Practice in the Workplace

Practice in the Workplace

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The assessment is centred on the case study which involves aspects of medical negligence and violation of duty of care towards a patient. The case study involves a patient in the emergency department who was being administered Morphine via intravenous infusion post his operative procedure. Owing to his pain medication, the patient had been vomiting intermittently throughout the previous shift and it was now evening. On witnessing this scenario, Pamela (a newly graduated registered nurse) requested a senior nurse, Jane also working in the healthcare setting to review the patient’s analgesia. Listening to this, Jane asked Pamela to cease Morphine and administer Metaclopramide instead. Pamela pointed out that there was no written order to do the same and refused to administer this medication without prior written order. Jane then proceeded on to administer the medication herself and her actions resulted in severe medical consequences for the patient.

In context of this case study, the assessment first seeks to discuss legal aspects such as duty of care towards the patient and negligence. Ethical considerations in accordance with ANMC codes of practice and responsibilities of the nurse-client and nurse-nurse relationship have also been highlighted in the case study discussion.

A duty of care has been imposed on all nursing professionals and healthcare providers in Australia by law in all circumstances where this duty might be reasonably foreseeable. Duty of care of nursing professionals suggests that nurses have a legal responsibility to care for their patients and they must avoid all actions and decisions which might harm their patients. Duty of care of nursing professionals is not limited to situations where harm is caused as a result of their actions but extends to situations where harm is the result of not taking appropriate actions to benefit the patients in time (Young 2009). Furthermore, responsibility has been equated to duty of care in law. In other words, the legal implication of duty of care is applicable at all times ranging from tasks involving bathing the patient to a complex surgical procedure. This can be attributed to the fact that the possibility of causing harm intentionally or unintentionally exists in every situation. In this context, each nursing professional owes a legal liability to the patient by accepting to care for the patient. Legal implications of duty of care also suggest that in case a nursing professional fails to fulfil his or her duty of care towards a patient, nursing actions might be punishable by law depending on the severity of nursing actions and consequences for the patient. Individuals at the receiving end of these nursing actions also have a legal right to contest such nursing actions in a court of law (Weaver 2011).

In context of this case study, it is evident that the duty of care has been violated by Jane. Her decision of not seeking a written order for administration of Metaclopramide resulted in the patient suffering from an allergic reaction which had to be treated with the help of an immediate medical intervention. Jane also did not take enough care to examine the patient’s past medical history or listen to Pamela when she indicated that there is no written order. Jane’s actions are in severe violation of duty of care of nursing professionals and can be contested in a court of law.

Malpractice and negligence are interchangeably used in Australian litigation with the only difference being that malpractice is a specific kind and restricted form of negligence (Turton 2009). Negligence in nursing literature has been defined as a specific action or non action which results in breach of standards of care and causes damages or results in malpractice. Australian legislation however requires that the aspect of negligence needs to be properly established before a case can be filed in a court of law. In this context, four key elements of negligence have been defined by the legislation. These elements comprise of duty, breach of duty, causation and damages or injury. It has been suggested that all four elements of negligence need to be present in an incidence before it is recognised in a court of law (Walker 2011).

All four elements of negligence can be recognised in the provided case study. The aspect of duty can be realised as Jane had agreed to oversee revision of analgesia of the patient. Aspect of breach of duty can be realised as Jane failed to comply with standards of nursing care, procedures and policies as prescribed by the ANMC when she decided to proceed with administering Metaclopramide without seeking a written order. Aspect of causation can be realised by the fact that Jane’s decision led her to administer Metaclopramide without a written order. Lastly, the aspect of damages can be realised by the fact that Jane’s actions led to a severe allergic reaction which had to be controlled by an immediate medical intervention. Thus, this case can be contested in a court of law.

Scope of practice of a nursing professional has been defined as the concerned nurse’s ability to undertake medical decisions based on her/his knowledge, skills, education, competence and lawful authority. In this case, Jane was an experienced registered nurse. Her knowledge skills, competence and the lawful authority in Australia made her eligible to administer intravenous medication. However, such medication could only be provided after a written order in this context has been issued by the treating physician. Jane in accordance with scope of her practice did not have the authority to decide on the patient’s medication and proceed on to administer the same without consultation (Pulcini et al 2010).

Code of conduct for nursing practice in Australia suggests that nursing professionals practice in a competent and safe manner. In other words, nurses are personally accountable for provision of safe nursing care. Further, it has also been suggested that all nursing professionals need to understand that undertaking actions which do not fall within their scope of practice might harm the patient. Code of conduct also suggests that all nursing professionals are required to practice and conduct themselves in accordance with laws which are relevant to their profession. Both these codes of conduct have been violated in this case scenario. Jane can be held accountable for the fact that she needed to deliver safe nursing care to the patient and should not have taken a decision which had the potential to harm the patient. Another code of conduct which might be considered violated in this case study involves an element of trust. Code of conduct for nursing professionals in Australia suggests that nurses act in a manner so as to build and enhance the community’s trust in the profession. Jane’s actions can certainly be considered in direct violation of this code of conduct (ANMC 2009).

