Legal and ethical parameters of nursing

Case Study
Suzy Martin is an enrolled nurse who works part time 15 hours per week on a surgical ward at the local public hospital. She has been employed for the past year and has attended all of her mandatory training. 
Suzy is currently completing her bachelor of nursing at the local university
Suzy has developed a good relationship with a client Jasmine on the ward, who has been admitted for exploratory gynecological surgery. Jasmine had a termination many years ago and is now finding it hard to conceive. This evening, Suzy is looking after Jasmine who has returned to the ward after her surgery.

Question 1

Suzy has received a notification from AHPRA that her renewal of registration is now due. 

Question 1(a)  

Discuss the roles of the two leading nursing bodies (give the full name of each), who are regulatory partners of AHPRA and name the law under which nursing registration is governed. 
From July 2010, the regulation of the nurses is done by the Nursing and Midwifery Board of Australia, which is an agency operated under the Australian Health Practitioner Regulation Agency (AHPRA) and also under the National Registration and Accreditation Scheme. Previously, state and territorial nursing regulation authorities used to govern the practice of the nurses and after the establishment of Australian Nursing and Midwifery Accreditation Council (ANMAC), those authorities worked together, but as of now Nursing and Midwifery Board of Australia (NMBA), took over and is the regulatory body. 
The law under which nursing registration is governed is the (Health Practitioner Regulation National Law (ACT) , 2017), based on which Nursing and Midwifery Board of Australia (NMBA) outlines its functions.

Question 1(b)

Demonstrate your understanding of the registration standards, by providing 2 examples of requirements that must be fulfilled by Suzy for her renewal to be successful. Use examples of how Suzy might have fulfilled some of that criteria.
The requirements that must be fulfilled for nursing registration renewal are that the mandatory disclosure questions, comprising of the criminal checks and also Professional indemnity insurance arrangements, which must be answered in totality and that must correspond to the registration standards as set out by the Nursing and Midwifery Board of Australia (NMBA), in accordance to the (Health Practitioner Regulation National Law (ACT) , 2017), along with the payment of the renewal fees.

Question 1(c)

In January of this year a new set of enrolled nurse standards for practice came into effect. Discuss the domain of professional and collaborative practice, and explain and explain 4 ways in which Suzy can ensure that she meets the standards set within it.  
The four ways in which the enrolled nurse, i.e. Suzy can ensure that they met the standards set in the professional and collaborative practice domain of the enrolled nurse standards for practice 2016 are that:
i.She is in compliance with the legislation along with the regulations and also the policies and other guidelines, in the process of making decisions and,
ii.That she is engaged into fostering a culture of safety by sharing knowledge in support of care which is person centred. 
iii.Suzy must be in acceptance of the accountability of any kind of decisions or actions she herself is taking or she have delegated the same to some other person. 
iv.Suzy must ensure that she conducts the assessments systematically after analysing the information based on the practice. 

Question 1(d)

Provide an explanation of the history of NSQHS standards; outline at least two (2) examples of those standards and explain the role of the enrolled nurse in providing safe and quality care.
The National Safety and Quality Health Service (NSQHS) Standards (National Safety and Quality Health Service Standards, 2011) provides the ten standards which were developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC). The standards as set out is aimed at protecting the public from harm and also to uphold and maintain the good quality practice by the health service providers, by a quality assurance mechanism which allow in setting up the goals needed for development. 
Maintenance of the standards are the adherence to the fact that they provide and deliver the safe and quality care by active participation in the processes which ensure safety systems and also the initiatives which are to be taken through the training to gain the accountability. Amongst the ten standards the Partnering with Consumers and Preventing and Controlling Healthcare Associated Infections are described here. The former one relates the process where the strategies are created by including the consumers within it so that they can help the organization achieve the quality, and the later one describes methods which must be implemented so that the infection of the patients can be prevented and can also be minimized or managed. So, both these standards are aimed at protecting the consumers from any further harm and also helps to maintain that system within the health practice which equates to safety and high-quality service. 

Question 2

As the shift nears its end, Suzy enters the nurses’ station to complete documentation. Suzy’s colleague Sarah is already there and tells Suzy she has forgotten her password she asks if she can use Suzy’s to complete her notes.

Question 2(a)

What reasonable precautions must an organisation take to protect the privacy of a client? Discuss how using someone else’s password might infringe an organisation’s policy on privacy. Use relevant legislation to support your answer. 
The reasonable precautions that must be taken by an organisation to protect the privacy of a client are that they are in adherence with the (Privacy Act- Federal Register of Legislation, 1988) and also the (Australian Privacy Principles- Australian Information Commissioner - Australian Government - Office of the Australian Information Commissioner), since the (Privacy Act- Federal Register of Legislation, 1988) is applicable to the personal information, where the information regarding health is considered to be subset to it. So, the precautions must be in such a manner that the patient information are in no way used outside the purpose it is taken for and the Practices must also take the expressed consent from the patient before disclosing it to any other person, so it is essential that the patient is physically and legally capable to give consent about using his or her personal information, concerning health.

Question 2(b)

Your client asks you if she can look at her notes to see what the doctor has written about her operation. Discuss the legislation that relates to the access of medical records in this hospital. Detail any other health professionals you would engage with and the commonalities of the information that the client may have access to.
The legislation that relates to the access of medical records by the patients before 2014 was National Privacy Principle 6 (NPP 6) (National Privacy Principles), but as of today (Australian Privacy Principles- Australian Information Commissioner - Australian Government - Office of the Australian Information Commissioner) governs and provides rule for the on-request access to the medical records for the organization, on satisfaction that the information which will be provided to the patient who is requesting must be capable of accepting it, which in other words mean that the availability of the information will not leave the patient with serious threat of life or any other danger.

