Patient Rights And Role Of Nurses In Healthcare Ethics And Law

Patient Rights and Policies in Healthcare

The role of a specialist nurse is diverse, it encompasses multifactorial and multidimensional professional competencies in order to address the different care needs that a patient might encounter while availing specialist or critical care in the healthcare facility.  Being a student nurse with specialty area being high dependence care in the ICU units, I can state that there are various crucial challenges and issues that present themselves regularly while providing care for the critically ill patients in the ICUs.  As discussed by Donnelly and Psirides, (2018) providing safe and effective optimal care remains integral ideal of intensive care practitioners at all times.  There is mounting evidence that suggest that Intensive Care Units (ICU) are critical settings, associated with an emergency and urgency oriented professional climate which is susceptible to many errors, due to either technological infrastructure or human errors (Tracy et al., 2013).

Hence, undoubtedly there are various safety issues plaguing the ICU scenario, and among the various patient safety issues that are pertinent now, the most impactful and important safety issue are medication errors (Garrouste-Orgeas, Flaatten & Moreno, 2016). Medication errors have been defined as the consequence of multiple actions pertinence to a whole chain organization and human interactions, where a single individual does not have the intention of doing wrong or harm to the patients. In spite of that, the consequences of an adverse drug events resulting from a medication error can have severe consequences resulting in the patient having to experience exacerbation of the existing health issue that the patient is facing (Parshuram & Dryden-Palmer, 2018).

On the other hand medication errors also have been reported to prolong the hospital stay and increase the cost associated with health care for patients in ICU as well (Nuckols et al., 2014).  All the most impactful and important impact of adverse drug event or medication error in the ICU setting are fatal consequences, which can even lead to death of the patient. Hence, regardless of the intention be Tracy hind the medication error, the impact is overwhelming for both the patient and the care provider (Fridh, 2014).  Medication error issue destroys the professional competence and confidence in a nursing professional and also becomes a significant emotional and moral burden on the conscience of the care provider that has been associated with the medication error. For severe cases which lead to severe consequences for the patient, the medication error is also associated with legal and professional implications which can encompass monetary compensation, penalties, and even suspension.  In terms of both the patient and the care provider medication error is a grave issue which needs to be addressed at the earliest in all care settings (Garrouste-Orgeas et al., 2015).

  In order to address this particular safety issue it is also important to explore the exact reasons contributing to the frequency of medication errors.  One of the most important contribution factors that contribute to enhance frequency of medication errors include extreme workload and burnout,  complicated and contradicting protocols in the Intensive Care Unit,  and most importantly symptoms of depression in the Intensive Care staff (Keiffer et al., 2015). The daily struggle of dealing with life and death situation often takes a toll on the emotional health of the ICU staff which in turn is reflected in differential and affects the professional competence leading to various errors including medication errors. There is need for extensive research that explores the root cause analysis of these medication errors and also research to discover different intervention techniques to reduce medication errors such as one-on-one chaining and independent risk factor analysis for medication errors specific to ICU setting (Ryan & Seymour, 2013).

Role of Nurses in Ensuring Patient and Carer Input

Holistic approach to healthcare is becoming more and more popular in various healthcare settings across the globe. One of the most important elements of holistic care approach is the patient centred care, providing priority to the patient and making the patent the centre of the care delivery scenario at all circumstances In this context, confidentiality and patient privacy pertains to the most fundamental aspect associated with care delivery which also is the origin of a considerable ethical dilemma as well. On a more elaborative note, confidentiality is a very important legal and ethical element of care delivery. It encompasses the rights of the patients to have their personal information discrete unless the patient himself to disclosing the information.  On a more elaborative note it is the responsibility of the care providers to keep the information shared by the patient and the information that has been generated during the care program confidential under all circumstances unless instructed otherwise by the patient. Undoubtedly, confidentiality and patient privacy is one of the most important aspects of the legal Framework that healthcare delivery and composites and any breach of the confidentiality and patient privacy is associated with many professional legal and ethical consequences (Echeverría et al., 2015).

