Emergency Nursing Ethics and Practice Analysis

Section 1: Analysis of the video

The patient Daniel Thompson is 19 years old and had epilepsy and learning disability, he was suffering from abdominal pain for few days and he along with his mother came to emergency department (ED) of the hospital, where he diagnosed to have constipation. Two staff nurses Joe Jackson and Laura Parr were involved to treat the patient by following the essential and complex nursing practice skills. Following are the analysis extracted from the video conversation.

How staff nurses use their skills to administrate the medicine?

The skills of the staff nurses are not appreciable in all circumstances. According to Nursing and Midwifery Council code certain guidelines to be followed by staff nurse. They must listen to the patient and also understand their preferences and concerns, however neither Laura nor Joe made a conversation with the patient and started the treatment. Laura asked Daniel’s mother regarding the problem instead of directly talking to Daniel. Moreover Laura and Joe did not inform Daniel’s mother about the medication until she asked about the nature of laxative. This is beyond the ethics of nursing practice, as the NMC code (NMC code, 2018) properly describes the activity of nurse and caregivers should be inclusive in nature and they must include the patient party during the practice. Before going to administer the medicine, the nurse should be careful regarding the side effects of the medicine. In current scenario Daniel have epileptic history, so the laxative Movicol may have drug interaction with antiepileptic drug. (Madsen, 2010) Therefore, the nurse should cross check whether Daniel take any antiepileptic regularly. According to drug administration guideline provided by Royal pharmaceutical society (RPS), there is a certain amount of responsibility on the person who administer the medicine and he or she should consider the risk factor associated with administration. (RPS, 2018; Bagnasco, et al, 2016) From the video it can be seen that the nurse Laura could not convince the patient to drink the laxative solution and finally Daniel’s mother manage to administer the laxative. This is not at all a good practice. There are nine rights during administration of drugs, which includes right patient, right reasoning, right medicine, right doses, right way, right time, right documentation, right response and right to refuse. Among them the staff nurses missed right documentation and right response. (Elliott, et al, 2010) Laura could not even delegate the duty of follow up administration of laxative to Daniel’s mother.

Analyse the behaviour of the staff nurses with the patient. Do you think it was appropriate?

The behaviour of the staff nurses specifically Laura was not appreciable. According to the nursing ethics there are some modes of nonverbal communication which are important to maintain for sustainable nursing care. These are like “sit squarely”, “open posture”, “ Lean towards the other”, “eye contact” and “relax”, are termed together as SOLER (Stickley, et al, 2011). Both of the staff nurses did not greet or make eye contact, they were not in an open posture or they did not sit squarely for discussion about the medicine. When Laura did not get proper answer from Daniel regarding his problems, she just frowned and moved away instead of properly taking care of Daniel. She did not pay attention on the fact that Daniel has a learning disability and epileptic history and should be cared in a special way. Laura was seemed annoyed with the behaviour of Daniel and asked his mother whether he will take the medicine leaving out of his mobile. Moreover, she did not make any attempt to convince him to take the medicine rather she seemed relieved when Daniel’s mother took the responsibility. This kind of uninterested behaviour is not good for effective nursing and against the integrity and ‘no harm’ policy of nursing practice. There was a serious communication gap between Joe and Laura, when Joe was asking Laura regarding the details of the patient he found that Laura was playing with her nails and again he had to repeat his words. When Daniel’s mother asked about the laxative both the nurses answered together in a odd manner, Laura was trying to say something but Joe interrupted her and described the name and nature of laxative. (Guest, 2016) It’s a case of serious communication gap between them. These behavioural problems are serious and bad for working environment. According to NMC code, nursing practice should be inclusive, co-operative and should convey positivity towards patient and colleagues. However, Laura failed to do her job.

Section 2:

What are the ethics of the nursing practice and the skills of the nurse need to deal with emergency condition in the ED?

Working as a staff nurse in emergency department is many fold intricate with respect to accountability, specialization and responsibility. Ethical, professional and legal issues are often needed to be kept in mind while making a quick decision. To make the nursing practice in ED clear with respect to legal and ethical consideration a certain point is always kept in mind, consent is a fundamental need of ethical nursing. In emergency this is very important and should not be overlooked during most rushed condition . The consent may be taken in form of verbal, non-verbal or written and it should be bring to be effective very soon. For a unconscious patient this is bit complicated, according to Petrini video recording can be a good alternative in this context (Petrini, 2011). Dutiful behaviour is another important factor in ED nursing and the important thing that should always be kept in mind that, the nurse must be aware of his/her scope. A nurse involved in emergency service must have versatility in terms of experience and skill. However, going beyond the skills and experience is not the mark of a dutiful nurse. The power and duty of restraining the movement of patient is important in ED to confirm safety of the patients and others. For the patients with mental problem their physical movement should be restrained in ED by means of physical or chemical interventions. Lastly the most important thing is privacy and confidentiality, the key factors of common nursing practice should also be kept in mind during ED nursing practice. During the rush of the emergency treatment the nurse should keep in mind under which condition he/she will share the personal information of a patient. In a nutshell the legal and ethical points are critical and complex however should always be kept in mind for nursing care in emergency department.

References

Bagnasco, A., Galaverna, L., Aleo, G., Grugnetti, A.M., Rosa, F. and Sasso, L., 2016. Mathematical calculation skills required for drug administration in undergraduate nursing students to ensure patient safety: A descriptive study: Drug calculation skills in nursing students. Nurse Education in Practice, 16(1), pp.33-39.

British Medical Association and Royal Pharmaceutical Society of Great Britain eds., 2018. BNF: 76. BMA.

Elliott, M. and Liu, Y., 2010. The nine rights of medication administration: an overview. British Journal of Nursing, 19(5), pp.300-305.

Guest, M., 2016. How to introduce yourself to patients. Nursing standard, 30(41).

Madsen, L., Magor, C. and Parker, B.A., 2010. Comparison of two bowel treatments to prevent constipation in post-surgical orthopaedic patients. International journal of orthopaedic and trauma nursing, 14(2), pp.75-81.

Nursing & Midwifery Council, 2018. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.

Petrini, C., 2011. Ethical issues in videorecording patients lacking capacity to consent. Annali dell'Istituto superiore di sanità, 47, pp.247-252.

Stickley, T., 2011. From SOLER to SURETY for effective non-verbal communication. Nurse education in practice, 11(6), pp.395-398.