Reference no: EM132359478
Assessment - Underpinning Knowledge/Questions
Instruction to Students:
• Answer the questions below in the spaces text box provided.
• Ensure all references are documented under each individual question.
• Answers are to be typed or for written submissions, useblack or blue ink and ensure your name is attached to the responses.
Case Scenario 1
Julie is currently attending an Alzheimer's Australia workshop on the following issues for people with dementia in the aged care system.
-elder abuse
- clinical capacity and incapacity; and
- false imprisonment with the use of restraints
During the workshop Julie overhears one of her colleagues stating "how can this be classified as abuse, they hit me more times than I hit them" and another colleague stating "we always use both physical and chemical restraints to manage behavioural and psychological symptoms of dementia, how is this abuse"
Julie is ‘shocked' to hear such information as she has never had to use restraints with her residents as she has always managed them by checking all behavioural and psychological symptoms of unmet needs, such as untreated pain, hungeror thirst, or boredom as a first response to difficult or challenging behaviour.
Julie has decided that on her return to work she will put in a written complaint related to the use of restraints or assault to her supervising manger to ensure the safety of residents.
Provide responses for the following questions in relation to case scenario 1
1. Do you think that Julie's colleagues have practiced nursing in their work practices within their scope of practice and nurses code of conduct?
2. The workshop Julie attended was discussing clinical capacity and incapacity and false imprisonment what does this mean?
Clinical capacity:
Clinical incapacity:
False imprisonment: Use of restraints
3. How has Julie advocated for the dementia residents in accordance with jurisdictional enrolled nurse scope of practice? (Min 50 words)
4. What should all patient health documentation; including written complaints contain to ensure they meet with Health RecordsAct? (Min 100 words)
5. Are there any other strategies that Julie could develop and implement to improve the ethical practice of nurses working with people with Dementia? (Min 100 words)
Case scenario 2
Ajay is an enrolled nurse who works on the spinal injuries ward. Ajay has just returned from 3 weeks off on worker's compensation due to a lower back injury at work as a result of incorrect manual patient handling. Ajay has returned to work on light duties (no manual lifting) as part of the return to work process for the next 10 shifts.
The majority of work on a spinal injuries ward is manual handling of patients including turning and lifting patients in and out of bed. All of Ajay's colleagues know that he has recently hurt his back but are continually asking him to help with patient manual handling as he is the only male on the ward this shift. Ajay's colleagues feel he is useless to them if he cannot lift patients, they are calling him lazy, uncooperative and have put in a complaint to the Nursing Unit Manager.
Ajay wants to do the right thing but knows that he risks further injury if he agrees to lift patients who are in desperate need of his care, he is confused and conflicted.
Provide responses for the following questions in relation to case scenario 2
6. What legislation could Ajay draw upon to support his actions of not lifting patients even though he has returned to work? (Min 50 words)
7. What responsibility does Ajay have to his work colleagues in this situation? (Min 50words)
8. What should have occurred in the workplace regarding Ajay's situation before he commenced back at work, and what recourse does Ajay have to this complaint?
9. What framework will assist Ajay in making decisions regarding the care of his patients and care of his own workplace safety? (Min 50 words)
10. From the scenario what are the ethics, bioethics and nursing ethics relevant to Ajay? (Min 100 words)
Case scenario 3
A 17-year-old girl named Samira presents herself to the emergency department of the local hospital with facial bruising, lower left quadrant abdominal pain and a small laceration to her right arm. Samira states that she has been beaten and robbed at knife point by some men. The girl is accompanied by her mother who works in the administration department of the hospital, signs all of Samira's admission paperwork,requests to see Samira's medical records and received the 'Patient Bill of rights'.
Samira consents to has an ultrasound which rules out internal abdominal bleeding as a cause of her abdominal pain. The male doctor wants to examine Samira again with the attending nurse, they both assume that Samira 's mother wants to stay in the room and do not ask her to leave. The doctor asks Samira if she is sexually active, and Samira quickly states that she is not and that she has just started her 'period'. Samira's mother can tell by the tone of the questioning that the doctor and nurse do not believe that Samira is still a virgin. After the abdominal examination the doctor requests a urinalysis, venous blood sample for a list of tests and a full pelvic examination.
Samira constantly states that she has been robbed not raped and refuses a pelvic examination, but allows the collection of urine and blood. The nurse insists on performing a pelvic examination for swabs to be taken. Despite Samira's mother's best efforts to calm her during the examination it is traumatic and painful. Samira is told by the attending nurse in a condescending tone that the exam hurts because of her failure to relax and cooperate.
The doctor states that the urinalysis is inconclusive due to blood in the sample and that the pelvic examination results are inconclusive due to the patient being uncooperative during the exam.
Samira 's mother is told by the nurse that the blood sample will also be tested for pregnancy due to the high incidence of "immaculate conceptions" in their emergency department, and the results would be given to her daughter.
Samira is told that she will be given some pain medication before she has arm wound swabbed and dressed and will then she should be right to go home.
