LAW & ETHICS IN HEALTH CARE

The nurses violated the standards of practice for enrolled and registered nurses, resulting in suspension of their registration. The complaints committee plays a crucial role in identifying and evaluating any discrepancies or violations of the regulations and norms by health care professionals. Factors such as negligence, bullying, long working hours, lack of staff, poor education and training, financial constraints, and stressful working conditions can lead to violations of ethical and legal standards.

Running head: LAW & ETHICS IN HEALTH CARE
LAW & ETHICS IN HEALTH CARE
Name of the student
Name of the university
Author’s Note

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LAW & ETHICS IN HEALTH CARE
Case Study 1
1.
The concept of the ethics and the law play a very essential role towards the provision of
the guidance in the conduct and the behaviour of the individual who are working in the
system of the health care. As per the given case study the enrolled nurse of the
organization initiated the practise of the nursing or the health care activities going out of
her permitted scope of the practise. She has initiated to independently administer the
intravenous solution of glutathione for the individual at her home. She has violated the
regulations and the norms and the breach of the standard 1 of the standards of the
practises for the midwives and the nurses and the midwives with generic skills and the
core competencies for the enrolled nurses (Gower et al., 2017). Some of the factors of the
core competencies of the enrolled nurses includes their working under the profession
supervision of the registered nurses which this particular nurse has violated (Koshy et al.,
2017). Furthermore the enrolled nurse like this particular nurse are generally accountable
for all the aspects of the delegated are within their limited scope of the practises as their
educational preparation, their experiences and the standards of the practises for the
midwives and the nurses.
As per the case study as illustrated above the nurse has violated both the core
competencies and the generic skills as per the Singapore nursing board and the
regulations of the nursing and the midwives norms.
While the context of the are organised and divided in three of the major domains , some
of the actors that the nurse has violated can be summarized below.

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The professional, ethical and the legal nursing practices are one of the standards of the
competency for the enrolled nurse that includes the indictors of the competency which
the nurse has violated.
 Proper identification and the understanding of the legislative framework, the role
of the Singapore nursing boards and its functional regulatory like the code for the
nurses and the midwives for the Singapore nursing boards.
 Effective practice of the health care actions and the nursing in the accordance
with the national or the institutional legislations, the policies and the procedural
guidelines (Koshy et al., 2017).
 Maintaining of the clear and the legible documentation and the records within the
scope and the permits
 Recognition of the differences in the accountability and the responsibility of the
registered nurses and the enrolled nurses in the provision of care(Singapore
Government, 2012)
 Support, collaboration and the co-operation with the members of the team and the
other professionals of the health care before taking any of the actions towards any
patient
Another standard that the nurse has violated includes management of the care and the
related professional development that includes the responsibility of each and every enrolled
nurse to inform the seniors and the registered nurse before taking any of the action related toe
patient and their care and also the medicine and their dosage before taking any sort of action
Some of the generic skills of the enrolled nurses as per the Singapore nursing board that the
nurse has violated includes performance of the nurse under the supervision of the senior. This

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mean that the nurse should have perform the skills independently only under the supervision and
the deligation of a senior or a registered nurse either directly or indirectly. Further generic skills
that has been hampered includes the factor that the enrolled nurses should only perform any of
the skills related to the patients care or medical dosage only as the assistant to the registered
nurse (Gower et al., 2017). The nurse furthermore has violated the generic skills and the norms
of the enrolled nurses of the country by not taking any of the data or the information prior
injecting the intravenous solution. The nurse should have taken in accent of the temperature, the
respiration the blood pressure, the pain the pulse in the oximetry (Koshy et al., 2017). The nurse
should however take care of the safety and the comfort of the client together with the mobility
and the ambulation of the patient before the injection of the intravenous solution.
2.
The code for the midwives and the nurses generally sets out the professional level of the
conduct, the practising stands, and the ethical values that each and every nurses and the
midwives of the Singapore generally tend to act upon and uphold. There includes four of
the major regulatory and the ethical provision of the Singapore (Singapore Government,
2012). These are the nurses and the people, the nurses or the midwives and their
practices, the nurses or the midwives and their profession and the nurses or the midwives
and co-workers.
Some of the principles from the SNB code for nurses and the midwives that the nurse of
the given vase study breached includes the following.
Principle 5 – The practise in a responsible and accountable manner.
The enrolled nurse of the given case study should have responsible and accountable
enough for her judgments, decision and their actions. She must have ensure that the

