The Legal and Ethical Issues in suck IntroductionThe amounting is a wrangleion regarding a slender casualty outline that centers on a problem encountered by the checkup plosive speech soundup mental faculty of an indis publishs magnate infirmary . The polish of this discussion is to critic some(prenominal)y evaluate what happened and utilise pensive practice waitress at what could be gleaned from the geological faults madeAside from arduous to get to the bottom of things this study lead likewise look at the underlying estimable dilemmas confront by every(prenominal)(prenominal) those clienteleed during and after the incident . This includes the usages of the regenerates reserves , the family of the persevering and the forbearing unremarkable him selfWhen all(a) these things argon put together , it is withal th goal of the ensuing discussion to find ways on how to foreclose the identical mistakes made by the health workers . unless , it would be best if some another(prenominal)s contri scarcelye find ways on how to relieve adeptself the err iodineousnesss prevent adequate to(p) after turn out th high-strung this studyCritical n geniusssential AnalysisBefore going either and it is important to de o.k. the correspondentlyl called critical incident analysis and the related learning technique called reflective practice . Judith Thomas notices on the increasing desire for students and medical practiti starrs to learn , in and through work . Thomas pick outed that in that location is pressure to , .carry dual roles of worker and learner (p . 101 . Stephen uninfected accordingly highlights the importance of critical incident analysis in the course of understanding problems found in work and he said , Critical incident analysis functions teams understand troublesome symptoms in problematic situations . It is possible that the most assistanceful triangulation of info great deal fail to reveal patterns (p 95 . White further clarified this by say that , Critical incident analysis uses soft data , not unlike the penury for narratives to egest the story behind the numbers (p . 96Reflective practice on the other go by is , The do by of creating and clarifying the meaning of experience in terms of self in relation to both self and the cosmea . The emergence of this process is metamorphosed conceptual perspective (p . 2 . Both these similarlyls will be use to look into the depict to learn in a to a greater extent than deeper way how to correct the existing health c be system Critical concomitant ReportA 55 year old man who will be named as forbearing 1 was admitted in an emergency hospital at 5 in the afternoon . After 12 seconds in con gracefulment he was transferred to the High Dependency fall in (HDU ) because his tally has worsened overnight . The initial diagnosis was lancinating PancreatitisThe consultant operating sawb bingles ed to focalize a naso gastric thermionic vacuum provide (Ryle s pipe ) via the left nostril and rigid on free drainage . On the third sidereal daylight , the unhurried was visited by the consultant Surgeon . In the evening that identical day , the enduring s condition deteriorated further . He had developed respiratory problems on top of the initial astute Pancreatitis other diagnosis was also made the patient has Pulmonary dropsy and Respiratory FailureOn the 4th day the , the patient s condition was better . Then the following morning , on the 5th day , the same Consultant Surgeon ed the becomement of enteric nutriment . A arrest ( nanny A ) inserted a fine wear out naso gastric resistance via the rightfield nostril . When the Consultant Surgeon was posterior inquireed about such procedure he could not remember giving such an . So a new tube was inserted even though the Ryle s tube was all the same in placeSince maintain A could not obtain whatsoever gastric spirate from the fine standard of measurement tube , thither is no other way to as trusted the position of the tube . So the renovate (PRHO ) was assured and a authority x-ray was performed to substantiate the exact position of the fine bore tube . When the PRHO locoweedvas the consequents of the x-ray , he could no determine whether the said tube was in the stomach or not . He accordingly asked the assistance of a to a greater extent senior pertain (SHO 1 ) and requested that he should determine the exact position of the tube . After looking at the x-ray , SHO 1 was commensurate to ascertain that the tube was indeed in the stomach of patient of 1 and so proceeded to authorize for enteral feeding to commence . Enteral feeding commenced at 25 ml per hour and then doubled to 50 ml as order by the Fine Bore Feeding Tube ProtocolSix hours afterwards the patients condition deteriorated . patient of 1 was having fever in the highs of 39 .5 Celsius . The patient was extremely rest slight , agitated , and experienced precipitateness of breath . A subaltern pay off (SHO 2 ) was asked to check on the patient . On several occasions SHO 2 visited on Patient 1 . A third chest x-ray was made and reviewed by SHO 2 together with the anesthetist . They were able to conclude that there is a need to split Continuous Positive Airway Pressure Ventilation or CPAPOn the sixth day at 0100 HRS the SHO 2 discontinued enteral feeding . At 0200 HRS the feed was started again . Two hours afterwards the patients condition did not improve . The SHO hinted on removing the Ryle s tube if it hindered with the CPAP . The Nursing Staff did not remove the Ryle s tube because there was concern that doing so would dislodge the fine bore tube . thusly , two tubes were in place indoors the body of Patient 1On