Careers Australia HLTENN008 Practical Case Study: Nursing Ethics & Law

This case study, designed for nursing students, focuses on applying legal and ethical parameters to nursing practice, specifically within the context of the HLTENN008 unit. The scenario involves two patients undergoing surgery, presenting ethical dilemmas related to patient safety, consent, and adh...Read More

STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
Student Name: Student ID:
Group: Date:
Type of Assessment
This summative assessment will enable your Assessor to make a judgement of competency based on
the submission of your completed assignments against the requirements of this unit of competency.
Assessor Instructions
The Assessment Benchmark developed for each unit of competency is the evidence criteria used to
judge the quality of performance (i.e. the assessment decision-making rules). Assessors must use these
benchmarks to make a judgement on whether competency has been achieved and to determine if the
participant has performed to the standard expected to meet the unit requirement and learning outcomes.
Competency results for each unit are recorded in the Record of Assessment Form.
Reasonable Adjustment
Careers Australia will allow flexibility in relation to the way in which each unit is delivered and
assessed based on the student’s requirement. The following are the reasonable adjustments for this unit:
Trainer/Assessor must select which of the following is suitable for this unit and DELETE
rows that are not applicable
Reasonable Adjustment for this unit C
ollege
Based
O
n-Line
Delivery
The assistance of a Learning Support Teacher for LLN issues 1 1
Modifications to physical environment, e.g. Wheelchair access 1 1
Changes to course design, e.g. Instead of written assessment task –
change to verbal questioning & assessor to write the answers 1 1
Changes in lecture schedules and arrangements, e.g. Relocating
classes to an accessible venue 1 1
Modifications to computer equipment in the computer lab 1 1
Provision of information or course materials in accessible format, e.g.
A textbook in braille 1 1
Supply of specialised equipment or services, e.g. A note taker for a
student who cannot write 1 1
Assessment Coding
Assessment of this program of study is based on competency-based principles.
S = Satisfactory
NS = Not Satisfactory
Students who fail to perform satisfactorily for the assessment in the prescribed date may be
assessed as ‘not satisfactory’. You are required to be assessed as ‘Satisfactory’ on completion of
Assessments assigned by your assessor for this unit of competency.
Re-assessment
Any re-assessment is conducted as soon as practicable after you have been informed of the
requirement to be re-assessed and have been given the opportunity to be re-trained and assimilate the
training. You are re-assessed in only the areas assessed NS. It is at the assessor/s discretion to re-assess the
entire assessment should it be demonstrated an overall understanding of this unit has not been achieved.
Students that are assessed ‘satisfactory’ after re-assessment of areas deemed NS will achieve competency for
this assignment.
I acknowledge the assessment process has been explained and agree to undertake the assessment. I am aware of Careers Australia’s
appeals process, should the need arise. I also understand that I must be assessed as ‘satisfactory’ in all parts of the assessment to gain a
competent result for this unit of competency.I declare that the work contained in this assessment is my own, except where acknowledgment of
sources is made. I understand that a person found responsible for academic misconduct will be subject to disciplinary action (refer to student
handbook).
Student Signature:
__________________________
Date:
______
Assessor use only
Assessor Comment/Feedback:
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
Assessor Name: _________________________ Assessor Signature:
_____________________________
Date: _________________ Result: Satisfactory/Not Satisfactory
Office use only:
R
esults
entered
by:
D
a
t
e
:
S
kill
s
Ce
ntr
e:
ASSESSMENT: Practical – Case Study
S/NS result given. All criteria must be answered correctly to attain a satisfactory result.
STUDENT INSTRUCTION:
This case study is based upon one (1) scenario and fifteen (15) associated questions. Please
read the scenario carefully and answer ALL of the questions. Word counts are provided as a guide
only.
Case Study
15 Questions
All must be answered correctly to attain a
satisfactory result
Reference texts:
Clarke, L, Gray, S, White, L, Duncan, G & Baumle, W 2016, Foundations of Nursing –
Enrolled/Division 2 Nurses, Cengage Learning, Victoria.
Nursing and Midwifery Board of Australia 2016, Professional codes and guidelines, viewed 5
January, 2016, <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements.aspx/>
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
Scenario
On 15th April 2015, EN Rose Baxter is working on the day surgical ward alongside RN Simone
Jones. EN Baxter has been allocated the following two clients, both of whom are booked for surgery
today.
Client 1.
Mr John Smith DOB 6/9/1945
Mr Smith is a diabetic - type 1, fasting from midnight for surgery at 0800 for removal of skin
lesions. As Mr Smith is diabetic, his treating doctor has ordered an antibiotic (intra venous Cephalexin
500mg), to be delivered during his surgery as a prophylactic. (He has an increased risk of wound
infection associated with his diabetes).
