Moral Distress in Healthcare Professionals

The assignment discusses moral distress in healthcare professionals, focusing on the principles of informed consent, beneficence, non-maleficence, autonomy, truthfulness, and confidentiality. It includes references from books and journals, as well as online sources, to provide a thorough understanding of the topic.

Contemporary Professional
Practice In Mental Health
Nursing

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Critically evaluate the application of professional boundaries and how this will impact the
nurse-client relationship and the provision of MH nursing care............................................3
Legal, ethical and professional perspectives..........................................................................4
The impact of the power differential on the nurse-client relationship...................................5
Best practices regarding mental health patients.....................................................................7
Relevant actions expected for optimum relationship development and the crossed boundaries
in case study...........................................................................................................................7
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

INTRODUCTION
Contemporary professional practices refers to clinical practices used by nursing staff to
conduct currently while dealing with mental patients. It includes utilisation effective
technological machines, provide technical aids for supporting people with psychological illness
in order to make them well being (Liberati, Gorli and Scaratti, 2016). However, it is observed
that nursing staff should follow overall set care standards and policies while providing care to
mental patients through utilisation of appropriate resources. The present essay is based on case of
misconduct with patient named Miriam Merten in Lismore Adult Mental Health Inpatient Unit
which is situated in 60 Hunter Street, Lismore in Australia. This report will focus on application
of professional boundaries and its impact of nurse client relationship. It will also includes impact
of power differential on the nurse- client relationship. The best practices in mental health and
crossed professionals boundaries are given below.
MAIN BODY
Critically evaluate the application of professional boundaries and how this will impact the nurse-
client relationship and the provision of MH nursing care
The professionals boundaries can be described as set of care standards and regulations
which must be followed by medical professionals while dealing with patients. It is helpful to
make them understand about limitations to be considered while providing treatment for mental
health patients. However, there are number of standards that must be considered by mental health
practitioners such as safety, consumer & carer participation, diversity responsiveness, promotion
& prevention, consumers, carers, governance, leadership & management, integration, delivery of
care and rights & responsibilities (Fitzgerald, 2016). It is necessary for mental health nursing
staff to fulfil their responsibilities by conducting secure clinical practices in regards to deliver
safe treatment for their wellness. In context of Lismore Adult Mental Health Inpatient Unit, they
staff members should consider these care standards while dealing with psychological condition
of Miriam Merten for improving her health status. It is essential to focus on supporting recovery,
access, entry, review & assessment, support & treatment and proper medication for patient well
being in selected care study.
On the other hand, the it is observed that consideration of professional boundaries are
favourable to establish an effective relation between a nurse and client. It includes the role of

nursing staff to to take care of rights of patients along with completing their own duties in
accurate manner. Meanwhile, it is essential for nursing staff in Lismore Adult Mental Health
Inpatient Unit to make effective communication with given patient and provide support by
solving her daily routine difficulties. It will provide support to establish an appropriate nurse and
client relationship which facilitate to make correct decision making regarding treatment. In
addition to this, professionals boundaries pays an important role in performance of care providers
as it helps to reduce chance of occurring issues regarding clinical practices (Lim, 2016).
Moreover, better client and nurse relations is favourable for care professionals to thoroughly
understand actual condition in terms of conduct appropriate medications and therapies for
improving mental condition of Miriam Merten.
Professionals standards are responsible for encouraging quality and safety in regards to
mental patients. It includes responsibility of care providers in terms of conducting clinical
practices securely for improving conduct of a mental patient. Meanwhile, it is necessary to keep
such individuals under observations through technological support to ensure safety of them.
However, professional care standards of mental health should be follow in case of Miriam
Merten by supporting her to avoid her problem of falls and relevant injuries. Moreover, it is
essential for them appoint a nurse to observe her activities in the ward and organise favourable
atmosphere to avoid severe injuries (Lim, North and Shaw, 2017). If these measures were taken
then they can save her by preventing traumatic & hypoxic brain injury due to fall. Additionally,
this is a kind of misconduct that has been done by nursing staff to avoid patient fall and ignore
when she was lying on the floor due to which she become dead.
Legal, ethical and professional perspectives
Professional care standards regarding mental health patients focus on quality and safety
of medical services in order to deliver correct treatment. It includes to consider specific codes of
conduct which make care providers capable to put efforts in correct direction for providing
appropriate medical facilities. However, it has been analysed that there are various kinds of legal
and ethical rules which are required to be followed by nursing staff dealing with psychological
patients in respect of making them healthy (Davis and et. al., 2018). In addition to this, it is
observed that legislations are significant to avoid drug errors and other clinical mistakes which
helps to make an individual well-being. Professional perspectives includes to conduct
appropriate clinical procedures according top requirements of given patient for their well-being.