the morning of the sixth day (9AM-11AM , a physical therapist worked on Patient 1 . Th Physiotherapist then inform that the patient looked tired and had a dry cough without the ability to expectorate . The patient was again reviewed by the Consultant Surgeon and instructed to increase feeding to 75 ml per hour . whole of these came even though they could not pinpoint the exact situation of the fine bore tubeIn the afternoon of the same day (1400 HRS ) the Physiotherapist nameed the presence of enteral feed in the patient s sputum . Enteral feeding was promptly stopped . A fourth chest x-ray was performed on Patient 1 . The Charge Nurse who was on debt instrument examined the x-ray and was able to discover that the the fine bore tube was misplaced . The fine bore tube as it turned out was in the patient s lungs . The Charge Nurse then had the tube removedTwo hours later , the patient was transferred to the Intensive C be Unit (ICU ) with a diagnosis of Respiratory Failure and Acute Pancreatitis . On the 7th day the ICU somebodynel spoke to the family of Patient 1 and told them that the patient had multiple organ failure , a complication of the Acute Pancreatitis . They were also sure that a naso gastric tube used for enteral feeding may have been accidentally placed in his lungs This then may have inadvertently caused the liberty chit of food into the bronchial tree which in turn modify his conditionAnalysis of EventsWhat happened with Patient 1 can be attributed to human error . A human error that resulted in his be critically ill . The mistake was avoidable and in the said hospital and medical staff can greatly improve on their practice to avoid the same thing to happen in the futureThe number one thing that one could notice from the incident fib was the high number of health workers involved for the health c ar of one man This is to be expected in a demesne that is keen on specialization . This is must also be expected in the modern age where there is no concept of bedtime and that there are shifts working or so the clockIn the vitrine of this hospital , there can be at least three curbs working on a whizz patient . There was also a consultant operating surgeon who obviously could not be near all(prenominal)day or even the whole day when he is scheduled to be in that token hospital . An interesting point to spirit is that aside from the consultant there was a senior and junior concern and add to that a Physiotherapist and Anesthesiologist . To add to a greater extent(prenominal) confusion to the system , all the doctors mentioned above can technically every nurse available to do a feature task . Adding all these together then one has a potential colloquy nightmare coiffe to clank havoc . It did in this particular sideslip . The consultant surgeon first ed for the placement of a Ryle s tube ready for enteral feeding when the patient s condition worsened on the second day after admission . On the twenty percent day when the condition of Patient 1 deteriorated further the same consultant ed for the commencement of enteral feeding . Since this is already the fifth day and assuming that the patient will be in the hospital for a long time , Nurse A placed a fine bore tube to be used for enteral feeding . In the later(prenominal) investigation following the accident , the consultant denied ever ing Nurse A to put a fine bore tube into Patient 1Thus , there are now to tubes inserted through the patient one directly into the stomach while the other one placed inadvertently into the bronchial region . This resulted in the give of the patient s bodily system and gave rise to this critical incident analysisThe role of DoctorsLeadership is the key role of a doctor inside a hospital easiness Aside from the necessary skills needful to function as a competent professional it is his lead skills that can spell keep and death in any medical situation . It is trustworthy(a) that a advanced doctor can help save a person s life but without properly delegating the activities and work load necessary to cure that person , it would be too daunting a task for a single doctor to the job only if . He will be in need of nurses and other health care workers who will form as a team to combat diseases in a clinic or hospitalOne of the principal(a) function of a loss leader in any arena is the ability to communicate clearly and effectively . This skill is get the hang so as to ensure efficiency and precision in a kind of work that demands excellence separately and every time because this profession is in the business of saving livesAccording to Dr . butt Gorney , Faulty talk is among the most common underlying causes of medical error and frequently erodes the doctor-patient affinity [ .] The dislocation is usually between doctor and patient but may also be involve mis parley between physician and nurses or between physicians and family members (p . 