Registered Nurses: Ensure Professional Care for Patients - Essay Example

Registerd nurses must make clinically sound decisions within the legal and ethical framework to ensure professional care for patients. Introduction The area of work for Registered Nurses or RN, is vital both for the patients and for the doctors as the nurses are the link between the two. The services rendered by them make the proper delivery of medical advice and line of treatment possible. Keeping this in mind it is important to equip them in a manner so as to provide the best medical care to the patients. In the practical world, the nurses find too much of workload on them. Their area of work expands from administering medication, monitoring the progress and providing all other medical attention to provide emotional and educational support to the patients. Since their area of work and responsibilities are an important component in the medical world, whenever any case of negligence comes up, the onus is on them. That makes their job even more vital. They need to be very alert towards how they are delivering their services and should always be prompt to make clinically sound decisions for the best of the patients. They need to be aware of the legal and ethical framework to ensure professional care for the patients. Legal The most common accusation against the nurses is of negligence. Whenever there is any damage caused to the patient, the question of negligence comes up. Everyone and especially the nurses must know the legal implications of negligence. The definition of Negligence is “The Omission to do something which a reasonable man, guided upon those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.” All the injuries cannot be summed as negligence. Similarly all acts of omissions that cause an injury cannot be termed as negligence. It has been acknowledged by the courts that a “mere’ error in clinical judgment by health professionals or embark on procedures which with hindsight are recognized as a misadventure, will not be treated as negligence in all cases. This is an indication that the law accepts the nature of health care as a profession where some injuries are possible due to unforeseen circumstances that cannot be termed as negligence by the health professionals or the health institutions. The Patient or the plaintiff has to establish all the elements to succeed in a claim of negligence- The health professional owed a duty of care towards the patient The health professional’s conduct was below the standard requirement of care and a breach of duty The patient suffered damages due to this conduct The loss or damage was reasonably foreseeable. It is a question of law to decide whether the relationship between the plaintiff and the defendant was proximate and thereby giving rise to a duty of care. This proximity need not always be physical proximity. It can also be closeness in terms of time and space. There was a case (Jaensch v Coffey) where the plaintiff (patient) was told about her husband being thrown off from his bike by a negligent driver. This caused a nervous shock for her. Although she was not present at the accident site but even then her response to the event was sufficient to satisfy the proximity requirement. It was stated in the judgment that the liability cannot be shifted away from the health professionals if the plaintiff was not physically present at the accident site. Because she suffered the same aftermath of the accident at the hospital and this should not prevent her from claiming damages for the injuries caused. In another case (Perre v Apand), the element of proximity was considered as a significant determinant about the validity of duty of care. This was a case for claiming economic loss in relation to the contamination and inability to sell the crop. In this case the Australian Hugh Court said that proximity was “incapable of constituting a universal criteria of liability” and although it may have some role to play it was no longer “the unifying criteria of duties of care.’ According to Gummow, in order to determine whether there was a duty of care or not there are some important factors that should be considered – Whether the plaintiff was aware of or should have been aware of the risk? Whether the plaintiff had the means to appreciate the existence of the risk to which he was exposed as a result of the conduct of the defendant. In absence of such knowledge the plaintiff has no ‘avenue’ to seek protection from such risk. When all these features exist together, a close enough relationship is formed that gives rise to a duty of care. There is no common approach to determine the existence of a duty but some factors that need to be considered are – vulnerability, powerlessness, dependence and the level of knowledge of the plaintiff and the control exercised by the defendant. It can be said that the determinant of existence of a duty of care is the ability of the health professional to foresee or know the risk of injury to a patient and inability or lack of knowledge in the patient to take the steps to protect himself. Ethical It is very clear from the study of legalities involved with the profession of nurses that most of their judgment is subjective. Depending on the case and all other factors involved, it is decided whether they are responsible for the damages caused or not. At the same time there are certain ethical issues as well. Registered nurses have to be very particular about patient education. Patient Education is one of such areas where the treatment protocols are “soft “ or not so concretely defined. It has to have flexible guidelines. There are many variables like patient receptivity etc. As it is nursing profession is very demanding. When there are too many things to be done in a limited time, corner cutting is natural. And it goes unnoticed as long as patient safety is not endangered. Shortage of staff, shortage of equipment and resources are the usual features in this profession. With these limitations, they have too many patients to handle. Under these circumstances proper utilization of time and energy and correct decision-making is vital. Jack Glaser, the medical ethicist says- “there is always more good calling to be realized than we have the capacity to accomplish.” Since there are many other duties assigned to them, it is important to understand the priority level of patient