Health Law and Ethics - Operating Theatre

Health Law and Ethics
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Table of Contents
Case study 1...............................................................................................................................3
Introduction/overview................................................................................................................3
Reflection...................................................................................................................................3
Conclusion..................................................................................................................................4
Case Study 2...............................................................................................................................5
Introduction/overview................................................................................................................5
Reflection...................................................................................................................................6
Conclusion..................................................................................................................................8
Case study 3...............................................................................................................................8
Introduction/overview................................................................................................................8
Reflection...................................................................................................................................9
Conclusion................................................................................................................................10
References................................................................................................................................10
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Case study 1
Introduction/overview
I have started my internship in the operating theatre (OT) at the Sunshine Coast University
Hospital (SCUH). I have to assist a registered nurse or midwife. The list covered
gynaecology procedures and I have just taken the consent of my first patient with a RM. The
patient refused to give consent to have a student observe or assist in the procedure. My RM
mentor asked me to come into the theatre with her. I have stated that I am not allowed to go
into the theatre as the patient does not want students to come inside theatre while they are
under anaesthesia. I am highly stressed and confused about what to do and what not. I have
received a huge opportunity to learn practically, but patient also has the right to refuse the
engagement of students. Similarly, it is the responsibility of the RM to consider the wishes of
students as well as patients.
Reflection
As per the Provision 1.4 of Code of Ethics with interpretative statements mentioned in the
American Nurses Association (2015), the responsibilities of the nurses in support of patients
include right to self-determination (ANA, 2015). It is the moral and legal right of the patients
to determine what could be done with and to their own personality. According to this
provision, it is the specific responsibility of the nurse to take informed consent of the nurses
(Lachman, 2016). The consent of the patients should be received if they would allow student
nurses or any other external learners to their wards or OTs and they cannot take students with
them until patients give their consent (International Council of Nurses, 2012).
Similarly, the ICN Code of Ethics for Nurses states that the primary responsibility of the
nurses is to care about the people in need of the nursing care (ANA, 2015). In this context, it
is essential for the nurses to ensure that the individual receives accurate, sufficient and
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appropriate information in culturally suitable manner regarding which to base the consent for
care as well as related treatment (International Council of Nurses, 2012; Johnstone, 2015). As
the nurse possesses lot of confidential personal information, they need to utilize their
judgment in sharing such information with others (ANA, 2015). It is essential for the RNs to
follow proper code of conduct and professional ethics in order to be in compliant with the
ethical conduct in the nursing practices (Anthony & Stablein, 2016).
In this case, when the consent was not provided by the patient, it is essential not to involve
the student along with them in the theatre to the patient. The patient holds the right to have
confidentiality and privacy and can suggest if they need student nurses to enter in their
theatre with the RM or RN (Australian Nursing and Midwifery Journal (ANMJ), 2015). At
the same time, it is essential for the RN to be concerned about the student nurses as well. The
students need the opportunity to practice their skills practically when they are placed in
clinics or hospitals (ANA, 2015).
One such example has been experienced by me during the catheterization, when a patient
refused to get the process done in front of me. It also affected my learning experience;
however, the case is not the same with all the patients, as all the patients do not refuse entry
of students in their wards (Johnstone, 2016). So, I went to my facilitator and consulted with
him and explained that if I will not learn from here, I will not get to learn from anywhere else
(ANA, 2015). Then, the facilitator consulted with the buddy nurse and she explained the
matter to the patient that there is no harm in having student inside the ward and they are
allowed inside to learn through practical knowledge. When student nurses deal with the
patients practically, it develops their skills and practice efficiencies (Lachman, 2016).
Conclusion
After reflection on the analysis of the condition of the student nurses and their learning
requirements, it has been identified that the opportunities provided to the student nurses to
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learn in practical environment is sometimes contrasted with the consent provided by the
patients to allow them in OTs or their wards. It has been identified that the student nurses
should take the consent from the patients or should take permission from their facilitator to
convince or take the consent of the patient to allow student nurses with them. On the
contrary, it is also the responsibility of the RNs to take care about the concerns of the patients
as well. So, the permission should be taken from the patient, as it is the right of the patient to
refuse as they come first in the priorities of the nurses when compared to students. In this
situation, it is essential for the RNs or the facilitator to convince the patient or to take the
informed consent of the patients before allowing the student nurses while they are
anaesthetic.
