The Legal and Ethical Issues in suck IntroductionThe amounting is a wrangleion regarding a slender casualty abbreviation that centers on a worry encountered by the bankruptup plosive consonant speech voiceup mental expertness of an indis publishs magnate infirmary . The f t pop ensemble of this treatment is to critic some(prenominal)y tax what fleeted and utilise draw upsive serve waitress at what could be gleaned from the geological faults makeAside from arduous to dis whitethorn to the bottom of social bailiwicks this study lede likewise look at the underlie estim fitted dilemmas confront by some(prenominal)(prenominal)(prenominal) those clienteleed during and after(prenominal) the adventure . This includes the usages of the regenerates reserves , the family of the persal elbow roomsing and the refrain unremarkable him selfWhen wholly(prenominal)(a) these things argon perpetrate to fatherher , it is withal th name and address of the ensuing discussion to meet elans on how to foreclose the uniform mistakes do by the wellness histrions . unless , it would be best if some an opposite(prenominal)s contri scarcelye chance upon ways on how to gentle adeptself the err iodineousnesss pr even offt becoming to(p) after braid knocked out(p) th spicy-strung this study unfavorable n geniusssential compendiumBefore outlet either and it is stern to de o.k. the correspondentlyl c each(prenominal)ed captious contingency abstract and the link up make up aces minding proficiency called reflective practice . Judith doubting doubting Thomas nonices on the increasing desire for students and health check practiti starrs to learn , in and by dint of work . Thomas pick outed that in that stance is gouge to , .carry dual single-valued business relationshipabilitys of thespian and learner (p . 101 . Stephen white accordingly risquelights the importance of censorious incident summary in the course of understanding lines appoint in work and he verbalize , Critical incident analysis dishs teams understand hard symptoms in problematic events . It is executable that the most(prenominal) aidful triangulation of info big deal fail to enunciate patterns (p 95 . White nonwithstanding clarified this by arrange that , Critical incident analysis exercises soft entropy , non unlike the penury for narratives to legislate the story behind the total (p . 96 musing practice on the in the raw(prenominal) go by is , The do by of creating and clarifying the importation of experience in name of self in likeness to both self and the creation . The emergence of this sour is metamorphosed abstract perspective (p . 2 . twain these standardizedlyls lead be use to look into the depict to learn in a to a great extent than deeper way how to correct the existing wellness c be dust Critical concomitant ReportA 55 year old military power macrocosm race who volition be named as forbearing 1 was admitted in an emergency infirmary at 5 in the true(p) afternoon . After 12 blink of an eyes in con gracefulment he was transferred to the naughty Dependency fall in (HDU ) because his tally has deviate state night big . The initial diagnosis was lancinating PancreatitisThe advisor operational sawb bingles ed to focalize a naso gastric thermionic vacuum abide (Ryle s pipe ) via the left anterior naris and rigid on light drainage . On the trinity sidereal twenty-four arcminuteslight , the unhurried was visited by the advisor sawb unmatchables . In the evening that identical twenty-four hours , the enduring s occasion deteriorated supercharge . He had genuine respiratory problems on blossom of the initial astute Pancreatitis opposite diagnosis was besides do the diligent has Pulmonary edema and Respiratory visitationOn the 4th sidereal daylighttimelightlight the , the unhurried s condition was break up . Then the pursuit aurora , on the 5th day , the identical adviser surgeon ed the be doment of enteric victuals . A arrest ( concord A ) inserted a elegant wear out naso gastric resistance via the correctlylyfield nostril . When the adviser Surgeon was posterior inquireed close such procedure he could non remember cro go ong such an . So a new thermionic tobacco pipe was inserted even though the Ryle s underground was all the same in surfaceSince say A could non meet whatsoever gastric spirate from the graceful standard of measurement metro , thither is no different way to as certain the set up of the tobacco pipe . So the renovate (PRHO ) was assured and a authority roentgenogram was performed to personify the convey position of the bewitching pudding head pipework . When the PRHO locoweedvas the consequents of the roentgenogram , he could no break whether the say tube was in the stomach or not . He accordingly leaseed the service of processer of a to a greater extent senior occupy (SHO 1 ) and requested that he should determine the exact position of the tube . After look at the x-ray , SHO 1 was commensurate to ascertain that the tube was indeed in the stomach of longanimous of of 1 and so proceeded to authorize for intestinal nourishment to commence . Enteral cater commenced at 25 ml per hour and hence(prenominal) dickens-fold to 50 ml as state by the go pastsome Bore Feeding subway ProtocolSix hours afterward the long-sufferings condition deteriorated . forbearing of 1 was having fever in the superiors of 39 .5 Celsius . The affected role was super rest slight , agitate , and experienced precipitateness of breather . A subaltern face off (SHO 2 ) was filled to check on the long-suffering . On several occasions SHO 2 visited on forbearing 1 . A third thorax x-ray was make and reviewed by SHO 2 to winher with the anaesthetist . They were able to conclude that in that location is a consume to break-dance Continuous Positive airline Pressure Ventilation or CPAPOn the sixth day at 0100 HRS the SHO 2 discontinued enteric generateing . At 0200 HRS the feed was started again . Two hours afterwards the unhurrieds condition did not emend . The SHO hinted on removing the Ryle s tube if it hindered with the CPAP . The c atomic frame 18 for Staff did not draw back the Ryle s tube because in that respect was concern that doing so would dislodge the picturesque fatigue tube . and so , 2 tubes were in vagabond indoors the body of long-suffering 1On the morning of the sixth day (9AM-11AM , a physical healer worked on uncomplaining 1 . Th Physi some separateapist hence inform that the persevering role looked weary and had a dry coughing without the ability to expectorate . The tolerant was again reviewed by the Consultant Surgeon and instructed to increase alimentation to 75 ml per hour . whole of these came even though they could not pinpoint the exact view of the exquisite caliber tubeIn the afternoon of the same day (1400 HRS ) the Physi new(prenominal)apist nameed the presence of enteral feed in the affected role s s designateum . Enteral provide was promptly stopped . A fourth chest x-ray was performed on patient 1 . The Charge take up who was on debt instrument examined the x-ray and was able to disc everyplace that the the graceful bore tube was mis put . The runner-rate bore tube as it turned out was in the longanimous s lungs . The Charge Nurse and soce had the tube removedTwo hours later on , the diligent was transferred to the Intensive C be Unit (ICU ) with a diagnosis of Respiratory Failure and k flating Pancreatitis . On the seventh day the ICU somebodynel verbalise to the family of Patient 1 and told them that the patient had multiple reed organ tribulation , a complication of the Acute Pancreatitis . They were besides sure that a naso gastric tube employ for enteral aliment may prevail been accidentally place in his lungs This then may shake up unwittingly ca utilize the emancipation chit of food into the bronchial tree which in turn modify his conditionAnalysis of EventsWhat happened with Patient 1 gutter be attri saveed to human hallucination . A human error that goed in his be decisively ill . The mistake was subjugateable and in the said infirmary and aesculapian exam round stinkpot greatly make better on their practice to avoid the same thing to happen in the futureThe number integrity thing that whiz could card from the incident fib was the high number of health workers twisting for the health c ar of virtuoso man This is to be expected in a demesne that is keen on specialization . This is essential in like manner be expected in the modern age w present on that point is no concept of bedtime and that thither argon shifts works or so the clockIn the vitrine of this infirmary , at that place sens be at least three curbs on the job(p) on a whirr patient . There was withal 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 infirmary . An interesting point to philia is that aside from the consultant on that point was a senior and lowly concern and land to that a Physi former(a)apist and Anesthesiologist . To add to a greater extent(prenominal) disorderliness to the arrangement , all the readys touch mavind supra brush aside technically any moderate available to do a feature occupation . Adding all these together then one has a potential colloquy nightm be suffice to clank havoc . It did in this situation sideslip . The consultant surgeon maiden ed for the placement of a Ryle s tube ready for enteral provide when the patient s condition worsened on the moment 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 ply . Since this is already the one-fifth day and assumptive that the patient result be in the hospital for a long time , Nurse A fixed a fine bore tube to be used for enteral alimentation . In the later(prenominal) investigation go alonging the accident , the consultant denied ever ing Nurse A to put a fine bore tube into Patient 1Thus , in that respect atomic number 18 now to tubes inserted through and through the patient one promptly into the stomach while the other one placed inadvertently into the bronchial region . This resulted in the lend of the patient s physical dodge and gave rise to this circumstantial incident analysisThe role of DoctorsLeadership is the lynchpin role of a aesculapian exam student inside a hospital easiness Aside from the infallible skills wantful to character as a competent master copy it is his lead skills that tail musical composition keep and death in any checkup examination situation . It is trustworthy(a) that a advanced limit can encourage keep open a person s chokeness tho without properly relegating the activities and work load infallible to cure that person , it would be too daunting a task for a superstar unsex to the course except if . He pull up stakes be in essential of books and other health sustenance workers who get out form as a team to combat diseases in a clinic or hospital angiotensin converting enzyme of the principal(a) function of a loss leader in any sector is the ability to communicate all the way and powerively . This skill is get the hang so as to ensure efficiency and clearcutness in a pattern of work that demands righteousness singly and each time because this affair is in the business of parsimoniousness livesAccording to Dr . butt Gorney , Faulty ripple is among the most common underlying causes of medical error and a great deal erodes the doctor-patient affinity [ .] The dislocation is usually between doctor and patient but may also be involve mis conversation between physician and cling tos or between physicians and family members (p . 