• Subject Name : Nursing

The Metaethics of Nursing Codes of Ethics and Conduct

Introduction to Professional Errors in Nursing

According to Ducharme et al. (2017), in the workplace of a nurse, in some cases, few professional errors or issues arise due to unethical and misconduct of the professional nursing practice standards. Few elements lead to professional malfunction or negligence, these include the following elements: injury or harm, breach of duty, unprofessional actions, unethical acts, ineffective communication, and a few others. A nurse is always required to maintain the ethical principles of autonomy, beneficence, non-maleficence, and justice (Cusack et al., 2017). The professional nursing practice standards of National Safety and Quality Health Service Standards (NSQHS) and Nursing and Midwifery Board of Australia (NMBA) are also important to maintain for professionals and lawful nursing practice. The thesis statement includes – professional behavior that should be maintained in nursing practices to ensure ethical and legal levels of care delivery for the patient. The essay will discuss the professional errors in the case study that occurred due to the mis-conduction of ethics and standards in nursing.

Summarization and Analysis of The Case

Due to the unprofessional and unethical behavior of the nurse, various legal issues can arise. In this case study, the patient was found dead on the floor. The patient was admitted to the Acute Ward of the mental health facility. The unprofessional and unethical conduct of the registered nurses contributed to the death of the patient. The registered nurse RN Pandya, left early form the shift without informing the leader, did not maintain the handover properly and observations were also not taken at the scheduled time. The registered nurse RN Prasad, did not interact with the patient and inappropriately signed the handover and had inadequate information and understanding as a mental health nurse, this is so because she described the patient as ‘not mentally unwell or anything’. In action to their acts, legal actions were taken against them. If there is an incomplete transfer of information to the nurse leader about the presence or absence of the nurse in the wards or inadequate information about the health condition of the patient’s disease; then delivery of care services by such a nurse can lead to harm the health of the patient. There is a breach of duty if the patient is harmed due to the unprofessional actions of the nurse (Happell et al., 2018). For example, signing of the handover without interacting with the patient and checking for the patient’s ID is an inappropriate way as this can lead to medical errors and risk to patient’s safety. It is required for the nurses to interact with the patient and double-check the identity before signing the handover. Moreover, it is the duty of the nurse to transfer all the information to the nurse leader (Snelling, 2016; Aylott et al., 2019).

Professional Error – Inappropriate Communication

In this case study, the professional error was due to inappropriate communication. This happened because one of the RN left early without informing the nurse leader about her presence or absence and the other RN did not interact with the patient properly and his condition was not observed. Moreover, Ms. Khan was also not informed about the early leaving as the RN Pandya neither the start of the shift nor at the end of the shift. RN Pandya thought to inform Ms Khan but then he forgot and thought that Ms. Khan must be having the idea of his early leaving. These communication errors lead to harm to the patient’s condition. The nursing practice standard of communication for safety standards (National Safety and Quality Health Service (NSQHS) standard 6) was not maintained in this case study (National Safety and Quality Health Service (NSQHS), 2018). In this case study, the code of conduct of nursing practice standard 3.3 of effective communication, principle 4 of professional behavior was also not maintained (Nursing and Midwifery Board of Australia, 2020). Poor communication is found to occur either intentionally or unintentionally. Due to the breakdown of communication in nursing adverse effects can be observed like no surveillance of the patient, non-transfer of information to the other health professionals. All these factors will ultimately affect the patient’s anxiety, stress, health outcomes, unexpected outcomes, and harm to the patient’s safety. Ineffective communication in health care can result in medication errors, wrong, delayed or expensive services, incomplete patient follow-up, improper handling of medical records, and uninformed recommendations (Aylott et al., 2020). Thus, if the nurse is leaving early without informing the nurse leader then it will lead to inappropriate communication that can result in various unexpected results; leading to another violation of principle 1 of legal compliance of code of conduct of nursing with lawless behavior and no mandatory reporting.

Professional Error – Improper Handling of Handover

In this case study, the professional error was due to improper handling of handover. RN Pandya did not take the behavioral observation of the patient at the scheduled time, leading to unsatisfactory professional conduct. There are no maintenance of handover and no recording of the observations by RN Pandya. RN Prasad did not interact with the patient and did not check the patient’s ID before signing the handover. Moreover, without double-checking the medical records the handover was signed and there was no communication or transfer of the patient’s mental health state or other records between the nurses before the handover. It is required to interact with patient about his/her health status while maintaining handover (Park et al., 2019). RN Prasad also did not monitor the patient for unexpected swelling or other health issues while the handover was signed. As there was no clinical record maintenance, violation of principle 1 of legal compliance of code of conduct of nursing with lawless behavior, violation of principle 2 with a poor patient-centered approach, violation of principle 4 and 5 for unprofessional behavior, and poor assessing of the patient. The NSQHS standards of clinical governance standard, comprehensive care standard, and recognizing and responding to acute deterioration standard were also not maintained. This is so because the patient was found dead on the floor of the washroom it means the risks were not assessed accurately while delivery care services to the patient and as he patient was in a mental health issue still he was left alone leading to a risk to his safety. Such unprofessional and unethical practice leads to harm to the patient. There should be communication with the previous shift nurse before handover and before leaving the patient for other shift nurses the handover should be rechecked and timely updated (Glas, 2017; NSW government, 2019).

