The official rules and procedures in an organisation will vary depending on several factors: the nature of the business, the personality and purpose of its stakeholders, the goals of the organisation and the external environment it is situated in. Protocols are important for the fulfilment of the organisational goals, easier communication, for compliance purposes, to facilitate business process, to keep workers and clients safe and to project positive image to customers (Houston Chronicle, n.d.).
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For KRCRH our protocols are dedicated to respond to the elderly and his needs in a way that is safe and appropriate for him. There are protocols that are applied to the whole organisation and there are protocols that are confined to our departments. These are the following areas where protocols are applied:
- Finance department- financial management, information technology, purchasing
- Frontline staff – admission, complaints
- Maintenance- safety risk hazard management, equipment and building safety management, transport
- Security- resident safety and security, employee general safety management
- Human resource department- employee general safety management, privacy and confidentiality, complaints resolution, admission, research and best practice, recruitment, training and development, employee responsibility, diversity, performance management, counselling and discipline, volunteer workers, social media, employee grievance, transfer and separation
- Care Staff-privacy and confidentiality, complaints resolution, research and best practice, admission, resident care management, freedom of choice, consent, transfer and separation, management of resident funds, clinical documentation and accountability, medication management, resident safety and security, sexual health and sexuality, restraints, management of behaviours of concern, falls management,resident accident and incident, palliation, actions on death, coroners cases, complementary and alternative medicine therapies, resident weight management, alcohol and drugs, safety risk and hazard management, equipment and building safety management, infection control, gastroenteritis management(Frontline Care Solutions, 2012).
Some KRCRH protocols are also instituted to comply with regulatory standards. The MOH has issued certain requirements for the staffing of a residential care facility. This includes the qualification of a facility manager. He should be a general practitioner or a nurse and holds a qualification or experience related to management and health. An eight hour continuing development activity on rest home management is also required. It is the manager’s duty to make sure that the clients’ needs are sufficiently provided and that the services given comply with existing laws.
The nurses on duty should also be duly registered with the following responsibilities: 1. assess residents on admission, during changes in health or dependency status or after six months; 2. develop care plans within the day of client’s admission; 3. give advice on care and medication of client; 4. provide and supervise care; 5. monitor the competence of other staff; 6. recommend staff training; 7. help in the development of policies and procedures; and 8. document the work hours of the care staff. The care givers are required to have an experience in aged care or have received training within six months of hiring.
Being a hospital and residential facility, KRCRH also observes the following regulations with regards to their staffing. For KRCRH’s hospital area with 40 beds, there is at least eight duty nurses employed on a full time basis with one duty nurse in the hospital every shift. Since KRCRH has 100 residents, a total of 1000 working hours per week is allotted by care staff for the whole facility. Three carers are always on duty all the time.
An orientation that familiarises the staff with the organisational profile, facility map, their job, company policies and protocols are provided. An eight- hour in service training is also conducted annually for the staff (Ministry of Health , 2004).
Aside from the staffing requirement, KRCRH also documents the following quality indicators as one of the bases of their performance. Such quality indicators include:1.incidence of pressure ulcers; 2.incidence of falls; 3.medication use; 4.usage of physical restraint; 5.unplanned weight losses (Victorian Government Department of Human Services, 2007).
Managers and health practitioners often face moral dilemmas in their work. There are several approaches that can be applied to make the appropriate decisions in the facility. Some of these approaches are the following:
Virtue ethics is an approach where one’s character and virtue will determine the course of action of the person when given a moral dilemma. The proponent of this theory was Aristotle. It starts with the proposition that men seek “eudaimonia,” or the highest human good. This can be achieved by a virtuous life. A virtuous life cannot be achieved instantly. It is achieved by continuously engaging in virtuous acts. In health care, a virtuous health provider can be developed through education and years of health practice. Only after acquiring the practical wisdom can the practitioner be able to make the appropriate decisions when faced with a moral dilemma.
This approach places a premium on experience and training to be able to be a good decision maker. This is the underlying principle for hiring experienced managers in KRCRH. The clinical manager and the unit managers have years of experience working in the hospital and has been undergoing continuing education since they practiced their profession. Their education and experiences and trained clinical eye make them the best person for the job. KRCRH believes that an experienced manager will make decisions that would benefit our residents and the organisation as a whole.
