Accountable practitioner article

As registered healthcare professionals you will be legally and professionally accountable for your activities, irrespective of whether you are following the instructions of another or using your individual initiative (Griffith and Tengnah, 2010). The consideration of what answerability means in nursing practice is a crucial part inside the foundation of nursing jobs, some might say that being accountable means being dependable, and as a consequence taking the pin the consequence on when something goes wrong.

Being accountable is to be answerable for your acts and omissions, this can be the approach used by the Breastfeeding and Midwifery Council (NMC) the medical regulatory physique.

It says within it is code “You are personally accountable for the actions and omissions in your practice and must always have the ability to justify the decisions (NMC, 2008). Consequently accountability has been answerable to your acts to a higher authority with whom you may have a legal romantic relationship. A larger view of accountability is defined as an inherent self-confidence as a professional that allows a nurse for taking pride in being translucent about just how he or she has performed their practice (Caulfield, 2005).

In order to provide maximum protection for the public and patients against misconduct of registered nurses, four aspects of law are drawn collectively which singularly hold one to account. These are generally society through public rules, patient through tort legislation, employer throughout the contract of employment and profession through statute legislation, such as the NMC.

This assignment will reflect on the work and study completed within the Responsible Practitioner component including lectures and facilitated group lessons in which reflective diaries were completed [see appendix I-IV]. By completing a Cause Analysis (RCA), a system accustomed to find flaws and possibilities for improvement of healthcare, on the Pamela Scenario, it absolutely was highlighted the theme ‘consent’ was an area of concern (Transition to Practice, 2012). I will as a result be looking in the three key elements of answerability which are professional, legal and ethical and relating these to my personal chosen topic and applying this towards the Pamela Situation.

Professional Answerability

Professional accountability consists of an cast in medical that is based upon promoting the welfare and wellbeing of patients through nursing care. This all comes together inside the heart of nursing. Within our group classes we mentioned who signed up nurses will be accountable to, these getting through the procedures of the Nurses, Midwives and Health Visitors Act 1997 and the Nursing and Midwifery Order 2001.

The NMC was established below these procedures in 2002 to protect the general public by creating standards of education, training, conduct and performance for healthcare professionals to ensure these kinds of standards happen to be maintained (Nursing and Midwifery Order, 2001). Professional responsibility allows healthcare professionals to work within a framework of practice and stick to principles of conduct decide by the NMC that conserve the patients rely upon the individual nurse and nursing as a whole (Caulfield, 2005).

Obtaining consent states the patient’s right to self-discrimination and autonomy. The NMC code of professional execute has a distinct section on consent (NMC, 2002). Terms 3 requires that ‘as a rn, midwife or perhaps health visitor you must obtain consent prior to you give virtually any treatment or perhaps care’.

The professional responsibility recognises the importance of autonomy in clause 3. 2 and states that a refusal to receive treatment should be protected actually where this could result in damage or loss of life to the person. The professional duty as well requires the fact that nurse gives information that is accurate and truthful and this must be shown in a way that is easily understood (Bowman, 2012).

In the Pamela situation there is no suggestion as to whether permission was obtained. At the beginning of her care, when ever she was admitted to the orthopaedic keep they recommended a skin traction should be applied to the affected limb, however simply no consent was gained and the staff for the ward required it after themselves to ascertain whether it was the best action. Within our group we talked about that at this moment Pamela was mentally competent of supplying informed approval [see appendix II].

Pamela later became incredibly agitated and confused and was ultimately referred for a CT check which confirmed findings of Alzheimer’s disease. From this point onwards there is no facts to claim that consent was gained from someone with capacity following Mental Capability Act (2005) where they state “a person is unable to make a decision for themselves if they are struggling to: understand info given to these people, retain that information, employ or ponder that details as part of the method in making a choice and communicate that information.

In this instance it is far from possible to determine whether Pamela was able to offer informed approval herself or perhaps whether any kind of family members gave this on her behalf. Professionally the staff within the keep that made this decision on her behalf behalf can be held accountable.

Legal Responsibility

Legislation is a major area of accountability for medical practice. What the law states is a group of rules, polices and cases that provide interpretation of the regulations that apply at society. There are very clear charges for anyone, including nurses, who fail to follow the rules set out by law. Inside our group periods we talked about the two devices of rules within the UK [see appendix I]: civil legislation and legal law, every single one contains its own framework and different guidelines apply for every system (Young, 2008). The kinds of civil rules that have an effect on accountability in nursing practice include differences with business employers, cases of patients suing due to accusations of neglect and situations where a health professional sues her employer due to injury at work.

