This report discusses the importance of informed consent in nursing practice and reflects on a case study involving a breach of consent. It explores the cultural sensitivity required in providing care and the legal implications of obtaining consent.
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Running head: NURSING ASSIGNMENT NURSING ASSIGNMENT Name of the Student Name of the university Author’s note
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1NURSING ASSIGNMENT Introduction Informed consent provides autonomy to the patient for a shared decision making. It helps in preserving the rights of the patient and is an important element of shared decision making. This report will reflect upon my actions that I would take in order to prevent the occurrence of such cases in my future nursing practice. I will use Gibb’s model of reflection to reflect on my actions to prevent the occurrence of the incidents. Gibb’s Reflection Description This report is based upon a case study where Michael is a registered nurse working at the health care facility. Michael was working when an intimate examination of the patient was needed. The patient had been an aboriginal woman. Although Michael examined why the examination has been done but did not ask for a consent before the examination has been taken place. However, the women was uncomfortable with Michael doing the examination. The women being helpless complained to the facility manager about Michael doing the examination and that he has not taken any consent from the patient. Feelings I have always believed that cultural sensitivity in our profession is important as we come across several ethnic minorities, while caring for the, who have entirely different beliefs and different cultures. Modes of communications works differ with new patients, with diversified cultural background (Lamson, 2013). I was well aware of the fact that consent from the patient can be given as verbally as well as non –verbally (Vučemil et al. 2017). Hence, at first , I would
2NURSING ASSIGNMENT have greeted the patient, would try to develop a rapport of trust, so that it become easier to describe about the procedure and would asked her permission before touching her. Had the person being unable to give consent, the same would have been got from a family member or if language was the barrier, I would have used an interpreter to convey the permission to the patient. If the nurse is male, then the procedure could have been done in front of a female nurse (Fitzpatrick et al., 2016). Gender matching could have been ensure, respecting the decision of the patient at the first place.A competent nurse should be carefully while checking some the previous studies and would then stick to the school and the activities (Vučemil et al., 2017). I was well aware of the fact that aboriginal people follow some specific gestures of communication that might not be accepted in other cultures. In such situations, especially while dealing aboriginal patients the one has to be very careful in choosing the words and the gestures, such that they don’t hurt their dignity and respect (Bar-Zeev et al., 2016). At first I would have accompanied a female nurse while the follow up. Then I would have taken either a verbal consent or a non –verbal consent positively from the concerned children. Evaluation While I was thinking about this patient and was reflecting on my own perception, the first thing that came to my mind is that the patient belonged to an aboriginal back ground Reflecting on one of course modules, that dealt with cultural safety, I was surprised to find that the aboriginals are likely to get physically or sexually abused, 5 times higher than that of the non- aboriginal counter parts. Cultural safety concept can be defined as the empowerment of the patient and the health practitioner that ensured the acceptance of all the cultures and care. Effective communication has been referred to as the third most important element of a culturally safe care (Taylor,Nicolle &Maguire, 2013). The way, the aboriginal communicates can be
3NURSING ASSIGNMENT different from that of their non-aboriginal counterparts (Bar-Zeev et al., 2016). Some of the traits involves less eye contact. The person might take some more time to compose himself and take health care decisions. The person might not trust the westernized modes of treatments owing to its association with the racism and discrimination, this ethnic minority has been facing since time immemorial. Again aboriginal women might feel uncomfortable to engage in conversation with a health care professional of opposite gender. Hence, I believe, that my viewpoint has been correct about this patient. According to the NMBA codes of conduct, the nurses should advocate people’s right to be fully involved in decision about the care. It is necessary to provide adequate information to enable them to refuse their treatment. Also the NMBA codes states that it is necessary to respect and support the right of the patient. If a patient feels that the information provided to him or her is not sufficient, then he/she can refuse their treatment. A patient can lodge complaint to the NMBA in order to complain or to take the legal actions (Lamson, 2013). Surprisingly, the majority of the legal actions are on the basis of the allegation of negligence because the nurses should ensure the share information in a way by which they can understand and wanted to know about their health. It is the fundamental rule to seek consent from the patient before any treatment (Vučemil et al.,2017). As I have already stated earlier, that patient might give consent in any ways. On the other hand patients will also have the right to refuse for any treatment. The health care is becoming complex day by day and the clients are likely to pay to receive health care service, hence they are in the vulnerable side to receive any harm. There had been many instances where patients had been exploited by the health care workers. A written consent form is sometimes important, as it acts as a legal document, during the conduction of a legal lawsuit.
