Accountable Practitioner- Consent

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Accountable Practitioner- Consent

Caulfield’s (2005) Four Pillars of Accountability provides a good overview of the elements that need to be addressed in relation to the professional role. This assignment will look at three of the pillars: relevant legal, ethical and professional issues that impact on the role of a nurse. Other areas that can inform professional judgement and decision-making practice include clinical guidance from the Department of Health (DoH), the National Institute for Clinical Excellence (NICE), alongside information from the Nursing and Midwifery Council (NMC) and the General Medical Council (GMC). All of these have been looked at by my group throughout the module and will be considered when forming this essay.

This assignment will discuss my leaning throughout the module and analyse my development as an accountable practitioner. I will also discuss the accountability of student nurses and reflect on my branch of nursing which is Mental Health. Towards the end of my assignment I will write a critical incident report which will reflect on an event which happened on a past placement regarding my chosen topic.

Hendrick (2004) interprets accountability to be about justifying your actions, omissions and decisions. And in order to be accountable you must have the necessary knowledge to explain the motives behind your action (Dimond, 2005).

In the School of Nursing, this module has looked at the scenarios of Pamela and Eddie. From the Pamela scenario our group queried her ability to give consent when she was in a confused and agitated state. Even though consent may have been gained prior to the original operation date some changes were discussed in the scenario and therefore I believe these changes should have been discussed with Pamela and further consent should have been gained. So the concern that I have raised I have decided to base my assignment on the subject matter of consent. 


It is a general legal, ethical and professional principle that valid consent must be obtained before starting any treatment or physical investigation, or providing personal care for a patient. This principle reflects the right of patients to determine what happens to their own bodies, and is a fundamental part of good professional practice (Department of Health, 2001). Expressed consent can be given in writing or verbally. Dimond (1995) suggests that, written consent is by far the best form of consent.

The Department of Health (2001) declares that for consent to be valid, it must be given voluntarily by an appropriately informed person who has the capacity to consent to the intervention in question. Acquiescence where the person agrees but does not know what the intervention entails is not consent.


Ethics is defined as the knowledge of the principles of good and evil. Sensitivity to ethical issues should be prerequisite for any profession that holds public trust. Nursing holds a public trust and therefore we must be aware of ethical concerns when dealing with patients (Barry, 2002). Ethical dilemmas such as consent force nurses to decide on possible actions to take. By discussing the ethical principles of autonomy, beneficence and non-maleficence and applying the ethical theories I hope to make it clear how nurses justify their actions.

My understanding of ethical accountability is that I am answerable to myself; I must always be truthful, fair and respectful and I believe I must treat others as I would like to be treated. Nurses faced with an ethical dilemma have to decide which possible action is the right action to take and how choice of this action over others is justified (Singleton and McLaren, 1995). During the module we have looked at various ethical models including Seedhouse’s Ethical Grid (1998) and Curtin’s Ethical Decision Making Model (1982) which provide guidance toward the resolution of clinical dilemmas; some of the aspects of these models will be evolved in the next section of this assignment.

Rumbold (1999) insists that respect for a person’s autonomy is one of the crucial principles in nursing ethics and ethical models. Gillon (1986, pp.56) defines autonomy as “the capacity to think, decide, and act on the basis of such thought and decision, freely and independently and without let or hindrance”. Therefore, it can be said that patients can expect to be fully informed of any methods of treatment available to them, in order to exercise their rights to consent to or refuse such treatment. In order for a nurse to fully respect patients autonomy, she must respect whatever decision the patient makes, and to act otherwise is to disregard the patient as an autonomous being (Fletcher et al., 1995).                 

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Fletcher, Holt, Brazier et al. (1995) discuss that when considering patient well-being, nurses may demonstrate paternalism towards their patients. Paternalism is to believe that it is right to make a decision for someone without taking into consideration those persons wishes, or even to override their wishes; therefore overriding autonomy. This happens all the more in Mental Health and Learning Disability services because people assume that they may not have capacity to make decisions for themselves.

Singleton and Mclaren (1995) suggest that justification for nursing interventions rest on the concept that the principle of beneficence and non-maleficence takes precedence over considerations of ...

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