education in context with other duties. One fact is very clear that patient education directly affects patient’s recovery. There was a decade long research done on cancer patients and it was seen that the patients, who were given the education, adhered more to the treatment and managed drug’s side effects. They also had better pain control. In another study of the perception of nurses regarding patient education, 92% said that it was a priority. Patients also feel that when the instructions are explained and made clear and understandable, it increases their satisfaction. The challenge is to provide it within the limitations already mentioned. Another question is that is every patient’s need of education the same? It varies as per their background, age, gender, occupation, cognitive function etc. The need of education, varies in the same patient also according to the stage. Like his need of education is more after surgery than it is before surgery. With all these variables, it is a complex task to allot the right priority to it. The principle of distribution justice says that all individuals should be treated equally and fairly. But there are other factors attached to it. The severity or complexity of some patients could be different than others. Formal Education level also is a factor to determine how much patient education is required by them. This principle of justice and equality needs to be practiced in a balanced manner along with the principle of utility. The principle of utility says that expertise, time and energy should be used in a place where it will be most productive. It is up to the nurse to be judicious and try to fulfill the needs of the patients as much as possible. For example one patient may like to get more attention towards his education and would like the nurse to spend more time explaining things to him. At the same time another patient may have an urgent requirement. Since education is not as urgent as another urgent need, the nurse can excuse herself and attend the other patient but should not forget to get back to the earlier one to finish what she was telling him. It is a demanding task and it may not be possible for the nurse to do everything perfectly all the time. Time is the biggest challenge incase of patient education. The subject of patient education itself is such a subject that can vary from an objective description of usage of an instrument to a subjective handling of self -image building of a chemotherapy patient. Although time is a constraint but not spending enough time on it sends wrong message to the patient and his response to the treatment gets affected. A nurse cannot actually rush through the education without giving appropriate time to the patient so that they can absorb what is being said. The other bodies associated with this industry are also responsible for providing supporting environment to the nurses so that they can do their best. From the nurses’ side also they should find ways and do some research to identify some educational tools or strategies to help them increase their productivity. They can find out from the patients also regarding their needs. Using information from the Internet as well as intranet is helpful. An intranet of nurses’ inputs on their observations and their solutions, can be shared among all other nurses and can be implemented. Storing information on the hospital’s intranet saves cost and is readily available to all. Another solution is to use printed literature and cd’s to give the basic information and then get back to the patient to have a discussion on the same. This gives ample time to the patient to go through the information and the nurse can use her time more effectively. To make this strategy even more effective, patients can be asked to prepare their questions that they would like to discuss with the nurses. The issue of patient education is of prime importance as a patient is not only suffering form the illness but also from the negative emotions like anxiety, fear, and incapability etc. the ethical duty of the nurse covers all these areas as well. It forms a part of therapeutic services and duties of a nurse. An ethical practice cannot assume nursing as a bunch of actions needed to be performed. It has to focus on personal and character traits. They need to be based on moral virtues. The nursing practice should be guided by these virtues. (Armstrong, A.E., 2006, Towards a strong virtue ethics for nursing practice.) The virtue -based approach to nursing comprises of compassion, judgment and moral wisdom. One important question that arises is whether proper training, education and orientation is provided to the nurses. If they are better prepared, then they will be in a better position to exercise their ethical decision making skills. While we are talking about patient education, it will be wise to check whether nursing education is well equipped for providing the right inputs. (Woods, M, 2005, Nursing ethics education) The treatment process of the patient does not get over with his release from the hospital or clinic. It is continued in form of the patient education package provided to him by the hospital or the clinic. This can be a standardized format but the point to keep in mind is the difference in backgrounds of the patients. This has to be completed by personal interaction with the patient to fill in the gaps caused by their unique backgrounds. (Loxton, M.H., 2003, Patient education: The nurse as source of actionable Information.) As discussed in the legal part of this article, the onus of negligence cannot be shirked away when the physical proximity is done away with. If any complications arise and if it is caused by not providing the correct inputs by the registered nurse, the patient can still hold them responsible for the damages caused. Hence, it is a part of the duties supposed to be provided by the registered nurses to give adequate education to the patient while he or she is under their care and also ensure that they leave with proper education on the post release care. This will minimize the chances of any complication or any damage from happening. Once the patient returns home he or she would know exactly what they are supposed to do and what they are not supposed to do. For example if woman has undergone a surgery of the abdominal area, she would know that she is not supposed to lift any heavy thing or