Nursing is an occupation regulated by the Nursing and Midwifery Council (NMC 2008). The NMC is an organisation setup by the Parliament to safeguard the general public by making certain nurses and midwives provide high standards of care with their patients. These healthcare professionals are also in charge of their own actions. The body places standards for education, practice and conduct as well as providing advice for nurses and midwives. The NMC also considers allegations of misconduct or unfitness to practice. Using the case study given, it will be the author's try to demonstrate the understanding of the NMC Code of Do suggesting ways that it could be put on practice. In order to adhere to the NMC Code of Do of confidentiality, the patient to be mentioned in this task will be known as Mrs X. Furthermore the author will explore the four main concepts of the code relating those to issues arising from the case study. The writer will also show the understanding of ethical issues arising, analysing and discussing autonomy, non-maleficence, beneficence and justice.
The case study identifies an 80 time old girl with a hip fracture, accepted to a hospital ward from a nursing home and urgently put into the operation list. She actually is bedridden, with severe heart and soul problem and in first stages of Alzheimer's disease and appeared to be coherent and lucid as noted. She decided to have a hip substitute operation following the consultant explained the task. On her way to theatre, she changes her head and the expert was enlightened. The advisor insists on proceeding, citing a active week in advance and commenting that these older confused patients don't know their own head.
According to the NMC Code of Carry out, a healthcare professional has a duty to service and protect the interest of these in their care regardless of get older, gender, culture, spiritual and political beliefs. Mrs X is 80 years old but the specialists still have a duty of good care and must protect her hobbies. An interview was completed by the medical staff and the patient came out coherent and lucid but Mrs X has improved her brain on path to theatre. This author will critically study the procedures that implemented. The consultant explained the task to the individual who agreed to have the procedure. Thompson et al (1994) mentioned that communication is one of the essential aspects in nursing
The specialist was educated of the patient's decision to change her head on the procedure and responds stating that 'We must carry on'.
As a nurse you can argue that the specialist should value this decision as going against it would be breaching the NMC code. Mrs X's decision to change her mind on the way to theatre, not wanting to just do it with the operation should be respected. Anticipation et al (2008) explained that a patient's autonomy can lead to conflict, raise ethical dilemmas and may not be self-explanatory. Autonomy is thought as the right to choose or refuse treatment. Beauchamp and Childress (2009). The specialist may possibly also argue that he is working in the best interest of the individual but will this override the patient's to make her own decision? Beauchamp and Childress (2009) stated that individuals' views and rights must be well known as long as these individuals' thoughts and action do not cause harm to other folks. The NMC makes a point of highlighting the idea of advocating for patients. In this instance, the nurse faces the ethical dilemma of taking a stand to the advisor and advocating for the patient to be able to uphold the code. Thompson (2003, cited in Buka, 2008) suggests that ethics is a study of how people act, what they do, the reason why they give for his or her activities and the justification behind their decision. The necessity to maintain professional restrictions as well means that nurses have to raise their points in a fashion that does not destabilise the team. Every single person in the medical team must act as the patient's advocate and remind or task colleagues as long as they neglect to practice corresponding to criteria, Hindle and Coates (2011). If any medical associates working with the advisor on Mrs X's case are not in agreement along with his decision to continue, they should struggle or remind him of the moral code stipulating that the patient's decision must be well known. When healthcare specialists are confronted with dilemmas, patients should come first. Childs et al (2009) expresses that whenever considering our activities we are bound by NMC rules, standards and recommendations, for students suggestions established by their training establishment by local criteria and guidelines within the scientific practice area and by regulations of the country. It is unprofessional and unlawful to drive treatment on anyone.
Although the consultant explained the procedure, one could argue that making information available is different from effective communication. Consent was given the very first time however the patient later modified her head. An exploration for her reason to improve her mind must have taken place and at least inform the individual that the operation was going forward and the reason why for going ahead.
The wording utilized by the consultant is actually a concern. "We will have to proceed. We have a very active week in advance; these seniors confused patients have no idea their own head. Carry on as usual". One could interpret that the consultant is suggesting that whenever people get old, they automatically become lost; which could be stereotyping amounting to discrimination which is against the law. This could be taken to suggest that the specialist is of the assumption that older people are confused and do not know what's best for themselves and so must have decisions made for them. Patients are supposed to be cared for with dignity, value and as individuals considering their physical, internal and social care with decisions manufactured in relationship with clinicians, somewhat than by clinicians alone matching to DOH (2010).
