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Question 1: Consider the current NMC Code, relevant legislation, policies, guidelines, ethical principles. Identify, discuss and analyse the appropriateness of behaviours of the nurses involved in the scenario.
The presence of enhanced nursing behaviour in delivering care to the patient is to be maintained so that satisfactory and empathetic care can be provided to them and the nurses can act professionally to provide safe and enhanced quality ethical care (Mohammadipour et al., 2017). However, failure to maintain positive behaviour by the nurses according to the professional code leads them to make hindered care decision for the patient which leas the patient to suffered hindered health condition (Twibell et al., 2018). In this essay, one such incidence is to be analysed in which a nurse named Bola is seen to be showing hindered behaviour in caring for the patient named Jamal even though made aware of her act by the student nurse Mark. For this purpose, the relevant legislation and policies along with ethical principles and the NMC Code is to be explored and examined to understand to what extent the nurse acted appropriately towards the patient Jamal.
The NMC Code act as guidelines for the nurses to follow in delivering effective care to the patient under all condition to enhance their health (Baillie, 2017). According to section 4 of the NMC Code, the nurses are responsible to act in best interest of the patient and provide them appropriate care without delay. The nurses under this section is allowed to raise concern to the manager if they feel they have conscientious objection regarding any care to be delivered (NMC, 2018; Rajan-Brown and Mitchell, 2020). In Jamal’s case, it was seen that Bola did not appropriately followed the NMC Code and never raised concern that she is facing issue with keeping the nutrition and fluid balance records of Jamal that is been instructed in the care plan. As argued by Kane et al. (2017), failure to immediately show concern and action for the failure in care for the patient makes them develop deteriorated health condition. This is because lack of improving and altering the failed care leads the mistake or gap in care to remain unresolved. In Jamal’s case, Bola’s lack of raising concern about her failure to care for Jamal led the patient to experience dehydration and confusion which are deteriorated effects on his health.
The section 7 of NMC Code mentions that the nurses are responsible in communicating clearly to the patients by using verbal and non-verbal cues to better understand and respond to the raised need and demand of the patient (NMC, 2018). This is because effective communication between patients and nurses support development of therapeutic relationship along with help nurses to understand way care is to be arranged for delivering satisfactory support to the patient (Chan et al., 2018). However, the Code was not appropriately followed by Bola which is evident as Mark reported Bola lever made fruitful communication with Jamal to understand his needs and demand of care and delivering support according to own wish. This is also make Bola violate section 2 of the NMC Code that mentions nurses are to listen to the patient needs and respond to their concerns in effective manner (NMC, 2018). However, Mark is seen to appropriate follow this Code as he always asked for preferences and needs of care from Jamal which led him to known that he was hungry for two days and Mark accordingly arrange care for his well-being to resolve his concern. The section 8 of NMC Code mentions that nurses are to cooperatively work with the colleagues and maintain effective communication with them for delivering enhanced care to the patient and to preserve their safety (NMC, 2018). However, Bola is seen to violate the section 8 of the Code by avoiding working cooperatively with Mark by maintaining effective communication. This is evident as Bola is seen to avoid discussing the reason of the nutrition and fluid balance chart not been appropriately maintained for Jamal when the concern was raised by Mark. Moreover, Bola was seen to neglect Mark’s concern over Jamal by mentioning he needs to keep within his limit and remain calm enough to complete hi course as he is just a student nurse. The section 10 mentions that all the patient’s records are to be clearly and accurately maintained without any falsification (Scott, 2017). In Jamal’s case, it was seen that Bola violated the Code by not appropriately recording the nutrition and fluid balance score of the patient and mentioning score in a falsified manner by guessing them. It is argued by Choi et al. (2017) failure to maintain appropriate patient records leads to hindered recording of evidence that lead to act as irrelevant reference for treating similar patients in future. Therefore, it can be analysed that Bola’s falsified recording of Jamal’s care cannot be used as appropriate reference to decide care for similar patient due to negligence and hindered recording of care data.
The section 8 of NMC Code regarding nursing and midwifery students mentions that the student nurse is to report any concern to the mentor, tutor or lecture with immediate effect if they feel a colleague or peer is putting any patient in danger (NMC, 2018). The student nurse named Mark caring for Jamal is seen to inappropriately follow the Code in this respect as he did not raise the concern of hindered nutrition and fluid balance by Bola at the first instance to Yemi who was his mentor and supervisor. Mark only reported the incidence after deteriorated health condition was mentioned by Jamal. Thus, it can be analysed and argued that failure to report concern at the appropriate time to the mentor by the student nurses leads them to be responsible for causing deterioration of health of the patient. This is because the error in care is not resolved that could ensure well-being of the patient (Assiri et al., 2018). The NMC Code regarding nursing and midwifery students mentions that the student nurses are to immediately ask for assistance from qualified professionals if they perceive any patient they are caring has experience harm or report being unhappy in care (NMC, 2018). This part of the Code is seen to be appropriately followed by Mark as a student nurse. This is because he was seen to immediate report Jamal’s unhappiness with not being provided adequate food and drinks in the past two days by Bola when he was on leave to Yemi who is Mark’s supervisor. As argued by Lomas et al. (2018), resolving raised concern of the patient regarding care with immediate effect makes them feel valued by the nurse. This us because they feel the nurses genuinely care for them due to which immediate actions are taken to ensure their enhanced health under all condition. Therefore, Mark by immediately acting to resolve the raised concern and unhappiness of care of Jamal helped to value him and feel respected.