Principlism is an ethical approach that is based on the following pillars, autonomy, beneficence, non- maleficence, and justice.
Autonomy denotes a person’s ability to make his own decisions and manage himself. Carers are providing autonomy to the residents by obtaining an informed consent, giving information to the clients with regards to his health, cares and treatment, allowing client to make his choices and accepting the client’s refusal for any tasks or treatment given to them.
Beneficence includes all actions done by the care provider that will benefit the client. This will include assistance in morning and evening care, making sure that the resident eats nutritiously and regularly, assisting in the activities for daily living, providing recreational activities for the elderly.
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Non-maleficence. this means that carers shall avoid actions that will harm the client. This is practiced when carers do not. The facility’s policies on safety and risk management, infection control are samples of non- maleficence in care.
Justice is the equitable distribution of resources. In KRCRH, every client is special. Everyone is given the preferred treatment. Our meals are planned by the dietitian and prepared by our experienced chef. Cares are given to all residents in a way that is responsive to his needs.
Ideally there is no principle that should supersede the other but sometimes these principles conflict against each other. The important task is for the managers, carers and nurses to strike a balance when using these principles in decision making (Rich and Butts, n.d.).
Deontology is derived from the Greek word “deon,” which means duty. The main proponent of this thought is Immanuel Kant. This is a moral decision that is based on duty or law(Morrison,E.E., & Monagle,J.F., 2009). In KRCRH, there are manuals for every rules and guidelines in every department of the organisation. This is provided so that managers and practitioners are familiar with the business process and to reduce the uncertainty of the supervisors and managers in executing decisions within the facility. Furthermore, when care staff faces a moral dilemma they can always consult their superiors and managers to make the appropriate decision. However, in cases where the manager experiences the dilemma, there are other deontological bases for their decisions such as the Nurses Code of Ethics, Code of Ethics for the Medical Association and religious laws.
Consequentialism is a teleological approach which is derived from the Greek word “telos,” meaning end (Morrison,E.E., & Monagle,J.F., 2009). This is a moral decision based on the outcome of the problem. In the absence of compliance standards, most geriatric facilities form their rules and procedures after determining its effect on the greatest good achieved for the organisation. This is done by considering all the individuals that would be affected by the decision and its impact on them.
For managers in KRCRH the consequentialist approach poses a challenge because it requires a deep understanding of the effects their decisions would make. This is time consuming and difficult to measure. There are also instances when making an ethical decision can violate existing rules. Other decisions may also violate the rights of the individual. In this situation a virtuous manager, one with the skill and experience is required to make the appropriate decision.
Frontline Care Solutions. (2012). Policies and Clinical Procedures for Aged Care Facilities and Community Home Care Organisations. RetrievedNovember24, 2014, from http://www.frontlinecaresolutions.com/policies-and-procedures
Victorian Government Department of Human Services (2007). Resource Manual for Quality Indicators in Public Sector Residential Aged Care Services. Retrieved from http://www.health.vic.gov.au/agedcare/downloads/psracs_resource_manual.pdf
Ministry of Health New Zealand (2004). Staffing Regulations for Aged Care Facilities: Consultation Document. Retrieved from http://www.moh.govt.nz/notebook/nbbooks.nsf/0/b9019d55a6d7079ecc257702007ee13c/$FILE/staffingregulations.pdf
Rich,K., & Butts,J. (n.d.). Foundations of Ethical Nursing Practice. RetrievedNovember24, 2014, from http://samples.jbpub.com/9781449691509/81982_CH04_Pass1.pdf
Houston Chronicle. (n.d.). The Importance of Obeying the Rules and Regulations in the Workplace | Chron.com. RetrievedNovember26, 2014, from http://smallbusiness.chron.com/importance-obeying-rules-regulations-workplace-18690.html
Morrison,E.E., & Monagle,J.F. (2009). Health care ethics: Critical issues for the 21st century (2nded.). Sudbury, MA: Jones and Bartlett Publishers.
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