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Nowadays a person has a more legal status than they previously had, in the health and social care. A registered practitioner such as a nurse is accountable to the public, patients, their employers and the profession and it is fundamental that as a future nurse, I have a clear understanding of the legal, ethical and professional dilemmas I will be facing in the course of my professional career. Professional and legal regulations such as: duty of care, confidentiality, trust, consent, privacy and dignity, accountability and responsibility. Health care professionals are governed by their specific regulating bodies, such as NMC and GMC which provide guidelines and set standards on ways to practice. The NMC code set the standards to which Nurses and Midwives must adhere to, to be able to provide a high standard of care at all times. The key purpose of the NMC Council is to set up occasionally standards of education, training, conduct and performance for nurses and midwives and to ensure the preservation of those standards. The main purpose of the council is to put into actions, its standards and those are to protect the health and welfare of the people using or needing the services of registrants. NMC and other health professional registration bodies safeguard the general public against registered practitioners who are unfit to practise. Many laws, regulations and guidelines are in place to support nurses` actions, the ways people are treated and care is delivered. Nurses and other healthcare professionals must keep up to date with their clinical skills and practice within a legal framework and to a particular standard set in the NMC Code. I am reflecting and exploring a particular scenario I came across in clinical practice to enhance my knowledge of the legal and professional obligation, nurses must fulfil while caring for people. The situation I encountered involves the interaction between the nurse, myself and a patient, who refused to take his prescribed medication. To maintain confidentiality I will be referring the patient, as Mr M. Throughout this essay I will be mainly exploring the Mental Health Act 2007 in regards to Mental Capacity, consent and acting in the best interest of a patient. Throughout this essay I will be demonstrating my understanding of the legal and professional aspect of the nursing profession that relates to this situation. I will demonstrate how a registered nurse is legally and professionally accountable for his/her actions and has a duty of care to the people he/she looks after. In case of negligence in relation to the administration of medicines, the fitness to practise in the NMC Code is in place to provide guidance.
Mr M is an 85 year old gentleman, admitted to vascular unit to treat an ischaemic foot caused by diabetes. I am a first year student nurse and have recently completed a 6 weeks placement on a surgical ward specialising in vascular surgery. One morning while undertaking the drug round, under the supervision of a registered nurse, myself and the nurse went to greet Mr M who was staying in a single room near the nurse`s station. We approached Mr M, after dispensing his prescribed morning dose of medicines in an appropriate container. We carried out all the usual safety checks to ensure we administer the drug to the right individual, the correct drugs, prescribed dosage and acknowledging the allergy status etc, before gaining consent from Mr M to take his medication. Mr M then refused to take his drugs, he expressed himself with few words in English and the rest in his own language, stating he does not know the reason we are giving him the amount of medication that we were and he doesn't need or want them. Luckily I was able to communicate with him using his preferred language. Mr M was not able to speak English and could not understand very much English. The nurse was not able to communicate with Mr M due to the language barrier and I was asked to translate the sentences in the patients` language. According to the NMC Code a nurse must make arrangements to accommodate an individuals` language and communication needs. In this case I was able to communicate with Mr M without any issue but if I come across a situation where I am not able to do so, I would request for an interpreter`s assistance to fulfil the communication needs.
To be able to establish the causes of Mr M refusal to take his drugs, I started by asking Mr M, what were the reasons he was refusing his medication. I gathered the information from his drug chart, that he has not previously refused any medication. He insisted he did not need all the drugs we were giving him and he will not be taking them as they are not making him feel any better. Mr M also expressed anger towards his relatives, stating that they were late this morning in bringing him, his homemade breakfast and that his relatives should be more responsible as they are aware he suffers from diabetes. After listening to Mr M, I came to a conclusion that there were many underlying issues in regards to his refusal to take his medication. He was generally not happy that morning however I tried to explain to him the importance of his medication and the effects of not taking them. I informed Mr M of the risks to his health, of not taking his diabetes, antibiotics and Parkinson medication. I carried on translating the information given to me by the nurse to try and convince Mr M to take his medicine. After some persuasion Mr M decided the medicines he believed he needs more and did not take the rest of medicines. He was able to make a decision while I respected his rights to do so.
For a person capable of making a decision, must understand the information being given to them and must retain the relevant treatment information provided. Mr M was prescribed some analgesics, which he has been taking previously but that morning he refused to take them stating he was not in pain. Myself and the nurse decided to discard the painkillers as Mr M completely refuse to take them and he understood what they were for. I understood the fact that he was been given so many medication in the morning, infuriated him even more and due to the reason he was already upset, he needed some reassurance in regards to taking his pills. Mr M understood and retained the information I gave him and made a decision, as a student nurse and a future registered practitioner I must respect a patient`s autonomy to make a decision, even if it seems unwise decision( Dimond 2008).
Dimond states that an individual has mental capacity until unless deemed incapacitated. Mr M was mentally competent as he was able to weigh and retain the information given to him to make a decision, even if the decision is not sensible. An individual has a right to refuse any treatment but it must be clear that he/she has mental capacity. If consent is withdrawn after a treatment has started then the person must be left in an acceptable state. A person who is mentally competent has the right to consent. To be valid, the consent must be given voluntarily by a mentally competent individual. Consent must be obtained prior to any procedure, treatment or to any touching of his person (Dimond 2008). In this situation Mr M refused clearly that he will not take any medication that he has been prescribed. He made that decision without having the information he needed to allow him to make a decision. After providing him with the relevant information he made a choice of whether to accept or decline what we were offering him. Mr M needed to know about the benefits of taking his medication and the results of not taking them. In this case mental capacity was not an issue and the patient had been given the relevant information, was offered the available options and therefore changed his mind and accepted the care. If a patient chose to refuse treatment, after been given necessary information decides to refuse the intervention, then that decision would have to be respected by the nurses, doctors and other health professionals involved in his/her care.
