Accountable Practitioner Essay

As registered nurses you are lawfully and professionally accountable for your actions. irrespective of whether you are following the instructions of another or utilizing your ain enterprise ( Griffith and Tengnah. 2010 ) . The consideration of what answerability means in nursing pattern is a cardinal portion in the foundation of nursing. some would state that being accountable agencies being responsible. and as a effect taking the incrimination when something goes incorrect.

To be accountable is to be answerable for your Acts of the Apostless and skips. this is the attack adopted by the Nursing and Midwifery Council ( NMC ) the nursing regulative organic structure. It states within its codification “You are personally accountable for your actions and skips in your pattern and must ever be able to warrant your decisions” ( NMC. 2008 ) . Therefore answerability is being answerable for your Acts of the Apostless to a higher authorization with whom you have a legal relationship. A wider position of answerability is defined as an built-in assurance as a professional that allows a nurse to take pride in being crystalline about the manner he or she has carried out their pattern ( Caulfield. 2005 ) .

In order to supply maximal protection to the public and patients against misconduct of registered nurses. four countries of jurisprudence are drawn together which separately hold you to account. These are society through public jurisprudence. patient through civil wrong jurisprudence. employer through the contract of employment and profession through legislative act jurisprudence. such as the NMC.

This assignment will reflect on the work and analyze carried out within the Accountable Practitioner faculty including talks and facilitated group Sessionss in which brooding journals were completed [ see appendix I-IV ] . By finishing a Root Cause Analysis ( RCA ) . a system used to happen flaws and chances for betterment of wellness attention. on the Pamela Scenario. it was highlighted that the subject ‘consent’ was an country of concern ( Passage to Practice. 2012 ) . I will hence be looking into the three pillars of answerability which are professional. legal and ethical and associating each of these to my chosen subject and using this to the Pamela Scenario.

Professional Accountability
Professional answerability consists of an ethos in nursing that is based on advancing the public assistance and well-being of patients through nursing attention. This all comes together within the bosom of nursing. Within our group sessions we discussed who registered nurses are accountable to. these being through the commissariats of the Nurses. Midwifes and Health Visitors Act 1997 and the Nursing and Midwifery Order 2001.

The NMC was established under these commissariats in 2002 to protect the populace by set uping criterions of instruction. preparation. behavior and public presentation for nurses to guarantee these criterions are maintained ( Nursing and Midwifery Order. 2001 ) . Professional answerability allows nurses to work within a model of pattern and follow rules of behavior set out by the NMC that maintain the patients trust in the single nurse and nursing as a whole ( Caulfield. 2005 ) .

Obtaining consent affirms the patient’s right to self-discrimination and liberty. The NMC codification of professional behavior has a separate subdivision on consent ( NMC. 2002 ) . Clause 3 requires that ‘as a registered nurse. accoucheuse or wellness visitant you must obtain consent before you give any intervention or care’ .

The professional responsibility recognises the value of liberty in clause 3. 2 and provinces that a refusal to have intervention must be protected even where this may ensue in injury or decease to the person. The professional responsibility besides requires that the nurse gives information that is accurate and true and this must be presented in a manner that is easy understood ( Bowman. 2012 ) .

Within the Pamela scenario there is no suggestion as to whether consent was gained. At the beginning of her attention. when she was admitted to an orthopedic ward they suggested a skin grip should be applied to the affected limb. nevertheless no consent was gained and the staff on the ward took it upon themselves to find whether this was the best action. Within our group we discussed that at this point Pamela was mentally capable of giving informed consent [ see appendix II ] .

Pamela subsequently became really agitated and baffled and was finally referred for a CT scan which showed findings of Alzheimer’s disease. From this point onwards there is no grounds to propose that consent was gained from person with capacity following the Mental Capacity Act ( 2005 ) where they province “a individual is unable to do a determination for themselves if they are unable to: understand information given to them. retain that information. usage or weigh that information as portion of the procedure in doing a determination and communicate that information” .