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patient have received safe, effective and ethically appropriate care under the supervision
of a senior nurse.
Principle 6 – The maintaining of the competency in the care of the people
It is furthermore the responsibility of the enrolled nurse to evaluate her knowledge and
her skills as well as the effectiveness of the care that is provided by her. She should have
maintained her competencies through the continuous education, the improved quality
activities and the lifelong learning (Singapore Government, 2012).
Principle 7 – Maintenance of clear ad accurate records
The nurse should have ensured that all the records are complete, accurate and timely in
nature. She should have made some of the relevant entries as per the date, time within the
supervision of a registered nurse.
Principle 9 – Practise of the self-regulation
The nurse of the case study should have been responsible and accountable for the self,
and the professional maintenance of the competencies and also the continuous personal
and the professional growth. The nurse has violated this principle by not practising within
her own level of competencies and the scope of the practices (Singapore Government,
2012).
According to ANA (2015), the health and the wellbeing of each and every individual is
one of the first priority in the world. As per the United Nations declaration of the human
rights, each and every person has their rights to safe and wellbeing and the right of life. In
the study by Koshy et al. (2017) the author highlighted the fact how the nursing practise
and the limits of the enrolled nurses falls short in case of the emergencies. For this kind
of scenario its is thus important to take care of the emergency medical need of the patient

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than the professional limitation. The author furthermore stated how it is also essential to
take in account of the help and the supervision of the registered nurses in case of the
emergencies to avoid further mishaps sine the enrolled nurses have little authority of the
patient care and medical dosage. With reference from the national and the internal
literature it can thus be stated that the nurse who have violated the norms and the code of
the practise, has done this to ensure that the patient gets her requirements or needs (Wu et
al., 2015). She has adhere to the respect for the patient’s need, values and the rights with
the provision of the effective are that is determined by the value, the needs without any
kind of unfair or the prejudicial discrimination over the basis of the ethnicity, the gender ,
the religion , the age, the economic status and the attributes and the preferences (Stančić
et al., 2016). She has ensured to treat her patient with respect and for the sake of the
humanity she has ensured to fulfil the emergency need of the patient which required her
to inject the intravenous solution of Glutathione irrespective of knowing that being an
enrolled nurse she does not have the authority to take these actions or do any of the
practises without the permission or the supervision of the registered nurse.
3. The role of the complaints committees in the health care regime and also the nursing
practises includes the identification of any sort of violation of the regulations and the
norms by the health care professionals within the nursing and the health care practise
(Gower et al., 2017). The function of the complains committee is to develop the
principles and the norms related to the registered nursing professions and the enrolled
nursing practises and evaluate any sort of discrepancies and the complains regrading ant
of the misuse or ineffective health are practises done towards any patent of the registered
organization. The committee takes in consideration of the norms and the values of the

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registered nurses and the midwives for the effective evaluation of the proficiency and the
level of professionalism and the quality of the productivity of the health care professional
s and the nurses within the organization in Singapore.
Case Study 2
1.
The above vase study is the demonstration of the sheer irresponsibility and the lack of the
proper knowledge regarding the nursing practises within the health care practises. With
the respect to the new codes for the nurses and the midwives, the principles that this
registered nurse violated includes the principle 5 which is the practise in a responsible
and accountable manner, principle 6 that illustrate the maintenance of the competency in
the care of the people and principle 7 which states that the nurses should maintain clear
and accurate records of the patient. It is the responsibility of the nurse to ensure that the
patients are safe, effective and ethically appropriate in the care (Simmons et al., 2016).
This is because it is essential as per the code of the practise of the nurses and the
midwives that all the health care practises are carried out in the accordance with the
ethical principles, the policies of the institution and the requirements. Furthermore it is
also essential for the registered nurses to evaluate their knowledge and their skills for the
effective care of the patient (Koshy et al., 2017). The violation of the norms and the
principles that the registered nurse did by false charting the parameters of the patient
without analysisnga and ensuring them has resulted the nurse to violate he major factors
and the norms of the code for the nurses and the midwives.