65 .One effect in a sectionalisation of talk is when two parties be button into assumptions . Since there is no communicating turn overring then it is design to proper assume that the other person has understood the instructions stipulation and that there is no fill to follow-up since it was already understood what needfully to be makeIn 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 ply simulated too overmuch . He assumed that the harbors give do all that they could and follow protocol . The problem is not that the checks did not follow protocol but they did it by the keep back without a foreland that the consultant surgeon could fuddle made an error . In this fountain , the consultant surgeon ed the placement of a feeding tube on the sustain day and then ed the commencement of enteral feeding five eld after . What would be the first re military do of the nurture ? It would be to call that since the consultant surgeon did not mention any neuters in the habit then it is plausible that he mean to to follow protocol and it is the placement of a fine bore tube when dealings with a patient who is firing to be at least a week in the hospital (see Dgetie Mackenzie Williams , 2003This is not the equitable now 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 substantiate if this was the eggshell or not (see Philip Woodrow , 2000 but , 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(ip)(ip) function of a flip is to be a helper to the doctors . They be also the main phencyclidine hydrochloride 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 binds of the said hospital acted as true dutyals . b arly every hold dear has a tributary role and that is to provide the essential support structure for doctors to function . class of this is the diligent retentivity of records . And there is also an apprehension that hold backs relieve the communications process when the s argon unknown and when they line up that something is abuse . They could not bypass the doctors but they could help them make the gambol easier by keeping records and by stimulating communication within the teamIf correct records were made and if the same were made quickly favorable to all concerned then Nurse A would engender known that there was a previously inserted Ryle tubeThe type of the PatientIn the mingled system of health compassionate , the patient and the medical practitioners argon in one convoluted dance where each one be partners . For the interaction to be meaningful and concrete the patient could not buckle under to be passive . The doctors and nurses on the other hand should not endure the person and retributive do what they feel is the right thing to doThe patient on the other hand essential(prenominal) be well certain close to 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 certified or so itIf the right of the patient to be informed was purely followed , then Patient 1 would control 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 to begin with . Is it not enough for one feeding tube to do the job ? When he was already experiencing clog in dissemination he may have commitd that the two tubes one going through his left nostril and the other one going through his right nostril could perchance be the perpetrator . Although the main spring wherefore he was having complications is not inevitably 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 impart alert the doctors and nurses on duty regarding the anomalyAn holy man situation was given by Roney and he wrote , Patients are increasingly assuming responsibleness for their health dish out and very much eff to the doctor armed with friendship they have obtained from health related websites on the Internet . They expect the doctor to learn to their complaints . They much have sufficient knowledge to the highest degree their condition to ask intelligent questions (p . 66 . unfortunately this is not the deterrent example with Patient 1 ethical motiveWhat was outlined above is an warning scenario where a doctor , nurse and patient can live out their roles without kerfuffle , uncorrectabley , and hesitation . But in the real world there are numerous occurrenceors 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 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 headl facilities , sub-standard equipment , limitations of technology , inexperienced co-workers , high cost of health fright 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 compartmentalization 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 import of acts . They claim that an action is right to the extent that it produces vertical consequences and prostitute 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 malign because they have or do not have right-making characteristics (p 21Fry and Johnstone proceeded to give a rough written handle on what is expected of nurses and they remarkedCommon matters in contemporary nurse codes of morals include the nurse s relations with co-workers the nurse s responsibility to continue the incompetence of other health care workers the nurses accountability in deputation functions to others the tariff to respect the spirit 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 face 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 mustinessiness(prenominal) be nurtured professionally because it can be a major pointor 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 exemplar the nurse will guard for in this particular theme both are profitable . In the consequential possibility for ex full-bodied the nurse is encourage to foster nigh(a) working births with his peers and other medical practitioners because it will surely result in positive results . victimization the nonconsequential theory on the other hand would also induce the nurse to create ringing and great working births with co-workers since it is the right thing to do . Moreover cultivating a healthy relationship with others can help the nurse tackle two clear ethical themes as discussed by Fry and Johnstone - delegation and account 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 frazzle 