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Case Study Analysis | Nursing Assignment

Case Study

History

Suzy Martin is an enrolled nurse who works part time 15 hours per week on a surgical ward at the local public hospital. She has been employed for the past year and has attended all of her mandatory training.

Suzy is currently completing her bachelor of nursing at the local university

Suzy has developed a good relationship with a client Jasmine on the ward, who has been admitted for exploratory gynaecological surgery. Jasmine had a termination many years ago and is now finding it hard to conceive. This evening, Suzy is looking after Jasmine who has returned to the ward after her surgery.

 

  1. Suzy has received a notification from AHPRA that her renewal of registration is now due.
  1. Discuss the roles of the two leading nursing bodies (give the full name of each), who are regulatory partners of AHPRA and name the law under which nursing registration is governed.

 

The name of the two leading nursing partners of AHPRA, who are also regulatory partners, are "The Nursing and Midwifery Board of Australia”(NMBA) and “Australian College of Nursing”. The roles of these two regulatory partners are vital as they are responsible for registering the students and practitioners and to protect the people. They also take responsibility for accrediting the providers of education and the programs of the study. The Australian Health Practitioner Regulation Agency works with the National Board in partnership to keep the safety of the public by assuring that everyone has access to competent and qualified midwives and nurses in order to provide midwifery and nursing care to the public. Under the national law of Health Practitioner Regulation National Law Act 2009, the registration of nursing is governed (Bismark et al. 2015).  

 

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ing at the local university

Suzy has developed a good relationship with a client Jasmine on the ward, who has been admitted for exploratory gynaecological surgery. Jasmine had a termination many years ago and is now finding it hard to conceive. This evening, Suzy is looking after Jasmine who has returned to the ward after her surgery.

 

  1. Suzy has received a notification from AHPRA that her renewal of registration is now due.
  1. Discuss the roles of the two leading nursing bodies (give the full name of each), who are regulatory partners of AHPRA and name the law under which nursing registration is governed.

 

The name of the two leading nursing partners of AHPRA, who are also regulatory partners, are "The Nursing and Midwifery Board of Australia”(NMBA) and “Australian College of Nursing”. The roles of these two regulatory partners are vital as they are responsible for registering the students and practitioners and to protect the people. They also take responsibility for accrediting the providers of education and the programs of the study. The Australian Health Practitioner Regulation Agency works with the National Board in partnership to keep the safety of the public by assuring that everyone has access to competent and qualified midwives and nurses in order to provide midwifery and nursing care to the public. Under the national law of Health Practitioner Regulation National Law Act 2009, the registration of nursing is governed (Bismark et al. 2015).  

 

  1. Demonstrate your understanding of the registration standards, by providing 2 examples of requirements that must be fulfilled by Suzy for her renewal to be successful. Use examples of how Suzy might have fulfilled some of that criteria.

 

The nurse or midwives have to register under their legal name which is registered under the national law and they also have to renew and update the contact details to renew the registration of nursing and midwifery care. Under the national law the midwives and nurses who are already registered in one division, must not unknowingly or knowingly claim to be registered in other divisions or part of the registers. The nurses and midwives also cannot claim to be qualified for which they do not have qualification which can lead to a new change of status in their registration.

Suzie must have renewed her registration as soon as she can, long before the closing period of registration renewal. According to the renewal process, Suzie needs to update her contact details in case of appointing her to take care of some patient.

 

 

  1. In January of this year a new set of enrolled nurse standards for practice came into effect. Discuss the domain of professional and collaborative practice, and explain and explain 4 ways in which Suzy can ensure that she meets the standards set within it. 

 

The registered nurse standards for practice consist of seven standards which are,

Engages in professional and therapeutic relationships.

Thinks and analyses critically the practice of nursing.

Conducting the assessment comprehensively.

A plan for nursing practice should be developed.

The nurse should maintain the capability to practice.

