Negotiating with Patients and Families

The assignment explores a nursing case study involving Mr. HD and his family where language barriers pose a challenge. It delves into NMBA Standard 2, 'Therapeutic Relationship,' emphasizing its importance in patient care. The analysis highlights the nurse's efforts to establish trust, respect cultural differences, and communicate effectively despite the language barrier. The reflection section outlines personal learning experiences and areas for improvement in future interactions.

Running head: LEGAL AND PROFESSIONAL ISSUES
Legal and professional issues
Name of the student
University name
Author’s note

1LEGAL AND PROFESSIONAL ISSUES
Introduction
The current study focuses on the aspect of the application of nursing and midwifery board
standards (Australia) in providing optimum care and support to patients within an acute hospital
care set up. The goal of the nursing standards is to establish a person-centred and evidence-
based care approaches. The analysis for the present scenario is done on the basis of the tanner’s
model. The tanner’s model provides a comprehensive clinical judgment.
I have used the tanner’s approach to evaluate the legal and professional boundaries
applicable within the context of nursing studies. Here, I have tried to use various parameters of
the model for handling my care duties as a nursing professional.
Background of the case study
In one of my recent professional experience, I have come across a 72 years old patient
named Mr HD who had to be undergone surgery on the same day of admission to the hospital.
The man was admitted to the hospital owing to pain due to appendicitis. However, one of the
issues encountered by me while attending the patient was that the ‘no objection' consent form
was not signed by the patient. I tried reciprocating the same to the patient, only to realise that he
was a German speaking man and could not decipher my message. Thus, I had to take the help of
a language interpreter for understanding the messages communicated to me by Mr HD. Cultural
and language differences possesses a major hindrance in the obtainment of objectives of health
and care (Birks et al., 2016).

2LEGAL AND PROFESSIONAL ISSUES
Noticing
From my initial assessment of the situation, I realized that the man had great difficulty in
comprehending any of the instruction or messages delivered to him within the care centre. This
could be attributed to the language or cultural differences possessed by the man. In this respect,
as a nursing professional catering to the health requirements of Mr HD, I need to make sure that
he understands every bit of the procedure that he is going through.
In the course of spending more time with the patient, I realized that Mr HD lives in the
Hesse region of Germany with his family, which consisted of his wife and a 24 years old son.
Mr Hesse worked in a local bakery and his son worked in a construction factory and had only
relocated to Australia two years ago. However, language illiteracy can come across one of the
biggest hindrances in the context of healthcare (Ossenberg, Henderson, & Dalton, 2015).
Interpreting
Working as a nursing professional looking after the care concerns of Mr HD and family I
had identified the possible factors which resulted in the deterioration of the patient health
condition. In this context, Mr HD and family held on to a number of cultural beliefs and
attributes, which formed the basis of their cultural paradoxes. As per the cultural beliefs of Mr
HD, health issues could be treated with simple homely therapies and thus ignored the pain in his
lower abdomen. As commented by Gill et al., (2017), sufficient health advocacy or health
education can help in removing the wrong health beliefs and cultural paradoxes from the minds
of people.
In my practice, I encountered a similar situation in the past, where I had to take charge of
an 85-year-old lady of Australian aboriginal context. The woman had been admitted to the

3LEGAL AND PROFESSIONAL ISSUES
hospital at the terminal stage of breast cancer and was unwilling to receive chemotherapy stating
that the intention of the almighty needs to translate. Thus, I had difficulty in convincing her for
treatment owing to her strict and firm spiritual beliefs. However, I received sufficient
participation from her family who could otherwise identify with the requirements of the
situation.
Here, with respect to providing care and support to Mr HD, I found that he does not remember
half of the conversations that transpired between him and the doctor. Therefore, I organised a
meeting between the doctor and the patient and his respective family. The conversation was
further supported by an interpreter and made sure that I record all the relevant conversation
between the doctor and the patient. The recorded helped in completing the consent form of the
surgery (Nielsen, Lasater, & Stock, 2016).
Responding
In this context, for providing Mr HD with optimum care and support I could apply a
number of nursing principles and standards. Through the application of the Nursing and
Midwifery standards (NMBA), I could ensure that the patient or his immediate family are given
sufficient autonomy to provide their consent for the surgery. It would be my goal to ensure that
complete details are provided to the patient as per the policies of informed decision making
regarding the surgeries and other measures. I had used the standard 1 of NMBA ethics and
guidelines and analysing the present situation.
One of the major hindrances I have faced over here includes the cross-cultural and
language barriers which prevented me in fully comprehending the present situation of the patient.
Here, the use of situation, background, assessment and recommendation (SBAR) tool was used