The basic and vital principles of the Mental Health Act 2007 are that as health care practitioners, we must respect patients` choices, past and present wishes and feelings. We must ensure to acknowledge the contribution patients bring to their care and that they are involved in the planning, development of their care, while maintaining their health and safety and wellbeing. The Mental Health Act sets out that a person has mental capacity unless it is established they he is mentally incapacitated.
Before administering Mr M`s medication, I asked him for consent, as a student nurse and future registered nurse, I have a professional obligation to gain consent before the start of any treatment or care intervention. I must respect and support patient`s rights to accept or refuse. I must uphold people`s right to be fully informed and act as an advocate. I should acquire sufficient knowledge in regards to the legislation regarding mental capacity. I must be able to demonstrate I acted in a person`s best interests when providing care in an emergency situation (NMC Code 2008).
Professional and legal accountability
4 arenas of accountability to patient
Accountability is a key concern for nurses and midwives in the NHS today. Professional accountability - being responsible for your actions and for the outcomes of these actions - is part of the framework of clinical governance, which aims to provide good quality, cost-effective, evidence-based care. The second edition of Accountability in Nursing and Midwifery addresses current issues and key concerns in accountability, focusing on accountability in the four main branches of nursing (adult, child, learning disabilities and mental health), as well as in midwifery, community nursing, and nursing management. In an increasingly litigious society, the ethical and legal implications of accountability are growing and it is important that nurses understand the implications for everyday practice.
The patient has been placed at the centre in the government policy in the relation to the NHS. This can be seen accountability is one particular type of accountability but nurses need to be aware of the ways in which they may be accountable to the law and the ways in which their work may open up their employers to legal proceedings through their vicarious liability. The purpose of the law is not just to punish but a things go wrong. Nurses are accountable in a great many ways and many penalties can be imposed outside the law. However, the harshest penalties rest with the law and it is the wise nurse or midwife who has, at least, a working knowledge of their legal liability.The problem of multiple accountability is raised by Tingle and the example of poor staffing levels is used to illustrate this: nurses are accountable to their employer but also to the Nursing and Midwifery Council for the standards of care they deliver. In the case where something goes wrong then the law has a hard job to decide an outcome. As Tingle argues, the law cannot be seen to sanction poor standards of care but must also offer reasonable protection to those working under difficult circumstances.
A policy perspective Tracey Heath provides an overview of the policies relevant to accountabilityand clinical governance. An important shift has been made from implicit to explicit accountability and this is now visible in what Health describes as the 'bold type' of Government policy. In many ways, it is remarkable to look back at landmarks in NHS management, such as the Griffiths Report in the early 1980s, which saw the introduction of general management in the NHS, and the reforms of the late 1980s which introduced the purchaser-provider split into the NHS in an effort to increase efficiency and patient care. Those days seem long gone but the web of legislation around the NHS remains. According to Heath, who takes a generally positive view of clinical governance, the reforms of the post-1997 Labour Government were building on previous Conservative legislation. However, the purchaser-provider concept and market forces have been replaced by a range of new bodies each purporting to oversee accountability in so to provide deterrence and to provide
As registered nurses, we are aware that we msut behave in a
'professional' way. We know that we must achieve certain standards
of behaviour and that our conduct as registered nurses is constrained
by regulation. The Nursing and Midwifery Council (NMC) have
the statutory power to decide how we must act and how we must
not. Certain types of behaviour can and will attract sanctions from
the NMC professional committees. Registered nurses are removed
from the register in ever-increasing numbers, and one of the reasons
given by the professional committees for a removal from the register,
is that there was failure to act to protect patients by providing
a safe environment. Examples of negligent behaviour include
misadministration of drugs, a failure to properly manage dietary
needs or failures to protect the integrity of the person from pressure
sores and damage to the skin.
Key words: Codes of conduct n Nursing nmc
By reflecting on your practice and determining the limits or boundaries of
practice, and ensuring that you are properly insured, you are recognizing
that your patients are entitled to the safety of knowing that your practice is
adequately insured, so that they can be adequately compensated in the event of
harm. Professional indemnity insurance is a must, for all people concerned with
Most nurses are employed, but to the growing minority
who are not, it is vital that the following is made clear: where
you practice as a nurse, you owe a duty of care through the
common law principle, and the premise of the Code, you
are accountable for your practice. This principle includes
ensuring that where care or treatments go wrong and harm is
caused to patients, you can adequately compensate them for
the harm, should compensation be deemed payable. To act in
such a way as to cause a harm (no matter how unintentional)
but then be unable to compensate the person harmed, is a
double insult - your patient is harmed twice; the Code is
very clear (9.2-9.3):
'It is the individual registrant's responsibility
to establish their insurance status and take
appropriate action...In situations where employers
do not accept vicarious liability, the NMC
recommends that registrants obtain adequate
professional indemnity insurance…
The outcome was fairly positive as he agreed to consume most of the dispensed medication after a lot of encouragement.
The nursing profession evolves round caring for vulnerable people. A vulnerable adult is an individual aged 18 or over, who are unable to take care of themselves or from being exploited. This may be due to their circumstances such as chronic illness, disability, age, mental health issues or the environment they are in, causes them to be at risk in some situations. Nurses, Doctors and many other members of the multi disciplinary team work together to serve and protect the society