If given patient has a problem of falls then desired measures must be taken for her safety and
avoid injuries to save her. Moreover, such effective actions were avoided by nurse of selected
organisation due to which condition of Miriam leads to death.
In context of Miriam Merten, the nursing staff of Lismore Adult Mental Health Inpatient
Unit should consider legal norms while dealing with patient. It includes various laws like Mental
Health Act 2014, Controlled Substances Act 1984, Public Intoxication Act 1984, Health Care
Act 2008, Safe Drinking Water Act 2011 and many more (Prince and Davis, 2016). However,
these legislations encourage professionals to maintain safety of patients and conduct appropriate
clinical practices in order to avoid any type of complication. It is necessary for nurses to focus on
condition of given patient and take proper precautions for preventing falls along with taking
immediate action while she get fallen on the floor. Staff avoid her fall and did not support her
due to which severe brain injury occurs that is responsible for patient death in hospital.
Ethical principles can be defined as values that are helpful to determine fair and honest
conduct while dealing with patients. It includes number of factors such as confidentiality &
truthfulness, informed consent & autonomy, non maleficence, justice and beneficence. Initially,
it is necessary for care practitioners associated with case of Miriam Merten to maintain
confidentiality of relevant data and provide effective treatment by remaining honesty towards
her. Basically, it important to consider informed consent which states that selected treatment
process should be conveyed to patient before conducting the same (Feiler, Hordern and
Papanikitas, 2018). Meanwhile, factor of autonomy motivate care providers to render right to
patient for selecting suitable treatment by providing options and relevant knowledge to them. If
given Miriam Merten is not able to understand then professionals should convey this information
to her daughter and take her approval for conduct appropriate treatment process for patient
wellness. Moreover, nurses are responsible for ensuring the consideration of beneficence, justice
and non maleficence while providing care facilities to mental patients for improving their
conditions.
The impact of the power differential on the nurse-client relationship
Power differential refers to inherently greater power and influence that helping
professionals have as compared to those individuals they help. It includes that fact that care
professionals has more authority as compared to their client due to which an individual must
follow the guidelines of carers. However, some of times it is observed that few of physicians

conduct misuse of their power and attempt abuse, neglect or ignore patient which is not correct.
Such kind of negative activities carried out by psychologist or nurses is knowing as power
differential that impact nurse client relationship negatively. In addition to this, it can be
considered as power inequality which affect client nurse relationship along affecting the patient
outcomes. It is necessary for care providers to avoid misuse of their power and remain honest
towards their duties for performing to achieve better health of patients.
The misuse of professionals power impact negatively on condition of patient due to
which their situation may gain complications which was observed in case of Miriam Merten. It
consist that negligence of nursing staff in care institutions who did not pay attention when she
fallen on the floor and kept her locked in room for whole bight (Gildberg and et. al., 2016).
However, the condition of mental patient become complicated if they become locked because it
is responsible for creating their psychological status more complex as well as unstable.
Meanwhile, this misconduct took life of Miriam for which associated professionals must get
punishment by government by cancelling their licence or put another penalties. Moreover, it has
been analysed that power differential create misunderstandings between nurse and client due to
which patient is not able to trust their care providers. The factor of fear also get generated due to
power inequality in mind of patient which impact on their psychological condition more
severely.
In other words, it has been identified that Miriam faced extreme injuries by fall which is
not noticed by any care professionals which leads to death. It is analysed that of nursing staff
carefully fulfil their responsibilities and pay attention of given patient then they can save her life.
However, the misconduct of negligence and ignore the condition of patient which is not
appropriate (Richardson, Yarwood and Richardson, 2017). Basically, it is necessary medical
practitioners to focus on condition of mental patient and keep an eye on them to monitor and
ensure their safety. Meanwhile, staff of Lismore Adult Mental Health Inpatient Unit ignore
patient which create fear in her mind due to which she did not share anything about her problem
and not even show injury to anybody. The negligence behaviour and ignorance of staff members
make Miriam feel uncomfortable and uneasy because of that there is not understanding or
relationship exist between her and care providers.