Change in Practice

Upon reflection, I notice that the NSQHS standards of comprehensive care, effective communication, and recognizing and responding to acute deterioration standard should be maintained. The knowledge of these standards ensures that the patient should be comprehensively assessed, monitored, and evaluated for the risk factors that can result in harm to his/her health. The ethics of justice, non-maleficence, and beneficence by delivering fair care services to the patient that ensures safety and improve his/her health. It is the duty of the registered nurse to report the nurse leader, timely assess and update the handover, ensure effective communication with the patient and the other health professionals; so that there is the transfer of complete information (Bussard et al., 2019). There should be effective communication with the patient such as asking and checking for the ID, infection, or swelling if cannula or IV is used, clearing of doubts with a clear acknowledgment of the patient’s ideas and questions (Aylott et al., 2020). I learned through this incident that the nurse should have the complete and latest information about the patient’s health issue and it should be ensured that the patient with serious or mental issues should never be left alone. The next shift nurse should be informed about the patient’s status before leaving the shift with the maintenance of updated and appropriately structured and detailed handover (NSW government, 2019).

Conclusion on Professional Errors in Nursing

The use of standards in nursing practice is very important as it ensures that ethics, professionalism, and patient safety is maintained. A nurse is required to inform the nurse leader if there is a need to leave early from the shift. There should be the use of clear communication for transfer of information such as maintenance of well-structured and updated handover and clinical notes/records. If unprofessional behavior is exhibited by the nurse then it will lead to a risk to the health of the patient. Moreover, I will never sign the handover without double-checking the patient’s health status, records, and ID with proper face-to-face interaction. If the patient is not assessed comprehensively for risk factors then such ineffective care services can harm the patient. As every patient has the right to get treated well with improved care but improper care will violate the ethic of non-maleficence justice and beneficence in nursing.

References for Professional Errors in Nursing

Aylott, L. M., Tiffin, P. A., Brown, S., & Finn, G. M. (2020). Great expectations: Views and perceptions of professionalism amongst mental health services staff, patients and carers. Journal of Mental Health, 1-8.https://doi.org/10.1080/09638237.2020.1818195

Aylott, L. M., Tiffin, P. A., Saad, M., Llewellyn, A. R., & Finn, G. M. (2019). Defining professionalism for mental health services: A rapid systematic review. Journal of Mental Health28(5), 546-565. https://doi.org/10.1080/09638237.2018.1521933

Aylott, T., Bezati, R., Trivett, S., Lee, M., Bulk, L. Y., Battalova, A., & Drynan, D. (2020). Professionalism and disabled clinicians: The client’s perspective. Disability & Society35(7), 1085-1102. https://doi.org/10.1080/09687599.2019.1669436

Bussard, M. E., & Lawrence, N. (2019). Role modeling to teach communication and professionalism in prelicensure nursing students. Teaching and Learning in Nursing14(3), 219-223. https://doi.org/10.1016/j.teln.2019.04.005

Cusack, L., Drioli-Phillips, P. G., Brown, J. A., & Hunter, S. (2019). Re-engaging concepts of professionalism to inform regulatory practices in nursing. Journal of Nursing Regulation10(3), 21-27. https://doi.org/10.1016/S2155-8256(19)30144-9

Ducharme, M. P., Bernhardt, J. M., Padula, C. A., & Adams, J. M. (2017). Leader influence, the professional practice environment, and nurse engagement in essential nursing practice. JONA: The Journal of Nursing Administration47(7/8), 367-375. https://doi.org/10.1097/NNA.0000000000000497

Glas, G. (2017). On the existential core of professionalism in mental health care. Mental Health, Religion & Culture20(6), 536-543. https://doi.org/10.1080/13674676.2017.1380122

Happell, B., Platania-Phung, C., Bocking, J., Scholz, B., Horgan, A., Manning, F., & Pullo, J. (2018). Nursing students’ attitudes towards people diagnosed with mental illness and mental health nursing: An international project from Europe and Australia. Issues in Mental Health Nursing39(10), 829-839. https://doi.org/10.1080/01612840.2018.1489921

National Safety and Quality Health Service (NSQHS). (2018). The NSQHS standards. Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards

NSW government. (2019). Clinical Handover - Standard Key Principles. Retrieved from: https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2009_060

NSW government. (2019).Communication Strategy Guidelines - Department of Health. Retrieved from: https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=GL2005_074

Nursing and Midwifery Board of Australia. (2020). Professional standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Park, S., Kwon, D. W., Kim, D., & Kim, S. H. (2019). Influences of gender‐related perceptions and experiences on nursing professionalism: A cross‐sectional study. Nursing & Health Sciences21(4), 515-522. https://doi.org/10.1111/nhs.12636

Snelling, P. C. (2016). The metaethics of nursing codes of ethics and conduct. Nursing Philosophy17(4), 229-249. https://doi.org/10.1111/nup.12122

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