In this case it is non possible to find whether Pamela was able to give informed consent herself or whether any household members gave this for her. Professionally the staff within the ward that made this determination on her behalf would be held accountable.

Legal Accountability
The jurisprudence is a major country of answerability for nursing pattern. The jurisprudence is a set of regulations. ordinances and instances that provide reading of the regulations and ordinances that apply to society. There are really clear punishments for anyone. including nurses. who fail to follow the regulations set out by jurisprudence. Within our group sessions we discussed the two systems of jurisprudence within the UK [ see appendix I ] : civil jurisprudence and condemnable jurisprudence. each one consists of its ain construction and different regulations apply for each system ( Young. 2008 ) . The types of civil jurisprudence that affect answerability in nursing pattern include differences with employers. instances of patients actioning due to allegations of carelessness and instances where a nurse sues her employer due to injury at work.

All these instances are heard in civil tribunals and the justice can present compensation. Condemnable jurisprudence is the system designed to measure that regulations set out by parliament are followed. The Acts of the Apostless of parliament trade with issues such as medical specialties. self-destruction. organ and tissue contribution. mental wellness and determinations about wellness attention where a individual does non hold the capacity to do their positions known.
Condemnable punishments include mulcts or imprisonment ( Caulfield. 2005 ) .

The jurisprudence recognises that grownups have a right to find what will be done to their organic structures. Touching a individual without consent is by and large improper and will amount to conflict to the individual or. more seldom. a condemnable assault. Unlike other civil incorrect behaviors such as carelessness which requires injury. any improper touching is actionable despite whether being done with the best of motivations ( Tingle and Cribb. 2007 ) . When obtaining consent. you must guarantee that the patient agrees with all the intervention intended to be carried out. Continuing with intervention that the patient is incognizant of. or has refused to hold to will be a trespass to the individual and actionable to jurisprudence.

Nurses must therefore take attention to explicate all the intervention or touching that will happen when obtaining consent from a patient and guarantee that any extra intervention is capable to farther consent ( Savage and Moore. 2004 ) . “Consent is an look of liberty and must be free pick of the person. It can non be obtained by undue influence” ( Griffith and Tengnah. 2010. p. 82 ) . In jurisprudence. undue means that the influence must take the patient’s free will and be so forceful that the patient excludes all other considerations when doing their pick.

It is an constituted portion of jurisprudence that no intervention may be given to an person. whether it be clinical or nursing unless the patient has consented ( Johnstone. 2009 ) . Therefore as consent was non gained within the Pamela scenario when make up one’s minding whether to use grip to her leg the physicians and nurses involved in doing the determination on her behalf would be held lawfully accountable and could confront condemnable prosecution.

Within our facilitated group Sessionss we discussed the following established rules which must all be satisfied before consent is sufficient [ see appendix III ] : ‘consent should be given by person with capacity’ . Within the scenario it is stated that Pamela was diagnosed with Alzheimer’s disease. nevertheless the household were non asked to accept on her behalf following the Mental Capacity Act ( 2005 ) .

‘Sufficient information should be given to the patient’ is the 2nd rule. Pamela’s household province they were unaware of what was go oning with her attention and within the ailments missive. Pamela’s girl provinces staff did non give her relevant information even when Pamela was diagnosed with Alzheimer’s. The 3rd rule ‘the consent must be freely given’ . due to the staff non deriving any consent and taking the determination into their ain custodies this rule like the old two was besides non followed. The carelessness and consent entirely within this scenario would put the staff involved straight into legal answerability. Ethical Accountability

Accountability is an of import ethical construct because nursing pattern involves a relationship between the nurse and the patient ( Fry. 2004 ) . Within our group sessions we discussed Beauchamp and Childress ( 2001 ) who developed a model which offers a wide consideration of ethical issues. This consists of four rules: regard for liberty which means esteeming the decision-making capacities of independent individuals ; enabling persons to do reasoned informed picks. Beneficence. this considers the reconciliation of benefits of intervention against the hazards and costs ; the healthcare professional should move in a manner that benefits the patient.