Question 2(c)

In detail, outline your responsibilities in contributing to the nursing records of a client.
The responsibilities in contributing to the nursing records of a client must be in the following way:
The statements which are to be recorded must be factually correct and be in the consecutive manner, and only those records are to be documented which are personally perceived. 
Avoidance of medical jargons is important along with the personal opinions. 
The abbreviations must also be avoided, and only those acronyms should be used which are in general use and is understandable by all, for e.g. BP is commonly understood as Blood Pressure, so BP can be used. 
Speculations and offensive statements must be kept at bay. 
Maintenance of legible handwritten document with short sentences is required of the nurses. 
Before recording any confidential information, one must carefully decide, the necessity to record those in writing, since the documentation is available to anyone and can be easily misused.

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Question 3

Suzy reads the surgeon’s notes, where it has been written that it is ‘unlikely’ Jasmine will ever conceive naturally. Jasmine asks you to tell her what the surgeon has written. 

Question 3(a)

Discuss the ethical dilemma you are in, what resolution you would come to and who else might you involve?
Answer:The notes so written by the surgeon is quite a sensitive information for Jasmine, and so the ethical dilemma Suzy is in can be resolved by staying in adherence to the Code of Ethics for Nurses in Australia, and she may also involve the family members of Jasmine to share the sensitive information, if she believes that Jasmine may not be in apposition to hear the information and can cause ill effect of mental strain. 

Question 3(b)

Provide an explanation of the term bioethics, include one theoretical concept in your response.
Bioethics is that activity in which the ethical issues within the health care are examined. This activity involves not only the health care professionals but also the general public and have impacted in changing the standards, so that the patients becomes aware of the treatments and can also refuse to it. So, the bioethics is basically the moral enterprise, where the ethics and the morality overlaps. 

Question 3(d)

Sarah who has also looked after Jasmine tells you that she had not read the notes thoroughly and that her religion forbids her from caring for Jasmine.
On what grounds is such a refusal to care for someone made?
The legislation of euthanasia in Australia is the RIGHTS OF THE TERMINALLY ILL ACT, 1995 (RIGHTS OF THE TERMINALLY ILL ACT, 1995), but basically it is governed by the common law, where the doctor can end the life of the patient on their request. 
The doctrine of double effect is that if accomplishing something ethically great has an ethically awful symptom it's morally ok to do it giving the awful reaction wasn't proposed, and is used to legitimize where health care providers offers medications to a patient to mitigate upsetting manifestations despite the fact that he knows doing this may abbreviate the patient's life.    

Question 4

Overnight, the registered nurse is busy with several clients. He fails to complete a proper assessment when Jasmine complains of feeling unwell. Eventually the on-call medic is alerted and Jasmine is taken to intensive care for monitoring.  Jasmine’s partner is called and asked whether he is a power of attorney (POA) for Jasmine as she is deteriorating.

Question 4(a)

In what circumstances might a POA be used and what authority might they have?
Medical power of attorney is also the legal document which gives someone the right in making the medical choices for someone else when that person is not in a position to do it, due to the fact that the person is having acquired brain injury or having any thinking impairment or is unconscious, or is not in a position to communicate properly or may be suffering from dementia. 

Question 4(b)

Jasmine’s partner stays at her bedside. He is very distressed as she becomes much sicker and a decision is made to intubate her and put her on a ventilator. Jasmine’s partner becomes very angry and tries to stop the doctors from doing this. Discuss the medical staff’s duty of care and consent.
When a person is not in a position to make the choices on his or her own capability, due to the fact that the person is having acquired brain injury or having any thinking impairment or is unconscious, or is not in a position to communicate properly or may be suffering from dementia, is the time when the medical power of attorney is required.

Question 4(c)

Jasmine starts to recover over the next few days, she is breathing with the assistance of a ventilator but she remains sedated as she is very agitated and still quite unwell. Jasmine’s partner believes that the sedation (chemical medication) is a form of restraint. 
Discuss the nurse’s responsibility in the use of lawful restraint.
Lawful Restraint is needed to be done by the nurses, when the nurses provides the restraint to the patient for conducting the medical treatment on them. The person’s voluntary movement or behaviour is also restricted or intentionally restrained by the nurses only to provide treatment to the patients which may not be possible when the patient is in motion. 

Question 5

Several weeks later when Jasmine is recovering, she puts in an official compliant to the hospital about the registered nurse who she says ignored her when she felt unwell. A departmental meeting is called with Jasmine and her partner.

Question 5(a) 

Discuss the framework developed by the Australian Council for Safety and Quality in Health Care which guides organisations to express regret for an adverse incident. Discuss the philosophy behind the framework.
The Australian Open Disclosure Framework (The Australian Open Disclosure Framework ) is intended to empower the health care service providers to impart straightforwardly with patients when the pre- decided thing do not happen as per the schedule.

Question 5(b)

Outline the elements of the framework. 
The essential elements of an open disclosure are to express that one is regretful and that must be expressed, 2ndly the facts must be explained without any distortions, 3rdly, the patient, their family and care givers must be provided with the opportunity to narrate or relate their experience and 4thly, the mitigating steps must be explained so that there is no further recurrence of the event. 


Australian Privacy Principles- Australian Information Commissioner - Australian Government - Office of the Australian Information Commissioner. (n.d.). Australian Privacy Principles. Retrieved from
Health Practitioner Regulation National Law (ACT) . (2017). Retrieved from
National Privacy Principles. (n.d.). Retrieved from
National Safety and Quality Health Service Standards. (2011). Retrieved from
Privacy Act- Federal Register of Legislation. (1988). Privacy Act. Retrieved from
RIGHTS OF THE TERMINALLY ILL ACT. (1995). Retrieved from
The Australian Open Disclosure Framework . (n.d.). Retrieved from

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