Case Study 2
Introduction/overview
I am a registered nurse (RN) and I am currently working at the local hospital. I have been
working with other RN or RM who shares duties with me for the allocated patients. Despite
specific infection control protocol in place, I have noticed it that one of my colleagues is not
washing his hands between patients. I became highly concerned about the process of cross-
contamination among patients and their vulnerable health conditions and that infection
control procedures are not being followed by my colleagues. Previously, during the last
month, several cases of patients developing urinary tract infections as well as wound care
infections have been noticed. I am really aware regarding the association of these infections
with the lack of effective control procedures within the hospital. It is strictly essential for the
staff members in the hospital to adhere to the policies and procedures related to safety and
hygiene and hand washing is one of the most common universally followed procedures in the
context of infection control.
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Reflection
Hand washing is the primary and most fundamental perquisite for those who are associated
with any kind of functions and operations in healthcare facilities. Being a student nurse, I
consider it as the mandatory responsibility to follow the policies and procedures strictly in
order to prevent incidences of infections to the patients as well as to staff members and to us
(NSW Health, 2017).
As per the “Australian guidelines for the prevention and control of infection in healthcare
(2010)” in the “National Health and Medical Research (NHMRC)”, standard precautionary
measures are considered as the work practices essential to attain fundamental level of
infection prevention and control, which are minimum requirements and practices to be
followed for care of all the patients in all setups. In addition to it, transmission-based
precautions are also utilized when standard precautionary measures are not sufficient to
achieve the purpose of preventing the spread of infection among patients and others
(ACSQHC, 2019). This two-tiered approach that follows standard as well as transmission-
based precautionary measures provide extensive protection to the patients, healthcare workers
as well as others in healthcare establishments. The standard precautions are considered as
those work practices that are essential for achieving fundamental level of infection control.
With the utilization of standard precautions, the risks related to transmission of infection
could be minimized and eliminated effectively. These procedures are applicable to all the
patients without considering the diagnosis or status of their infection (Commonwealth of
Australia, 2017). In this context, hand hygiene is considered as one of the highly effective
infection control measures to achieve the purpose of reducing the spread of infection among
patients and from them to others. The process of hand hygiene generally refers to hand
cleansing, which include hand washing and hand rubbing. As there are numerous micro-
organisms generally present on hands known as resident flora or some could have been
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acquired in the processes related to healthcare, which are known as transient flora. The
purpose behind hand wash is to reduce the number of micro-organisms on the hands and
specially, the transient flora that might become the reason behind huge risks for transmission
of the infections (NHMRC , 2019).
The hands should be washed with soap and water to perform the process of hand washing
effectively. For the purpose of hand rubbing, the use of an alcohol-based hand rub (ABHR) is
considered as the highly preferred method for hand cleansing within the healthcare setups.
ABHRs are known to be as one of the most effective process because of its most effective
impact against most of the bacteria and viruses as compared to medicated soaps (State
Government of Victoria, 2018).
According to the “Hand Hygiene Australia” (HHA), the 5 Moments for hand hygiene have
been mentioned by the World Health Organisation (WHO). It suggests that hand cleanliness
is must;
 before touching patients
 before performing a procedure
 after a procedure or exposure to body fluids or such substances
 after touching patients
 After touching the environment around the patient
These hand hygiene procedures must be followed by all those associated with the functions in
a healthcare facility (HHA, 2019).
Being student nurse, I follow all these guidelines and these are also strictly required to be
followed by all those associated with healthcare setup. According to the ICN Code of Ethics
for nurses, it is my responsibility to sustain a collaborative and respectful relationship with
my co-workers. However, it also comes under my ethical responsibility to take suitable action
in order to protect the patients and others associated with the healthcare organization when
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there is risk of danger to their health by any co-worker or from any other person. It is
essential for me to take suitable action to support and guide the co-workers in line with the
ethical conduct (International Council of Nurses, 2012). So, being a registered nurse, I will
fulfil my ethical responsibility and advise my colleagues to follow the standard precautions
and hand hygiene so that severe urinary tract infections and wound related infections could be
controlled and prevented among the patients. I will perform my responsibility towards
patients and make every possible effort to protect them from getting infected due to poor
hygiene practices been followed by my colleagues (International Council of Nurses, 2012).