Evaluates the results to inform the practice of the nursing.

Provides responsive, appropriate and safe quality practice of nursing.

Suzie can read the Registered nurse standard for practice or RNs in collaboration with the applicable companion documents of NMBA which are, codes, guidelines and standards including the Code of ethics, Code of the professional conduct for the nurses, the Supervision guidelines for nursing and midwifery, the Guidelines for mandatory notifications and National framework for the development of decision making tools for midwifery and nursing practice. Suzie can also provide responsive, appropriate and caring nursing by communication and understanding. Suzie will also have to practice continuously without many years of gap in order to be able to stay a caring nurse and to think and analyse critically.

 

 

  1. Provide an explanation of the history of NSQHS standards; outline at least two (2) examples of those standards and explain the role of the enrolled nurse in providing safe and quality care. (Minimum 200 words)

 

According to the study of Quality in Australian Health Care, published in a medical journal of Australia in the year 1995, 16% of patients in hospital had experienced some kind of adverse incident at the time of their admission and this report was mainly focused on the quality of health and safety of the patient. The standards of National Safety and Quality in Health Service (NSQHS) have covered medication safety, infection control and protection, clinical governance and handover and identification of the patient. The two instances of NSQHS standards are the Governance for the quality and safety of the organisations of Health Services and controlling and preventing any health associated with infections.

 

 

 

  1. As the shift nears its end, Suzy enters the nurses’ station to complete documentation. Suzy’s colleague Sarah is already there and tells Suzy she has forgotten her password she asks if she can use Suzy’s to complete her notes.
  1. What reasonable precautions must an organisation take to protect the privacy of a client? Discuss how using someone else’s password might infringe an organisation’s policy on privacy. Use relevant legislation to support your answer.

 

Nurses are the vital key to providing good quality care and safety and they are the irreplaceable aspect who is responsible to take good care of the patients. In providing quality care, the nurses play a significant role as they have to follow the orders of the doctors and give the patients the proper medication and analysing the patient's response to the medication and changing dressings and so on. The nurses interpret critically the data of the patient and evaluate them. They focus on helping clients to fulfill their needs like emotional, physical, spiritual, social and cognitive needs.

The organisation of healthcare services must train all the employees, be it security, human resources or the medical department, and they should provide a clear understanding on why it is important to protect the data of a patient (Bennett & Raab, 2017). If only the IT department stays aware regarding the protection of the client's data, it can harm the hospital due to the lack of knowledge of other employees. The organisation can restrict the access to the whole data of the patients to the users who are authorised only which can reduce the risk of breaking the law if the data of a patient is lost. The hospital should invest a sufficient amount of money to the protection of the client’s data according to the experts of MIFA, who state that more than 10% of the budget should be allotted to the protection of patient’s data (Barrows & Clayton, 2014). The organisation can also implement BYOD policies to put a policy that restricts the limits on how patient data can be transmitted and viewed on devices.  The hospital needs to develop and renew the plan regarding any breach of client's data and they have to train the employees the procedures and policies daily. They need to encourage the whole staff of the organisation to keep a mindset of violating the policies regarding the protection of a patient’s data and the organisation can also give an easy access of the records to the patient herself as the patient can easily shows the record to get a third opinion without transmitting or downloading which is an insecure process (Ganz, Wagner & Toren, 2015).  

The organisations and agencies have obligatory policies under the Privacy Act 1988 (Cth) to implement logical safeguards and can take steps to protect the private information of a patient that can be misused due to the usage of someone else's password for documentation. These reasonable steps also may include the implementation and preparation of policy of data breach and a response plan which means that the concerned individual will be notified and OAIC too will be notified.  

 

  1. Your client asks you if she can look at her notes to see what the doctor has written about her operation. Discuss the legislation that relates to the access of medical records in this hospital. Detail any other health professionals you would engage with and the commonalities of the information that the client may have access to.