Client 2.
Mr John Smythe DOB 6/9/1945
Mr Smythe has been fasting from 0200 for surgery to remove polyps from his bowel.
Culturally, Mr Smythe is a practicing Buddhist and has requested no narcotic analgesia, preferring to
meditate to relieve any pain. Mr Smythe is partially deaf and with poor hearing, unless he has his
hearing aids in place. He has a medication alert on his chart as he has an allergy to Cephalexin. When
EN Baxter admits him, she notes this in his chart and she places an allergy alert band on Mr Smythe’s
wrist.
Actions
Neither of the clients has been flagged during the admission process as having similar names
and identical dates of birth. EN Baxter reports this to RN Jones and places an alert band on each client
and an alert notation in their medical record, to notify all staff.
At 0800 Mr Smith is called for theatre and EN Baxter checks his blood glucose level (BGL) before
his transfer to theatre. As she approaches him with the BGL kit Mr Smith holds out his hand ready for
the finger prick test for his BGL. EN Baxter hands over his diabetic status and BGL to theatre staff.
At 0810, the theatre staff called for Mr Smythe to come down to theatre. The doctor handed
EN Baxter a pathology slip for skin lesions, and a medication order to start an IV antibiotic,
Cephalexin. When EN Baxter looks at the documentation she was given, she notices it has Mr Smith’s
details on the pathology request and on the Medication order, and that it is incorrect for Mr Smythe
to have this order.
Answer the following questions:
1. As an enrolled nurse, your practice is guided by legislation. The Standards for Practice: Enrolled
nurses, are an element of the legislation. Identify what these standards are used for, generally. (50
words or less)
The standards are used to develop the nursing curricula through the education providers, to
assess students, nurses that are educated overseas and nurses that are returning to their work after
breaks. In addition, the standards could be used by the NMBA or other relevant tribunals to assess
professional conduct1.
1 Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
2. Explain the duty of care the enrolled nurse had in caring for Mr Smith and Mr Smythe, taking into
account if there was a breach, or a potential breach of duty of care during this scenario. Use any
actions or evidence from the scenario to discuss the answer. (100 words or less)
The enrolled nurse has fulfilled her duty in an effective manner. She has provided proper
attention to the each patient. She has noticed the allergy of MR. Smyth in his medical chart and
placed alert band on his wrist. Due to similarity in the name and date of birth of the patients she has
reported to the registered nurse and other staffs. Even she has identified the mistakes of theatre
staffs when Mr. Smyth was called in the theatre instead of Mr. Smith. Thus, it can be said that the
enrolled nurse has fulfilled her duty of care in an effective manner.
3. In regard to Mr Smith having his BGL taken before transfer to theatre, briefly explain how he
consented to the BGL procedure and what type of consent does this represent.
Mr. Smith was called for the theatre and the enrolled nurse Baxter has checked his blood
glucose level before transferring him to the theatre for surgery. When the enrolled nurse has
approached Mr. Smith for BGL he has held his hand for the finger prick test and has shown his
consent regarding the BGL process. Such consent is represents the implied consent in which
patient’s action indicates their wish regarding the treatment process2.
4. Conduct Statement 1, from the Code of Professional Conduct for Nurses states;
“Nurses practice in a safe and competent manner.”
Identify how the enrolled nurse applied Conduct statement 1 in the scenario.
It is important to apply safe and competent manner in the nursing practice3. In the case
study the enrolled nurse has maintained the safety fact in an effective manner. She has placed an
alert band for Mr. Smyth after identifying his allergy to Cephalexin. Such action has helped her to
ensure patient safety. She has reported the registered nurse regarding the similarity of name and
identical date of birth of the patients. She has placed alert band on each patient and provided an
alert notation on their medical record in order to notify other staffs. Such effort has helped her to
identify wrong patient in the theatre and save the patient from incorrect treatment that could lead
to severe harm.
2 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
3 Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
5. Explain what EN Baxter should do when she realises the pathology slip and medication order is for
the wrong client, including who must be notified of this error.
(100 words or less)
After the recognizing that the pathology slip and medication is for wrong patient the
enrolled nurse should inform the doctor in the theatre to stop the treatment. She should cross check
the patient in order to confirm that the theatre staffs have called wrong patient for surgery. She
should inform the doctor about the Cephalexin allergy of Mr. Smyth in order to save the patient
from severe harm. In addition she should inform the higher authority regrading the error of theatre
staffs even after placing alert band on the patients4.