65 .One effect in a breakdown of talk is when two parties are going into assumptions . Since there is no communication occurring then it is normal to proper assume that the other person has understood the instructions given and that there is no need to follow-up since it was already understood what needs to be doneIn this compositors eccentric person the consultant surgeon was complacent and vacated the role of an active leader . The consultant upon ing the commencement of enteral feeding assumed too much . He assumed that the nurses will do all that they could and follow protocol . The problem is not that the nurses did not follow protocol but they did it by the book without a question that the consultant surgeon could have made an error . In this case , the consultant surgeon ed the placement of a feeding tube on the second day and then ed the commencement of enteral feeding five eld after . What would be the first re military action of the nurse ? It would be to think that since the consultant surgeon did not mention any changes in the routine then it is plausible that he mean to to follow protocol and it is the placement of a fine bore tube when dealing with a patient who is going to be at least a week in the hospital (see Downie Mackenzie Williams , 2003This is not the only time that the doctors made assumptions . When Patient 1 developed complications in the respiratory system they assumed that it was ascribable to his previous diagnosis . No one verified if this was the case or not (see Philip Woodrow , 2000Moreover , there was a further breakdown of communication when the doctors did not inform the family of the complications - not until it was already too late and the patient has already suffered multiple organ failureThe role of NursesThe major function of a nurse is to be a helper to the doctors . They are also the main caregiver and provides transport and assistance to the patient to apply their stay in tramp bay to be as pleasant as possible . In these two roles the nurses of the said hospital acted as true professionals . barely every nurse has a secondary role and that is to provide the necessary support structure for doctors to function . class of this is the diligent keeping of records . And there is also an expectation that nurses relieve the communications process when the s are vague and when they line up that something is wrong . They could not bypass the doctors but they could help them make the job easier by keeping records and by stimulating communication within the teamIf correct records were made and if the same were made quickly accessible to all concerned then Nurse A would have known that there was a previously inserted Ryle tubeThe type of the PatientIn the intricate system of health care , the patient and the medical practitioners are in one complex dance where each one are partners . For the interaction to be meaningful and concrete the patient could not afford to be passive . The doctors and nurses on the other hand should not dominate the person and retributive do what they feel is the right thing to doThe patient on the other hand must be well informed about the nature of his sickness and also the means of treating it . The patient need to decide each and every time a major procedure is to be done to him . If the procedure is routine the patient still has to be informed about itIf the right of the patient to be informed was strictly followed , then Patient 1 would have known that a second feeding tube was inserted on the 5th day . This would probably lead him to question what is the need for a second feeding tube when one is already installed a a couple of(prenominal) days primitively . Is it not enough for one feeding tube to do the job ? When he was already experiencing difficulty in airing he may have commitd that the two tubes one going through his left nostril and the other one going through his right nostril could possibly be the culprit . Although the main spring why he was having complications is not necessarily due to the two tubes placed through both nostrils but technically it was that one tube was misplaced and went like a shot to the lungs . Still , he would have made a interrogatory regarding this and very possibly will alert the doctors and nurses on duty regarding the anomalyAn ideal situation was given by Roney and he wrote , Patients are increasingly assuming responsibleness for their health care and very much come to the doctor armed with knowledge they have obtained from health related websites on the Internet . They expect the doctor to learn to their complaints . They often have sufficient knowledge about their condition to ask intelligent questions (p . 66 . Unfortunately this is not the case with Patient 1ethical motiveWhat was outlined above is an ideal scenario where a doctor , nurse and patient can live out their roles without kerfuffle , difficulty , and hesitation . But in the real world there are many factors and many hindrances for a health worker and even a patient to exercise their rights or to function in a way they believe is admit (see Thompson , genus Melia Boyd , 2000One of the major obstacle to excellence and efficiency is the deathless problem regarding the lack of resources . The lack in resources could mean , less ideal facilities , sub-standard equipment , limitations of technology , inexperienced co-workers , high cost of health care etcMost of the time when these problems are placed in forward of health worker , various ethical dilemmas develop into something that immobilizes a health worker from doing his or her job effectivelyAccording to Sarah Fry and Megan-Jane Johnstone there are two major classification of ethical theories which can help in sorting out the various ethical dilemmas a professional faces in the work place : 1 consequential theories (utilitarianism and 2 ) nonconsequential theories (deontologyFry and Johnstone expounded on this idea by saying thatConsequential theories are those theories that look at the consequence of acts . They claim that an action is right to the extent that it produces good consequences and wrong to the extent that it produces hopeless consequences [ .] Nonconsequential theories on the other hand , are those theories that maintain that certain acts are right and others are wrong because they have or do not have right-making characteristics (p 21Fry and Johnstone proceeded to give a rough sketch on what is expected of nurses and they remarkedCommon themes in contemporary nurse codes of ethics include the nurse s relations with co-workers the nurse s responsibility to report the incompetence of other healthcare workers the nurses accountability in delegating functions to others the tariff to respect the life and dignity of the patient the nurse s responsibility for maintenance of patient confidentiality (p . 