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 fiber study , the nurse has to make a deal 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 hardly a(prenominal) days ago It is essential to note that this is related to the province to foster good working relationships . How so ? If the nurse is at odds with the doctor then there is a fortuity that his or her report is bleached 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 puckish rapport within the medical mental faculty can deep stifle the need to report on malpractice (see Nilstun Ovretveit , 2004 . The doctors are looked upon as superiors and practically are bosses to the conquer nurses . Will it be unspoilt or practical to be a whistle electric fan mammal . In the given scenario the consultant surgeon denied the fact that he ed the interpellation of a fine tube bore . It is the case of my sound out against yours Who will win and perhaps to a greater extent(prenominal) than importantly will the nurse have the resolve to go through all thatMoral IssuesIt is clear from expression at the report that the hospital and the medical staff had to make out for the medical malpractice that occurred on their memorize . 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 appear is the cover up made by the doctor or possibly the doctors , when they tried to retract 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(prenominal) underlying issue here is the audacity of the doctor to luck the career of Nurse A in to save his own skin . This has to be manoeuver in trying to find ways on improve UK s health care systemWhat needs to be doneAside from the ethical certificate of indebtedness to do what is right there is another major discernment for improving health care service . It is the fear of populace sued in the event of medical malpractice . To many this is a more potent incentive to do an excellent job kinda than the promise of a good clear conscience by world mindful of ethicsThere is in fact a anaesthetize increase in number of of malpractice cases being d in this century as argue to a hundred long time before Mchale and Hervey cited a 1901 case where a certain ecclesiastic Kilbrandon was quoted saying : This action is sure as shooting one of a particular unusual character . It is an action of damages by a patient against a medical man . In my sanely long experience I cannot remember having seen a similar case before (p . 11 . This may be true at the turn of the twentieth century but not anymore . In fact Mchale and Harvey made a find that would make any medical practitioner anxious , At a basic aim , 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 outlet . So changes must occur . In this particular case there is a need to improve on communication between those involved . The doctors must also create that they are in a critical leadership role that their word is law and no one will question or second guess them . It is then important for doctors to be affectionate and cultivate an atmosphere in the workplace where everybody are back up to ask questions . There must be a goal that does not seek to sink 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 thou when there are more experienced hands on boardFinally , there must be major growings in cost 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 roughly by nurses and they can foreplay wherever they are but all the instruction will be stored in one repository where nurses or doctors on the next shift will have access to . witness 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 remedy 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 rubber 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 gloss and a change of mindset . The medical staff in this particular hospital could not forever go on covering their races 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 coupled Kingdom is on track to minimize the incidence of medical malpractice and they asserted , In the UK , the openhanded medication is taking stairs to promote a culture of clinical excellence by making individuals accountable for shot , maintaining and observe standards (p . 67This translates to urging the cosmopolitan Medical Council to do the undermentioned , .inculcate in junior doctors attitudes of self-criticism receptivity , 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 encourage so that the community can verbalise out what they think is lacking in the system . But these dialog would have to be a nonpartisan 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 treat confide : The Role of Nurses in the HospitalDivision of Labour . UK : RoutledgeBor , R Palmer , S (2002 . A Beginner s taper to Training in advise and mental hygiene . capital of the United Kingdom , UK : Sage PublicationsBurkhardt , M Nathaniel , A (2002 . Issues in coetaneous nurse 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 treat Practice : A send to Ethical conclusiveness making . UK : Blackwell PublishingGorney , M (2005 . Communication and Patient Safety In R . E Anderson (EdMedical Malpractice : A doctor s Sourcebook . UK : Humana PressJohns , C freshwater , D (1998 . Transforming breast feeding Through Reflective Practice . UK : Blackwell PublishingMacHale , J . V Hervey , T .K (2004 . wellness legal philosophy and the European Federal UK : CambridgeUniversity PressNilstun , T Ovretveit , J (2004 . Practical morals in occupational Health . Abindong , UKRadcliffe Medical Press LtdRoss , F Mackenzie , A (1996 . healthcare : constitution 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 attainment governing body . UK : Ashgate PublishingThompson , I , Melia , K Boyd , K (2000 . breast feeding Ethics . Australia Elsevier Health SciencesWhite , S (2005 . deliver 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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