Non maleficence. this means avoiding the causing of injury. the healthcare professional should non harm the patient. All intervention involves some injury. even if minimum. but the injury should non be disproportional to the benefits of intervention. And eventually. justness. this includes administering benefits. hazards and costs reasonably. the impression that patients in similar places should be treated in a similar mode.

Consent is a moral and legal foundation of modern wellness attention. Treatment that returns without consent of the patient instantly requires a thorough moral probe. Despite the fact that consent may hold been given it is of import to guarantee this means more than the mere fact a signifier has been signed. The chief function of consent is to protect patients and in peculiar to protect their position of liberty and enable them to stay in control of their ain lives ( Fry and Johnstone. 2008 ) .

In ethical footings. consent is of import because it demonstrates regard for liberty. hence through take parting in a consent procedure the person’s liberty may be farther enhanced by holding the pick to accept or worsen attention. For some persons their ability to consent may be compromised by their place within their cultural group. For illustration. adult females within certain civilizations might hold the capacity to consent but would non anticipate to hold the right to find what happens to them ( Chadwick and Tadd. 2003 ) . If consent was non gained and intervention was carried out on a individual within an ethical group who did non hold to the intervention. so that individual would be held ethically accountable.

In the scenario. nurses did non use skin grip to Pamela’s leg despite the acknowledging physician proposing that it be applied. Ethically. this related to non-maleficence as it can be assumed the grip was non applied due to the intervention holding a conservative nature and the nurses believing it would be of no benefit to Pamela in respects to trouble alleviation. Besides a big bulk of attention was carried out after Pamela was diagnosed with Alzheimer’s which leaves her vulnerable to intervention being carried out without consent from her or her household.

Decision
Throughout the faculty I have developed my consciousness of the professional. ethical and legal issues that are associated with supplying accountable wellness and societal attention. I was able to reflect on my ain acquisition and development as an accountable practician and take part in the facilitated group Sessionss. I have increased in assurance and developed communicating accomplishments by holding the chance to talk and voice my sentiment in forepart of other co-workers ; this will enable me to take part in handover and assorted squad meetings whilst out in pattern.

Analyzing the scenario in groups enabled me to derive a clearer understanding into the issues raised and this allowed the assignment to be completed with assurance. I was able to beef up my ability to measure and utilize related grounds based literature to endorse up my statements which were from a assortment of beginnings. Finally. being able to take our ain subject from the scenario enabled me to hold a greater consciousness of consent which will profit me when out in pattern.

Part B
I shall be utilizing the Gibbs Reflective Cycle ( 1988 ) to reflect upon a critical incident that I have witnessed out during a ward based arrangement. The Gibbs brooding rhythm suggests that theory and pattern addendum each other in a ceaseless circle which was coined from Kolb’s experiential acquisition rhythm. By utilizing the Gibbs brooding rhythm I shall be looking into how I felt during the clip. what I felt and thought after the incident and most significantly what I would make otherwise following clip. Event

The incident I will be looking back on occurred whilst on arrangement within an orthopedic ward when I was given the chance to help a registered nurse on her drug unit of ammunition. I had antecedently assisted her on drugs unit of ammunitions she was happy for me to administrate the medicine which was Enoxaparin on this peculiar patient. As I joined her with the drug round portion manner through. due to assisting another patient she had already confirmed the patients name and day of the month of birth and the patient had verbally consented to the disposal and hence I was told me to merely administrate it.