Conclusion
It has been identified that the lack of effective infection control procedures could lead to
serious consequences and it is the responsibility of each and every staff member associated
with the healthcare facility to adhere to the infection control policies. I will advise my
colleagues to follow standard precautionary measures, which are essential for handling all the
patients. Furthermore, I doubt that the frequent cases of severe infections informed might be
the result of the lack of effective hand hygiene. So, I will suggest them to perform their duties
in compliance with the standard procedures and to follow 5 moments of hand hygiene while
handling patients. If they do not start following the recommendations to the earliest, I will
inform about the negligence to the seniors as it is serious matter and patients are suffering due
to it.
Case study 3
Introduction/overview
I am working as a facilitator in the hospital. I noticed that one of my student nurses coming to
work have been behaving in such a manner, which is not acceptable and she does not behave
as such during her normal presentation at workplace. It is essential duty of a student to learn
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as much as from the environment and opportunities they are provided with. However, the
students under the influence of drugs and alcohol lose their abilities to learn. I also noticed
that the student has been unable to follow the instructions and has not been concentrating on
work and is fidgeting continuously. I took her aside and asked about their strange behaviour
and if she has been on any drugs. The student accepted that she had some drugs the night
before and is still feeling the effects. She informed that she had taken drugs because she has
been deeply saddened due to the death of a family member. I agree that death of a family
member is a disheartening experience but, it does not provide anyone with a right to risk the
life of others.
Reflection
Being in a nursing profession, the student nurse should always be aware about their
responsibilities towards the healthcare setup and towards the patients (Fowler, 2016). In case
if they are unwell or not feeling mentally, physically or emotionally capable to work, they
should take a day off but should not keep the life of the patients at risk (Nursing and
Midwifery Board of Australia, 2016).
As per the ICN Code of Conduct for nurses, the nurses should maintain a standard of
personal health so that their ability to provide care could not be compromised. They should
take decisions regarding individual competence while accepting and delegating
responsibilities. It has also been stated in the provision 2 of the “Code of Ethics for Nurses
with Interpretative Statements” that the primary commitment of a nurse is to the patient.
Being in nursing profession, they have to experience conflict of interests in their life that
might arise between their personal and professional lives (ANA, 2015; Winland-Brown et al.,
2015). The nurses should always remember that their primary focus should only be their
patients and in case conflict creates stress for the moral integrity of the nurses, they can opt
for diligent objection with regard to their duties and obligations (Lachman, 2016).
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It is the duty of the facilitator to provide ethical knowledge to the student nurses and should
provide teaching and learning opportunities with regard to the ethical issues and decision-
making (Atabay et al., 2015). The student nurses must also be informed about the concepts of
professional ethics and ethical code of conduct. The student nurses must be taught about their
duties and responsibilities being in a nursing profession (State of Queensland, 2017). It is
essential for the facilitator to keep a watch on the student nurses if they are unable to perform
their duties effectively and should keep communicating with them to avoid any sever
incidences (Lachman, 2016). Furthermore, student nurses should be taught to strictly adhere
to the professional code of ethics and to follow their duties towards the patients.
Conclusion
Considering the case, it has been analyzed that the personal health of nurses is also
responsible for affecting the health and care of patients. If the student is not in a position to
deal with the patients, they cannot perform well and might put the life of the patients at risk.
So, it should be mandatory for the students to be aware about their mental, physical and
psychological condition before accepting duties. The facilitator should also guide the students
to perform their responsibilities effectively. The students should be advised to take off if they
are not feeling well like performing their duties effectively instead of bringing the life at risk.
References
ACSQHC, 2019. Australian Infection Prevention and Control Guidelines. [Online] Available
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infection-control-guidelines [Accessed 26 August 2019].
ANA, 2015. Code of ethics with interpretative statements. Silver Spring, MD:
Nursesbooks.org (Publishing Program of American Nurses Association).
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Anthony, D.L. & Stablein, T., 2016. Privacy in practice: professional discourse about
information control in health care. Journal of Health Organization and Management, 30(2),
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Atabay, G., Cangarli, B.G. & Penbeck, S., 2015. Impact of ethical climate on moral distress
revisited: Multidimensional view. Nursing Ethics, 22(1), pp.103-16.
Australian Nursing and Midwifery Journal (ANMJ), 2015. Leading nursing scholar
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https://www.amr.gov.au/what-you-can-do/hospitals/infection-prevention-and-control
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NSW Health, 2017. Infection Prevention and Control Policy. [Online] Available at:
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