Best practices regarding mental health patients
The best practices refers to clinical procedures and activities which are appropriate in
ethical and legal manner. It includes more effective as well as efficient activities and practices
which can be conduct for providing correct treatment for welfare of an individual. In context of
mental health patients, it consist the prior conduct of making effective communication with
medication and counselling therapy to make them stable mentally. However, communications is
favourable to understand actual cause behind specific psychological problem. In addition to this,
it is essential to ensure comfort level of an individual (Carubia, Becker and Levine, 2016). In
case of Miriam, staff of Lismore Adult Mental Health Inpatient Unit are required to make sure
presence of her daughter initially which is favourable to provide morale support for patient. It is
observed that presence of family member is helpful to make an individual stable and treatment
process can be conduct easily. It is necessary for mental care practitioners to focus on best
practices in which some of them are described here.
Initially, the care standards should be focused in order to make correct decision of
treatment which facilitate to increase patient outcomes. It includes to make effective
communication with patient to make them comfortable and put efforts to establish mutual
understanding so that they can share their problem easily. However, it includes to utilise
effective and advanced technological support which helps to identify actual cause behind specific
mental illness as in case of Miriam to treat it properly. In addition to this, technical aids can be
provide to patients for improving their independent living if they are stable mentally with the
help of medications. Meanwhile, effective therapies should be applied like counselling therapy,
cognitive behavioural therapy, recreational therapies, meditation and so on. These are favourable
to make an individual mentally stable which can become possible to encourage them for
participating in these procedures (Durbin and et. al. 2016). Moreover, it is necessary for
professionals associated with Miriam should follow such medications, therapies in legal and
ethical way to save her life.
Relevant actions expected for optimum relationship development and the crossed boundaries in
case study
According to the given case study, a patient named Miriam Merten get dead due to
negligence of hospital's staff in Australia. It includes the misconduct by care providers due to
which patient gain extreme complex situation which leads to death. Meanwhile, she was

admitted in hospital to get treatment in regards to get specific psychological disorder to
overcome with the same. It has been analysed that Miriam kept locked and secluded in a ward till
five hours as a part of treatment process. In addition to this, the locked get unlocked by nurse to
the next norming which is a pat of negligence because nobody check patient condition whole
night to ensure better health status. Meanwhile, it is observed by nurse that Miriam came out
naked and stumbled in hallway, collapsed in a corner but staff ignored her condition. Moreover,
it has been evaluated that patient get died after two days because of severe traumatic and hypoxic
brain injury (Sullivan and Skelcher, 2017). This clearly reflects the negligence of employees
working in Lismore Adult Mental Health Inpatient Unit that is responsible for death of Miriam
Merten. Additionally, it is required to take strict action against associated professionals so that
this severe misconduct will not happen again in any of health care organisation at global level.
The staff has a misconduct of ignoring severe condition of Miriam due to which she
become dead. Initially, the staff crossed limitations of ignoring factor of safety ans their
responsibility to provide treatment to patient securely. There Are various kinds of care standards
which are required to be followed by care providers associated with case of Miriam but they all
ignored due to which patient become severely injured and then finally get dead. However, it is
mandatory to focus on encourage participation of patient and understand own responsibilities
towards them by delivering appropriate treatment to achieve their better health status
respectively. Nursing staff of given hospital did not attempt any correct clinical practices for well
being of Miriam and avoid safety criterion while dealing with her. Meanwhile, care professionals
did not consider their duty of promotion better health and prevention of falls or other injuries
through providing secure environment for sick people (Lawson, 2016). They did not provide any
kind of support for Miriam due to which she face severe fall on the floor that results into critical
traumatic and hypoxic brain injury to her. Moreover, it reflects that employees of were not well
trained and skilled as they do not check their patient regularly to make sure about their stable
condition.
CONCLUSION
From the above report, it has been concluded that contemporary professional practices
can be described as a set of clinical practices that are used by nursing staff to conduct currently
while dealing with mental patients. It includes the criterion of compulsorily obey national carte
standards by nursing staff including right & responsibilities, participation of client, safety,