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2. The registered nurse failed towards the provision of the effective care within an
accountable and responsible manner breaching the value statement 5 of the code of the
ethics and the professional conduct (Board, 2012). Her actions includes sheer
irresponsibility since she has been reported to have falsely charted the parameters and the
records related the patient without even entering the room of the patient. This action of
her has led her registration to get suspended for the period of 8 months. In this section
some of the possible reasons will be analysed regarding the actions that the nurse have
taken breaching the statement 5 of the code of the ethics and the professional conduct
with the context of some of the literary norms and actions (Simmons et al., 2016).
According to the joint Commission or Accreditation of the Health care organizations, one
of the major reason behind these kind of activity is sheer negligence. According to the
insight of Wu et al., (2015) negligence is the failure for using such care as the reasonably
prudent and the careful person for using under similar circumstances. The improper or
unethical conduct together with the unreasonable lack of the skills of the nurse has
resulted in these kind of actions. According to the research study by Effken et al., (2016) ,
one of the main factor that led the psychological hampering of the nurses resulting them
to be unfocused and distracted from their responsibility towards the patients is the
continuous bullying of the doctors. According to the research study on more than 10
hospitals, the nurses both the registered and the enrolled ones reported how they have
been the victim of the doctor bullying which is still veiled as the organization’s silence.
This is because many of the nurses tends to get afraid to report against the doctors since
they believe that the administrators of the health care organization will refuse to admit
their actions. The nurses in turn showcase their frustrations over the working pattern by

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neglecting their works. Furthermore factors such as long working hours, lack of proper
staffs and adequate helping hands are some of the major factors that led he nurses to go
fail towards fulfilling their responsibilities towards the patient. According to Ariyaratne
et al., (2015) the registered nurse of the case study as described might be facing several
issues within the nursing practises. These might include factors such as the low level of
prestige, poor perception of the public, the issues related to the finances, the heavy level
of the workload, the stressful conditions and the lack of the proper professional
gratifications which is furthermore coupled with the shortage of the nursing professionals
un the emergency wards. Besides these factors, poor level and the quality of the
education and the training of the professional nurses furthermore might play an important
role towards the reluctance and the irresponsible nature of the nurse. According to Gantz
et al. (2012) , the poor public perception of the profession of the nursing together with the
heavy rate of the financial constraints might also be one of the facto that has been
influencing the specific registered nurse towards doing her activity effectively.
Furthermore the lack of the professional gratification and the stress working conditions
might also led the nurse to violate the basic norms of the collection and the maintenance
of the accurate data for each and every patients of the ward.
3. It is the responsibility of the registered nurses to utilise the evidence based knowledge of
the nursing and the judgements related to the professional nursing for assessing the health
need, provision of the nursing care, the education of the clients and the supporting of
individual for the management of the holistic health practises. There are various domains
and indicators within the principles of the core competencies and the generic skills for the

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registered nurses (Board, 2012). These set of the minimum standards define the required
qualities, the skills and the abilities of the registered nurses for the practise in Singapore.
The four of the major competency domain of the registered nurses in the Singapore
includes the professional, legal and the ethical practise of nursing, the management of the
care, the leadership and the management of the nursing and the professional
development. Some of the domain or the standards of the competencies that the registered
nurse has violated or breached as per the given case stud includes the following.
 The effective undersigning of the legislative framework , the role of the
regulatory functions of the Singapore national board and the codes of the nurses
and the midwives.
 Maintenance of the legible and clear documentation and the records
 Demonstration of the accountability and the responsibility for he care within the
scope of the practises and the level of the competencies (Board, 2012)
 The management of care that includes the comprehensive performances and the
systematic client assessments
 Implementation and the documentation of the planning of the care of the nursing
in a timely manner
 Maintenance of the updated clinical or technical skills that are relate o the practise
of the nursing
 Initiatives and engagements in the dialogue and the new initiatives regarding the
change process in the healthcare and the nursing(Board, 2012)
 Taking effective steps for remedying of the deficits in the skills and the personal
knowledge of the nurses