4LEGAL AND PROFESSIONAL ISSUES
by me, which is a communication tool and helps in understanding the complications associated
with the patients through an empathetic and situational analysis.
Criteria for standard 1 of NMBA
The standard 1 promulgates the use of evidence-based frameworks in accessing and
understanding the current situation of the patient. The standard 1 helps in complying with
the policies, legislation and guidelines. Apart from the establishment of evidence-based
frameworks, the method also helps in improvement of the quality of relevant research
(Herinckx et al., 2014).
Reflection in action
In this context, the patient and his respective family were apprehensive about the
consequences of the surgery and the financial burdens brought about by the same. In this
respect, I had undertaken the therapeutic relationship approaches for negotiating with the patient
and his respective families (standard 2, NMBA).
Criteria for standard 2
The therapeutic relationship helps in differentiating between the personal and
professional boundaries. It also helps in respecting culture, values and dignity of a person.
The implementations of standard 2 helps in providing support and direct patients to
resources for optimising health-related decisions (Lasater et al., 2015).
Reflection on action and clinical learning
As a nursing professional, I have developed my skills in a number of different areas of
healthcare which helped me enhance my expertise in caring for a vulnerable lot of people. Thus,

5LEGAL AND PROFESSIONAL ISSUES
I had gained experience in the areas of effective communication, care framework development
and developed and empathetic approach to patient care. However, in case of facing a similar
situation again, I think the present experiences would help me in framing effective evaluative
frameworks for analysing the present situation.
I think one of the major challenges that I have faced over here is understanding the
language used by Mr HD and his family, as they communicated only in German. Thus, I think
learning the skill of using effective and friendly body language and hand gestures for
communicating with the patients would help me in the future. However, from my present
experiences, I have learned to become more patient and empathetic towards patients seeking
support care. It has enabled me to develop the skills of therapeutic relationship further.
Figure 1: Tanner’s clinical judgment model
(Source: Kim, 2014)

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References
Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in
Australia: an integrative review of the literature. Contemporary nurse, 52(5), 522-543.
Gill, F. J., Kendrick, T., Davies, H., & Greenwood, M. (2017). A two phase study to revise the
Australian Practice Standards for Specialist Critical Care Nurses. Australian Critical
Care, 30(3), 173-181.
Herinckx, H., Munkvold, J. P., Winter, E., & Tanner, C. A. (2014). A measure to evaluate
classroom teaching practices in nursing. Nursing education perspectives, 35(1), 30-36.
Kim, E. J. (2014). Nursing Students' Clinical Judgment Skills in Simulation: Using Tanner's
Clinical Judgment Model. Journal of Korean Academic Society of Nursing Education,
20(2), 212-222.
Lasater, K., Nielsen, A. E., Stock, M., & Ostrogorsky, T. L. (2015). Evaluating the clinical
judgment of newly hired staff nurses. The Journal of Continuing Education in Nursing,
46(12), 563-571.
Nielsen, A., Lasater, K., & Stock, M. (2016). A framework to support preceptors’ evaluation and
development of new nurses’ clinical judgment. Nurse education in practice, 19, 84-90.
Ossenberg, C., Dalton, M., & Henderson, A. (2016). Validation of the Australian nursing
standards assessment tool (ANSAT): a pilot study. Nurse education today, 36, 23-30.
Ossenberg, C., Henderson, A., & Dalton, M. (2015). Determining attainment of nursing
standards: The use of behavioural cues to enhance clarity and transparency in student
clinical assessment. Nurse education today, 35(1), 12-15.

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