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Law and Ethics in Nursing. The aim of this assignment is to reflect back on a critical incident that happened whilst on placement. The incident will include an ethical issue with an elderly lady who has dementia and refused to take her medications whils

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Introduction

The aim of this assignment is to reflect back on a critical incident that happened whilst on placement. The incident will include an ethical issue with an elderly lady who has dementia and refused to take her medications whilst under our care. The author will discuss how the situation arose and why there was a need to covert her medication and will look at law and ethical issues surrounding covert medication. Laws on consent and mental capacity which are in place to protect patients will also be looked at. A model of reflection will be used to reflect back on the incident, looking at each of the stages of Gibbs model of reflection to help breakdown the incident. Moral theories and principles and how they influence decision making in nursing will be discussed and related to the patient. For the purpose of this assignment and to comply with the NMC, (the code 2008) on confidentiality my patient will be called Mrs M. Nurses are required to work within the law and according to the requirements of the NMC the code. These rules and legal obligations are set out for nurses and midwives who have a legal and professional duty to care for patients when under their care and are accountable for their actions; this is to protect patients so they are not harmed by your acts or omissions (Griffith & Tengnah 2008). Fremgen (2009) quotes that law is a system of principles and rules of human conduct prescribed by society and enforced by public authority. Buka (2008) states for a law to be effective it should have sanctions for punishing those who fail to adhere to its stipulations. Laws are developed in response to the needs of society and the survival of the law depends on customary usage. With the Human Rights Act in force, Patients Association and other informative organisations, patients and families are becoming more aware of their rights and are more open to challenging healthcare decisions such as end of life issues or do not attempt resuscitation orders (DNAR). ...read more.

Middle

They are able to absorb information about their required treatment and able to make a decision without the influence of others and achieve the best possible outcome. Mrs M lacked autonomy as she had made a decision not to take her medications even though it was important for her health, each time consent was required she would continue to refuse her medication regardless of the implications of not taking them. She did not have the capacity to make the right decision and continued to believe her vomiting was associated with her medications and could not encourage her otherwise. Mrs. M had been taking these tablets for some time before coming into hospital due to her condition and with this in mind a best interest decision was made on Mrs M's behalf to avoid deterioration with her health. For an autonomous person this also gives the right to refuse treatment, even if life saving treatment was essential. The NMC the code (2008) states "respect and support people's rights to accept or decline treatment and care". Aveyard (2002) states 'If a patient refuses care, care cannot be given. To do so would be to infringe patient autonomy and to contravene the principles of consent'. A competent person has the right to refuse treatment even if initial consent was granted. If the individual does not feel it is in their best interests or changes their mind then consent is no longer valid. To continue with treatment would be grounds for trespass to that individual. However, Mrs M. was not competent and as such her refusal was taken into consideration but her health was the main issue and what was best for Mrs M. The decision to covert her medication was made to alleviate her symptoms from not taking her medication and to prevent any further deterioration with her health. To return to the issue of best interest decision making Griffith et al (2009) states that where a patient lacks decision making capacity, the (Mental Capacity Act 2005) ...read more.

Conclusion

London: NMC. NURSING AND MIDWIFERY COUNCIL., 2010. Fitness to Practice annual report. Available from: http://www.nmc-uk.org/Documents/Annual_reports_and_accounts/FTPannualReports/NMC_FTPannualReport2009_2010.pdf Accessed 16 June 2011 NURSING AND MIDWIFERY COUNCIL., 2010. What is the NMC's Function?. Available from: http://www.nmc-uk.org/Press-and-media/FAQs-for-journalists-About-the-NMC/What-is-the-NMCs-function-/ Accessed 28 May 2011 PALMER, A, BURNS, S, BULMAN, C., 1994. Reflective practice in nursing: The growth of the professional practitioner. Blackwell science: Oxford PARAHOO, K., 1997. Nursing Research: Principles, Process and Issues. Great Britain: Macmillan PATERSON, J.G, Zderad, L.T., 1988. Humanistic nursing. National league for nursing. New York PENDLETON, J,. 2006. Truth telling and dementia, Faculty of Medical and Human Sciences, University of Manchester, UK PELLEGRINO, E.D., 1994. The four principles and the doctor-patient relationship: the need for a better linkage. In: R. GILLON Principles of healthcare ethics. New York: John Wiley, 1994, pp. 353-365 POOL, J,. 2007. Facts or feelings: Do we need to choose? Journal of Dementia Care, 15(2), 27. REID, B., 1993. 'But were doing it already!' Exploring a response to the concept of reflective practice in order to improve its facilitation. Nurse Education Today 13, 305-9 Re W (A Minor) (Medical Treatment: Court's Jurisdiction) [1993] Fam 64 ROBERTSON, M.; WALTER, G., 2007. A critical reflection on utilitarianism as the basis for psychiatric ethics. Part 1: utilitarianism as an ethical theory. Journal of Ethics in Mental Health 2(1), 1-4 SANDELOWSKI, M., 1995. Sample size in qualitative research. Research in Nursing and Health, 18: 179-183 SAVULESCU, J., KERRIDGE, I.H., 2001. Competence and consent. Med J Aust 175(6): 313-15 SCHON, D., 1991. The Reflective Practitioner, 2nd edition. San Francisco. Jossey-Bass SEMPLE, M, CABLE, S. 2003 'The new code of professional conduct', Nursing Standard, 17:(23), 40-48 TINGLE, J, CRIBB, A., 2007. Nursing law and ethics 3rd edition. Oxford: Blackwell publishing TRELOAR, A, BEATS, L, PHILPOT, M., 2000. A pill in the sandwich: covert medication in food and drink. Soc Med 93:408-411 TSAI, D.F.C., 2005. The bioethical principles and Confucius' moral philosophy. Journal of Medical Ethics 31, 159-163 TUCKETT, A.G., 1998. An ethic of the fitting: a conceptual framework for nursing practice. Nursing Inquiry 5(4), 220-227 WILKINSON, J., 1999. Implementing reflective practice. Nursing Standard, 13(21) 36-40 ...read more.

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