quality, diversity responsiveness, promotion & prevention, consumers, carers, governance,
leadership & management, integration and delivery of care. However, it consist the legal norms
to be followed like Controlled Substances Act 1984, Public Intoxication Act 1984, Health Care
Act 2008 and Health Act 2014. ethical factors should be consider by mental care professionals
including informed consent, beneficence, non maleficence, autonomy, truthfulness and
confidentiality.

REFERENCES
Books and journals
Carubia, B., Becker, A., & Levine, B. H. (2016). Child psychiatric emergencies: updates on
trends, clinical care, and practice challenges. Current psychiatry reports, 18(4), 41.
Davis, A. J. & et. al. (2018). Healthcare professional narratives on moral distress: disciplinary
perspectives. In Moral Distress in the Health Professions (pp. 21-57). Springer, Cham.
Durbin, A. & et. al. (2016). Barriers and enablers to integrating mental health into primary care:
a policy analysis. The journal of behavioral health services & research, 43(1), 127-139.
Feiler, T., Hordern, J., & Papanikitas, A. (Eds.). (2018). Marketisation, Ethics and Healthcare:
Policy, Practice and Moral Formation. Routledge.
Fitzgerald, L. (2016). Interprofessional interactions and their impact on professional boundaries.
In The Oxford handbook of health care management.
Gildberg, F. A. & et. al. (2016). Humor: Power Conveying Social Structures Inside Forensic
Mental Health Nursing. Journal of forensic nursing, 12(3), 120-128.
Lawson, H. A. (2016). Stewarding the discipline with cross-boundary leadership. Quest, 68(2),
91-115.
Liberati, E. G., Gorli, M., & Scaratti, G. (2016). Invisible walls within multidisciplinary teams:
disciplinary boundaries and their effects on integrated care. Social Science &
Medicine, 150, 31-39.
Lim, A. G., North, N., & Shaw, J. (2017). Navigating professional and prescribing boundaries:
Implementing nurse prescribing in New Zealand. Nurse education in practice, 27, 1-6.
Lim, W. M. (2016). Social media in medical and health care: opportunities and
challenges. Marketing intelligence & planning, 34(7), 964-976.
Prince, A. E., & Davis, A. M. (2016). Navigating Professional Norms in an Interprofessional
Environment: The Practice of Healthcare Ethics Committees. Conn. Pub. Int. LJ, 15,
115.
Richardson, A., Yarwood, J., & Richardson, S. (2017). Expressions of cultural safety in public
health nursing practice. Nursing inquiry, 24(1), e12171.
Sullivan, H., & Skelcher, C. (2017). Working across boundaries: collaboration in public
services. Macmillan International Higher Education.
Online
Australia: 'Deeply distressing' footage shows mentally ill woman suffering before death due to
hospital's negligence. (2019). [Online]. Available
through:<https://www.indiatoday.in/fyi/story/australia-nsw-footage-mentally-ill-
woman-suffering-death-hospital-negligence-976777-2017-05-12>