Discuss about the Nursing for Australasian Competency Standards for Paramedics.
The essay deals with the case study of Jack and Sophie who are paramedics. They were called for emergency service by Sandra, who complained that her 2 year old child Milly had a fall and is in critical condition. The case study presents the actions of the paramedics and attending nurse in the hospital that demonstrated certain ethical issues. The aim of the essay is to identify the ethical issues that are raised by the events described in the chosen case study. The ethical issues are analysed in relation to the professional code of ethics/conduct, principles of health care ethics, human dignity and human rights. Based on the analysis the essay makes the recommendations for professional practice.
The paramedics did not take the informed consent for patient care. The patient Milly was taken to the hospital even when his father refused to move Milly from house. The paramedics threatened to call the police if Milly’s father stopped them to take care of child. It can be considered as disrespectful and unkind towards others. The paramedics could be more polite in dealing with the father. Further the paramedic did disclose about the possible physical abuse to the nurse, Beth in the hospital. There was no confirmation taken with Sandra in regards to physical abuse of chid. Sophie presumed child was physically abused even when Sandra informed that her son had a fall. Further without confirmation, sharing the information with Beth could be considered a breach of confidentiality. In the hospital the agency nurse was found to abuse Morphine that was supposed to be given to the patient in the pain. It is indicating that the care provided was not safe and effective. The agency nurse demonstrated unprofessional behaviour. It can be interpreted that there was lack of medication safety in the hospital due to mis-utilisation of resources. It is again a breach of professional standards (Black, 2016). It is also the breach of the medication standards. It is also regarded as the ethical issue as because the medicines are designated for patient use and such resources in the hospital are restricted. These resources if not utilised properly may lead to increase in health care cost and adversely impact the patient care. In conclusion the ethical issues in the case study can be summarised as breach of human respect and dignity, respect for autonomy, confidentiality of the patient information, professional standards and medication standards.
As per the code of conduct for paramedics in Australia, the paramedics are also responsible for ensuring that their actions and treatment demonstrates respect for client (Paramedics Australia, 2018). In the given case study Sophie was worried about the patient but was refused to be taken to the hospital by Sandra’s partner. In this case, she must have behaved more respectfully towards him. It is true that the saving the life of the patient was the first priority but then explaining the parents especially Sander’s partner about the need of the intervention and transferring the patient to hospital in respectful manner was required. As per the code of conduct, the paramedics must maintain the confidentiality of any information that is obtained during the course of work. It must be disclosed only to third party in case of legal and professional obligation (Paramedics Australia, 2018). Respect for autonomy is the basic principle of ethics (Grace & DRN, 2017) but in this case the patient is 2 years old and is not in state of giving consent for care. In this case the paramedic did override the parent’s wishes and there is a risk of legal precedence. However, in this case the precedence may be given to principle of avoiding the harm of vulnerable minor child and giving medical benefit to restore life. Here principle of beneficence was given priority than principle of autonomy as part of emergency medicine, where the patient cannot act in best interest (Brown, Kitson & McKnight, 2013).
In the given case study the paramedic Sophie did not maintain the confidentiality of the patient information. She did mention to the triage nurse about the possible physical abuse. It was true that the patient was physically abused as the wounds and bruises and broken and fracture of the humerus is inconsistent with the patient’s age. However, the care to Miley was provided at highest professional standard. It demonstrates the respect to the patient as per code of conduct. It can also be interpreted that the paramedics demonstrated competence in their area of practice by using their skills and knowledge. The paramedics practiced in the non-discriminatory manner as they acknowledged the patient’s needs and optimised the health outcomes (Competency Standards for Paramedics, 2018).
As per the code of ethics for nurses in Australia the nurse must value the quality nursing care for all. They should provide safe and competent care to the patient by accepting their moral and legal responsibilities (NMBA Code of ethics, 2018). They must practice within the boundaries of their professional role and with the agreed practice standards of the profession. However, in the given case study it was found that the nurse was taking morphine for herself instead of focusing in patient’s condition (NMBA Code of ethics, 2018). Addiction in hospital premises means going beyond the professional boundaries. According to code of ethics, the nurse must value the culture of safety in nursing and health care. The nurse must develop the health care environment that can reduce the incidence of the preventable adverse events (NMBA Code of ethics, 2018). In the give case study the agency nurse was also involving other nurse in taking morphine, instead of working together to create culture of safety. Misusing the hospital resources is the violation of professional standards, code of ethics and conduct.
According to the medication standards, set by the Australian commission on safety and quality in health care, the clinical leaders must improve the safety and quality of the medicine use. The clinicians, nurses and the staff must be competent to safely prescribe the medicines, store, dispense and administer the appropriate medicines to the informed patients and monitor the effects. They are responsible for safe distribution and storage of the medication. The medicine must be stored in accordance with the manufacturer’s directions, legislations, jurisdictional orders, and operational directives (NSQHS standards, 2018). In the given case study it was found that the agency nurse did not follow the medication standards for the morphine. It was stored in the locked cupboard and she has been using for herself instead of patients. It is also the breach of the NMBA code of ethics, where nurses are obliged for sustainable and efficient use of resources (NMBA Code of ethics, 2018).
