The motive of this assignment is to discuss how law, ethics and elements of professional practice have influenced care and professional judgements within this case study. A critical analysis approach will be adapted with the main focus on ethical principles and also reflecting on elements of law and professional practices. The main source of the care intervention will be focusing on maintaining confidentiality in relation to patient’s personal information, and the handling of patient’s information in a way that does not breach confidentiality. Within the context inter-professional collaboration and how the impact a different professional perspective may bring will be explored. The privacy of patients’ will be respected, pseudonym will be used to give a fictitious name to protect the identities of those involved, this is acknowledgement with the nursing and midwifery council (NMC, 2018). The Human Rights Act (1998) also states to respect people’s rights to privacy and personal information. In this case study the patient will be identified as Elsie.
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This is a case presentation of a 76-year-old lady Elsie, who visited day case surgery for an elective procedure to have a corticosteroid injection in to her joints due to an ongoing back problem. She is a widow who lives alone. She was a factory worker and has been retired for the last 12 years. She has a medical history of C.O.P.D. and arthritis. COPD foundation (N.D) details Chronic Obstructive Pulmonary Disease (COPD) is used to describe progressive lung diseases which are recognised by accumulative breathlessness. Arthritis foundation (N.D) describes arthritis as an informal way of referring to joint pain or joint disease. She is independent with abilities to do activities in her daily life but is occasionally limited by her long-term condition arthritis and is currently cared for by the pain management clinic for the last few months.
To begin Elsie’s care experience on a surgical ward she was introduced to the author, the author was supervised by a trained nurse. On admission the author went over Elsie’s medical paperwork which consisted of her personal details, this was done by carrying confirmation of consent, identity checks and medical history before her surgery. The author also took Elsie’s clinical observation pre and post operatively.
Saunders (2016) expresses in the health care setting, that confidentiality means restricting the circulation of patient’s information with the agreement to protect information shared between a patient and a provider, unless explicit permission is given to share that information. General medical council (GMC) (2018) for doctors state it is a crucial part in confidentiality to preserve trust and it is also a matter of legal and ethical safeguards. In support of this Winters (2013) states the duty to safeguard patients confidentiality and information is a statutory and ethical feature all healthcare professionals should have. In the circumstance of Elsie’s care the author had to use critical decision making and have a understanding how actions can have an negative and positive effect on Elsie’s physical and mental welfare. With this in mind it is advised by the NMC (2018) to draw special care to encouraging well-being, and averting ill health. It is important for author to have an understanding of these principles and be able to apply them in to practice.
Buka (2015) writes ethics is based on classifying what is deemed in human behaviour as righteous and unrighteous. Adjoining on to Buka (2015) an interpretation from Griffith and Tengnah (2017) suggest ethics as the study of what is acceptable and unacceptable in human nature in regards to the way they conduct themselves. Deontology theories of ethics insist that the means must justify the end (Barrow and Khandhar, 2019). It states that some rights must not be violated even if it may produce the greatest overall good. Utilitarianism, on the other hand is an ethical theory of moral principles which states that the moral act is one, which produces the greatest amount of benefits over harms for everyone involved (Gallagher and Hodge, 2012).Historically the approach that utilitarian emphasis is the premise of doing things based on the greater good for the greater mass of people (Edwards, 1996).In other words it means to overall diminish suffering and upsurge happiness for the greatest number of people, an example of utilitarian reasoning in the case of Elsie, would consist of letting Elsie suffer to benefit 5 patients, so if having to choose minimizing the loss of life would be considered .
The standard theoretical framework which is used to analyse ethical situations in nursing practice is the biomedical principles of ethics by Beauchamp and Childress (2013). Almost all episodes of care encompasses of the four ethical principles: autonomy, non-maleficence, beneficence and justice.