I followed all the relevant policies and processs whilst administrating the medicine nevertheless I did non understand why the registered nurse would let me to administrate the drug without myself deriving consent from the patient to guarantee he was happy for a pupil nurse to transport out the disposal. I hence explained to the patient that I was a pupil nurse and I had antecedently carried out an disposal of enoxaparin but explained to him that I would non be offended if he was non happy for me to administrate the drug myself. I had been looking after this patient over a figure of yearss and had therefore gained his trust so he verbally consented to me administrating the drug and allowed me to go on.

Ideas and Feelingss
Whilst I was administrating the medicine I felt really confident as I had administered a figure of these antecedently and besides holding a patient who was happy for me to transport this out enabled me to finish this aptly. The patient besides spoke to me throughout about his personal life so I was reassured that he was non experiencing worried or dying and hence placed me in a confident frame of head. The registered nurse was besides shadowing me whilst I administered the drug so I was happy I was non traveling to do a error.

Evaluation
There was nil bad about this experience apart from the confusion of the registered nurse stating me non to follow protocol and dual look into his day of the month of birth and consent. nevertheless I felt I did the right thing. I enjoyed administrating the Enoxaparin as I felt it would heighten my experience and it was good pattern for me. particularly as this drug was a really common drug used within most hospital wards.

Analysis
Although I felt confident administrating the Enoxaparin. I did non experience all that confident when asked to administrate the medicine without look intoing the patient’s name and day of the month of birth and deriving consent which is a critical protocol of disposal of medical specialties set out by the NMC ( 2010 ) . Looking back I should hold voiced my concerns and asked why she did non desire me to corroborate these ; nevertheless I did non desire to oppugn my mentors’ experience or authorization.

A figure of answerability issues were raised within this pattern in which I subsequently discussed with my wise man so I could corroborate I did the right thing. The Nursing and Midwifery Council ( NMC ) states that the disposal of medical specialties is a critical facet of professional pattern for registered nurses which are to be performed in rigorous conformity with the written prescription of a medical practician necessitating exercising of professional opinion ( NMC. 2010 ) .

The NMC ( 2010 ) besides province within their consent codification “To make the attention of people their first concern and guarantee they gain consent before they begin any intervention or care” I did transport out this rule although asked non to by the nurse I was working with. If I did non transport out these cheques although merely a pupil nurse I would still be held accountable for my actions when I knew this was against protocol.

Decision
As a pupil nurse it is acceptable to help with drug ward unit of ammunitions and administrating medicines. nevertheless when I was asked to administrate the medicine without the patients individuality confirmed and consent gained I should hold said I did non experience comfy with the undertaking as it was non working in concurrence with the NMC’s criterions of medical specialties disposals but I would detect. When learning a pupil and to better general pattern overall the nurse in inquiry should hold asked me to corroborate the patients name and day of the month of birth and gained consent before administrating the medical specialty.

Although there was no issue with administrating medical specialty to the incorrect patient or any ethical issues due to non deriving consent on this twenty-four hours. this could hold been a really large nursing mistake doing a potentially large job with answerability on my behalf.

Action Plan
As a pupil nurse it is of import to take chances to larn new accomplishments when following a wise man that you might non needfully experience wholly confident with nevertheless ultimate duty remains with me if I do non experience confident in the state of affairs that I have been assigned. Although I was confident with the undertaking in manus I was non happy with the manner I was asked to transport out this process by losing out critical NMC codification protocols. The lone thing I would hold done different in this state of affairs would be to state I did non experience comfy with administrating medicine to a patient without transporting out the relevant cheques and I should hold confronted the nurse in inquiry and asked why she did non state me to inquire for these inside informations.

Although she had carried these out antecedently she did non explicate to the patient that I was a pupil nurse and this could hold gone really incorrect. If placed in this state of affairs once more I would non alter anything which I personally did myself. I would still follow the NMC counsel on medical specialties disposal ( NMC. 2010 ) which therefore takes me out of the answerability inquiry if anything was to travel incorrect. nevertheless I would face the nurse and inquire why these cheques were asked to be skipped.

