Reference no: EM132318489 , Length: 1700 Words

Practical- Case Study

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)

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)

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.

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.

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)

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

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.

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)

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)

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 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)

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)

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)

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.

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:			DOB:
Incident type (Circle appropriate type)		Actual		Potential
Date
Time
Location
Description
Reported to:
Signature role:	and

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)

Attachment:- Apply legal and ethical parameters to nursing practice.rar