Legal Considerations

In the given case study scenario, there are legal considerations that have an impact on Sandra’s life and medical case. There is ethical dilemma that the nurses face on a daily basis. They face conflict between the duties of medical care that preserves life and promote recovery and also have moral considerations where they have to consider the informed consent of the parents as the patient is minor. There are many other legal considerations encompassing consent of a minor, communication, guardianship, duty of care and negligence in regard to the parents.

Informed consent is an ethical way in the nursing practice which they face on a daily basis (1). In the given case study, the parents refused to give their consent in using blood products for Sandra’s operation as she have a cancerous tumor in her eye and also agreed. However, she expressed that she know the consequences of withholding the blood products that would risk her life and said the multi-disciplinary team that she would like them to do whatever is good for her. As Sandra is minor, her consent cannot be considered and in this case, her parents’ consent is valid and takes the custody for legal guardianship. In an ethical manner, informed consent is about the patient’s autonomy where the patient is able to understand and freely accept the treatment procedure. In the case scenario, despite of being a minor, Sandra understand the risks involved in the treatment and requirement of blood products for her operation. However, the nurse has to take consent from her parents as a part of duty of care. The multi-disciplinary team face ethical dilemma between duty of care and legal considerations involving informed consent, guardianship and negligence in regards to parents (2).

In this case, nurse can improve the informed consent by patient teaching. In a calm setting, the nurses should make the patient understand the treatment and obtain their informed consent (3). In the case scenario, Sandra’s parents need to be assessed for paternalism and they should be convinced for the informed consent. In case of minor, Sandra’s parents should be properly informed about the nursing and medical treatments that are planned for her. The imparting of education to Sandra’s parents through continuance of techniques through quality assurance, true consent can be obtained and negligence in regards to the parents can be minimized. In patient-teaching, communication is also a big challenge for the nurses.  Effective communication is also important for her parents for the informed consent (4). This would help to reduce the medical errors, ensure patient safety and have improved health outcomes. When Sandra’s parents would know about the need for blood products and medical treatment required for Sandra, these legal considerations could be managed and promotes recovery through duty of care.

In the given case study, there is legal considerations and ethical dilemma faced by the nurses and the informed consent. There is conflict between the duties of medical care that preserves life and promotes recovery and also has moral considerations where they have to consider the informed consent of the parents as the patient is minor. As Sandra is minor, her consent cannot be considered and in this case, her parents’ consent is valid and takes the custody for legal guardianship. Through effective communication, informed consent can be obtained from Sandra’s parents and help in solving the ethical dilemma.

Competency Task

Competency in nursing is the display of strong capabilities along with skills and professionalism to perform the nursing practice without error. The competence in professional practice encompasses the activities and attitudes through which they are engaged in direct clinical care and practice in the nursing profession (5). Developing of competency also develops excellence and influences the health systems and professionalism. For example, the communication in therapeutic relationship is important and it is an essential skill in the nursing practice. It is developed through NMBA Competency Standards that provides the scope for building competency in communication as a nurse in the therapeutic relationship. Therefore, the following essay deals with the understanding of competency in nursing and the ways to develop effective communication competency in the nursing practice.

Nursing and Midwifery Board of Australia (NMBA) has provided the understanding and definition of the communication in therapeutic relationship competency in the nursing professional practice. It acts as a guide in delivering safe and competent care and nursing practice. The competency standards are an integral component of the framework to assess the performance of the nurses and work in accordance with the Australian nursing competency for registered nurses in Australia (6). The competency under the standard stated in NMBA is related to therapeutic and collaborative care. In developing this skill, NMBA states that the nurses have the responsibility to establish, sustain and conclude professional relationship with the individuals and this also helps them in understanding their contribution in the multi-disciplinary healthcare team. It also guides them in facilitating the therapeutic and provision of care, they have to demonstrate effective communication techniques like interpreter when required, verbal and written communication skills through language that is appropriate for discussion. Moreover, they can develop this skill through open or close ended questions when appropriate and alternative communication methods for the individuals who are not able to verbalize. The communication should be logical, clear and comprehensive and concisely written so that the information conveyed should be pertinent. This relates to the competency under standards of collaborative and therapeutic care in NMBA by the nurses to the inter-disciplinary healthcare team (7).