Mentions
Beauchamp. T and Childress. J. ( 2008 ) Principles Biomedical Ethics. 6th erectile dysfunction. Oxford: Oxford University Press. Bowman. D. ( 2012 ) Informed Consent: A Primer for Clinical Practice. Cambridge: Cambridge University Press.

Caulfield. H. ( 2005 ) Accountability. Oxford: Blackwell Publishing.

Chadwick. R and Tadd. W. ( 2003 ) Ethics and Nursing Practice: A Case Study
Approach. Hampshire: Palgrave Macmillan.

Fry. ST. ( Ed. ) ( 2004 ) Nursing Ethical motives: Encyclopaedia of Bioethics. 3rd erectile dysfunction. New York: Macmillan.

Fry. ST and Johnstone. MJ. ( 2008 ) Ethics in Nursing Practice ; A Guide to Ethical Decision Making. 3rd erectile dysfunction. Oxford: Blackwell Publishing.
GIBBS. G. ( 1998 ) Learning by Making: A Guide to Teaching and Learning. London: FEU

Griffith. R and Tengnah. C. ( 2010 ) Law and Professional Issues in Nursing. 2nd erectile dysfunction. Exeter: Learning Matters Ltd.

Johnstone. MJ. ( 2009 ) Bioethics: A nursing position. 5th erectile dysfunction. Sydney: Elsevier.

Nursing and Midwifery Council ( NMC ) ( 2002 ) Code of Professional Conduct. London: NMC.

Nursing and Midwifery Council ( NMC ) ( 2008 ) The Code: Standards of behavior. public presentation and moralss for nurses and accoucheuses. London: NMC.

Nursing and Midwifery Council ( NMC ) ( 2010 ) Standards for Medicine Management. London: NMC.

Nursing and Midwifery Council ( NMC ) ( 2010 ) Regulation in Practice: Consent. London: NMC.

Nursing and Midwifery Order ( 2001 ) Article 3. London: NMC.

Savage. J and Moore. L. ( 2004 ) Interpreting Accountability. London: Royal College of Nursing.

Tingle. J and Cribb. A. ( 2007 ) Nursing Law and Ethics. 3rd erectile dysfunction. Oxford: Blackwell Publishing

Passage to Practice ( 2012 ) Root Cause Analysis Steps. [ on-line ] Available at: hypertext transfer protocol: //transitiontopractice. org/files/module4/QI % 20- % 20Root % 20Cause % 20Analysis % 20steps. pdf [ Accessed 12 September 2012 ] . Young. A. ( 2008 ) Reappraisal: The legal responsibility of attention for nurses and other wellness attention professionals. Journal of Clinical Nursing. 18: pp. 3071-3078.

Bibliography

Confidentiality Act ( 1991 ) Great Britain. London: HMSO.

Data Protection Act ( 1998 ) Great Britain. London: HMSO

Hendric. J. ( 2000 ) Law and Ethical motives in Nursing and Health Care. Cheltenham: Stanley Thornes Ltd.

Nursing and Midwifery Council ( NMC ) ( 2006 ) Standards of Proficiency for Nurse and Midwifery Prescribers. London: NMC

Royal College of Nursing ( RCN ) ( 2006 ) Nurses and Medicines Legislation: An Information Paper. London: NMC.

Reeves. M and Orford. J. ( 2002 ) Fundamental Aspects of Legal. Ethical and Professional Issues in Nursing. Wiltshire: Mark Allen.

Tschudin. V. ( 1996 ) Ethical motives: Nurses and Patients. London: Bailliere Tindal. Watson. R. ( 1995 ) Accountability in Nursing Practice. London: Chapman and Hall.

Appendixs

Appendix I
Personal Diary Sheet 1 ( 25/06/12 )

Appendix II
Personal Diary Sheet 2 ( 09/07/12 )

Appendix III
Personal Diary Sheet 3 ( 16/07/12 )

Appendix IV
Personal Diary Sheet 4 ( 23/07/12 )