6. Identify if the enrolled nurse was working within her scope of practice during this scenario. Explain
how you came to this conclusion, based on the enrolled nurse’s actions. (100 words or less)
Remember the scope of practice for an enrolled nurse includes:
 Implementing planned nursing care to achieve identified outcomes
 Recognising and reporting changes in the health and functional status of individuals/ groups
to the registered nurse
 Ensuring communication, reporting and documentation are timely and accurate
 Organising work load to facilitate planned nursing care for groups and individuals
The enrolled nurse has implemented the care plan and properly conducted the BGL test for
Mr. Smith with the consent of the patient. She has effectively recognized the health condition of Mr.
Smyth and placed alert band for the cephalexin allergy. She has provided effort to communicate and
placed alert notification on the patient’s report to inform other staffs regarding the similar name and
identical date of birth of the patients. Such effort has helped her to organize workload and facilitate
the care plan effectively. Hence, from the above activity of the enrolled nurse it can be concluded
that the enrolled nurse has successfully worked within her scope of practice.
7. The Standards for Practice: Enrolled nurses, Standard 1, states;
“Functions in accordance with the law, policies and procedure affecting EN practice”
Identify how the enrolled nurse applied the Standards for Practice: Enrolled nurses, standard 1 in the
scenario.
The enrolled nurse has fulfilled her duty of care in an effective manner. She has provided
care to the patients according to the care plan, work policy, professional standard and guidelines of
the procedure. She has effectively identified her responsibilities and collaborated with the registered
nurse and other staffs of the organization by providing adequate information and inform them about
the similarity of the name and identical date of births of the patients. She has worked within her
scope of practice and did not cross her limits; rather she has taken help from the registered nurse.
When unsafe practice has occurred in the theatre she has reported the registered nurse regarding
4 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
the wrong patient. In this way the enrolled nurse has applied standard 1 of standards of practice in
the scenario5.
8. From the Code of Ethics for Nurses in Australia, Value Statement 6 states;
“Nurses value a culture of safety in nursing and health care”
In addition to the information given in the scenario, you are also aware that recovery staff in the
healthcare facility are known for regularly ensuring their clients receive their maximum allowances
of narcotic analgesia. As a result many clients return to the wards heavily sedated.
Identify how the enrolled nurse can apply Value Statement 6 in the scenario. In your
response, include reference to Mr Smythe’s cultural beliefs about analgesia. (100
words or less)
Mr. Smyth was admitted for the surgery of polyps, thus he had to take narcotic analgesia to
reduce his pain. He has requested for avoiding narcotic analgesia as he practiced Buddhism in which
pain is regarded as the spiritual growth and requested for mediation to manage his pain. However, it
is not that effective for him due to his age, thus the enrolled nurse should provide him adequate
information regarding the importance of narcotic analgesic for faster recovery and reduce the risk of
adverse event and get his consent regarding the use of narcotic analgesia6. In this way she could
apply value statement 6 to maintain culture of safety.
9. Within the scope of practice of the enrolled nurse, outline an example of the actions and strategies
that would be implemented when handing over Mr Smythe to the theatre staff. These actions
should advocate for his needs and rights to be upheld when in theatre, in order to address any
ethical issues. (100 words or less)
While handing over Mr. Smyth to the theatre staff the patient would be informed about his
surgery so that he could provide his consent. The staffs would call the enrolled nurse that has
documented the patient’s condition to avoid misunderstanding regarding the patient. They would
transfer the patient to the theatre after the confirmation of the enrolled nurse. The theatre staff
would check the presence of any alert band or notification regarding the patient provided by the
enrolled nurse to avoid any mistake. Such actions could help the enrolled nurse and other staffs to
ensure patient’s need, right and safety, thus help to avoid ethical issues in the nursing practice7.
10. As the error/s of pathology and medication were intercepted before the clients were in theatre,
discuss the benefits or harm of practicing open disclosure in this instance, taking into account if Mr
5 Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
6 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
7Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
Smythe would benefit from knowing the near-miss mistake and if discussing the near-miss error with
Mr Smythe falls within your scope of practice. (150 words or less)
In the particular case open disclosure practice could provide benefits to the patient.
Discussing about the illness, medication, treatment process and importance of such process
could help the patient to identify his problem and benefits from the treatment, thus he could
provide his consent without any hesitation. In case of Mr. Smyth, if the doctor would informed
the patient regarding the medication such as injecting Cephalexin and the patient could revert
regarding his allergy to Cephalexin. It could help to identify the mistake related to call wrong
patient in the theatre. Thus, it can be said that practicing open disclosure could have been
beneficial for Mr. Smyth. Such practice falls under the scope if practice of enrolled nurse, thus it
could be used to reduce the risk of error in the treatment and ensure patient safety in an
effective manner8.
