This assignment is based on the ethical and legal issues that are significant to nursing practice.  The specific areas that are going to be covered will be that of consent, accountability, duty of care, the Nursing and Midwifery council’s code of professional conduct and the four fundamental principles used in ethical decision making, also known as principlism.  

The following statement will also be discussed: “Ignorance of the law is no defence and the nurse should be aware of the limits which the law imposes on her, and also the power it gives her” (Dimond 2004).  Nursing practice is affected by many pieces of legislation and law (Kozier) and so areas such as negligence and trespass will be discussed.  A scenario taken from practice will then focus on some key legal and ethical issues that arise during practice, adhering to confidentiality at all times.  The main issue from the scenario that will then be discussed is that of informed consent and also how a nurse may use her role to influence people and their decisions and what the implications this could cause.  Throughout the assignment, personal reflective thoughts will be given to show learning and understanding.   A conclusion of what has been discussed throughout the assignment will then summarise the main points and make recommendations for future practice.  

As a health care professional, nurses are accountable for their acts and omissions within four areas; the public, the patient, their employer and the Nursing and Midwifery Council (Kozier 2008).  Accountability refers to a person been answerable for their own actions (Heath el al. 1995), and also been a responsible person being able to give a rational, coherent account of their actions (Thompson et al. 2000).  A nurse is accountable to their employer for the way in which they practice and this is regulated through documentation such as the contract of employment (Walsh 2000).  This contract of employment is an agreement both the employee and employer enter into that is protected by law (Staunton and Chiarella 2003).  The Employment Rights Act (1996) sets out certain rights that the employee has and gives guidance to the employer in regards to what the contract of employment must include such as a description of duties the employee is to undertake.  

A nurse is accountable to the public in the form of criminal law and they have a duty to maintain standards of care, which includes reporting incidences of negligence and poor patient care (Thompson et al. 2006).  These professional standards of care are set out by the Nursing and Midwifery Council (2008) who states that nurses must always act lawfully and uphold the reputation of their profession.  Part of this professional accountability includes the delegation of work.  The NMC (2008) states that when a nurse delegates work, they must ensure the person is able to properly carry out the task and it must be ensured it has been done.  When in practice, as a student nurse, my mentor may ask me to take a patients blood pressure.  I would carry out the task and report any findings back to my mentor, but it is ultimately my mentor’s responsibility as a registered nurse to ensure I have carried the task out properly, as she is accountable for the patient and must ensure any care is carried out safely and effectively, as she would if she was taking the blood pressure herself.  Delegation involves the transfer of responsibility to another person to perform a task, but the delegator, in this case the nurse, is still accountable for the task (Curtis and Nicholl 2004).  The council also states that nurses have a responsibility to deliver safe, effective evidence based care (NMC 2006).  

Nurses are accountable to their patients in the form of civil law and owe duty of care to them.  This duty of care was recognised through the case of Donoghue versus Stevenson (1932).  The case consisted of a lady, Donoghue, drinking a bottle of ginger beer which her friend had purchased for her.  Half way through consuming the drink, Donoghue noticed part of a decomposed snail fall from the bottle into the beaker in which she was drinking from.  Donoghue later complained of stomach pains, which a Doctor diagnosed as gastroenteritis as a result of consuming the contaminated drink, and claimed that she had suffered emotional stress as a result of the situation.  Donoghue later brought an action of Tort negligence against Stevenson, claiming he owed purchasers of his product a duty to ensure no harmful elements contaminated his product.  Donoghue claimed £500 on the grounds that Stevenson owed a duty of care to the consumers of his product to ensure it contained no substances that could cause harm.  Years later, the case was discussed further and Lord Atkin made a speech that revealed his neighbour principle in light of the case (Cited in Stone 1965):

You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. Who, then, in law, is my neighbour? The answer seems to be—persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions that are called in question (p.176).  

This statement structures the basis on which duty of care is formed and suggests that a duty of care exists when it is reasonably foreseeable that a persons action may cause harm to another person (Dimond 2005).  This is an important statement for nurses to consider as by the sense of a nurse-patient relationship, there is always a duty of care owed by the nurse to their patient (Dimond 2005), and if this duty of care was to be breached, the question that must be asked is what standard of care has been given?  The standard of care is measured by using the Bolam test.  This test was brought about from the case Bolam V. Friern Hospital Management Committee (1957).   This case involved a doctor carrying out Electro convulsive treatment (EVT) on a patient, Bolam.  When the patient was undergoing the treatment, the doctor did not administer muscle relaxants, which is usually given, and he did not restrain his limbs.  As a result, Bolam fractured his hip whilst undergoing the treatment.  The legal question then asked was whether the doctor was negligent and whether he had acted in accordance with what other professionals in the same field would have done (Hope et al. 2003).  Even though it was found that most doctors in the same field would have used either restraint or muscle relaxants when carrying out EVT, there was a small number of professionals that supported the method used on Bolam and so the doctor was found not to be negligent as he could not be found guilty just because some of the doctors disagreed with his methods (Elliott and Quinn 2005).  The Bolam test therefore is the method of measuring standards of care by seeing what a responsible body of professionals in a similar field to the professional in question would do in the same situation, at that point in time (Tingle and Cribb 2002).  

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In practice it can be seen that a patient who is very unsteady on their feet is at high risk of falling and it can be reasonably foreseeable that the patient could fall.  In this situation, the nurse should take appropriate action to try and prevent the patient falling, and this falls within the duty of care that the nurse owes the patient.  The nurse could communicate with other staff about the patient’s mobility and also put interventions in place to help prevent the patient falling.  However, if the nurse was to ignore this reasonably foreseeable event and the ...

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