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Apart from NMBA standards that provide scope for developing communication skills among the registered nurses, there are other approaches that help the nurses to develop competency in their nursing practice. Dreyfus’ Model of Skill Acquisition is an approach that aids in developing competency as a registered nursing in their nursing practice. This model offers a framework for the professional expertise that depicts an individual’s progression through five levels. Novice, advanced beginner, competent, proficient and expert is the five levels in a person’s life that aids in developing competency. During the novice stage, the nurse follows context-free rules and has no responsibility other than following of rules. The competency develops after gaining considerable amount of experience when they start interacting with individuals and with the inter-disciplinary healthcare team. Proficiency is developed when nurses use intuition in the decision-making process and to formulate plans, they develop their own rules. Professional expertise is achieved when they are not dependent on the explicit of knowledge anymore. Therefore, this five step model shows progression from rigid rule adherence through intuitive knowledge to expert level (8).

Professional Reflection Task

From the above analysis, it is evident that competency is an essential component that is required in professional nursing practice. Nursing and Midwifery Board of Australia (NMBA) has provided the understanding and definition of the competency skills like communication in therapeutic relationship in the nursing professional practice. The competencies under the competency standards stated in NMBA are used as a guide to develop effective communication in therapeutic and collaborative care. Dreyfus’ Model of Skill Acquisition is an approach that aids in developing this competency as a registered nursing in their nursing practice.

Professional reflection is an important aspect as it helps an individual to recognize the progress that one has made in their profession and at the same time, allow considering the scopes for improvement and effective action through quiet reflection (9). People learn through their mistakes and experiences where they question themselves through introspection. It is a form of research where a person questions on what they have learnt from their experiences and think over them and look for any scope for improvement. It also enables a person to move from a level of experience to understanding. This is not only required at the individual level, but, also in the professional development.

At the professional level, reflective practice is important as it is a process that makes sense leading towards action. There is a constant questioning of the assumptions and the acceptance of the ways of doing work that would be leading to transformation and scope for improvement (10).

The Nursing and Midwifery Council (NMC) states that the nurses use feedback that gives them an opportunity for learning and reflection and in improving their nursing practice. This provides revalidation of the process of how they have achieved it (11). Although, nurses work in busy environments that are hectic and demanding and they do not have time for self-reflection, NMC put great emphasis on reflective practice that provide benefits for the nurses and overall development of their nursing profession. There are various models of reflection like Gibb’s reflection cycle that assist in thinking and enable the nurses to make them what they have felt during the event and retrospective in nature that reflects on action and consider the approach to future action plan. It is a key skill that makes the nurses engage in managing the professional and personal impact of addressing the patients’ fundamental well-being and health needs (12). The following example depicts the experience of professional reflection, obstacles observed during this process and the action plan to manage it.

During my second year of nursing practice, I was working under the supervision of my mentor and was advised to dress the patient’s wound as he was busy. I saw the doctor came and examined the patient’s wound without washing hands or using alcohol gel.

I felt embarrassed to confront the doctor and was shocked by the incident. I spoke to my mentor about the incident and he decided to talk to the doctor about hand hygiene.

While reflecting on this incident, I evaluated that I should have acted at that moment before he examined the patient. However, I was glad that the doctor responded well to his mistake. During this reflective practice, I realized that it is important to talk about hand-hygiene and it is a barrier that needs to be removed through effective strategies to ensure patient well-being.

To overcome this obstacle and to avoid these kinds of incidents in the future, I planned and aimed to develop my assertive skills while working with other in my nursing profession that will ensure patient well-being and quality of care.