The concept of autonomy is widely understood to mean, the patient having the rights to self-govern with the ability to constitute this in relation to their own best interests (Entwistle et al., 2010).The word autonomy symbolises having the freedom of choice regarding situations about one’s life (Stacey et al., 2017).Throughout the care episode the author encouraged Elsie to participate in her own decision making and promoted Elsie’s rights to independence. The NMC (2018) have encouraged respect to be given to those who are in receipt of care, enabling them to have input into decisions about their own health and wellbeing. Autonomy was applied in relation to respecting Elsie privacy to disclose sensitive information shared to the medical staff, this decision was ultimately respected and also included the right to choose who should have access to her private information. Rebecca (2009) states promoting autonomy and independence underpin many tactics to cultivating the quality of nursing care for patients in the healthcare setting. As Rebecca (2009) raises the importance of promoting independence she neglects to realize healthcare professionals such as nurses may often fail to identify indirect violations of patient’s autonomy. Burkhardt (2014) hypotheses nurses misleadingly have a perception that patients hold the same goals and principles as their own personal ones. This way of thinking may compel them to deliver care consistent with their own values and goals. Supplementing this in professional guidance the NMC (2018) advises nurses to avoid making assumptions and identify diversity and personal preferences.
Beneficence and non-maleficence can sometimes be viewed together however, the difference between them is that beneficence for a healthcare professional is to actively act in way that benefits patients (Gillion, 2015).Beauchamp & Childress (2013) state the principle of beneficence also upholds that we must prevent evil and maltreatment. Whereas the principle of non-maleficence is to do no harm such harm whilst doing beneficial acts (Burkhardt, 2014). Beneficence is seen to involve a protection of duty in a way that benefits the patient (Hendrick, 2011). Coyne and Gallagher (2011) identifies that issues can arise within healthcare situations involving patients, particularly regarding principles of beneficence and autonomy. In the authors view nurses must follow their respected professional codes as well as bearing in mind what is most beneficial for the patient, whilst respecting the wishes of the family members which might not be steering towards the same decision as the healthcare professional. NMC (2018) state to balance care treatment which is tailored around the person’s rights and wishes to accept or refuse care, nurses must always make sure they promote the most advisable treatment which would benefit the patient. Following this guidance would entail sharing Elsie’s personal data with healthcare professionals this is only acceptable if Elsie’s safety was compromised, as breaching her confidentiality would be overruled to prevent her from harm that could be inflicted (GMC,2018).
Non maleficence as already stated is said to be not to harm, this obliges nurses from imposing a risk of harm to others (Beauchamp and Childress, 2013). In regards to harm the NMC (2018) highlight to respond immediately if someone in care has suffered potential or actual harm. The guidance the author took in to consideration from the Royal College of Nursing (RCN) (2016) in relation to sharing Elsie’s information to other healthcare professionals around the bay was to be mindful of not been overheard. Protecting Elsie’s confidentiality consisted of using effective communication methods which were used by not deliberately sharing Elsie’s details to a person of no concern. Purposely shouting Elsie’s information out loud would put her at risk and breach her privacy. Jonsen (2003) in his earliest works listed medical non-maleficence into four categories: firstly dedicate themselves to well-being (not harm) of patients, secondly provide adequate care, thirdly properly assess the situation, that is the risk/benefit analysis; and fourthly make proper detriment benefit assessments.
Justice is related to fair treatment and care that is equitable to meet everyone’s needs and care that will promote equality (Crawshaw et al, 2012).The principle of justice could also be described by Alperovitch et al. (2009) as a moral obligation that is linked to fairness, entitlement and equality. Elsie’s was treated fairly and was not discriminated in any way in line with her treatment, at times she had more assistance then others in her care provision to make her care more equitable to meet her needs. With regards to equality in a healthcare environment some healthcare professionals show acts of favoritism to certain individuals over others. According to Cropanzano and Stein (2009) behaviours expressing stigmatisation and acting in a discriminative and prejudice nature can be seen to categorize people into groups which makes individuals feel devalued on certain characteristics. The NMC (2018) have advised nurses to act with the utmost honesty and integrity, and to also treat patients without discrimination in anyway.