Hendnrick (2004) defines consent as the authorization distributed by patient voluntarily, without pressure, pressure or manipulation or undue affect. The NMC emphasises that professional medical specialists must seek consent off their patients otherwise they might be prone to be billed with assault or battery. The consent could either be in writing or verbal. In case of a law suit, such documents and conversations can then be utilized in courts of rules. Although Mrs X had given consent for the operation to proceed, health professionals should value the withdrawal of consent. Proceeding with the planned operation against Mrs X's wish amounts to violation of her privileges and the nurse has a responsibility to emphasize this aspect.
The Mental Capacity Action (2005) was set up to empower also to protect prone people in making their own decisions. Specifically, this was to safeguard those who lack capacity and the ones who have complications to make decisions because of disease, disability and the ones with mental health issues. The mental capacity take action has four main key points of capacity:
A person must be assumed to acquire capacity unless it is proved often. Mrs X should be deemed to possess capacity as she was interviewed and came out coherent and lucid.
Any act or decision used with respect to someone missing capacity must be in the individuals best interest. The expert could argue he was working in the best interest of the patient. When Mrs X lacks capacity, an advocate could be appointed to do something on her behalf.
An unwise decision is not to be studied as too little capacity. Even though Mrs X changed her mind and appears to have made an unwise decision, this should not be seen as lack of capacity.
Until all practicable steps have been taken up to help someone make a decision without success, they cannot be cared for as lacking capacity. The expert didn't exhaust all initiatives to help Mrs X in her decision making as no conversation occurred after she improved her head. The consultant needed it upon himself to consider and dismissed Mrs X as an elderly confused patient who does not know her brain.
The Mental Capacity Take action (2005) has a test for capacity which declares that a person lacks capacity if at the material time he's unable to decide for himself in relation to the matter because of an impairment of or a disturbance in the working of, your brain or brain. It does not matter whether the impairment or disruption is temporal or long term (Brammer, 2007). A person is unable to decide for himself if he's struggling to understand the info relevant to your choice, to retain the information, to make use of or to think about that information within the process of choosing, or to continue the decision (Brammer 2007). Section 3 of the action state governments that if the patient can hold on to information relevant to your choice for a short time only, this will not necessarily mean she cannot decide. When Mrs X transformed her head the consultant must have well known this decision because she was with the capacity of retaining information for some time, got thought it through and chose she didn't want to carry on.
The Mental Health Act (1983) covers the reception, care and treatment of psychologically disordered folks, the management of their house and other related things. The work empowers government bodies to detain those identified as having a mental disorder in clinic or police custody and also have their disorder assessed or treated against their desires, known as sectioning. Mrs X was diagnosed as having early on signals of Alzheimer's disease. This disease is a form of dementia, a neurologic disease characterized by loss of mental potential severe enough to hinder normal activities of everyday living. It usually occurs in later years, and is marked by a decrease in cognitive functions such as keeping in mind, reasoning, and planning. As Alzheimer's disease is a progressive illness without recovery, it isn't applicable to utilize the Mental Health Work (1983) because whether or not treatment is given for the disease, this won't enhance the decision making capacity of Mrs X.
The Standard Medical Council clearly stipulates that medical care professionals ought never to discriminate but should treat those in their attention fairly predicated on their needs. The specialist is going from the GMC's code of carry out when he ignores the patient's wish to discontinue with the procedure. The GMC emphasises that patients have the to change their imagination on decisions. (ref)
Nurses are essential by the NMC Code of Conduct expressing compassionate attitudes in their occupations (Byrne and Byrne 1992). Nurses become advocates for patients and therefore can be described as special and unique to other health care specialists as they spend more time with the patients (Norman and Ryrie 2004). They are anticipated to develop a nurse-patient romantic relationship which must be kept professional. Additionally it is a nurse's obligation in accordance with NMC to teach the individual. Mrs X should have been educated and made alert to advantages and cons of the operation.
The principle of non-maleficence is one which seeks to avoid intentional harm. Mrs X does not wish to experience the procedure to agree with her wish would be harmful although proceeding may damage any existing romance between the healthcare professionals and the individual. What then happens if for case the procedure will not go according to plan?
