Ethical and LEGALITIES in Nursing

INTRODUCTION

Ethical and Legal Issues in Nursing are applicable for any nurse, from starter to expert. They are generally considered as the vital part of medical. This assignment will discover honest and legal implication of the nurse who disguises the info of the lethal ill patient at the demand of his family. The family will not want the nurse to notify the patient about the lethal dynamics of his disease. The family also dreams that the nurse shouldn't tell the individual about the medications approved to him.

Johnstone (2011, p 21) says that nursing professional is very uncertain. The nurse is often in issue whether she should cooperate with the family or not. Now the questions that arises here's that if the nurse will not disclose the reality to the individual then what could be the legal implications. In addition, the nurse is uncertain whether she'd go after the wishes of the family or not. In the next discussion, I am going to go through the ethical concepts and legal implications of concealing information from the patient and administering morphine without his information or authorization.

PALLIATIVE CARE

According to WHO, palliative attention is defined as an approach that helps in improving the grade of life of the patients and their families facing the condition associated with life-threatening disease. Patients desire a palliative care to aid their long and gradual treatment technique Tang, (2006, p. 360). It really is centered on providing comfort and relief from the pain and the other distressing symptoms of a serious illness. It integrates the emotional and spiritual areas of patient care. It includes a support system that helps patients to be exciting as much as possible until death. In addition, it provides a solid support to the family to cope up with the patient illness and also includes bereavement support for the family.

Palliative care runs on the team method of manage the needs of the patients and their families. It is a team established effort of treatment giving and it is also accountable for initiating the concept of dedicated palliative good care development team. The team includes doctor, nurse, massage therapy therapists, nutritionists and pharmacists. Several doctors from different areas of medical sciences are constantly working on developing and planning new measures to provide the best palliative attention to the patients who are suffering from serious illness. All the principles of the palliative health care must be employed from enough time of identification. Palliative health care is often associated with terminal diseases like Cancer tumor and AIDS but now the idea has been transformed. There are various palliative regimes which can be applied for other diseases, such as cardiac or renal disease, in order to help the patient to cope with the anguish (Johnson et al. 2011). Sometimes, a term 'Long term health care' is utilized to describe the palliative treatment.

ETHICAL PRINCIPLES

(Hodkinson 2008) state that

"The therapeutic character of this nurse-patient romantic relationship is a central strategy in nursing. The most important issues related to the bond are disclosure of real truth, kindness and communication. " The patients who are suffering from terminal health issues generally prefer to listen to the truth however they wish it to listen to it in a receptive way (Maria, Ann & Anna 2011).

Autonomy- The main principle of autonomy is that the patient really should have enough information about his condition so as to make a substantial selection of treatment (Moulton & King 2010). The nurse should properly converse with the patient and ensure that the patient is well alert to all available treatment options (Johnstone 2011). (Collis 2006) advised that before disclosing the info to family members it is must to get the patient's consent. It expresses the admiration because of their autonomy. The nurse should think about patient's autonomy before administering morphine.

(Starzomski 2009) known,

"Patients and people from diverse neighborhoods have different beliefs about autonomy and might not exactly envision disclosure of information in the same way as their healthcare providers. In such cases this is an area that should be carefully explored with patients to ensure their wants are respected and they're contained in the information process in the way that they would like to be. " In this particular situation nurse should talk to the members of the family to be able to convince and find out their preferred way to reveal the analysis and prognosis of disease.

Beneficence- The main of beneficence as a 'do good' describes applications of interventions that are carried out by nurse and doctor for the advantage of patient. In addition, it include the protection of right of health service consumer (Staunton & Chiarella 2008). Doctor should treat the individual 'autonomously' and prevent him/her from harm and care supplier should also aware of legal implication of action taken(Ulysse, Balicas & Yiquing 2011). Revealing reality is not damaging for patient it will cause the peaceful death(O'Sullivan 2009). The health professional should inspire the family presenting them the good thing about healing discloser and dangerous effects of concealing information e. g. administer medication without consent.