climb up the stairs. She should take precaution to avoid catching cold as sneezing might be harmful for her. But she can walk on an even surface to keep her muscles toned and help improve the rate of recovery. If this education is provided by the registered nurses and the patient creates a complication by violating the instructions given, she cannot hold the registered nurse guilty for not providing the correct and much needed information. While technological advancement can be helpful in providing effective education, too much dependence on technology may have its own set of problems also. Like an increasing role of medical decision support systems is giving rise to certain concerns. They are supposed to provide more accurate, effective, and reliable diagnosis. (Marckmann,G. 2001, recommendation for the ethical development and use of medical decision support systems) This notion has an underlying feeling that the physician may not have sufficient knowledge. But sometimes they fail to match the same expertise that a human expert has. The registered nurses also have similar responsibilities. At this point they need to understand about Patient Autonomy as well. It refers to the right of the patients to take part in the treatment related decisions. Now there are clear definitions by law to draw out the limits of patient autonomy. The law says that the right of every individual to take possession and control of his own remains with him as the most sacred law or most carefully guarded law. It is free from any other interference or restrain. Only the authority of law can intervene with it. [Union Pacific R. Co. vs. Botsford, 141 U.S. 250 (1891)]. It also mentions that a surgeon has no right to perform an operation without his consent and it can be treated as assault. He can even be penalized for that.{ Schloendorff vs, Society of New York Hospital, 105 N.W. 92(1914)} What the RN needs to understand is although this right lies with the patient but the right to provide patient education lies with them. As long as they have done their part well and the patient is not trying to exercise his right in absence of the education, they can be from the guilt. The duty of beneficence, that means actions for the benefit of the patient, is an important principle of ethics. The biggest dilemma is concerned with ending the patient’s life. It does not sound logical how ending a patient’s life could be termed as a benefit for the patient. But in certain circumstances , of which the RN could be a vital part of, can be such where the quality of patient’s life has become very poor or treatment has become very burdensome and ending of life could seem a better proposition than continuing with the treatment. Like beneficence, there is a concept of nonmaleficence. This means that there is no intention to inflict harm. This sounds quite logical that a medical professional will not indulge into something that will harm the patient but when examined closely, it is quite complicated. Some treatments may be needed to improve or save the patient’s life but it may have some harmful side effect at the same time. But with proper explanation of the situation to the patient by the nurse can straighten out the creases. Justice is one of the four key principles of contemporary ethics. When there are inter-conflicting issues and principles, they should be analyzed for proper justice. When there is a conflict of views on some line of treatment, and more than one principle is involved,it can not be solved by any one principle. In should be reconciled in accordance with the law, professional ethics, respect for professional disagreement and the available facilities of health care, and also the understanding of a civilized society.( Benson T,2001 Autonomy, justice and the legal requirement to accommodate the conscience and religious beliefs of professionals in health care.) When the RN is well aware of these concepts and does her duty to impart proper education there will be no feeling of guilt in her even if an undesirable situation arises which may be beyond her control. She would be safe from the legal point of view as well while performing all her ethical duties. Conclusion The relation between the doctor and the patient is similar and still different from the relation of the normal service provider and customer. There are various subjective and objective factors involved. As the registered nurses form a vital link between the two, their responsibilities increase beyond simple administration of drugs. They not only have to be compassionate towards the patients as they are dealing with human beings in a more than normally vulnerable stage. In this context, patient education becomes an important task that needs to be performed with equal urgency as the other tasks are performed. Just like a patient can sue a doctor for giving him wrong treatment, the lack of education provided to him can also be held against the medical staff. Therefore the registered nurses must be careful on this front and take help of the technology to make up for the shortage of available time. Again at this point they need to be careful and not omit the personal touch all together. It is through a conscious decisions made by them they can be sure to be correct on the legal and ethical fronts. References 1. Armstrong,A.E.,2006, Towards a strong virtue ethics for nursing practice 2. Chelt ,J.H. Agre P 2001 Cancer related patient education An overview of the last decade of evaluation and research 3. Glasor, J.W. 1994 Three norms of ethics, Kansas city 4. Grimes Hoalinger,V.2002 comparing the effects skills checklist on teaching time required to achieve independence in administration of infusion therapy 5. Loxton, M.H.,2003, Patient education 6. Marckmann,G.2001, recommendation for the ethical development and use of medical decision support systems) 7. Sorrention, C. Berger A.M.2002 Using the internet to deliver patient education materials 8. Semple C.J. & Mc Gowan B.2003, Need for appropriate written information for patients with particular reference to head and neck cancer 9. Woods,M,2005, Nursing ethics education 10. Health care ethics, Retrieved on 3may,2007, 11. Medicine plus, Retrieved on 3may,2007, 12. Benson T, 200, Autonomy, justice and the legal requirement to accommodate the conscience and religious beliefs of professionals in health care.) Retrieved on 3may,2007, Read More