In nursing, apart from the NMC code, the nurses are responsible in meeting the ethical principles of care which are autonomy, beneficence, non-maleficence and justice (NMC, 2018). The ethical principles are important to be followed in care because they ensure upholding the respect and value of the patient (Wehkamp et al., 2021). The autonomy informs that it is the ethical duty of the nurses to inform patients regarding the care available for them and support them in taking own decision for care (Vedam et al., 2019). The study by Johnson et al. (2018) argued that lack of autonomy leads the patient to feel unempowered and lack value in leading their own life as they cannot make or avail their own choices. In case of Jamal, Bola was seen to show failure in following autonomy as she never communicated to Jamal in effective manner to help him report his concern and preference regarding health or make decision regarding healthcare been provided.
The non-maleficence mentions that nurses have the ethical duty to protect the safety of the patients under all condition and avoid causing any harm to the patient (Sturdivant et al., 2020). In case of Jamal, it was seen that Bola expressed failure in following the principle of non-maleficence whereas Mark being a student nurse appropriately followed it to ensure safe care to the patient. This is evident as Bola ignored to follow nutritional and fluid balance required by Jamal with intention and never cared to ensure he takes in proper diet and fluid to avoid dehydration and further weight loss. It led to harm Jamal’s health by making him develop deteriorated and confessional state along with dehydration for which intravenous infusion was required to improve his health. In contrast, Mark always ensured non-maleficence principle is followed while caring for Jamal. This is evident as he raised concern regarding Jamal’s health management at the initial state and tried to resolve it by cooperating with Bola who ignored his concern. Moreover, Mark immediately alerted his mentor Yemi to ensure faster and accurate care is provided to Jamal to reverse his dehydrated and confused state for the past two days to avoid any further harm to be experienced by Jamal. Therefore, it can be analysed that failure to maintain ethical principle of non-maleficence leads the nurses make patient experience vulnerable deteriorated condition for their health (Jafari et al., 2019).
The ethical principle of beneficence mention that it is duty of the nurses in taking action to help patients in all sphere of care so as to prevent and remove any harmful consequence for them to promote their good health (McDermott-Levy et al., 2018). However, it is argued that lack of beneficence leads the nurses to deliver hindered care to the patients that compromise their health condition (Zheng et al., 2020). In case of Jamal, it was seen that Mark appropriately followed the duty of beneficence whereas Bola neglected and avoid fulfilling the ethical principle. This is evident as Mark holistically tried to communicate with Jamal at each point of care to determine any risk or harm and acted accordingly to resolve them such as alerted Yemi of arranging food and intravenous infusion of fluid to resolve the dehydration and hunger faced by Jamal for the past two days. However, Bola was seen to ignore maintaining the nutrition and fluid report of Jamal and even falsified the data. She also avoided recording them for two day as well as neglected to deliver any care for Jamal which led to his deteriorated health condition instead of improvement proving beneficence is not appropriately followed in care by Bola.
The ethical principle of justice is the duty of the nurse to deliver impartial and fair care to all (Juujärvi et al., 2019). In Jamal’s case, justice in care was maintained by Mark and Yemi as they both involved to ensure fair care is provided to him under all condition. However, Bola is seen to act in an unjustified manner towards Jamal as she always neglected care towards him while delivering appropriate care to others. The Public Interest Disclosure Act 1998 mention that for protecting people, individual or professionals are to raise concerns regarding wring doings of their colleagues at the workplace in good faith while acting in public interest (legislation.gov.uk, 1998). The Act is seen to be appropriately followed by Mark as he acted as whistleblower for reporting the wrong actions of care by Bola toward Jamal to his mentor (Yemi) to allow taking strict actions from the authorities against her deeds. According to the policy statement of the National Patient Safety Agency, it is the duty of the nursing authorities to report any error in care to the patient and their family members along with support them in resolving their condition (improvement.nhs.uk, 2014). The policy is effectively followed by Yemi in case of Jamal as she informed the error in care caused by Bola to the patient and hi family members along with mentioned the actions taken to mange the error. This leads to analyse that the patient and the family members are made aware by the nurse that error in care has occurred and they are responsible for taken action to resolve it.
The above discussion mentioned that Bola has mainly violated the section 4,7 and 8 of the NMC Code as she has not acted in best interest of the patient Jamal as well as avoided forming communication with him and cooperation with her colleague Mark. However, Mark has mostly followed all the NMC Code for student nurses in appropriate manner. Mark was seen to follow ethical principle of beneficence and non-maleficence while caring for Jamal whereas Bola failed to abide by any of the ethical principles of care. Moreover, Mark was seen to be responsible in abiding by the Public Interest Disclosure Act 1998 and Yemi was seen to report error in care to the patient and his family members, in turn, supporting to follow policy statement of the National Patient Safety Agency for medication error reporting and management.
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