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4NURSING ASSIGNMENT Analysis According to the nursing codes of conduct there are three professional responsibilities that ensured that the patients understands their rights for making the informed consent. Nurses are accountable to maintain a crystal clear accountability and the can even record any kinds of medical decisions, while obtaining the consent. For example, after the doctor had discussed with the patient, the patient can be asked some open ended question for ascertain their understanding. If the nurses finds things unanswered or thinks that the patient was having any sort of misconception, it is the responsibility of the nurse to alert the doctors to prior to them. A competent patient on the other hand should not be treated without a clear consent. According to Taylor, Nicolle & Maguire, (2013) patient autonomy is important in the field of medical science, but is challenging to the professional medical ethics. Individual patients would have a freedom of choice to decide on their life including the medical matters.Since the introduction ofThe Principles of Biomedical Ethicsin 1977 by Beauchamp and Childress, autonomy has been widely accepted as one of the four principles of ethics - beneficence, non-maleficence and justice. In spite of all these we find medical paternalism embedded in this profession (Murgic et al., 2016). I has already been mentioned that aboriginal women often might feel uncomfortable to consult with a male doctor, especially while exchanging birthing examination or while assessing the intimate parts, like a vaginal examination. In such cases, the hospital organization should arrange for a doctor or a health care professional of the same gender. Conclusion In conclusion, it can be said that it is the responsibility of the nurses to provide a culturally appropriate and safe care to the patient. I believe that Michael would have avoided this
5NURSING ASSIGNMENT consequences by seeking permission from the patient or the family. Informed consent is one of the prime step towards the provision of autonomy to a patient, to refuse or initiate a treatment as per the will of the patient. Informed consent also might act as legal evidences against any kinds of medical lawsuits. Informed consent is one of the important step of nursing ethics and breaching of the codes might bring a criminal law prosecution against a doctor or a nurse. Failure to obtain consent might amount to the crime of negligence against a common law offence. Action plan Informed consent is essential in the health care sector. It is essential that all the health care professionals understand the importance and the effectiveness of informed consent. It not only preserves the right of the patient but also have some legal implications. Clarity of the information required to make everything transparent. Guidance to informed consent has been clearly mentioned in the practice standards of the registered nurses (Taylor, Nicolle & Maguire, 2013). In future, I intend to brush up my knowledge regarding all the legal and the ethical guidelines of nursing. I would remain calm and content while examining a patient and would certainly check whether all the procedures had been done. It should be remembered that seeking consent increases the patient’s power to make an informed choice regarding their critical health.
6NURSING ASSIGNMENT References Bar-Zeev, S., Barclay, L., Kruske, S., & Kildea, S. (2014). Factors affecting the quality of antenatalcareprovidedtoremotedwellingAboriginalwomeninnorthern Australia.Midwifery,30(3), 289-296. Castellano, M. B. (2014). Ethics of Aboriginal research.Global bioethics and human rights: Contemporary issues,273. Fitzpatrick, E. F., Martiniuk, A. L., D’Antoine, H., Oscar, J., Carter, M., & Elliott, E. J. (2016). Seeking consent for research with indigenous communities: a systematic review.BMC medical ethics,17(1), 65. Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.BMC medical ethics, 16(1), 65. doi:10.1186/s12910-015-0059-z Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.BMC medical ethics,16(1), 65. Tam, N. T., Huy, N. T., Thoa, L. T. B., Long, N. P., Trang, N. T. H., Hirayama, K., & Karbwang, J. (2015). Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis.Bulletin of the World Health Organization,93, 186-198H. Hodgson, J., Mendenhall, T., & Lamson, A. (2013). Patient
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7NURSING ASSIGNMENT and provider relationships: Consent, confidentiality, and managing mistakes in integrated primary care settings.Families, Systems, & Health,31(1), 28. Taylor, S. P., Nicolle, C., & Maguire, M. (2013). Cross-cultural communication barriers in health care.Nursing Standard (Through 2013),27(31), 35. Vučemilo, L., Babić-Bosanac, S., Altarac, S., & Borovečki, A. (2014). Informed consent with specialemphasisonCroatia.Liječničkivjesnik:glasiloHrvatskogaliječničkog zbora,136(3-4), 104-109.