Operations to improve hip fractures in older people are common and also to abstain from performing them would bring about a lot of discomfort and pain not to mention the immobility concern. It's quite common knowledge that bedridden seniors patients if not moved regularly will develop pressure sores (Onslow 2005). The process that will require action which benefits the individual is recognized as beneficence. To benefit this action sometimes medical professionals have to ignore the wishes of the individual if indeed they can show the patient's incapacity to consent.
While respecting the right of Mrs X's treatment refusal, capacity test should be done to discover if she is with the capacity of making her own decision. If Mrs X lacks capacity, then your medical personnel should seek consent from the family members or Independent advocates (Tingle and Cribb, . 2008).
The ethical troubles are compounded by such circumstances as the Canadian circumstance of Malette v Schumann. The claimant came up to medical center after being involved with a road automobile accident. The doctor proceeded to go ahead to perform blood transfusion despite the nurse having found a credit card in her pocket saying that she was a Jehovah's Witness and never to get a blood transfusion. Later, on recovering the claimant earned $20, 000 of injuries (Tingle and Cribb, 2008). The physician was charged with battery pack. Mrs X's wish not to continue with the operation may be well founded and present grounds to litigation. The outcome of the operation also plays a major part in determining whether the decision to go on and operate is a good one or not.
On tacking this project l learnt that building the patient's consent is very vital for any action to be justifiable completed. The consultant performed manage to encourage Mrs X to agree to undergo the procedure after discussing her through it. He however could not allow her change of mind sighting her time as the trouble. I thought that Mrs X hadn't been given enough time to ponder the thought of undergoing the task.
She has been accepted to a healthcare facility ward and urgently added to the list. I thought because she was at pain, she was not thinking in a straight line and was pressured into providing consent. Looking back again l now have the consultant wanted the hip fracture operation to proceed immediately as this might subsequently ensure speed restoration. Taking a look at her age, I'd like to think that the earlier she got handled on the quicker the recovery. He previously the patient's interest at heart.
At the time l noticed team work and better communication would have brought about better decision. The associates must have objected or shown their feelings up against the consultants wish to carry on without consent. The positive was that if Mrs X was managed on, the pain would easy and she would then be mobile, which would be best for her heart and soul. Taking this issue into perspective the sooner she underwent the task the sooner she was expected to heal. The negative was that if anything gone wrong, bearing in mind Mrs X experienced severe heart problem, the whole team would maintain trouble.
When Mrs X transformed her brain about undergoing the procedure the issue should have been addressed properly since consent is important in a patient's care. A meeting between your medical care experts to check out the reason of change of plan, if you need to, a mental capacity test taken as is warranted under the Medical Health Capacity Work. In nursing the hobbies of the patients always come first. I think communication is vital in medical.
Communication is very important when interacting with patients in nursing. The consultant did not act as a specialist when Mrs X changed her head that she is not ready for the hip procedure. I had not been comfortable with his response as it sounded tough, commanding and unprofessional when he was up to date of Mrs X decision
I have learnt that team is important in nursing and healthcare specialists should always respect the rights with their patients and consent is at the centre of every action.
The creator has explored the professional, legal and honest implications of the case study provided. It's been identified that however the NMC provides information and regulates the medical vocation, the onus is on the specialist to make decisions predicated on the guidelines. Although nurses and doctors may be working alongside one another, it has also been noted the two professions are governed by two different body and therefore have different codes of ethics even though some of the rules could be similar. The NMC code of carry out is often updated as the code sometimes issues with other insurance policies and types of procedures from job and regulations. Nurses should ensure they are simply current with any changes and rules in this particular body (Beech 2007). Due to the trust accorded nurses by world (gained through recognition of nurses' competence) and the right given the occupation to regulate practice (professional autonomy) person clinicians and the job must be both in charge and accountable Hitchcock et al (2003). The basic ethical key points of beneficence, nonmaleficence, justice and autonomy that happen to be among the ethical principles that impact decisions in healthcare ethics have been explored and applied to the case study. The Mental Capacity Work (2005) in addition has been mentioned and recognized as the main legal instrument concerning this case study. It is very important that nurses understand how the law influences nursing practice, especially in relation to anticipating insufficient capacity Hindle and Coates (2011).
