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Mental Health Case Study Critical Analysis

Introduction to The Role of Nursing Codes of Conduct

The role of nursing codes of conduct can be considered as an integral part of the functioning of the nursing practice. These codes ensure that safe clinical services are rendered to the patients while managing care for them (Snelling, 2016). The provision of care is to be provided within the bounds of these ethical principles to ensure that ethical and legal misconduct is averted at all times. Nurses are the key manager for patient care in any given healthcare setting. The code of conducts helps in providing them with a legislative and patient-centered approach to make sure responsible actions are taking while providing patients with healthcare solutions. The given case scenario will help in identifying the faults and misconduct delivered on the part of nurse engaged in the care of a mental patient. the study will help in highlighting the particular code of conduct which was breeched during the same and will also define its adverse implications on patient’s health. The analysis will also help in identifying the actions that could have been corrected in order to avert this un-called-for situation.

Summary of Case Scenario

A visitor came by to the Bungarribee house to pay visit to a mental patient admitted in the care facility. The visitor was the wife of the patient. Registered nurse Sumintra Prasad was posted in the duty in that particular ward. She was the one who had received the clinical handover. When the nurse went to fetch the patient, he was not available in his chambers. The alarm was raised and there was a conduct administered for searching the patient through the facility. After looking for him, he was found to be dead on the bathroom floor. Several attempts were made to revive the patient but none of these attempts were able to save the patient. There was another nurse in the given case scenario, named Harivandan Pandya, who was assigned to the patient’s care before this nurse. Nurse Pandya left the patient unattended for a good amount of thirty minutes, without informing anyone, as her shift was about to get over. Nurse Pandya did not wait for the other nurse to come and take the proper handover in person before leaving and thus, her conduct was declared as “unsatisfactory professional misconduct”. Due her these actions, nurse Pandya was severely reprimanded and was relived from the charge with several work restrictions. Nurse Prasad also failed to provide the required standards of care to the patient which eventually lead to his death.

Error in Code of Conduct

Both of the nurses can be observed to be violating the codes of ethical and professional conduct as defined by Nursing and Midwifery Board of Australia (Nursing and midwifery Board of Australia, 2016). They failed to provide the primary intervention care to the patient and left him unattended, knowing the repercussions of the same. Patients suffering from mental health related concerns are required to be cared for with due consideration and vigilance, to minimize the risk and harm aligned with them. These directives are also defined by the government of Western Australia under the healthcare policy (Government of Western Australia, 2019). Despite the fact, both nurses can be held accountable for their irresponsible actions and their professional misconduct. There are multiple legal and ethical considerations as well, those is directly aligned with the case study and have a direct impact on the patient’s health.

Ethical Considerations

As per the initial code of conduct defined by Nursing and Midwifery Board of Australia, nurses are supposed to comply with the defined standards of respective legislature. The nurses left the facility without notifying any concerning authority and the same can be observed as a breach of ethical codes and conduct. The delivery and management of care also lack the element of sound coordination and communication between the two nurses. With safe and structured transfer of information, the key elements of concern would have been identified easily. Communication makes up for an integral part of the nursing practice, which ensures robust transfer of information between two channels, leaving no space for any faults and errors (Nursing and midwifery Board of Australia, 2016). It also the duty of nurse to ensure that no harm is ascertained to the patient, while managing their care. The responsibility can be observed to multiple by several folds in case of patients suffering form mental illness, as in our given case study. However, no such consideration for the AHPRA and Nursing and Midwifery Board of Australia guidelines were followed in the case (Edwards, 2017). The nurses also defied their sole responsibility of collecting vital information for the patient, which was dully required to analyse the risk associated with the patient and thus deliver the required care to him within stipulated time frame. Thus, lack of sense of responsibility and lack of good communication skills can be observed as the primary factors that can suggest of an ethical misconduct (James, 2020).

Legal Considerations

Any staff member who wishes to leave their duty before designated time, are required to obtain consent from the higher authority. This is one of the professional codes of conduct defined as per the policies of Western Sydney Local Health District, where this incident took place (Government of Western Australia, 2019). Thus, leading to a direct breach in the designated professional policy framework. Another legal concern was leaving the patient unguarded and that too a patient suffering from mental illness. This can also be observed as a breach of third standard of professional nursing practice (Nursing and midwifery Board of Australia, 2016). As per the sixth standard of nursing care, the nurses are supposed to be constantly delegated in the care of the patient, with a goal-directed approach (Nursing and midwifery Board of Australia, 2016). Therefore, a breach of this standard was also conducted in the give case study. The nurses defied the main principles of nursing practice as well, in regards with the Mental Health Policy of Western Australia defined under the Mental Health Service Act, 2016 (Davidson, 2017). The nurses failed to not only acknowledge the signs but also failed to deliver the required care standards to the patient. Their professional misconduct lead to disobedience of policy framework specifically defined for treating mental health patients. With the lack of supervision, the nurses also breached the overall policy framework for patients, as per the defined standards of Government of Western Australia (Government of Western Australia, 2019).

