Safety responsibility
Discuss about the Support Care Activities and Palliative Care.
The current assignment focuses upon the support care activities undertaken in an aged and palliative care. As mentioned by Holloway, Toye, McConigley, Tieman, Currow and Hegarty (2015), looking after and aged and palliative care a number of factors need to be taken into consideration which is the safety and legal responsibilities of a patient. Within an aged care home the patients are susceptible to getting hurt from fall as they may easily trip over by loosing balance (Butler, 2017). The reduced movement capacities could be attributed to the presence of diseases such as Rheumatoid arthritis, which is a secondary autoimmune disorder affecting the bones and the tissues. The inflammation in the knee bones and tissues affects the normal movement capacity making the aged class dependent upon additional support. Hence, evidence based practices need to be undertaken in looking after the support care needs of the aged patients. Additionally, undertaking therapeutic approaches can help in dealing with the emotional distress faced by the terminally ill patients (Tuckett et al., 2015).
However, a number of issues are faced in this regard such as the palliative old age patients have often been seen to depict violent behaviour owing to disagreements with the nursing professionals attending them. In this respect, the emotional and physical safety of the nurse also needs to be taken into consideration by the employer.
For understanding the issues related to safety and legal responsibility within a nursing care an actual clinical scenario has been explained over here. Here, the patient Mary is an 89 years old woman suffering from end stage leukemia, Rheumatoid arthritis and progressive macular degeneration. The woman had been living with her husband James in the Brisbane area of Australia. The Rheumatoid arthritis made conducting activities of daily living difficult for her. Additionally, the deteriorating eyesight further added to her grievances. Mary had also been abused by her husband James who often physically hurt her for extracting money. Therefore, in the lack of proper care and support the health conditions in the patient deteriorated. Since the patient was 89 years old she declined to undergo any aggressive treatment or procedure and was supported through a local community base care structure. As per the NMBA standards, the nursing professional is responsible for providing a safe, appropriate and responsive quality nursing practice.
In this respect, as a nursing professional looking after the support and care of Mary I need to ensure that sufficient safety standards are maintained around the patient. Additionally, I should ensure a safe work practice in order to prevent the occurrence of untoward incidents. Here, the patient was suffering from arthritis and progressive eyesight degeneration. Therefore, while attending the patient I can use systems such as alarm bells which could be used by the patient to call the nursing professional. Additionally, I can use effective pain management strategies to provide the patient with an effective end of life care. As mentioned by Rosenwax, Spilsbury, McNamara and Semmens (2016), holistic care based upon therapeutic approaches and pharmacological management of pain have been seen to produce positive results in end of life care. As per the enduring power of attorneys (EPA) sufficient power is entrusted on the care providers to report any incidence of abuse or suspected abuse (Sugimoto, Ogata & Kashiwagi, 2018). As mentioned by To et al. (2017), the employers should provide the nursing professional with a safe and sound environment to carry on their job roles and responsibilities. The staffing level and skill mix are some of the important factors to ensure that effective support and care services are provided which ensures the overall safety of the patients.In this respect, implementing strategies such as fall risk assessment in the patient could reduce the chances of fall alongside restoring mobility.
Dilemma of providing information to carers
Ethical dilemma arises when caring for adults with physical or mental health. It is attributed to the confidentiality issues that emerge when dealing with the care providers of adults especially partners of the patients. The issue of confidentiality arises as there is need of sharing appropriate information with the carers. It is necessary to share information with carers as not involving them in decision making leads to personal, practical, financial consequences for both the patient and the carer. Poor information sharing and lack of involvement of carers creates the feelings of isolation, loss, helplessness and grief. On the other hand the carer shows improvement in wellbeing when allowed to be the part of supportive team (Wilson et al., 2015). However, this involvement is associated with both legal and ethical issues.
There may be differences in opinions in regards to the type of the information that can be shared with the carers. It is because the patients like Mary have problems of sensitive nature and thus confidentiality is the main ethical concern, breach of which my results in legal implications. According to NMBA code of ethics, the nurses are ethically and legally obliged to maintain the patient’s confidential formations. Breach of confidence may lead to or be con sidered as professional misconduct (Levett-Jones, Reid-Searl & Bourgeois, 2018). It may lead to serious disciplinary action such as dismissal. According to NMBA 2016 Registered Nurse Standards for Practice for Nurses, the care must be provided by complying with standards of consent for care (NMBA- professional standards, 2016). Consent refers to the patient’s formation taken for disclosing information to the carer. Ethical dilemma and legal implication are occur when the patient is not in state of giving consent (Bernoth et al., 2014). In the given case of Mary the patient may or may not want her husband to involve as he abuses her financially. There are also chances that Mary’s husband may not realise that she is not in healthy condition. He may perceive that there is no need of contacting the professionals or share the information. In such situations, the ethical vs. legal dilemma for nurses emerge.
