NURBN1001 Legal And Ethical Decision Making In Person-Centred Care 2

In the health care setting, the patient is the core of the nursing practice. The patient being confined to their situation should not change how the nurse sees them or how the health care is delivered. Correlational nursing enables a health professional to deliver their services considering that the patient is of intrinsic value. Respect to professional values during nursing practice brings the uniqueness of legal, ethical and professional issues for every health professional. According to Haddad and Geiger (2020) nursing ethical values are rules of conduct that guide the nurse in their intentions, actions and motives. Ethics on the other hand are moral principles that govern the behaviour and conduct of a person. Ethics in the health care setting are important as the nurses must meet health care dilemmas and they would be required to make right decisions and judgements as per their values while staying within the boundaries of the laws governing them (Ostman, Nasman, Ericksson, Nystrom and Ethos, 2019). To maintain integrity in their practice, nurses have certain rules to guide them (Trobec and Starcic, 2015). This essay is going to tackle different legal and ethical considerations when dealing with a patient. It would focus on the Australian Charter of Health Care Rights, consent, confidentiality and privacy, breach of duty of care, medical negligence and actions taken and also look at bioethical principles according to Beauchamp and his colleagues.

According to the case study, Doris, who is 79 years old, was taken to the hospital after a fall. After assessment, X-ray showed that she had fractured her right hip and a surgery had to be done to repair the fracture. Nobody explained to Doris what had happened to her or where she was but remained confused and agitated throughout the process. She was admitted in the orthopaedic ward as she waited for her surgery. On reaching the ward, the orthopaedic surgeon gave Peter, Doris husband who is 88 years old, Doris’ blank consent form to sign as the next of kin. He did not even explain the proposed procedure to neither the patient nor to his husband. Peter maybe did not know why he was signing this form. Peter and the nurse caring for Doris spend some time together and he explained to the nurse how he had issues with memory, how he occasionally lost his way home as he came from the nearby shops, how he would forget turning off the washing machine and also stove. The nurse had concerns for peter wanting to understand the proposed procedure and conducted the surgeon but claimed that he could do nothing since the consent form was already signed. When Bert, Peter’s neighbor, visited them and requested to sign the consent form for them, he was left unattended. The surgeon took an afternoon off and delegated the operation to a junior doctor. With the junior doctor’s limited experience, he injured Doris’ hip and caused her continual pain and decreased mobility.

Australian Charter of Health Rights

According to the Australian Charter of Health Rights every patient is entitled to safe and quality health care. The charter claims that both the health care professionals and the patient have a crucial role to play in ensuring that health care rights are maintained and achieved. It allows every stakeholder in health care delivery to understand the rights of the person receiving the care. This charter in anchored on 3 principles. The charter gives everyone the right to have access to safe and quality health care services, it indicates the government’s commitment to international agreements on human rights which gives everyone the right to have the maximum standard of physical and mental health and finally promises every citizen that Australia being made up of diverse cultures and ways of life, they will be respected and acknowledged in the health care setting. Quality health care is defined on the basis of how health services leads to the likelihood of desired health outcomes. It is also based on the consistency of the health care services to the set professional knowledge and norms. Patient’s safety on the other hand emphasizes on preventing harm on the patient (Farmer, Bigby, Davis, Carlisle, Kenny and Huysmans, 2018). Doris health care was faced with a lot of safety flaws. First of all she was not aware of the health care procedure to be carried on her. It is important that the patient knows what procedures are to be done and why. This prepares the patient to the medical procedures. According to Major and Holmes (2015) providing information to a patient on the health care procedures has a positive impact on the patient’s wellbeing. This calls for an excellent therapeutic relationship between the nurse and the patient. The orthopaedic surgeon delegated Doris’s operation to a junior and went play golf. According to de Freitas and Martin (2014) claim that delegation should be done when there are fiscal constraints, increased patient care complexity and when there is shortage of nurses. They add that if delegation is done in the right way it improves the patient care outcome. According to Freitas and Martin (2014), the orthopaedic surgeon did an “improper delegation.” Improper delegation involves giving tasks to unregistered nurses and a person who is not accountable or has no proper knowledge of the job delegated to them. This leads to negative patient care outcomes. The surgery process was given to a junior who did not have full understanding of the process. This lead to further injuries on Doris’s hip and costed her continual pain and decreased mobility.