Provide responses for the following questions in relation to case scenario 3
11. What legislations or regulations or standards do you believe have been breached after reading this scenario? (Min 50 words)
12. What did the attending nurse do that demonstrateda lack of respect and support for the dignity of the person and/or their family members? (Min 100 words)
13. How would you in your role of the enrolled nurse, handle the request for a 17-year-old patient's medical records by a parent? (Min 50 words)
14. In your role of the enrolled nurse, how would you respond to the behaviour of the attending nurse which is in conflict with the codes of conduct and ethics for nurses? (Min 50 words)
Case scenario 4
A local homeless older male named Bill comes into the Local Medical Service for treatment. James is the enrolled male nurse on duty and suspect Bill just wants some food and drink and to get out of the pouring rain for a few hours, so James automatically triages him as low on the priority list for seeing the medical practitioner.
Due to the awful smell of Bill,James seatsBill away from the other clients and around the corner where his smell is less irritating to James.
The day gets very busy and 2 hours later James walks around the corner to get Bill to see the doctor,James find him sitting there hunched over and asleep, so he bumpsBill down to the bottom of the list again.
At the end of the shift James remembers Bill is still around the corner and goes to wake him up only to find that Bill appears to be in a coma and has a diabetic bracelet on his wrist.
James call for the RN and Doctor for emergency backup to get Bill onto a bed for treatment. James tells the RN that Bill had only been sitting there for a short time. Bill dies and the Doctor states he needs to refer this case to the coroner and that there will be an open disclosure internal investigation to determine vicarious liability of the Medical service.
James is informed that the coroner insists on a coronial inquest into the management of Bill within the service as the information provided in the internal investigation does not match up with his findings. Staff are gossiping and posting stuff on face book about the incident which is upsetting to James and he is now required to give evidence at the coronial inquest along with other expert witnesses.
At the inquest, the legal team were discussing lots of ethical concepts and principles in nursing regarding the case such as autonomy, beneficence and non-maleficence, fairness, rights and veracity which is making James very anxious and worried.
James was found guilty of negligence in not carrying out a health history and observations prior to placing a person on the triage list and will be disciplined by the licensing board. The family of Bill have decided to bring about a civil action preceding against the medical service for damages.
Provide responses for the following questions in relation to case scenario 4
15. How has James, been negligent in his work practice and breached his ‘Duty of care' to the client?
16. Under common and statute law would this be considered a criminal case?(Min 50 words)
17. What does it mean for the medical service that the Bill's family have decided to bring about a civil action for damages?
18. In this case scenario involving open disclosure, coronial inquest and a civil case,complete the following table below of who is involved and what their role is during these processes.
19. Discuss how the following legal terms listed in the table below might apply to this case Scenario 4. Complete the table.
STEPS IN ETHICAL DECISION MAKING
There are a number of steps that can be taken by nurses to ensure that the decisions made by nurses are ethical. Use the following steps when considering the following scenarios to make an ethical decision.
1. Clearly state the problem:
- Consider the context in which the situation occurs and attempt to distinguish between ethical problems and other medical, social or legal issues.
2. Get the facts by researching as much as you can about the problem and have all the facts.
3. Consider the four principles:
- What are the person's preferences?
- What are the risks and how can they be avoided?
- What benefits can be obtained for the person?
- How are the interests of different parties balanced?
4. Identify ethical conflicts, why the conflicts occur and how they may be resolved
5. Consider the law by identifying the relevant laws and how they might guide management and examine the relationship between the clinical-ethical decision and the law:
6. Take responsibility for the ethical decision made and document the justification for the decision.
Scenario 5
In the context of the enrolled nurse you are asked by a 14-year-old girl,who holds evidence of a positive pregnancy result, to give her advice on where she can go to get an abortion. The girl is approximately 12 weeks pregnant and is very distresses and agitated. Your religious belief if for pro-life and you are conflicted over how to approach this situation of an abortion. (Max 250 words)
Scenario 6
In the context of the enrolled nurse you are asked by a terminally ill patient who considers themselves to be a burden to their families, carers and society, to procure a particular medication for assisted suicide. The person states they have no quality of life and are not in a position to undertake this task due to their illness. You suggest that they have this discussion with their family but they are quick to respond that assisted suicide it's against their cultural beliefs. The patient has requested discontinuation of treatments that are of no medical benefit to them for this terminal illness. (Max 200 words)
Scenario 7
In the context of the enrolled nurse you are caring for a 17year old male with severe head injuries.The doctors have assessed this patient to have no electrical brain activity and is hooked up to life support to artificially prolong life. You have been involved with the family through discussions regarding the standing order ‘Not for resuscitation' when the patient first came to the acute care settingand now you areasked to support the family to make a decision to turn off all life support based on the final neurological assessment and EEG.
You question the criminal responsibility of doctors who decide that the patient should die by having life support removed so organs can be successfully donated and beds can be allocated to other emergency cases.
Attachment:- nursing practice.rar