 

The National Privacy Principle 6(NPP 6) establishes the rule generally that an organisation is required to provide the report of a patient on request with the access to the private information held of him or her. The rule applies to personal information and health information generally. However, the NPP6 has many exceptions to the general right of accessing the data of a client. For instance, the information will be health related and can only be accessed when the concerned person is in severe condition. The committee of healthcare accepts that there should be a right of the patient to have access to the medical report. The patient and his family can consult with the physicians and the higher staff of the authority in the hospital to get access to the personal information and the health report of the patient. The client can only have access to the health report if the person wants a second or third opinion about his health. The ACT Health Records (Privacy and Access) Act 1977 is a better model in its totality than the proposed bill. The Act gives the right to a patient to have access to his personal health report unless the provision of the health report would break a law of the Commonwealth, the order or territory of a jurisdiction or court, or the record is the subject of confidentiality and if the provision of that personal information can cause a significant risk to someone's life.

 

 

  1. In detail, outline your responsibilities in contributing to the nursing records of a client. 

 

The responsibilities regarding the protection of the privacy of the patient's data are important as the exchange of a password to document the patient's records is risky. It can harm the privacy of the patient; the staffs of the hospital have an ethical duty towards the patients to not share the patient's report knowingly or unknowingly.

 

 

  1. Suzy reads the surgeon’s notes, where it has been written that it is ‘unlikely’ Jasmine will ever conceive naturally. Jasmine asks you to tell her what the surgeon has written.
  1. Discuss the ethical dilemma you are in, what resolution you would come to and who else might you involve?

 

In an ethical conflict it is difficult to make decision to declare the news to a patient. The patient has a right to know but the nurse has to take into consideration the emotional and physical status of the patient. The nurse can involve the doctor on duty and the loved ones of the patient while giving some sensitive news to the patient. The nurse also has to take into account the empathy towards the patient as the patient cannot feel disregarded.  Therefore, the acting nurse has to be patient and comforting to deliver the news. 

 

 

b)      Provide an explanation of the term bioethics, include one theoretical concept in your response. (75 words)

 

Bioethics

Ethics is a philosophical concept that deals with the moral notions of good and bad according to the environment and actions. Bioethics is the application of ethics in the discipline of medicine and healthcare.

Theoretical concept

According to Healy (2016), the concept of Bioethics is most prevalent in the application of the law and governmental regulations on healthcare. The most observable implication can be seen as organisations face an ethical dilemma when deciding whether or not to reveal a patient's information to a third party.

 

c)      Sarah who has also looked after Jasmine tells you that she had not read the notes thoroughly and that her religion forbids her from caring for Jasmine. (50 words)

          On what grounds is such a refusal to care for someone made?

 

The reasoning that the previous caregiver Sarah provides is based on religious beliefs. Religion can have intrinsic effects on the decision making of an individual. This is due to the fact that religion is a prime contributor to the cultural belief of an individual. Certain religions impose certain rules on its followers. In this case, Sarah's religion prohibits her from caring for the patient.

 

 

  1. Sarah tells you that ‘people’ who terminate pregnancies are the same sort of people that support euthanasia.

Discuss the legality of euthanasia in Australia and the doctrine of double effect. (100 words)

 

Euthanasia is the act of intentionally ending a person's life (Beaupert et al. 2014). In Australia, all forms of euthanasia were considered illegal on a federal level. However, states and territories have recently legislated on the issue. In November 2017 assisted suicide passed the legislation. The new legislation will be in effect from mid-2019.

The doctrine of double effect

This doctrine says that any action that is morally good may have a bad side effect yet the action will be considered morally correct provided that the bad side effect was not intended in any way. Bismark et al (2015) stated that this idea remains true even if the bad side effect is foreseen as a consequence of the good action.