11. Nurses work in environments where several events can happen at once. In the scenario, discuss how
the enrolled nurse demonstrates that she can complete her usual tasks whilst managing a
circumstance which could not have been predicted. (100 words or less)
During nursing practice several unpredicted incidents could be happen. Thus, it is important
for enrolled nurses to demonstrate their practice in a way so that they could manage such incidents
in an effective manner. In this regards the enrolled nurse needs to prepare a time table for manage
her usual task and they should include extra time in the time table to manage unpredicted incidents.
Effective scheduling of tasks would help her to complete usual tasks within the expected time and
she could utilize the extra time for managing unpredicted situations.
12. Nurses are required to demonstrate ethical practice in all their interactions with clients, and their
families. In the above scenario, consider the example of Mr Smythe’s wife arriving at the end of the
day to take him home and asking if everything went well.
Discuss if you would be required to alert her to the near-miss (regarding medication orders),
or reassure her that everything went well. In your discussion, take into account the ethical principles
of autonomy, confidentiality and veracity and that there was no actual error or harm.
(200 words or less)
It is the duty of the enrolled nurse to inform the patient’s family about the health condition
and treatment procedure of the patient9. Thus, it is important to inform about the near-miss
8 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
9 Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
mistakes in the treatment of Mr. Smyth to his wife. According to the ethical principle of autonomy it
is the right of the patient and his family to know about the errors in the treatment process. The
enrolled nurse should inform Mrs. Smyth that they have recognized their mistake before the
treatment process have started, thus no harm has occurred to Mr. Smyth. In addition the enrolled
nurse should apologise for the mistake as it could cause serious harm to the patient. The enrolled
nurse should inform the wife of Mr. Smyth regarding the incident in order to maintain the
confidentiality. The nursing code of ethics indicated that it is important to maintain veracity in the
activity of enrolled nurse. If the nurse fails to maintain such rules and regulations it could be
consider as the breach of ethical codes, thus ethical issues could occur and legal steps could be
taken by Mrs. Smyth for such unethical action10.
13. Regarding the recording of incidents as given in the case study, identify at least five (5) aspects of
nursing documentation that ensure legislative requirements are met.
Five aspects of nursing documentation include-
Admission assessment: It is a compulsory assessment in nursing to document the patient history,
general information, vital signs and physical examination during the time of admission.
ISBAR: It is framework to document clinical communication. The documentation criteria include
identify, situation, background, assessment and recommendation. It helps to communicate and
cooperate effectively and avoid miscommunication in the clinical practice.
Real time progress notes: It includes the written documentation of timely manner during shift.
Shift assessment: It is the concise assessment conducted during the commencement of each shift or
during the change of patient’s condition during the shift.
End of shift progress: It is the written documentation that includes summary of the patient history
at the end of the shift11.
Such documentation aspects help to keep record of patient’s condition and ensure that all legal
requirements are met, thus helps to avoid ethical or legal issues in the nursing practice.
10 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
11 Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
14. Document the incident regarding Mr Smythe on a clinical incident form (provided below). Include all
of the issues that have led to the error, and your actions.
CLINICAL INCIDENT REPORT
Client Name: Mr. John Smyth, DOB: 6/9/1945
Inci
dent
type(Circle
appropriat
e type)
Actual Potential
Dat
e
15t
h April,
2015
Ti
me
02.
00
Loc
ation
Au
stralia
Des
cription
The patient has been admitted for the surgery to remove polyps from
bowls. He has been fasting from 02.00. He is partially deaf and unable to hear
without hearing aids. He has allergy to Cephalexin.
Re
ported to:
Registered nurse Simon Jones
Sig
nature and
role:
Rose Baxter (Enrolled Nurse)
15. Reflect on the legal and ethical concerns discussed in this scenario, taking into account that you are
working in a busy health facility as an enrolled nurse. Discuss how you would identify and monitor
your own actions and abilities to maintain your compliance with your professional responsibilities.
(50 words or less)
The main ethical concern is regarding sending the wrong patient to the theatre. The patients
were needed to be flagged during admission to avoid such ethical issues. As an enrolled nurse I
would like to document each detail about my patient and activities to monitor them effectively. I
would like to include reflective practice to identify my mistakes, improve my skills and introduce
interventions to avoid mistakes in future.
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STUDENT
Practical– Case Study
HLTENN008 Apply legal and ethical parameters to nursing practice
References:
Clarke, L et al, Foundations Of Nursing – Enrolled/Division 2 Nurses (Cengage Learning, 1st ed, 2016)
Nursing And Midwifery Board Of Australia - Professional Codes & Guidelines (2018)
Nursingmidwiferyboard.gov.au <http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements.aspx>
END OF CASE STUDY
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