All these instances are noticed in municipal courts and the judge may award settlement. Criminal rules is the program designed to evaluate that guidelines set out simply by parliament happen to be followed. The acts of parliament handle issues just like medicines, suicide, organ and tissue monetary gift, mental into the decisions about health care where a person does not have the ability to make their very own views regarded.

Criminal penalties include fines or perhaps imprisonment (Caulfield, 2005).

Legislation recognises that adults possess a right to determine what will be done to their bodies. Touching a person with no consent is usually unlawful and may amount to infringe to the person or, more rarely, a criminal attack. Unlike additional civil incorrect doings including negligence which will requires injury, any unlawful touching is definitely actionable irrespective of whether being done with the most of motives (Tingle and Cribb, 2007). When obtaining approval, you must make sure that the patient will abide by all the treatment intended to be completed. Proceeding with treatment the patient is definitely unaware of, or has declined to consent to will be a trespass to the person and useful to legislation.

Nurses need to therefore take care to explain all the treatment or perhaps touching that will occur when obtaining consent from someone and ensure that any additional treatment is susceptible to further permission (Savage and Moore, 2004). “Consent is usually an expression of autonomy and must be totally free choice of the person. It can not be obtained by undue influence (Griffith and Tengnah, 2010, p. 82). In law, undue implies that the effect must take away the patient’s free of charge will and be so powerful that the individual excludes all the other considerations when creating their choice.

It is an proven part of law that simply no treatment can be given to a person, whether it be clinical or medical unless you will have consented (Johnstone, 2009). Therefore as permission was not attained within the Pamela scenario when deciding whether to apply grip to her leg the doctors and healthcare professionals involved in making the decision on her behalf would be placed legally dependable and could encounter criminal prosecution.

Within our facilitated group periods we mentioned the following proven principles which usually must all be satisfied before consent is enough [see appendix III]: ‘consent should be given by somebody with capacity’. Within the situation it is stated that Pamela was diagnosed with Alzheimer’s disease, however the family weren’t asked to consent on her behalf following the Mental Ability Act (2005).

‘Sufficient information should be provided to the patient’ is the second principle. Pamela’s family point out they were unacquainted with what was occurring with her care and within the grievances letter, Pamela’s daughter declares staff did not give her relevant information even when Pamela wasdiagnosed with Alzheimer’s. The 3rd principle ‘the consent should be freely given’, due to the personnel not attaining any consent and taking decision to their own hands this theory like the earlier two was also not really followed. The negligence and consent exclusively within this circumstance would put the staff included directly into legal accountability. Ethical Accountability

Accountability is an important ethical concept because nursing practice involves a relationship between the nurse as well as the patient (Fry, 2004). Inside our group periods we mentioned Beauchamp and Childress (2001) who created a construction which offers a broad consideration of ethical issues. This involves four principles: respect intended for autonomy this means respecting the decision-making capabilities of independent persons; allowing individuals to produce reasoned educated choices. Beneficence, this looks at the handling of benefits of treatment up against the risks and costs; the healthcare professional should certainly act in a manner that benefits the individual.

Non maleficence, this meansavoiding the causation of damage, the physician should not harm the patient. Every treatment entails some harm, even if nominal, but the harm should not be extraordinary to the benefits associated with treatment. And lastly, justice, this can include distributing benefits, risks and costs fairly, the notion that patients in similar positions should be treated in a similar manner.

Approval is a meaning and legal foundation of contemporary health care. Treatment that earnings without permission of the sufferer immediately needs a thorough ethical investigation. Despite the fact that consent may have been given it is very important to ensure this implies more than the pure fact a form has been agreed upon. The main position of permission is to protect patients and in particular to protect their status of autonomy and enable them to remain in control of their particular lives (Fry and Johnstone, 2008).

In ethical conditions, consent is important because it demonstrates respect for autonomy, consequently through taking part in a permission process the person’s autonomy can be further increased by having the decision to accept or decline treatment. For some persons their ability to consent could possibly be compromised by their position into their cultural group. For example , women within specific cultures might have the capacity to consent but would not expect to have the right todetermine what happens to these people (Chadwick and Tadd, 2003). If agreement was not received and treatment was carried out on a person during an ethical group who would not agree to the therapy, then that person would be organised ethically accountable.

In the circumstance, nurses did not apply skin area traction to Pamela’s lower leg despite the acknowledging doctor indicating that it be applied. Ethically, this related to non-maleficence as it can be presumed the traction force was not applied due to the treatment having a conservative nature as well as the nurses thinking it would be of no profit to Pamela in regards to treatment. Also a huge majority of care was performed after Pamela was clinically determined to have Alzheimer’s which leaves her vulnerable to treatment being accomplished without agreement from her or her family.