Based on the analysis, there are various recommendations made for professional practice to avoid ethical issues. Lack of awareness of the ethical and legal issues is the main barrier in effective tackling of ethical issues (Poikkeus et al., 2014). The nurses must be given opportunities to rationally reflect on the scenarios of ethical issue to determine the right action to be taken. It will help create awareness of the ethical issues. Effective training would be useful tool to guide the learning about ethics within their profession ( Cerit & Dinç, 2013). It will ensure that the mistakes do not occur. Training is needed as health care sector is the dynamic environment. The need of the patients varies with illness and patient’s profiles. There is wide range of ethical issues right from consent for simple procedures to organ donation. There are ethical, legal professional guidelines in place it is not sufficient enough to mandate the conduct of professionals. To be able to hold accountability of the clinical decisions made there is a need of training to create awareness of risks. There must be regular surveys to assess the awareness of the nurses’ knowledge of ethical and legal issues. It will help identify the learning needs of the nurses (Griffith & Tengnah, 2017). The hospitals must create the environment where the nurse can report any ethical dilemma faced by them. There must be nurse ethicist in on site to look at ethical situation from other perspectives. Stringent policies may be formulated to punish the deliberate breach of professional standards such as cancelling the nurse license. In case of nurse found with medication abuse, employee counselling services may be adopted (Griffith & Tengnah, 2017).
Conclusion
It can be concluded that the ethical dilemma is inevitable in nursing. In the given case there was breach of respect to autonomy, code of conduct and medication safety standards. The nurses must well verse with the professional code of conduct and competency standards. The health care bodies must take intense efforts to give formal education and training in legal and ethical issues. There must be regular audit to check is the professional and medicine standards are met by the nurse and duties of care are performed within ethical and legal obligations. There is a greater need to create nurses’ awareness about the hospital policies, legislations and medication standards.
References
Paramedics Australia. (2018). CODE OF CONDUCT. Retrieved from https://www.paramedics.org/code-of-conduct
Competency Standards for Paramedics. (2018). Australasian Competency Standards for Paramedics. Retrieved from https://www.paramedics.orgjavascript:void(0)/content/2011/10/PA_Australasian-Competency-Standards-for-paramedics_July-20111.pdf
NMBA Code of ethics 2018. Nursing and Midwifery Board of Australia – Search. [online] Nursingmidwiferyboard.gov.au. Available at: https://www.nursingmidwiferyboard.gov.au/Search.aspx?q=code+of+ethics [Accessed 25 Jan. 2018].
NSQHS standards. (2018). Standard 4: Medication Safety. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard4_Oct_2012_WEB.pdf
Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=1OQlDgAAQBAJ&oi=fnd&pg=PR1&dq=ethical+issue+in+nursing+principle+of+ethic&ots=eMJBK9yut3&sig=80NPGg4UAmNXPHwGj3kuGZhNaMc&redir_esc=y#v=onepage&q=ethical%20issue%20in%20nursing%20principle%20of%20ethic&f=false
Black, S. E. (2016). Doctors on Drugs: Medical Professionals and the Proliferation of Morphine Addiction in Nineteenth-Century France. Social History of Medicine, 30(1), 114-136. Doi: https://doi.org/10.1093/shm/hkw065
Brown, J. M., Kitson, A. L., & McKnight, T. J. (2013). Challenges in caring: explorations in nursing and ethics. Springer. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=tM69BwAAQBAJ&oi=fnd&pg=PP6&dq=respect+to+autonomy,+beneficence+nursing+&ots=Q5FeThJ92E&sig=iUIRH1jIybq6LosaFQAyzzJbp84&redir_esc=y#v=onepage&q=respect%20to%20autonomy%2C%20beneficence%20nursing&f=false
Poikkeus, T., Numminen, O., Suhonen, R., & Leino?Kilpi, H. (2014). A mixed?method systematic review: support for ethical competence of nurses. Journal of advanced nursing, 70(2), 256-271. DOI: https://doi.org/10.1111/jan.12213
Cerit, B., & Dinç, L. (2013). Ethical decision-making and professional behaviour among nurses: a correlational study. Nursing ethics, 20(2), 200-212. Doi: https://doi.org/10.1177/0969733012455562
Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning Matters. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=z_X-DQAAQBAJ&oi=fnd&pg=PP1&dq=Lack+of+awareness+of+the+ethical+and+legal+issues+nurse+&ots=UF54FVOo9L&sig=fSjqrDXn8eZCCxwIr7xhJ3-POlQ&redir_esc=y#v=onepage&q&f=false
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