  The eminent ethico-legal construct that protects the confidentiality and patient privacy of the patients are failing healthcare in Australia is the Commonwealth Privacy Act and privacy and Personal Information Act (Health.gov.au, 2018).  Although unintentional disclosure does not necessarily include breach of these two ethical and legal requirements the intentional breach of confidentiality is considered breach of these two legal elements which in turn leads to a professional show cause followed by investigation and penalty where the convicted care professional would require to either go through monetary compensation or even suspension depending on the intensity of the privacy breach (Health.nsw.gov.au. 2018).

There are certain circumstances where the nurse often faces a particular article dilemmas regarding disclosing care information about the patient to the career or the closest family member on next to kin of the patient. The right to privacy is considered fundamental in medical care where staff nurse and physicians act as guardian of the physical information or personal information of the patient. However, when the health of the patient declines the nurses in physicians with need to protect patient privacy along with addressing the Expectations of the patients careers that seek medical information so that appropriate care can be provided to the patient by the carers (Echeverría et al., 2015).  It has to be mentioned in this context that the Expectations of the patients and their careers that of the medical staff due to the emotional investment that the carers have with their patients. In most cases the carers are either the spouse children or close family members of the patient who is going to the critical condition, and in these cases it is second nature for the carers to demand as much information as possible from the medical staff so that they have a clear idea of the progress of the patient is making.  Inversely the medical staff typically follows the protocol of discussions and sharing of information with the carers based on the patients’ clear instruction or permission (Gold et al., 2009). For the patients in ICUs, they are rarely capable of providing conscious consent to share information which provides in ethical to the cost of regarding whether they should be sharing information and to what extent they are required to share information to the careless or closest family members of the patient.  In this case I believe there should be a clear understanding between the expectations of patients and their careers with respect to the medical staff and Information sharing along with communication should be prompt and regular so that there is transparency and patient or family centred care being respected throughout the care journey. Although care should be taken to protect the patients right to privacy and confidentiality while sharing information emphasizing on only the key information which is required by the carer or the family member to know in order to care for the patient in the future to honour the right of the patient to confidentiality (Wilson et al., 2015).

Reporting	As a student nurse with a specialty area of high dependency care in the ICU, the concept of death and coping with the dying of a patient under my care has always haunted my mind. This activity has provided me the opportunity to identify a piece of literature evidence that has advertised on the physical and emotional turmoil that care staff has to undergo while dealing with the death of a patient in the ICU.  The evidence Donnelly and Psirides, (2018) indicates that there is significant distress among the nurses that have to go through the death of a patient that they have been caring for in the ICU.  Along with that comparing with the experience of the relative for families, strong sense of emotional connection and disenfranchisement,  has been reported in nurses and doctors post  the death of a patient.  The key theme identified from this literature evidence indicates at the need for ICU protocols to be flexible when a patient is time so that the emotional turmoil care staff of is going through can be addressed adequately (Donnelly & Psirides, 2018).
Responding	As per my opinion, nurses are the first point of contact between the patient and the care delivery scenario. Hence, with respect to the therapeutic connection that a nurse is professionally and legally bound to develop with the patients have a strong emotional connection as well. When the same nurses are faced with the inevitable end of a patient despite the days of comprehensive care, the bereavement stress is no less than that of a family member. Hence, the distress and emotional burnout affects the coping mechanism and in turn professionalism of the care staff which in turn might lead to various errors.
Relating	Death and dying is a constant factor in Intensive Care units.  ICU represents the clinical setting for the patient struggling with one or more than one critical chronic and acute health conditions. Often the patients are not able to recover from the adverse health conditions we have been suffering from and the inevitable death has a significantly detrimental impact on the staff that has been associated with caring for the patient (Donnelly & Psirides, 2018). The research findings indicate at the need for a comprehensive flexibility in the protocol post a death in the ICU so make the environment more feasible and merciful for the care staff going through a similar sense of bereavement as compared to the Family members. Relating the context to my personal practice, I can state that I would appreciate a little less rigidity in the practice protocol after the death of a patient I had been caring for as well in the ICU units (Ryan & Seymour, 2013).
Reasoning	The mortality rate of the ICUs is 18-24% all over the globe. Inevidently, the care staff of the ICU without a doubt faces a far greater emotional stress of having to encounter the death of the patient. This article has focused entirely on the emotional distress the care staff to through and its impact on their psyche. Although, I believe along with increasing flexibility in the practice protocol, there is need for regular psychological screening and psychotherapeutic support for the staff of ICU to help them cope with the trauma effectively (Fridh, 2014).
Reconstructing	This activity has given me ample opportunity to explore the issue of death and dying in the ICU setting. This article helped me understand the reality of the bereavement stress that I will have to eventually undergo in my future Practice. Along with understanding the need for advocating our right to a more flexible protocol for ICU and psychocounseling, I have also understood the need for personal development. I will be taking the assistance of my supervisor to engage in soft skill development courses and workshops to improve my coping strategies and professional competence (Parshuram & Dryden-Palmer, 2018).

