Nursing Review, 63(2), 162-179. doi: 10.1111/inr.12235

Glazer, G., & Fitzpatrick, J. (2013). Nursing leadership from the outside in. New York: Springer Pub. Co.

Karabakir, B., & Cetin, G. (2016). Awareness of Nursing Legislations and Legal Responsibilities among Nurses. The Bulletin Of Legal Medicine, 21(2), 78-78. doi: 10.17986/blm.2016220392

Kelly, P. (2014). A Human Rights Approach: The Work of Public Health Nurses. Public Health Nursing, 31(2), 97-98. doi: 10.1111/phn.12107

Mudaliar, S. (2017). Integrating cardioprotective glucose-lowering medications into clinical practice. Cardiovascular Endocrinology, 1. doi: 10.1097/xce.0000000000000142

Murad, F., Atta-ur-Rahman, & Bian, K. (2017). Cardiovascular diseases. Sharjah: Bentham Science Publishers.

Nursing and Midwifery Board of Australia – Home. (2018). Retrieved 29 Aug. 2018 from https://www.nursingmidwiferyboard.gov.au

Nursing Council of New Zealand. (2012). Code of conduct for nurses. Wellington [N.Z.].

Omboni, S., & Tenti, M. (2018). Telepharmacy for the management of cardiovascular patients in the community. Trends In Cardiovascular Medicine. doi: 10.1016/j.tcm.2018.07.002

Team, A., (2018). What is Negligence? – Offering a Standard of Care – Ausmed. Retrieved 29 Aug. 2018 from https://www.ausmed.com/articles/what-is-negligence/