Legislation and code of conduct that is associated with nursing care and healthcare practice ensure that high-quality patient care is provided and the actions that were taken in the provision of care are within the legal and ethical considerations (Johnstone, 2016). A systematic structure and standardization are ensured through these legislations and codes that also imply a responsibility for actions and ensure better quality care for the patients (Johnstone, 2019). This critical essay will present an evaluation of a specific case scenario and identify the professional errors and misconduct associated with the case. The importance and significance of the code of conduct of Australia and the health care policies will also be explained in light of identified breach in the case study. A retrospective analysis, where practices that could have changed the outcomes in the incident will also be identified and explained for a critical analysis of the case.
A visitor arrived on 28/02/2014 at the Bungarribee house, Western Sydney local health district, at 3 PM to meet a patient in the acute mental healthcare ward and identified as his wife. The registered nurse (RN) Sumintra Prasad, who had received the handover of the patient identified that the patient was not available at the designated ward. On searching, it was revealed that the patient was dead and the body was found in the bathroom of the care facility. An alarm was raised to ensure the well being of the patient and initiate the process of recovery however possible, but, the efforts went in vain and the patient could not be rescued. Prior to the collection of the handover, the nurse had taken a behavioural observation of the patient. Before nurse Prasad, the patient was in the supervision of the nurse, Harivandan Pandya who had left the facility thirty minutes before due, as he had to commence another shift. The absconding of the patient by nurse Pandya was identified as "unsatisfactory professional misconduct" and caused reprimanding of the nurse along with working restrictions and need for guided supervision for further education. The care provided for nurse by RN Prasad was found to be of lower than the required standard and resulted in cautioning of the nurse for practice in the facility.
The Nursing and Midwifery Board of Australia has established a comprehensive code of ethical and professional conduct to guide the nursing professionals ensure highest quality care and assist in the suitable application of the interventions for prime care (Willis et al., 2017). The directives have also been developed by the government of Western Australia as the health policy available the Western Sydney Local Health District for the staff practising care in the region (Daly & Jackson, 2020).
According to the policy of professional conduct by Western Sydney Local Health District, the staff members must seek permission to before leaving for breaks or early leave. At the local level, the conduct of RN Pandya is a breach of this standard as the nurse did not take any of the required permissions for her early departure from the care facility (Government of Western Australia, 2019). This amounts to the breach of General Information policy of the Western Sydney Local Health District. A professional working standard demands the nursing professionals participate in the process of critical thinking and decision making that was not followed by RN Pandya as well as RN Prasad. Mental health requires sensitive care and thus demands constant care (Johnstone, 2016). The patient was left unattended for more than thirty minutes in this case which is a demonstration of unprofessional conduct. Thereby, as the per the guidelines of professional conduct by the Nursing and midwifery board of Australia, this case also breached the third standard of professional practice where, as per subsection 3.7. the RN must promote practices that ensure the beneficence of the patient. This practice also breached the standard 6 of the professional conduct according to which, "professional nurses must delegate the care of the patient through a goal-directed manner where the well-being of the patient is ensured” (Nursing and Midwifery Board of Australia, 2016.) Hence, a significant breach and unprofessional conduct were observed. The RN in the case also failed to acknowledge the local, state, and national laws of professional practice that resulted in a breach of standard six of professional conduct. As per the Mental Health Policy of Western Australia and as per the Health services Act, 2016, the policy frameworks 26 and 27 and section 34 (2) c and sections 44 and 45, person-centred care and constant supervision should be ensured to the patients with mental healthcare needs to provide support and prevent critical incidences (Nursing and Midwifery Board of Australia, 2016). Therefore, the conduct of the RN Pandya is also a direct breach of the mental health policy. Therefore, the act of the nurses in the provided case scenario can be seen as the conduct of ignorance and breach of policy commitments as a healthcare professional and can also be seen under the light of guardianship and administration act of 1990 as the patient was in the supervision of the care professionals exclusively (Government of Western Australia, 2019).
The ethical code of conduct developed by the Nursing and Midwifery Board of Australia, the first standard is to ensure compliance with the national., state, and local laws (Nursing and Midwifery Board of Australia, 2018). By leaving the facility without permission, the ethical breach of the first standard has been observed in the practice of RN Pandya. A crucial aspect of ethical care is to ensure strong communication in nursing professionals (Monroe, 2019). Poor communication on behalf of RN Pandya where information about leaving early and the need for arranging a substitute to ensure patient supervision and safety is a breach of the conduct. The beneficence of the patient should be ensured as per the ethical guidelines by the AHPRA and the Nursing and Midwifery Board of Australia which was not ensured in the provided case study. The critical cues were not identified from the behavioural observation and this also indicated a lacuna in the practice of RN Prasad. Therefore, poor communication, negligence, and lack of adherence to nursing responsibilities and care requirements amount to be prime ethical breaches in this case study
The conduct by the RN Pandya in the case was highly unprofessional and of poor quality that resulted in a fatality. If the conduct of considered nurse sin the scenario would have been more responsible, such an incident could have been avoided. First, since the patient was admitted in the mental healthcare facility, constant supervision should have been ensured (Parker & Hill, 2017). Second, in the meantime of thirty minutes when RN Pandya left, no account of round visits by other healthcare professionals have been mentioned. Therefore, timely visits by professionals in the care facility can ensure supervision and better care for the patients (DeLaun et al., 2019). Third, a permission grant should have been taken by RN Pandya to ensure that patient is substituted with another healthcare professional for his needs as well as for supervision (McAllister et al., 2019). Fourth, when RN Prasad took behavioural observations, poor conduct resulted in a lack of identification of cues. Suitable identification of cues associated with the mental health and overall well being of the patient could have assisted in the application of suitable intervention and would have thus prevented the fatality in the case (Poorchangizi et al., 2019). Moreover, RN Prasad collected handover later, and thus, some essential details that could have been noted in ISBAR would have gone unnoticed in the initial observation. The handover should have been collected before meeting the patient for suitable debriefing (Willis et al., 2017).
These misconducts could have been managed with limited acknowledgement of responsibility and would have prevented the fatality in the Bungarribee house, Western Sydney local health district, Australia. The significance of need and importance ethical practice in mental health care was wound to be of substandard in the RN caring for the patient. If the care practice would have been under the lines of ethical as well as professional conduct, the loss of life could have been avoided.
This paper critically evaluates a case scenario regarding the conduct of registered nurses at the Bungarribee house, Western Sydney local health district, Australia. A summary of the case where the conduct of RN Pandya and Prasad has been provided. The ethical and legal breaches identified in the conduct of the nurses have been described. The legal breach at a local and national level have been observed on behalf of RN Pandya and prasad resulting in reprimand of the Rn Pandya and cautionary warning to RN Prasad. This paper also identifies the actions that could have been taken at the time of the incident that could have prevented the fatality. It can be concluded that the acknowledgement of responsibility towards care of the patient and obligation of the ethical and legal codes at the Bungarribee house, Western Sydney local health district, Australia could have prevented this incident
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