Therefore, it can be concluded that the issue of confidentiality and ethical dilemma is highly associated with my future practice in aged care for chronic illnesses. I am obliged to maintain the patient’s privacy, safety, confidentiality and dignity. On the other hand, sharing of information with carers without consent from patient leads to breach of confidentiality and right to dignity even if the breach promoted patient’ safety. Therefore, such dilemma greatly affects the disclosure in aged care for chronic illnesses (Bernoth et al., 2014). There is a fear of integrity of nurse-patient relationship being threatened. Thus, there is quandary between the doing good or beneficence by listening to Mary and not haring information and maleficence or doing harm by not disclosing vital information to her partner.
Reflection using 5R
In my opinion the dilemma could b overcome by considering that the confidentiality is not absolute. In case of instructions from court, the confidentiality may be broken for protecting the patient. It would be considered ethical, if the elderly patient in aged care or palliative care has dementia and lacks capacity to give consent. In conclusion, there is need of effective training for nurses in aged care ad palliative care to respond to information sharing and confidentiality issues and decision should be well based on evidence.
The reflection within a clinical set up helps in accessing the professional skills and loopholes encountered by one in the safe and effective delivery of nursing care practices. In this respect, the reflection through the present scenario has been done with the help of 5 R’s which are- reporting, responding, relating, reasoning and reconstructing.
In the present scenario, May was an 89 year old woman suffering from end stage leukaemia. The patient further developed rheumatoid arthritis as a side effect of chemotherapy and had progressive macular degeneration. The patient was also financially and physically abused by her husband. The lack of money further made treatment difficult for the patient.
Therefore, as a nursing professional looking after the support and care of Mary I felt a sense of responsibility. Since the patient was undergoing end of life care, pain management became crucial in the patient. Therefore, I felt undertaking an effective and holistic pain management pathway would have helped me in coping better. I also felt that the patient here responded much better by the implementation of therapeutic communication skills, as using effective communication approaches could help me in relating to the grievances of the patient.
Therefore, relating with the actual clinical scenario I felt that I should have focused upon the holistic care regimen, which would have helped in understanding the grievances of the patient better. In this respect, learning the effective communication skills could help me in understanding the dilemma faced by the patient. Additionally, it would have also helped me in coping up with the ethical dilemmas faced in decision making relevant to care.
Therefore, reasoning with the present clinical condition of the patient I can a say that more stress need to be given to pharmaceutical pain management. Here, the patient was suffering end stage leukaemia and the severe chemotherapy initiated a number of secondary reactions and side effects in the patient. Hence, in my opinion the balancing the aggressive medical treatment with holistic care approaches and practices could be more beneficial.
Therefore, based upon the evaluation of the current scenario future action plan could be developed for the patient. For example, the mobility in the patient could be restored by providing the patient with light and free handed exercises. Additionally, use of colour codes can help the patient identify things or objects as well as conduct her daily activities of living. One of the most important steps in this effect would be to effectively monitor the pain in the patient (Wiener, Weaver, Bell & Sansom-Daly, 2015). For the purpose of which tools such as Braden scale could be used for assessment of the pain.
References
Bernoth, M., Dietsch, E., Burmeister, O. K., & Schwartz, M. (2014). Information management in aged care: cases of confidentiality and elder abuse. Journal of business ethics, 122(3), 453-460.
Butler, J. (2017). Palliative care in residential aged care: An overview. Australasian journal on ageing, 36(4), 258-261.
Holloway, K., Toye, C., McConigley, R., Tieman, J., Currow, D., & Hegarty, M. (2015). National consultation informing development of guidelines for a palliative approach for aged care in the community setting. Australasian journal on ageing, 34(1), 21-26.
Levett-Jones, T., Reid-Searl, K., & Bourgeois, S. (2018). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences.
NMBA- professional standards. (2016). Nursing and Midwifery Board of Australia – Professional standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Rosenwax, L., Spilsbury, K., McNamara, B. A., & Semmens, J. B. (2016). A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?. BMC palliative care, 15(1), 46.
Sarmento, V. P., Higginson, I. J., Ferreira, P. L., & Gomes, B. (2016). Past trends and projections of hospital deaths to inform the integration of palliative care in one of the most ageing countries in the world. Palliative medicine, 30(4), 363-373.
Sugimoto, K., Ogata, Y., & Kashiwagi, M. (2018). Factors promoting resident deaths at aged care facilities in J apan: a review. Health & social care in the community, 26(2), e207-e224.
To, T. H., Tait, P., Morgan, D. D., Tieman, J. J., Crawford, G., Michelmore, A., … & Swetenham, K. (2017). Case conferencing for palliative care patients–a survey of South Australian general practitioners. Australian journal of primary health, 23(5), 458-463.
Tuckett, A., Parker, D., Clifton, K., Walker, H., Reymond, E., Prior, T., … & Glaetzer, K. (2015). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspective. Part 2. Progress in Palliative Care, 23(1), 9-17.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, 1.
Wilson, L. S., Pillay, D., Kelly, B. D., & Casey, P. (2015). Mental health professionals and information sharing: carer perspectives. Irish Journal of Medical Science (1971-), 184(4), 781-790.
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