51Fry and Johnstone went further to discuss about other roles and responsibilities of the nursing profession but in this case study there are only three themes that are relevant . First of all as mentioned preferably , nurses have to be aware of their working relations with others This blood must be nurtured professionally because it can be a major factor in the overall success of the facility . The nurse can draw from both consequential and nonconsequential theories to strike him or her into the right behavior . It does not matter what metaphysical framework the nurse will contain for in this particular theme both are useful . In the consequential theory for ex full-bodied the nurse is encourage to foster good working relationships with his peers and other medical practitioners because it will surely result in positive results . Using the nonconsequential theory on the other hand would also compel the nurse to create rapport and great working relationships with co-workers since it is the right thing to do . Moreover cultivating a healthy relationship with others can help the nurse tackle two distinct ethical themes as discussed by Fry and Johnstone - delegation and reporting of incompetenceWith regards to delegation , this stipulation could not be fulfilled if co-workers do not communicate with each other . And communication could be strained because the underlying relationship may have been frayed for the longest time .
How then can another nurse turnover duties and responsibilities when the shift is over ? How then can a fellow nurse ask the help of others when her plate is already full and there is a great need for assistance . All these could not be accomplished without first establishing good relationships with others (see Allen , 2001In this case study , the nurse has to make a report on the negligence of the doctor who ed a second enteral feeding without advising the nurse that previously a Ryle s tube was already inserted a few days ago It is important to note that this is related to the obligation to foster good working relationships . How so ? If the nurse is at odds with the doctor then there is a misadventure that his or her report is biased against the doctor and so the doctor would not receive a fair trialOn the other hand there is also a flip side to this . The stiff rapport within the medical staff can tardily stifle the need to report on malpractice (see Nilstun Ovretveit , 2004 . The doctors are looked upon as superiors and practically are bosses to the subordinate nurses . Will it be sound or practical to be a whistle cetacean mammal . In the given scenario the consultant surgeon denied the fact that he ed the insertion of a fine tube bore . It is the case of my sound out against yours Who will win and perhaps more importantly will the nurse have the resolve to go through all thatMoral IssuesIt is clear from looking at the report that the hospital and the medical staff had to answer for the medical malpractice that occurred on their watch . This is on top of the initial problem of not communicating properly to the family and then to the patient regarding the ongoing go up and methods of treatment that were given to the patient . As mentioned earlier if the patient or the family had been updated on the case then they would have alerted the staff about the presence of the first enteral feeding mechanics inserted on 2nd dayBut the most glaring moral issue is the cover up made by the doctor or possibly the doctors , when they tried to deny that there was indeed an error with regards to putting in two tubes inside the patient . It was implied that the nurse was at fault . This is serious because it reveals the common complaint about doctors that seemed to be untouchable Another underlying issue here is the audacity of the doctor to risk the career of Nurse A in to save his own skin . This has to be address in trying to find ways on better UK s health care systemWhat needs to be doneAside from the ethical obligation to do what is right there is another major reason for improving health care service . It is the fear of existence sued in the event of medical malpractice . To many this is a more potent incentive to do an excellent job instead than the promise of a good clear conscience by being mindful of ethicsThere is in fact a trouble increase in number of of malpractice cases being d in this century as opposed to a hundred geezerhood before Mchale and Hervey cited a 1901 case where a certain cleric Kilbrandon was quoted saying : This action is certainly one of a particular unusual character . It is an action of damages by a patient against a medical man . In my passably long experience I cannot remember having seen a similar case before (p . 11 . This may be true at the turn of the 20th century but not anymore . In fact Mchale and Harvey made a comment that would make any medical practitioner anxious , At a basic level , lawyers have become more interested in health because there was simply more litigation (p . 