Aston, McGown and Wakefield (2010) articulate a professional such as nurses has undertaken intensive theory and practical based training in the field which they practice, this enables them as professionals to make legal and ethical decisions regarding issues in nursing care. The NMC (2018) code was constructed around the laws set in the UK, it consists of ethical, professional and legal principles. The NMC (2018) code of practice must be adhered to by all nurses. The Code of the NMC (2018) states as a professional in their role, nurses must treat every patient who is under their care to be treated with integrity and also comply to the laws set in the country in which they practice. There are different healthcare professional within the healthcare settings such as psychologists and psychiatrists, they all have different governing bodies that they follow. In professional standards relating to confidentiality the NMC (2018) state that nurses have a duty of care by professional practice, to protect patient confidentiality in any care intervention which encompasses having a duty to inform patients of how information regarding them is shared appropriately. Elsie’s right to privacy was respected in all aspects of her care. The author made sure that Elsie’s was informed about how and why her information was used and shared in relation to her procedure this was done by following professional guidelines of the NMC (2018). Information was shared in a professional manner between the author and multidisciplinary team regarding all aspect of Elsie care. NMC (2018) had advised nurses to share information with patients and their next of kin or those who are legally bound to know.
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Griffith and Tengnah (2017)narrowed down and selected certain areas of the law which are vitally important for nurses to understand, they consist of a individuals human rights, equality, safeguarding, accountability, confidentiality and record keeping. Types of legislative process In the UK there are essentially three ways in which new laws come into being: through Acts of Parliament (statute), by secondary legislation and by common law (case law). There are acts which are brought to bear on the work of a nurse, these being the Mental Capacity Act (MCA) 2005 and the Human Rights Act 1998.
The MCA (2005) is the ruling which helps us understand the legal concept of capacity. The principle of consent is an important part of ethics law and professional requirement, it consist of informing Elsie regarding her rights and providing an explanation of the care intervention and potential risks and benefits (Nijhawan et al., 2013). For Elsie to be able to consent to any treatment she must be deemed to have capacity. The part of law that deals with capacity to consent is the MCA (2005). In the care episode consent was established before any care intervention was taken between the author and multidisciplinary team in relation to Elsie care. The GMC (2018) have various procedures on informing the patient before gaining consent, stating if sufficient information is not relayed over to a patient to make a informed decision regarding their treatment then the premises of consent is not valid.
Article 8 of The Human Rights Act (1998), enforces an individual’s right to privacy in regards to their daily life, family life and correspondence. This also relates to the sharing of Elsie’s personal information, this right means that professionals and local authorities must respect Elsie’s privacy unless it is on legal grounds, this is relative to public interest and public safety. (Lynch, 2016). Elsie’s disclosure to privacy can be overridden if its not seen to be in the public’s best interests.
In handling Elsie’s medical records duty of care was to ensure her medical records were not easy accessible to the general public or in a attainable place. It is was also important that all her records were kept confidential.The NMC (2018) require nurses to withhold responsibilities when handling patients data and storing medical records of patients securely, this also reflects the rights of the individual under the General Data Protection Regulation (GDPR, 2018). GDPR (2018) requires everyone to be responsible when using personal data, whilst making sure all information is used lawful and transparent.
When corresponding with the multidisciplinary team it is vitally important that the outcomes is to provide effective and safe care (van Veen-Berkx et al.,2015).During Elsie care experience there were various healthcare professionals involved ranging from student nurses, trained nurses, health carers and consultants.It is of vital importance that healthcare professionals work together collectively adopting practices of great understanding and effective communication (Burzotta and Hoble, 2011). Webb (2011) in a similar fashion state that healthcare professionals are encouraged to work together whilst cooperating and sharing various skills, healthcare professionals should also respect each other and be able to voice their own opinions. Care experiences which do not flow properly due to miscommunication will not meet holistic needs of the patient ,this is why team working should be the ultimate goal (Thurston, 2013). Burzotta and Hoble (2011) determine all inter professional team members all collectively contribute to vital information sharing which fundamentally make a strong team.The NMC Code (2018) encourages nurses to embrace skills which other healthcare professional bring, confirming and reassuring practices to ensure care is given in confidence .
In conclusion a healthcare professional must abide to professional ,legal and ethical guidelines, it is very important that nurses are educated in such areas as decision made may have a vast impact on patients, whether that be a professional or a personal decision (Gallagher and Hodge,2012).Regarding Elsie’s care it is essential that legal, ethical and professional practices conjoined to deliver a quality of care that is satisfactory. The GMC (2018) prides itself on the value of excellent and high quality care. The NMC (2015) also embed the same values of delivering a high standard of care which beneficially puts the patient at the centre of their care, by considering their best interest these professional aspects drive the decision making in all care episodes.
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