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4. According to my personal insight I believe that it is important to take care of the patients
and maintain the accurate information related to the patents on a daily basis since these
are some of the essential data that the doctors require during the diagnosis of the patient.
If I would have working alongside this nurse and gradually would have discovered how
this nurse has been falsely charting the parameters without visiting the patient, I would
have taken some drastic steps. I would have let her understand the threat she is causing to
the patient’s health and the wellbeing by putting false parameters. I furthermore would
have helped her if she has been going through stress or psychological barriers by taking
the parameters of the patient by my own and rectifying the data sheet with the correct and
the accurate parameters. I furthermore would have reported this action to the floor
manager of the health care organization in case of repeated reluctance and violation of the
rule by the nurse.
5. There are many of the principles from the new SNB code for the nurses and the midwives
that will help me to act and make my decisions for acting in this situation (Gower et al.,
2017). This includes the principle 5- the practise in a responsible and the accountable
manner, to ensure that the practise of the nursing is being carried out in accordance with
the ethical principles, the institutional policies and the requirements. Furthermore I
should have considered the principle 6 which is the maintenance of the competency in the
care of the people. This principle includes the ensuring of the practises that best on the
prevailing clinical guideline practises and the obtaining of the honest motive towards the
practises of the nursing towards the needs and the values of the patient.

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References
ANA. (2015). Nursing Scope and Standards of Practice. Retrieved from
https://www.iupuc.edu/health-sciences/files/Nursing-ScopeStandards-3E.pdf
Ariyaratne, M. H. J. D., Gunasekara, T. D. C. P., Weerasekara, M. M., Kottahachchi, J.,
Kudavidanage, B. P., & Fernando, S. S. N. (2015). Knowledge, attitudes and practices of
hand hygiene among final year medical and nursing students at the University of Sri
Jayewardenepura.
Ayre, T. C., & Bee, T. S. (2014). Advanced practice nursing in Singapore.
Board, S. N. (2012). Core competencies of registered nurse.
Effken, J., Weaver, C., Cochran, K., Androwich, I., & O’brien, A. (2016). Toward a central
repository for sharing nursing informatics’ best practices. CIN: Computers, Informatics,
Nursing, 34(6), 245-246.
Gantz, N. R., Sherman, R., Jasper, M., Choo, C. G., HERRIN‐GRIFFITH, D. O. N. N. A., &
Harris, K. (2012). Global nurse leader perspectives on health systems and workforce
challenges. Journal of Nursing Management, 20(4), 433-443.
Gower, S., Duggan, R., Dantas, J. A., & Boldy, D. (2017). Something has shifted: Nursing
students’ global perspective following international clinical placements. Journal of
advanced nursing, 73(10), 2395-2406.

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Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. J. (2017). Reflective practice in
health care and how to reflect effectively. International journal of surgery.
Oncology, 2(6), e20.
Nevins, C. M., & Sherman, J. (2016). Self-care practices of baccalaureate nursing
students. Journal of Holistic Nursing, 34(2), 185-192.
Ning, T. J., & Costello, J. (2018). Implementing clinical nursing supervision in Singapore
hospitals. GSTF Journal of Nursing and Health Care (JNHC), 5(1).
O Brien, A. P., & Arthur, D. G. (2007). Singapore nursing in transition: Perspectives from the
Alice Lee Centre for Nursing Studies, National University of Singapore. Singapore
medical journal, 48(10), 875.
Simmons, S., Schnelle, J., Slagle, J., Sathe, N. A., Stevenson, D., Carlo, M., & McPheeters, M.
L. (2016). Resident safety practices in nursing home settings.
Singapore Government. (2012, July 31). Nurses and Midwives Act. Retrieved from
https://sso.agc.gov.sg/Act/NMA1999
Stančić, I., Petrović, M., Popovac, A., Vasović, M., & Despotović, N. (2016). Caregivers'
attitudes, knowledge and practices of oral care at nursing homes in
Serbia. Vojnosanitetski pregled, 73(7), 668-673.
Wu, X. V., Enskär, K., Lee, C. C. S., & Wang, W. (2015). A systematic review of clinical
assessment for undergraduate nursing students. Nurse Education Today, 35(2), 347-359.