References:

Donnelly, S. M., & Psirides, A. (2015). Relatives’ and staff’s experience of patients dying in ICU. QJM: An International Journal of Medicine, 108(12), 935-942.

Echeverría, C. B., Goic, A. G., Herrera, C. C., Quintana, C. V., Rojas, A. O., Ruiz-Esquide, G., … &Vacarezza, R. Y. (2015). Some current threats to confidentiality in medicine. Revistamedica de Chile, 143(3), 358-366.

Fridh, I. (2014). Caring for the dying patient in the ICU–the past, the present and the future. Intensive and Critical Care Nursing, 30(6), 306-311.

Garrouste-Orgeas, M., Flaatten, H., & Moreno, R. (2016). Understanding medical errors and adverse events in ICU patients. Intensive care medicine, 42(1), 107-109.

Garrouste-Orgeas, M., Perrin, M., Soufir, L., Vesin, A., Blot, F., Maxime, V., … & Azoulay, E. (2015). The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture. Intensive care medicine, 41(2), 273-284.

Gold, M., Philip, J., McIver, S., & Komesaroff, P. A. (2009). Between a rock and a hard place: exploring the conflict between respecting the privacy of patients and informing their carers. Internal medicine journal, 39(9), 582-587.

Health.gov.au (2018). Department of Health | 6.3 Confidentiality and the law. Department of health. [online]. Retrieved from https://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-fa-toc~drugtreat-pubs-front11-fa-secb~drugtreat-pubs-front11-fa-secb-6~drugtreat-pubs-front11-fa-secb-6-3. [Accessed on 19th Oct]

Health.nsw.gov.au. (2018). Patient Privacy. NSW Government. [online] Available at: https://www.health.nsw.gov.au/patients/privacy/Pages/default.aspx [Accessed 19th Oct. 2018].

Keiffer, S., Marcum, G., Harrison, S., Teske, D. W., & Simsic, J. M. (2015). Reduction of medication errors in a pediatric cardiothoracic intensive care unit. Journal of nursing care quality, 30(3), 212-219.

Nuckols, T. K., Smith-Spangler, C., Morton, S. C., Asch, S. M., Patel, V. M., Anderson, L. J., … & Shekelle, P. G. (2014). The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Systematic reviews, 3(1), 56.

Parshuram, C., & Dryden-Palmer, K. (2018). Practice in Pediatric Intensive Care: Death and Dying. Pediatric Critical Care Medicine, 19(8S), S1-S3.

Ryan, L., & Seymour, J. (2013). DEATH AND DYING IN INTENSIVE CARE: EMOTIONAL LABOUR OF NURSES. End of Life Journal, 3(2).

Tracy, M. F., Allen, J., Davis, T. M., Barden, C., Olff, C., & McCarthy, M. (2013). Patient Safety Issues in Critical Care. AACN advanced critical care, 24(4), 376-377.

Wilson, L. S., Pillay, D., Kelly, B. D., & Casey, P. (2015). Mental health professionals and information sharing: carer perspectives. Irish Journal of Medical Science (1971-), 184(4), 781-790.