 

  1. Overnight, the registered nurse is busy with several clients. He fails to complete a proper assessment when Jasmine complains of feeling unwell. Eventually the on-call medic is alerted and Jasmine is taken to intensive care for monitoring.  Jasmine’s partner is called and asked whether he is a power of attorney (POA) for Jasmine as she is deteriorating.
  1. In what circumstances might a POA be used and what authority might they have?

 

Power of attorney is a legal document that empowers a trusted person to make decisions for an individual. In a medical context, the power of attorney is used to make important medical decisions. When an individual is unable to make medical decisions for them, another individual with POA can make those decisions (Bennett & Raab, 2017).

POA is mostly utilised when a medical condition severely affects the decision making of an individual. Some examples where a POA can be utilised are,

  • Brain injury
  • Unconsciousness
  • Cognitive impairment
  • Inability to communicate
  • Dementia

The above mentioned medical conditions can severely affect an individual’s ability to make medical decisions for themselves. Thus appointed POA can aid them in making the medical decisions. POA can also be assigned in the following cases where the individual is not yet unresponsive or unable to make decisions.

  • Chronic illness (such as cancer)
  • In case the individual is taking part in an activity that has the risk of injury (such as combat sports)

In these cases, the individual is not impaired in any way but is expecting a need for a POA to arise.

As opined by Ganz, Wagner & Toren (2015), the POA for an individual can have significant authority in making critical medical decisions on the individual's behalf. However, the medical POA cannot make financial or property decisions as those specific fields require separate POA agreements. The agent that is selected as the POA will be legally bound to take actions that serve an individual's best interests. The agent will be capable of making almost all medical decisions that do not have a conflict of interest. Due to this reason in some specific cases, the POA cannot make decisions for an individual. Some of these specific cases are discussed below.

  • Any decisions that may lead to infertility.
  • Any decisions regarding termination of pregnancy.
  • Decisions regarding removal of tissue for any sort of transplant.

 

 

 

  1. Jasmine’s partner stays at her bedside. He is very distressed as she becomes much sicker and a decision is made to intubate her and put her on a ventilator. Jasmine’s partner becomes very angry and tries to stop the doctors from doing this. Discuss the medical staff’s duty of care and consent.

 

The medical staffs appointed for any kind of patient care is bound by certain legal rules and regulations and there are certain ethical implications involved as well. In the case study, it can be seen that Jasmine's partner becomes agitated and tries to stop the doctors from carrying out their medical procedures. In this example, the medical staff and the doctors that are involved are subjected to two main decision-making factors. These factors are described in brief below.

  • Duty of care: All medical staff and doctors are legally bound to provide medical care concerning the best interest of any patient. Failure in complying with this condition may result in legal prosecution. In the case study, the doctors and medical staff involved in the caring process for Jasmine are also bound to provide her with proper medical care.
  • Consent: Unlike the Duty of care, Consent is more in line with the ethical considerations of an action. Consent has some legal implications as well; however, those legal implications are not severe. The idea of consent stems from the moral consideration of acquiring consent from the patient or the POA before making any important medical procedures. This idea, however, is often challenged as certain critical conditions require doctors and medical professionals to make prompt decisions and do not leave enough time to acquire consent from the patient or the POA. In the case study, it is seen that the critical and deteriorating medical condition of Jasmine forced the doctors to move her to the ventilator. The severity of her condition did not allow the doctors to ask for consent from her partner.

 

  1. Jasmine starts to recover over the next few days, she is breathing with the assistance of a ventilator but she remains sedated as she is very agitated and still quite unwell. Jasmine’s partner believes that the sedation (chemical medication) is a form of restraint.

Discuss the nurse’s responsibility in the use of lawful restraint

 

Medical restraints are physical or chemical restraints that stop a patient from harming themselves or others. Medical restraints are also used to reduce the amount of discomfort or pain for the patient (Yang, Li & Niu, 2015). Medical restraints are generally used as a form of safety measure to ensure the wellbeing of a patient and the people around a patient. The use of physical restraints can be seen in many sorts of medical procedures. Such as a person might be tied to a wheelchair to prevent them from accidentally falling over, body parts are restrained during the MRI process so that there is no movement in the specific part that is being scanned. The most prevalent use of restraints can be seen in mental institutions. Mental patients often pose a threat to themselves and everyone around them. Such mental patients are often restrained to ensure the safety and well being of the people involved.