From the above analysis, it is evident that reflective practice is an essential component of professional practice. The reflective practice on this incident helped to consider the experiences one have during their nursing practice, the obstacles faced and ways to overcome or manage it. People learn through their mistakes and experiences where they question themselves through introspection. There is a constant questioning of the assumptions and the acceptance of the ways of doing work that would be leading to transformation and scope for improvement. The Nursing and Midwifery Council (NMC) states that the nurses use feedback that gives them an opportunity for learning and reflection and in improving their nursing practice. NMC guides through reflective practice in nursing to enhance their practice and enable improvement through training, support needs or allow scope for changes.

Conclusion

From the above essay, it can be concluded that in the professional nursing practice, nurses have to face dilemma on a daily basis while dealing with patients and their families. There is conflict between the duties of medical care that preserves life and promotes recovery and also has moral considerations where they have to consider the informed consent of the parents as the patient is minor. There are ethical and legal considerations involved with the patients and their families. For this, nurses have to develop competency in their professional practice to exhibit and work in accordance with the nursing standards. Dreyfus’ Model of Skill Acquisition is an approach that aids in developing competency as a registered nursing in their nursing practice. As they develop competency, they recognize the progress that one has made in their profession and at the same time, allow considering the scopes for improvement and effective action through quiet reflection called reflective practice. At the professional level, reflective practice is a constant questioning of the assumptions and the acceptance of the ways of doing work that would be leading to transformation and scope for improvement.

References

(1) M.J. HAMMER, September. “Informed Consent in the Changing Landscape of Research,” In Oncology nursing forum, Vol. 43, No. 5, pp. 558-560 (2016).

(2) A. NISHIMURA, J. CAREY, P.J. ERWIN, J.C. TILBURT, M.H. MURAD and J.B. MCCORMICK, “Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials,” BMC medical ethics, 14(1), p.28 9 (2013).

(3) L. TAMARIZ, A. PALACIO, M. ROBERT, and E.N. MARCUS, “Improving the informed consent process for research subjects with low literacy: a systematic review,” Journal of general internal medicine, 28(1), pp.121-126 (2013).

(4) D. BROCK, E. ABU-RISH, C.R. CHIU, D. HAMMER, S. WILSON, L. VORVICK, K. BLONDON, D. SCHAAD,  D. LINER, and B. ZIERLER, “Interprofessional education in team communication: working together to improve patient safety,” BMJ Quality & Safety, 22(5), pp.414-423 (2013).

(5) M.R. JEFFREYS, Teaching cultural competence in nursing and health care: Inquiry, action, and innovation, Springer Publishing Company (2015).

(6) A. SCANLON, A. CASHIN, J. BRYCE, J.G. KELLY, and T. BUCKELY, “The complexities of defining nurse practitioner scope of practice in the Australian context”, Collegian, 23(1), pp.129-142 (2016).

(7) Y. XU, “A comparison of regulatory standards for initial registration/licensure of internationally educated nurses in the United Kingdom, Australia, Canada, and the United States,” Journal of Nursing Regulation, 2(3), pp.27-36 (2011).

(8) C.J. HEYES, and A. THACHUK, “Queering know-how: Clinical skill acquisition as ethical practice,” Journal of bioethical inquiry, 12(2), pp.331-341 (2015).

(9) J.A. MOON, Reflection in learning and professional development: Theory and practice, Routledge (2013).

(10) J. TASHIRO, Y. SHIMPUKU, K. NARUSE, and M. MATSUTANI, “Concept analysis of reflection in nursing professional development,” Japan Journal of Nursing Science, 10(2), pp.170-179 (2013).

(11) J. SHEPHERD, “Achieving Nursing and Midwifery Council revalidation,” MIDIRS Midwifery Digest, 26(4), pp.424-430 (2016).  Professional Reflection In Nursing Practice Discussion Paper