Justice -Justice referred to as treat everyone 'similarly and fairly'. It is female phenomena in resolving ethical dilemmas. It necessary to be supplemented by providing proper care to health service user (Botes 2000). In order to apply justice medical researchers provide care consistently to all the patients in hospital not patient and family.

Non - maleficience - This process is based on the phenomena of 'will no injury' for example in health care when privateness hard to maintain for research or analysis purpose then health professional ensure that they do not disclose the patient's personal details. This principal assists with prevent the incident and possibilities of injury. Nurse should gain access to the risk of interventions that she /he does. (Ford & Reutter 1990). In addition, it refrain the nurse from the intentional commission of an wrongful take action. (Carlson et al. 2010)

In many communities for example Muslim and Indian cultures diseases are regarded as a family subject. Decision making is also "family centered" so withholding truth is not rare practice. Therefore beneficence and non-malfeasance play essential role in their moral beliefs as compare to patient right to consent in european countries (Pentheny et al, 2011).

It is also urged that in case there is a dilemma a specialist should seek help using their regulatory body or councils which can guide them towards a officially and ethically rightful avenue Hui, (2010, p. 76).

LEGAL AND ETHICAL IMPLICATIONS

Ethics and legal implications are very closely related to one another. Ethics package with the expectations of do and honest judgement whereas legal issues deal with medical practise which include licensing, nurse practice works and standards of treatment (Chaloner 2007).

According to Lawbreaker Code (Palliative Care) Amendment Monthly bill 2003,

"Section 282A will not address consent. The administration of treatment including palliative good care has already been governed by a legal regime. If one has capacity to decide their medical care the patient will consent to their medical treatment. Unauthorised administration of medical treatment would be assault".

AMA Queensland point out that medical researchers should respect the 'autonomy' terminally ill patients to be able to refusal and popularity of their medical treatments.

Ethical and legal implications in palliative care and attention are extremely significant because it is an end level treatment where majority of patient are moving towards an impending death. It really is a right of each Australian citizen to possess complete and right information about their medical situation. Because of this entitlement professionals delivering palliative care and attention and members of the family of the individual involves in legal and ethical problem. Where they are not sure which plan of action would be appropriate in both moral as well as legal manner. Due to these legal issues and emotional disruptions families of the individual and patient itself go through a great deal of stress and subconscious trauma. It is also decided by many experts of palliative treatment that increased stress would also impact the ability of the individual to handle the injury Oonagh (2009, p. 123).

In this case study patient is facing an impending loss of life from cancer and terminal examination of cancer that will brings her life to the end. This result in deteriorating in her physical health and she may ask question about her situation and prognosis of the disease. With a grown-up patient it is relatively important to comprehend the idea of fatality and disease and they can take a realistic approach towards it by spending their remaining time in a productive manner stating good bye to dear ones and caring for all formalities before achieving a demises. (ACMA 2011). It is very complicated to reveal the information opposite to relative's desires (Cavanna et al, 2009)

In this situation, the desires of the family to hide information from the patient is not different. Ethically it appears wrong for a healthcare practitioner to rest to the patients regarding her medical situation rather than notify her about her forthcoming death. There might be things which she wants to do before dying if she would have been enlightened. There is also legal implication with the actual fact that a patient is being cared for without her consent which is also violation of regulations which gives an individual to refusal for treatment on her body. For instance many patients want to hint DNR (USUALLY DO NOT Resuscitate) forms to ensure that no endeavors should be made to revive them if they are close to fatality. In this case study patient is being denied of this right as well Hanson (2002). If by family here it is implied that her legal guardian wishes to keep this information hidden from the patient, then according to Giacalone (2007, p. 368) the nurse is not legally bound to honour their really wants to do it would run counter to the law etc.