Bottom line

Through the module I’ve developed my awareness of the professional, ethical and legalities that are associated with providing accountable health and cultural care. I was able to think about my own learning and development as a great accountable doctor and be involved in the caused group periods. I have elevated in confidence and produced communication abilities by having a chance to speak and voice my opinion in front of different colleagues; this will enable myself to be involved in handover and various crew meetings although out in practice.

Analysing the scenario in groups empowered me to find a better understanding in the issues brought up and this allowed the task to be completed with confidence. I used to be able to enhance my capability to appraise and use related evidence structured literature to back up my assertions which were from a variety of sources. Finally, having the capacity to choose our very own theme in the scenario allowed me to experience a greater knowing of consent that may benefit me personally when in practice.

Part B

I shall be using the Gibbs Reflective Routine (1988) to reflect upon a critical event that I include witnessed out during a ward based location. The Gibbs reflective pattern suggests that theory and practice supplement one another in a never-ending circle that was coined coming from Kolb’s experiential learningcycle. Utilizing the Gibbs refractive cycle My spouse and i shall be looking into how I sensed during the time, the things i felt and thought after the incident and many importantly the things i would perform differently the very next time. Event

The incident We are looking back again on occurred whilst in placement inside an orthopaedic ward when I was given the opportunity to aid a registered nurse on her medicine round. I had previously aided her upon drugs models she was happy for me to administer the medication that has been Enoxaparin with this particular affected person. As I signed up with her while using drug round part way through, due to helping one more patient your woman had currently confirmed the patients name and day of labor and birth and the affected person had verbally consented towards the administration and thus I was informed me to just provide it.

I followed all of the relevant plans and techniques whilst giving the medication however Some understand why the registered nurse would allow me to manage the drug without me personally gaining approval from the individual to ensure having been happy for a student registered nurse to carry out the administration. I therefore explained to the patient i was a college student nurse and I had previously carried out a great administration of enoxaparin although explained to him that I would not be offended if he was not happy to administer the drug personally. I had been taking care of this patient over a number of days and had for that reason gained his trust and so he verbally consented in my experience administering the drug and allowed me personally to continue.

Feelings and thoughts

Although I was administering the medication I felt very comfortable as I acquired administered a great number of00 previously and also having a sufferer who was content for me to bring this out enabled myself to total this competently. The patient as well spoke to my opinion throughout regarding his personal existence so I was reassured that he was certainly not feeling anxious or stressed and therefore placed me in a confident perspective. The rn was likewise shadowing me whilst I actually administered the drug so I was cheerful I was never going to make a mistake.

Evaluation

There were nothing poor about this encounter apart from the misunderstandings of the rn telling me personally not to comply with protocol and double check his date of birth and consent, even so I believed I did the right thing. I enjoyed giving the Enoxaparin as I believed it would boost my experience and it had been good practice for me, especially as this drug was obviously a very common medication used inside most clinic wards.

Examination

Even though I experienced confident giving the Enoxaparin, I did not experience all that assured when asked to administer the medication devoid of checking the patient’s name and date of birth and gaining approval which is a essential protocol of administration of medicines set out by the NMC (2010). Searching back I ought to have voiced my worries and asked why the girl did not desire me to confirm these; even so I did not want to query my mentors’ experience or perhaps authority.

A number of accountability issues were increased within this practice in which I actually later talked about with my own mentor so I could verify I did the proper thing. The Nursing and Midwifery Authorities (NMC) claims that the administration of medications is a essential aspect of specialist practice pertaining to registered nursing staff which are being performed in strict compliance with the written prescription of a medical practitioner necessitating exercise of professional reasoning (NMC, 2010).

The NMC (2010) also state within their consent code “To associated with care of people their initial concern and ensure they gain consent prior to they start any treatment or care I did execute this principle although asked not to by the nurse I was working with. If I did not carry out these investigations although only a student registered nurse I would be held in charge of my activities when I understood this was against protocol.

Conclusion

As being a student nurse it is satisfactory to assist with drug ward rounds and administering prescription drugs, however when I was asked to administer the medicine without the people identity affirmed and consent gained I ought to have said I did not feel comfortable with the work as it was not working in conjunction with the NMC’s standards of medicines administrationsbut I would see. When instructing a student and also to improve standard practice general the registered nurse in question really should have asked me to verify the sufferers name and date of birth and gained agreement before giving the medicine.

Although there was no issue with administering remedies to the incorrect patient or any type of ethical concerns due to not gaining agreement on this day time, this could have been a very big nursing error causing a potentially big problem with responsibility on my behalf.