Valid consent

Consent is simply an agreement or permission to do something. In health care setting, nurses are required by the law and the ethical standards to obtain a valid consent before carrying out any examinations, treatment, physical examination or providing any care. A valid consent must contain the nature of health care procedures, risks and benefits accompanied by the procedure, any available alternatives and their benefits and risks and then an assessment on the patient on the their understanding of the consent requirements (Shash, Thornton and Hipskin, 2020). Through attaining the consent, the patient gets to know what would happen during the health care process, what would happen to their bodies and the type of care and support they would get. It is also the right of the patient to know all these. According to the nurses’ code, it is the responsibility of the health professionals to ensure a properly informed consent has been obtained. The Nursing and Midwifery Board of Australia (2019) defined an informed consent as a voluntary agreement the patient makes with sufficient knowledge and understanding of any potential risks and benefits that could be involved. In giving informed consent, the nurse must ensure that every information is explained in a way and language understandable to the patient, the patient should be given enough time to ask questions, make a decision or refuse the intervention and the nurse should act according the person’s decision. According to ethics, consent is about the patient’s autonomy and it is an indication that they understand and freely agree with the treatment procedures. It also means that the patient can withdraw the consent on their will. Nurse are obliged to accept and support the withdrawal and refusal of the patient’s consent regardless of whether they disagree with the patient’s decision (Taylor, 2014). From the case study, Peter was just handed the blank consent form to sign. The doctor did not explain the kind of procedure to be carried out and the risks that could accompany the medical procedure. In addition, the patient was not aware of what was going to happen to her. No one told her where she was, what had happened to her and what was going to happen to her in the hospital. According to Shash, Thornton and Hipskind (2020) there are different exceptions to informed consent. These exceptions occur when the patient is not capable of giving a consent, where an emergency is life threatening hence no enough time to give consent and voluntarily waived consent. In situations where the patient’s ability to make a decision is questionable and there is no next of kin, then the doctor has to make the decision. There is need for hierarchy of decision makers in this case. Children are not to give informed consent but their parents are requested to give an informed permission, unless the child is legally emancipated. The principle on consent in Doris’s case was violated.

Medical negligence

Medical negligence is the failure of action by a health professional that deviates from the set standards of care. According to Preskorn (2014) negligence alone is not enough for a claim but when the negligence leads to patient harm, then there is a case. Nurses owe a duty of care to the patients. It is their duty health care services that are in accordance the health standards. Medical negligence occurs when a health professional does not adhere to these standards in their actions toward health care delivery. To ascertain that medical negligence, a test is carried out with the aim to establish the person in fault, the nurse or the hospital.

When a patient is admitted, the relationship of duty of care is built and becomes the responsibility to care for the patient. It is therefore obligation of every nurse who comes across the patient in the health care environment to care for the patient. When Bert asked the nurse to sign the consent form, he left him unattended and went off duty. The nurse in the case study got concerned about Peter’s need as pertains the provisions of the consent. Breach of duty occurs when a health professional fails the meet the set standards for a given health care procedure. A Bolam test is done to determine if the health care professional has breached duty of care. Recently courts have claimed that when the medical opinion shows that there was no negligence, it is important to prove how logical and reasonable that opinion is (Oyebode, 2013). It is the doctor’s duty to act in a reasonable way in matter of health care. The doctor in the cases study delegated his work to a junior and went to play golf. To determine that negligence occurred, the claimant has to show that the negligence directly caused or contributed to certain harm. Causation could be hard to prove in most cases according to Vidanapathirana (2016). He claims that a patient could show that a wrong diagnosis was done but fail to prove how the diagnosis led to patient’s injuries. A patient proven breach of duty and causation should also indicate that they suffered some damage. This could be physical or psychiatric injury or even financial loss. Doris attained injuries during the surgery. Her hip was injured, she suffered continual pain and her mobility was affected. Therefore she would be right to make negligence claims. Currently courts and health care settings have abandoned the community standard and adopted the reasonable person standards where the patient has to material risks so as to give a consent concerning a treatment. It allows the nurse and the patient to discuss the proposed treatment.

Bioethical principles

There are 4 bioethical standards in health care setting. The principle of respect for autonomy respects the patient’s autonomy in making decisions concerning their health care. The patient should make the clinical decisions with understanding and without any form of coercion that could affect their free and voluntary act. The principle of non-maleficence protects the patient from any harm either through omission or commission. This principle considers negligence to be any unreasonable and careless action that harms the patient. The doctor’s act of delegating surgery to a junior violated this principle. This led to more injuries on the patience. The principle of beneficence holds that it is the duty of the nurses to be of benefit to the patient and also be at a forefront to remove and prevent any harm. This principle allows a patient to enter into a relationship with licensed physician with the aim of attained health care (McCormick, 2019). The junior doctor knew he had limited knowledge on surgery by he did it anyway. If he had refused to take this surgery it would have saved Doris injuries. Finally it is the principle of justice. This principle is anchored on fairness in distribution of resources. However, different resources are scarce and therefore a better way of allocating them should be sought. This hospital had one surgeon. This could be due to scarcity of the surgeons. If they had another surgeon these injuries would have been avoided.

Conclusion

This assignment has discussed on the Australian Charter of Heath Care Rights and how delegations have to be done in health care. It has found the doctor faulty in delegating surgery to a junior who did not understand the surgery procedures. It has also discussed on the provisions of a valid consent. It has also given exceptions in attaining consent. Additionally, it has discussed about medical negligence. The doctor in the case study breached duty of care which led to harm on the patient. Finally the 4 bioethical principles have been discussed in relation to the cases study.

References

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