11 ) One could easily imagine sharks being drawn to blood and in this case blood in the hands of doctors who committed critical errorsConclusionIf the number of litigation rises then there will come a time when lawyers are the only people who will be happy with the outcome . So changes must occur . In this particular case there is a need to improve on communication between those involved . The doctors must also realize that they are in a critical leadership role that their word is law and no one will question or second guess them . It is therefore important for doctors to be accessible and cultivate an atmosphere in the workplace where everybody are encouraged to ask questions . There must be a goal that does not seek to humiliate the inexperienced but help them grow into veterans . Replenishing the ranks of skilled workers is a boon to the profession and to all mankind . The doctors will have less problems and the nurses too will lessen their hectic pace when there are more experienced hands on boardFinally , there must be major developments in terms of record keeping - at least in this hospital . The facility should benefit from the new great strides made in Information Technolgy . If the hospital can afford it then it must look into acquiring tools to electronically record and row data . These equipment can be carried around by nurses and they can input wherever they are but all the information will be stored in one repository where nurses or doctors on the next shift will have access to . Consider the case of Patient 1 , if a similar system was already in place then the doctor and the nurses will immediately be informed that a Ryle s tube was already inserted and ready for use . With just a push of a button this critical information would have been ready at that time But unluckily there is nothing similar to it in the facility . If the hospital in question cannot afford to purchase gadgets such as these then they can resort to the old method of pen and . But this time the protocols and other standard procedures must be enhanced to ensure that no information can safety valve through the cracks and also that there is less of assumptions but more on double checking the factsHaving said all that the proponent realize that in to achieve all these there is a need to have a change of culture and a change of mindset . The medical staff in this particular hospital could not forever go on covering their tracks and not being transparent . This is difficult to do at first specially if doctors are used to be treated as the final authoritySchwartz , Preece and Hendry believe that the United Kingdom is on track to minimize the incidence of medical malpractice and they asserted , In the UK , the giving medication is taking steps to promote a culture of clinical excellence by making individuals accountable for setting , maintaining and observe standards (p . 67This translates to urging the General Medical Council to do the following , .inculcate in junior doctors attitudes of self-criticism openness , and continuous professional development . creation held to account is now an integral part of being a doctor (Schwartz , Preece , and Hendry ,. 67Dialog to improve health services must also be encouraged so that the community can verbalise out what they think is lacking in the system . But these dialog would have to be a two-way process . The community must also realize the pressure and problems faced by the medical practitioners . In this world where nurses and doctors can choose to work in any place in the world , some communities may experience shortage not only of medical personnel but experienced ones . A doctor or nurse are humans who need ample rest and incentives in to work at such a very high level of commitment . If their needs are not met then it is impossible to expect that they can meet the needs of patients and the communityReferencesAllen , D (2001 . The Changing Shape of Nursing confide : The Role of Nurses in the HospitalDivision of Labour . UK : RoutledgeBor , R Palmer , S (2002 . A Beginner s Guide to Training in Counselling and mental hygiene . London , UK : Sage PublicationsBurkhardt , M Nathaniel , A (2002 . Issues in coetaneous Nursing UK : DelmarDownie , G , Mackenzie , J Williams , A (2003 . Pharmacology and Medicines oversight for Nurses . Australia : Elsevier Health SciencesFry , S . T Johnstone , M .J (2002 . Ethics in Nursing Practice : A Guide to Ethical conclusiveness Making . UK : Blackwell PublishingGorney , M (2005 . Communication and Patient Safety In R . E Anderson (EdMedical Malpractice : A Physician s Sourcebook . UK : Humana PressJohns , C freshwater , D (1998 . Transforming Nursing Through Reflective Practice . UK : Blackwell PublishingMacHale , J . V Hervey , T .K (2004 . Health Law and the European Federal UK : CambridgeUniversity PressNilstun , T Ovretveit , J (2004 . Practical Ethics in occupational Health . Abindong , UKRadcliffe Medical Press LtdRoss , F Mackenzie , A (1996 . healthcare : Policy into Practice . UK RoutledgeSchwarts , L , Preece ,Hendry , R (2002 . Medical Ethics : A Case-Based Approach . Australia : Elsevier Health SciencesThomas , J (2004 . Critical Incident Analysis In N . Gould and M Baldwin (Eds . Social bet , Critical Reflection and the Learning Organization . UK : Ashgate PublishingThompson , I , Melia , K Boyd , K (2000 . Nursing Ethics . Australia Elsevier Health SciencesWhite , S (2005 . Show Me the Proof : Tools and Strategies to Make Data Work for You . UK : travel Learning PressWoodrow ,(2000 . Intensive Care Nursing : A theoretical account for Practice UK : RoutledgeEthical Issues in Nursing - PAGE 16 - ...If you neediness to get a full essay, order it on our website:
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