Prima Facie it is a clear circumstance of violation of constitutional rights of an individual if medical professional does not inform the individual about her medical condition and learn her desire and common sense in building and expanding her future treatment and palliative treatment plan. Matching to Australian constitutional laws the patient contain the first directly on information regarding his medical condition and it is on his discretion that with whom this information should be distributed. If a patient expressively declares that he doesn't desire to discuss his medical information along with his family then it is legal obligation of medical center and medical professional to keep the wish of the individual. Laws handbook Victoria identifies another law regulating certain facet of hospital care and attention and ethical issue. This law is known as doctor patient confidentiality regulation this state that medical practitioner doctor, nurse or a paramedical staff cannot divulge information about his patient to a non related person or a person without patient's medical lawyer until and unless directed by the court of legislation. . This regulation ensures that dignity and personal privacy of the patient is preserved and there is absolutely no legal or honest negligence from the physician in the entire exchange Vickers, (2004, p. 232).

SOLUTIONS AND BEING ETHICALLY RIGHT

In days gone by years, the medical professionals were very unwilling to tell the truth with their patients regarding their existing health issues. Alternatively, in these times the patients do want their medical professionals to inform them the reality about the diagnosis and the medical solutions. According a review conducted almost three generations ago, it's been cleared that 97% of the medical doctors felt that it's correct to tell the truth to the patients regarding all the relevant aspects of their illness which include the type of the illness and its own expected outcomes. Sometimes it is seen that there surely is psychological effect on the patient's mentality and it's very difficult to allow them to handle such a demanding situation (Kendall 2006). In such a situation, palliative attention specialists can be proven quite helpful as they can provide resources to help the individual and his family offer with emotions that come with a serious health problems. They may provide counseling, set up family getting together with or make referrals to mental health professionals if needed (Bush & Bruni 2008). However, if the conditions are shown in an undignified manner then it is possible that it could create a negative picture of the situation in the patient's brain and in that case it is evident that the sufferings and stress of the individual would increase instead of decreasing and the individual may lose the desire to live (Li et al. 2008). Tuckett shows that it's important to understand the mental state of the patient before moving on the entire information to him. The final decision is manufactured by the physician and his medical team about the disclosure of the reality to the patient after inspecting all his mental status (2012). Even the court of legislation has approved this argument that if the doctor and his medical team verify with an data that the information could have a devastating effect on the patient they have a complete power to hide the information from the individual or they disclose the truth to the individual when they believe that it is appropriate time for you to tell Seymour (2004, p. 165). Alternatively, it may be possible that the individual will not want to listen to the info regarding his health but in such a situation it is the work of the medical doctor to supply the basic information to the patient (council 2004).

IMPACT ON NURSING PRACTICE

When the medical practitioners talk to the patients, being honest is a fundamental way to develop trust and admiration for the individual. Patients show a great deal of trust in their physician and they may feel deceived if indeed they discover that you can find lack of credibility by the medical professional. But, sometimes a situation occurs when the medical professional feels that disclosure would generate a harmful effect on the individual and it can be validated to hold back the truthful information if so. (Robinson January-February) explains that sometimes possessing again the truthful information from patient may lead to sense of regret in the health good care providers. It may also be one of the main reasons of moral distress with them. (Goethals, Gastmans & de Casterl 2010) declare that many a times the moral distress can lead to less engagement of nurse in his work. Additionally, it may cause some kinds of health issues which may eventually brings about resignation from job. Ulysses et al (2011) asserts that in health practise the therapeutic nondisclosure may lead to frustration which influences the practitioner's responsibility towards his patient and his family.

CONCLUSION

Many types of complex situations tend to be encountered by several nurses throughout their professional life. Some experts consider such types of troubled more badly than death. It is totally unfair to withhold the truth from the patient about his existing health conditions, especially when the patient is able enough to give the consent about various medications and strategies. Based on the constitution of Australia, it isn't at all acceptable to claim the life of an person for any medical reason and lead any medications without his consent. This case study has proven very beneficial in developing a very comprehensive understanding of the many medical regulations and legal problems that are faced by medical professionals. It should be the duty of each medical expert that in any situation he should not break any of the legal obligations. It also provides specific information about the various significant steps that needs to be taken to cope with these types of ethical dilemmas.

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