Action Plan

As a pupil nurse it is vital to take opportunities to learn rewarding when using a mentor that you not necessarily think entirely confident with however greatest responsibility continues to be with me if I do not feel confident in the situation that I have been assigned. Even though I was more comfortable with the task in hand I was unhappy with the method I was asked to carry out this procedure by missing out vital NMC code protocols. The only thing I would personally have done several in this scenario would be to declare I did not feel comfortable with administering medication to a individual without undertaking the relevant checks and I really should have confronted the nurse showcased and asked why the lady did not tell me to ask for these details.

Although the girl had taken these out previously the girl did not show the patient that we was a student nurse which could have gone very wrong. If put in this situation again I would certainly not change nearly anything which I personally did me personally, I would still follow the NMC guidance on drugs administration (NMC, 2010) which therefore takes me out of the accountability issue if whatever was to get it wrong, however I would confront the nurse and ask why these types of checks had been asked being skipped.

References

Beauchamp, T and Childress, T. (2008) Principles Biomedical Integrity. 6th education. Oxford: Oxford University Press. Bowman, G. (2012) Informed Consent: A Primer pertaining to Clinical Practice. Cambridge: Cambridge University Press.

Caulfield, L. (2005) Answerability. Oxford: Blackwell Publishing.

Chadwick, R and Tadd, W. (2003) Values and Nursing Practice: A Case Study

Approach. Hampshire: Palgrave Macmillan.

Fry, ST (Ed. ) (2004) Nursing jobs Ethics: Encyclopaedia of Bioethics. 3rd ed. New York: Macmillan.

Fry, ST and Johnstone, MJ. (2008) Ethics in Nursing Practice; A Guide to Ethical Decision Making. third ed. Oxford: Blackwell Creating.

GIBBS, G. (1998) Learning getting into: A Guide to Teaching and Learning. London: FEU

Griffith, 3rd there’s r and Tengnah, C. (2010) Law and Professional Problems in Breastfeeding. 2nd ed. Exeter: Learning Matters Limited.

Johnstone, MJ. (2009) Bioethics: A nursing jobs perspective. 5th ed. Sydney: Elsevier.

Nursing jobs and Midwifery Council (NMC) (2002) Code of Specialist Conduct. London: NMC.

Nursing jobs and Midwifery Council (NMC) (2008) The Code: Standards of carry out, performance and ethics intended for nurses and midwives. Greater london: NMC.

Breastfeeding and Midwifery Council (NMC ) (2010) Standards pertaining to Medicine Supervision. London: NMC.

Nursing and Midwifery Council (NMC) (2010) Regulation in Practice: Consent. London: NMC.

Breastfeeding and Midwifery Order (2001) Article three or more. London: NMC.

Savage, J and Moore, L. (2004) Interpreting Responsibility. London: Regal College of Nursing.

Tickle, J and Cribb, A. (2007) Nursing jobs Law and Ethics. 3rd ed. Oxford: Blackwell Submitting

Transition to rehearse (2012) Cause Analysis Steps. [online] Sold at: http://transitiontopractice.org/files/module4/QI%20-%20Root%20Cause%20Analysis%20steps.pdf [Accessed 12 September 2012]. Young, A. (2008) Review: The legal duty of care for nurses and other health care professionals. Diary of Specialized medical Nursing. 18: pp. 3071-3078.

Bibliography

Privacy Act (1991) Great Britain. Greater london: HMSO.

Info Protection Act (1998) The united kingdom. London: HMSO

Hendric, L. (2000) Rules and Integrity in Nursing and Healthcare. Cheltenham: Stanley Thornes Limited.

Nursing and Midwifery Authorities (NMC) (2006) Standards of Proficiency for Nurse and Midwifery Prescribers. London: NMC

Royal School of Medical (RCN) (2006) Nurses and Medicines Guidelines: An Information Conventional paper. London: NMC.

Reeves, M and Orford, J. (2002) Fundamental Aspects of Legal, Ethical and Professional Issues in Nursing. Wiltshire: Mark Allen.

Tschudin, V. (1996) Integrity: Nurses and Patients. Birmingham: Bailliere Tindal. Watson, 3rd there’s r. (1995) Answerability in Medical Practice. Greater london: Chapman and Hall.

Appendices

Appendix We

Personal Diary Linen 1 (25/06/12)

Appendix II

Personal Diary Bed sheet 2 (09/07/12)

Appendix III

Personal Diary Linen 3 (16/07/12)

Appendix IV

Personal Diary Sheet 4 (23/07/12)