According to House et al. (2015), medical restraint has some major ethical and legal implications. Legally the health and well being of the restrained person becomes the responsibility of the restrainer. The restrainer has to do certain tasks to ensure proper safety of the restrained person according to the severity of the restraining method used. For example, if a person is physically restrained, the restrainer must conduct periodic checks for indications of distress. On the other hand, a person who has been rendered unconscious or semi-conscious by using chemical medications must be constantly monitored by computer controlled equipment and well-trained staff. The ethical considerations are, however, mostly concerned with the consent of the patient and their family members or POA. Due to this reasoning, it can be assessed that the chemical restraint used on Jasmine was completely lawful.

 

  1. Several weeks later when Jasmine is recovering, she puts in an official compliant to the hospital about the registered nurse who she says ignored her when she felt unwell.A departmental meeting is called with Jasmine and her partner.
  1. Discuss the framework developed by the Australian Council for Safety and Quality in Health Care which guides organisations to express regret for an adverse incident. Discuss the philosophy behind the framework.

 

The Australian Council for Safety and Quality in Health Care has developed a framework for expressing regret. The act of apologising or expressing regret is a key component of open disclosure. One of the principal aims of this framework is to restore patient's trust in the clinicians and the healthcare system in general (Engelbrecht, Wood & Cole-Sinclair, 2014). The framework imposed by the Australian Council for Safety and Quality in Health Care provides an organisation with proper guidelines to apologise and to express regret. The framework consists of the following key points.

  • Acknowledgement of the fact that an adverse event has occurred.
  • Apologising and expressing regret for what has occurred.
  • Providing known and clinical facts that discuss ongoing care and any potential side effects.
  • Listen to constructive feedback from the patient’s side on how the adverse event has affected them both clinically and personally.
  •  Conducting a clinical review and implementing preventative measures to ensure that the adverse event does not happen again.
  • Agreeing to provide feedback whenever necessary.

Along with the apology and the expression of regret all known facts about the adverse event should also be provided. The following points should be considered when preparing a formal disclosure.

  • All known facts about the event should be provided.
  • There must not be any speculations regarding the causes of the event.
  • The results of the clinical review must not be pre-empted.
  • A single individual or system must not be blamed for the event.
  • Harm should be acknowledged and appropriate apology must be made.

The philosophy behind this framework is based on the moral and ethical standing of good and bad. The basic human aspect of morality is focused on this framework. An apology is the neutral and most basic human response to harming another person. This is true even when the harm is blameless and inadvertent. Not conforming to these guidelines of this framework and not apologising may be considered abnormal or morally incorrect. This severely hampers the trustworthiness of the medical institution and the medical staff.

 

  1. Outline the elements of the framework.

 

The open disclosure framework consists of some significant elements. These elements are discussed in brief below.

  • Detecting and assessing incidents: This element involves detection of the adverse event, providing prompt clinical care that reduces and prevents further harm, notify relevant authorities and personnel.
  • Signalling the need for open disclosure: Provide written confirmation, avoid speculations and blame, acknowledge the adverse event and properly apologise.
  • Preparing for open disclosure:  Gather and process all necessary information.
  • Engaging in open disclosure: Provide all collected information and clearly explain what happened.
  • Providing follow-up: Agree on future care and share all findings of the clinical investigation periodically.
  • Completing the process: Reaching an agreement between the patient party and the clinicians, providing the patient party with written confirmation of the agreement.
  • Maintaining documentation: Keeping up to date data on the patients and maintain a record of the open disclosure process itself.