Further, codes of ethics for nursing professionals as provided by ANMC suggest that all nursing professionals are required to fulfil the responsibility and accountability of their inherent roles. It has been suggested that nurses are morally autonomous professionals and thus are completely accountable for their decision making in a clinical setting. Further, codes of ethics as provided by ANMC are suggestive of the fact that nursing professionals need to make a positive contribution to the healthcare setting by collaborating with each other and respecting everyone’s opinion in the healthcare setting. These codes of ethics have also been violated in this case study. As an autonomous professional, Jane should have been completely aware of the consequences that her decision might have on her patient. Thus, it can be argued that she did not fulfil the aspects of responsibility and accountability inherent in her role. Also, she did not respect Pamela’s opinion when she indicated the absence of a written order and proceeded on to administer the medication. In this context, it can be argues that Jane’s actions were not ethical in nature (ANMC 2009).

Further expanding on the ethical aspect of this case study, it can be concluded that the ethical principles of beneficence and non-malfeasance have been violated. The ethical principle of beneficence states that all healthcare professionals should seek to benefit their patients and the community by their decisions and nursing actions. In this context, nursing professionals should clearly evaluate their potential benefits for the patient. This ethical principle has been violated as Jane failed to speculate and evaluate the fact that her decision might lead to serious consequences for the patient. She also did not speculate that her decision to administer the medication had the potential to harm her patient (Harrowing et al 2010).

The ethical principle of non-malfeasance is closely related to the principle of beneficence and suggests that all nursing actions which have a potential to harm the patient should not be undertaken. This principle suggests that health and safety of patients is paramount and no nursing action should be undertaken to compromise care. Bearing similarity with the principle of beneficence, this ethical principle has also been violated in this case study. Jane’s decision to administer Metaclopramide without a prior written order or consultation of the patient’s prior medical history harmed the patient and resulted in a severe allergic reaction. This decision and following action was undertaken despite its potential to cause harm (Goethals et al 2010).

Proceeding with discussion on this case study, several nurse-client and nurse-nurse relationship responsibilities have been suggested in literature. In context of nurse-client relationships, it has been suggested that the relationship needs to be therapeutic in nature. Additionally, it has also been suggested that the needs of the client need to be placed first and nursing professionals are responsible for maintaining components of trust, respect, professional intimacy, empathy and power. Further, nursing professionals are responsible for ensuring that they maintain a professional relationship with the client and seek to provide a holistic care to their patients (Fronek et al 2009).

Analysing this aspect in context of the present case study, it can be argued that Jane was unable to fulfil her responsibility in the relationship. Her actions would certainly serve to breakdown the trust the patient would have had in his healthcare professionals. It can also be argued that Jane misused her power over the care provision system and performed procedures she was not supposed to.

Also according to nursing literature, nurse-nurse relationships are based on mutual understanding and respect for each other and for the profession. Primary responsibility of this relationship consists of respecting each other’s opinion and honouring each other’s expertise in the healthcare setting. Furthermore, responsibilities of this relationship include reminding each other of their moral and ethical responsibilities and not letting mistakes happen. Discussing this aspect in context of this case, it can be argued that these responsibilities have not been fulfilled. Jane did not honour Pamela’s opinion and her expertise when she tried to suggest that a written order is missing. Pamela also was not assertive of her opinion. She merely stated that she is not willing to administer Metaclopramide without a prior written order but did not stop Jane from doing the same (Hughes & Fitzpatrick 2010).

In conclusion, analysis of this case study is suggestive of several violations with regard to ANMC codes of ethics, professional code of conduct, ethical principles of practice and responsibilities of relationships which exist between a nurse and her client as well as between two nursing professionals. Legal aspects of the incident can also be drawn as all key elements of medical negligence can be identified in the case study. Lastly, it can also be said that duty of care of nursing professionals has been violated by Jane in the case study and this incident would serve to decrease the amount of trust patients and the community has on nursing professionals.

References

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Harrowing, J. N., Mill, J., Spiers, J., Kulig, J., & Kipp, W, 2010, ‘Culture, context and community: ethical considerations for global nursing research’, International nursing review, vol 57, no 1, pp 70-77, viewed 05 September 2013, via PubMed< http://www.ncbi.nlm.nih.gov/pubmed/20487477>

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Pulcini, J., Jelic, M., Gul, R., & Loke, A. Y, 2010, ‘An international survey on advanced practice nursing education, practice, and regulation’, Journal of Nursing Scholarship, vol 42, no 1, pp 31-39, viewed 05 September 2013, via PubMed < http://www.ncbi.nlm.nih.gov/pubmed/20487184>

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Walker, R, 2011, ‘Elements of negligence and malpractice’, The Nurse Practitioner, vol 36, no 5, pp 9-11, viewed 05 September 2013, via NursePractitioner < http://journals.lww.com/tnpj/Citation/2011/05000/Elements_of_negligence_and_malpractice.4.aspx>

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Young, A, 2009, ‘Review: the legal duty of care for nurses and other health professionals’, Journal of Clinical Nursing, Vol 18, no 22, pp 3071-3078, viewed 05 September 2013, via PubMed < http://www.ncbi.nlm.nih.gov/pubmed/19825113>