Nursing Practice Which Could Have Helped

The actions of nurse Pandya can be observed as highly unprofessional. Her actions are the main reason due to which the patient died. Patient suffering from mental health related concerns should not be left unguided or unsupervised. The nurse Pandya should have waited for the other nurse to arrive before reliving herself off the duty. During the evident gap of thirty minutes, not only the patient was left on his own, there was no other healthcare professional around him to take care of him. Leaving the patient unattended, let alone in a mental health facility, can be considered as a major violation of code of conduct of nursing care practice (Lustgarten, 2018). The mental health patients require a constant supervision to ensure that they do not inflict any harm on themselves as well as the people around them. Before leaving not only nurse Pandya should have informed a concerning authority, but she should have taken due permission for the same. This would have ensured provision of supervision for the patient, with her replacement. She also lacked professional skills in identifying the underlying cues and information pertaining to the patient (Ring, 2019). With proper identification, well-structured healthcare interventions would have been provided to the patient. The observations that were made, were not noted dully in the charts, which further lead to miscommunication. Even so the details were left unnoticed and unrecognized, which further prevented effective healthcare management for the patient. There was a sheer lack of sense of responsibility in both of the registered nurses which lead to the patient’s death.

Conclusion on The Role of Nursing Codes of Conduct

The case study provides an insight as to how the nurses not only failed to deliver the required care to the patients, but also failed at displaying a sound professional conduct. The paper helps in critically evaluating the pitfalls of the case study and its direct implications on the patient’s health. The incident took place at a registered care facility of Bungarribee house, located in the Western Sydney local health district. The paper also describes the turn of events that took place that day and how they lead to patient’s death due to sheer negligence on the part of both experienced nurses. The study not only identified the professional misconduct, but also defined as to how knowingly the nurses, failed to deliver care to the patient with in the ethical and legal bounds defined by the Nursing and Midwifery Board of Australia. The paper also identifies the ramifications that could have been done in the given case scenario, to avoid such circumstantial death of the individual. However, the nurses were left free of charge with warning, the error committed by them was devastating as per the set standards of nursing care practice. There should be a sense of acknowledgement for individual responsibilities. Nurses should also deliver care to the patient, with in the set guidelines defined as per the framework of nursing care and practices. As in the given case the legal and ethical considerations for the given district should have been followed with due diligence to prevent this incident while managing patient care.

References for The Role of Nursing Codes of Conduct

Davidson, F., Heffernan, E., Greenberg, D., Waterworth, R., & Burgess, P. (2017). Mental health and criminal charges: Variation in diversion pathways in Australia. Psychiatry, Psychology and Law24(6), 888-898. https://doi.org/10.1080/13218719.2017.1327305

Edwards, J. L., & Crisp, D. A. (2017). Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology69(3), 218-225. https://doi.org/10.1111/ajpy.12146

Government of Western Australia (2019). Department of Health: Mental health policy framework statement. https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Mental-Health

James, S., McInnes, S., Halcomb, E., & Desborough, J. (2020). Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements. Journal of Advanced Nursing76(1), 234-242. https://doi.org/10.1111/jan.14221

Lustgarten, S. D., & Elhai, J. D. (2018). Technology use in mental health practice and research: Legal and ethical risks. Clinical Psychology: Science and Practice25(2), 122-134. https://doi.org/10.1111/cpsp.12234

Nursing and midwifery Board of Australia (2016). Professional standards of nursing care. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiq1eaisoTrAhWaA3IKHd8YAEwQFjAAegQIARAB&url=https%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fcodes-guidelines-statements%2Fprofessional-standards.aspx&usg=AOvVaw1_uNJ6G6fovBNmbGN-34La

Nursing and midwifery Board of Australia (2018). Code of conduct. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiZgp6GsoTrAhVZOSsKHc3zACsQFjABegQICxAD&url=http%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fdocuments%2Fdefault.aspx%3Frecord%3DWD17%252F23850%26dbid%3DAP%26chksum%3DL8j874hp3DTlC1Sj4klHag%253D%253D&usg=AOvVaw2_EwvXELm1PrjH5t5kPGZh

Ring, D., & Lawn, S. (2019). Stigma perpetuation at the interface of mental health care: A review to compare patient and clinician perspectives of stigma and borderline personality disorder. Journal of Mental Health, 1-21. https://doi.org/10.1080/09638237.2019.1581337.

Snelling, P. C. (2016). The metaethics of nursing codes of ethics and conduct. Nursing Philosophy17(4), 229-249. https://doi.org/10.1111/nup.12122

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