In the context of caregiving, the nurses have to maintain the safety of the patients to utmost degree in order to provide the high quality healthcare support. Likewise, in Australia, the safety code of conduct and instruction regarding ethics of the nurses have been transparently mentioned by the different regulatory bodies. NMBA (Nursing and Midwifery Board of Australia), along with the legal structure of the county have also strict regulation over the professional activity and behaviour of the nurses. In the provided case study, it has been identified that the postoperative condition of the patient has deteriorated for ill management of the patient during intramuscular administration of the drug. This has resulted in further 4 weeks hepatisation of the patient The purpose of this study is to identify and analyse the root cause behind the harassment that has been faced by Tim (the patient).
The case study of Tim has revealed that the patient was non uncooperative, restless and noisy and was not ready to wait for the operation on his shoulder. However, he had multiple health issues including scalp laceration, dislocation in shoulder along with bruising over the face and upper arms. As per the viewpoint of Gausvik et al. (2015), the process of caregiving demands interdisciplinary skill among which pain management is one of the major factors. A patient with a dislocated shoulder suffers from excruciating pain which turns the patient more violent and uncooperative. However, the case study has not mentioned any pain management episode before operation of Tim’s hand. Hence, from this angle, negligence in professional caregiving along with lack of knowledge in caregiving can prominently be pinpointed.
The management of uncooperative patient and non-pharmacological behaviour of the same is a special domain, in which the practising and registered nurses have to follow certain guidelines. This helps them to develop their mastery in the tackling of the patient for pharmacological intervention. In this case, the negligence of the caregivers, in the management of the patient has been identified. As per the viewpoint of Chana et al. (2015), the providence of psychological or emotional support is tagged with patient centred nursing practice. However, in this case, the lack of the same thing has been noticed. In this domain the application of the skill of critical thinking is also needed. NMBA standard of registered nurses, have provided multiple guidelines among which standard 1is tagged with the management and implementation of critical thinking skills. Application of NMBA standard 1.1, is noticed in the management of safety and quality practice (Nursing and Midwifery Board Ahpra, 2017). However, the safety management has not been focused in the process of postoperative caregiving of the patient.
The provided case study of Tim has revealed that the patient have returned to the ward from the operation theatre on foot (walking). As per the viewpoint of Burke & Ibrahim (2018), providence of assistance in the movement and locomotion is strictly been instructed in the process of post-operative care of nursing. On the contrary, Tim has not been assisted by his caregivers to get back in the ward. Additionally, in the process of postoperative caregiving, the nurse has not been able to manage the patient and has decided to administer morphine in the context of pain management. However, the patient has mentioned that he has no pain and has refused the administration of morphine. This has infringed the aspect of patient autonomy and informed decision making. As per the NMBA ethical standard -5, informed decision making should always be done when the patient is adult and has the ability to take the decision and in standard-7, the nurse should provide value to the decision of the patient in the ethical management of caregiving and information (Nursing and Midwifery Board of Australia, 2010). In this case, the patient has refused to take morphine and has not cooperated in the intramuscular administration of the same, which invoked the risk of needle breakage and further 4 week hospitalisation. Hence, lack of ethical practice of nursing has been specifically identified in the case of Tim.
As per the officially published NMBA guidelines, standard 1.4 is tagged with the legal aspect in which nurses are instructed to follow all the legislation, policies, guidelines and regulations in the process of decision making (Nursing and Midwifery Board Ahpra, 2017). However, in this case, the caregivers have not followed the legislation associated with the prevention of negligence in professional service providence (medical caregiving). This has endangered the clinical condition of Tim and has deteriorated the quality of caregiving of the health sector of Australia.
National framework for ethical decision making has been developed by NMBA for the beneficence of the practising and registered nurses. As per the official report of NMBA, the framework of ethical decision making has been divided into two parts namely, statements of national principles and explanatory statements for the same (Nursing and Midwifery Board of Australia, 2020). In the professional principal, it has been mentioned that the caregivers should be accountable for making professional judgement. This is applicable for the case where the activity is out of other capacity and power of the nurses. Regulatory and professional standards needed to be managed and compliance against judgment should also be associated with this (Nursing and Midwifery Board of Australia, 2020). Additionally, in the principle of decision making, it has been mentioned that the registered nurse is the most accountable person regarding selection of the most eligible person for taking care of the patient. However, in the case of Tim, the responsible nurse has not made any decision regarding the care plan of the patient (as per the case study). Hence, the nurse has not applied the decision making skill for providing better clinical care set-up to Tim.
Australia has structured legislation regarding the management of the issue of negligence and harm associated with professional service providence. As per the viewpoint of Cheluvappa & Selvendran (2020), tort law is associated with a nation as its primary and is focused over the physical and mental harm of the client tagged with professional services providence. In this case, the focus should be kept over the negligence and harm created in the process of clinic caregiving. Civil Liability Act (CLA)has been enforced in the year 2002, which has its key intension to safeguard the interest and safety aspect of clients in the process of caregiving. CLA-2002 Division 6 has its primary focus in the minimisation of professional negligence, in which, Section 5O have stated that a professional person associated with service providence should not be incurred for the liability negligence when the negligence of the service is widely accepted and practiced by the peer professionals of Australia (NSW legislation, 2020). However, in this case the negligence that has been shown by the caregivers of Tim are not accepted widely in Australia and is not practiced by the peer caregivers. Hence, as per the mentioned section of CLA-2002, the professionals should be incurred. Apart from this Negligence and Limitation of Liability Act -2008 is applicable.
At the end of the study, it can be concluded that Tim has suffered due to the lack of implementation of decision making skill and ethical practice of nursing provided by the caregivers. The safety aspect of the patient has not been prioritised along with the patient autonomy has been infringed. This invoked the legal issue tagged with tort law of Australia and CLA-2002, in the ground of negligence and lack of safety management.
Burke, R. E., & Ibrahim, S. A. (2018). Discharge destination and disparities in postoperative care. Jama, 319(16), 1653-1654. https://www.nbna.org/files/(02-22-2018)(Burke%20and%20Ibrahim)%20Discharge%20Destination%20and%20Disparities%20in%20Postoperative%20Care%20(JAMA).pdf
Chana, N., Kennedy, P., & Chessell, Z. J. (2015). Nursing staffs' emotional well‐being and caring behaviours. Journal of Clinical Nursing, 24(19-20), 2835-2848. https://doi.org/10.1111/jocn.12891
Cheluvappa, R., & Selvendran, S. (2020). Medical negligence-Key cases and application of legislation. Annals of Medicine and Surgery, 57, 205-211. https://doi.org/10.1016/j.amsu.2020.07.017
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary healthcare, 8, 33. https://doi.org/10.2147/JMDH.S72623
NSW legislation, (2020). Civil Liability Act 2002 No 22. https://www.legislation.nsw.gov.au/view/html/inforce/current/act-2002-022#sec.5O
Nursing and Midwifery Board Ahpra, (2017), Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx#
Nursing and Midwifery Board of Australia, (2010). Code of Ethics for Nurses in Australia. https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F1352&dbid=AP&chksum=GTNolhwLC8InBn7hiEFeag%3D%3D
Nursing and Midwifery Board of Australia, (2020). A national framework for the development of decision-making tools for nursing and midwifery practice. https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F3341&dbid=AP&chksum=3SWDivwEVXM4K6MsMHxTmw%3D%3D
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