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Introduction

This assignment will aim to reflect on an incidence that happened during my University allocated nursing placement.

The incident I chose to reflect upon related to a patient referred to Mr Smith, (not his real name); in line with NMC (2015) guidelines on patient confidentiality.

Mr Smith was admitted into the mental health ward under Section 3 of the Mental Health Act (1983)because of the worsening case of dementia.

The reason for choosing this incidence to reflect upon is to highlight the professional, legal and ethical issues relevant in nursing practice. The model that I have chosen for the reflective practice is Driscoll’s What Model (Driscoll 1994).

The reason for choosing this model is two-fold. Firstly, Driscoll’s model has a straightforward format that comprises of three simple questions:

What? So What? Now What? Secondly, Driscoll’s (1994) model has extra trigger questions that aid in giving a more profound
and meaningful reflection, stimulating a reflector to engage in a more detailed inquiry, thus leading to developing a future course of action.

Reflection is an important part of learning. Reflection has been defined as assessing the previous experience to develop tacit and intuitive knowledge(Driscoll and Teh 2001).

Nurses must reflect on the experiences they encounter in the course of practice regularly to improve practice, knowledge, competency, skills, and behavior, which are required to provide patient-centered care.

What

While on placement, I observed several legal, ethical, and professional issues relevant to Mr Smith’s scenario, who was suffering from dementia admitted to the mental health ward.

He has also had an issue of shortness of memory and deafness that made him unable to remember anything.

During my placement, I experienced Mr Smith’s case, who came into the office for complaining about a breach of his patient rights under the Mental Health Act.

Mr Smith shouted and complained that the staff members were informing “every Tom, Dick and Harry” about his health condition which is a breach of patient’s confidentiality under the Mental Health Act
(Rapaport et al., 2006).

After his complaint, I cross-checked with other nurse staff and patients that staff nurses are telling his information to other patients. This proved to me that staff nurses are doing this and breaching the patient’s rights in terms of confidentiality.

Another issue that I observed was the unprofessional behavior of staff nurses towards Mr. Smith. One of the staff nurses shouted at him and told him to go back to the room.

I observed that the behavior of the staff nurse was very unpleasant. The other nurses and healthcare assistants present in the room giggled as the staff nurse exchanged unpleasant words with MrSmith.

One of the nurses mimicked MrSmith and stated that he is such an attention seeker and laugh off the statement made by Mr Smith in the presence of the healthcare assistants.

So What

After seeing this situation, I felt that staff nurses are breaching patients’ rights, which are an important standard of the MHA 1983. The patient’s rights which were breached by the nurse’s staff include confidentiality and anonymity of the patient.

I was not happy with how the staff nurse and the nursing assistants reacted to Mr Smith. Firstly, they were breaching the Mental Health Act (MHA 1983), through which Mr Smith was admitted into the acute mental health ward.

The staff nurses were breaching the provision of MHA concerning breach of duty and privacy invasion. Telling everyone the mental health and information of Mr Smith was apparent to me, and this was the major ethical issue that I observed in the case of Mr Smith. The Mental Health Act (1983) is the law that provides the legal framework for people with mental health
needs in England and Wales.

The MHA (1983) provides guidelines on protecting the rights of individuals who are detained and treated in the hospital to receive the necessary care and support (Dimond 2011). However, in Mr Smith’s case, staff nurses were not doing their legal duty to protect a patient’s privacy and do the intentional torts to invasion to privacy.

It reflects that the legal issue that was apparent in Mr Smith’s case was the intentional tort in terms of invasion of privacy or
confidentiality, which is a legal right of a patient under the MHA 1983.

Based on risks associated with the mental health condition of Mr Smith that was dementia, he was detained under the Mental Health Act. In the case where a doctor thinks it is right for the patient to stay at the hospital, the confidentiality and anonymity of personal information is also a patient right that healthcare providers should maintain under the provisions of Mental Health Act.

The confidential information can only be shared with family members or carer, but only with the patient’s consent. However, sharing of patient’s information can be shared with the nearest relative, a legal concept for making decisions regarding their treatment or care plan (Larsson et al., 2011).

The healthcare providers can share confidential information without the patient consent if he cannot decide on the care plan and relatives or care is allowed to decide on behalf of the patient.

Without acquiring the patient’s consent, healthcare providers cannot provide any confidential information to anyone else as it is a patient’s confidentiality breach under MHA, which I have observed in Mr. Smith’s case.

However, it can be shared with the family members or carer when there is a serious risk to the person. Gostin and Wiley (2016) stated that confidentiality breaching has a legal implication as maintenance of patient confidentiality is demonstrated in common law and outlined in statute law. The patient can charge legal claims against the healthcare provider for breaching patient confidentiality.

According to Ulrich et al. (2010), patient confidentiality is an ethical and legal duty of healthcare professionals or practitioners in charge of patient care.

Breaching confidentiality has an ethical implication as it leads to the failure of respecting patient autonomy. Patient autonomy ensures that a patient’s personal information is protected by healthcare practitioners, and no one has the right to invade his anonymity or privacy. It reflects that patient autonomy was a major ethical issue that has been caused by the breach of ethical principles in terms of confidentiality.

The American Nurses Association (1985) demonstrated a code of conduct for nurses which stated that all nurses are liable to respect for patient’s autonomy and informed consent, respect for patient’s rights and dignity, and maintain a professional standard of conduct (Zahedi et al., 2013).

Moreover, Goodie et al. (2013) stated that nurses should maintain ethical principles in their practice. Nurses’ should adhere to the principles of beneficence, respect for autonomy, justice, etc. In Mr. Smith’s case, staff nurses are not adhering to the ethical principles in terms of respect for patients’ autonomy, beneficence, and privacy. It reflects that lack of adherence with the ethical principles was a major ethical issue that was apparent in Mr Smith’s case.

Coming towards the discussion of professional issues that I have observed during the mental health ward placement was the unpleasant behavior of staff nurses towards Mr Smith.

Staff nurses should provide safe, kind, and non-judgmental care to the patient, but in Mr Smith, the standard of care was not maintained by the staff nurses and showed unprofessional behaviour to Mr Smith.

From a professional level, it is expected that nurses should work in collaboration with other healthcare professionals while at the same time remaining as the advocates of service users (Stickley, 2006).

Based on this view, I found it was quite to develop a good working relationship with other healthcare professionals to provide holistic care to Mr Smith. It is demonstrated by the NMC code of conduct that relationships are an integral part of the
therapeutic process(NMC, 2015).

Moreover, relationships can be more helpful, especially because of the power imbalances between patients and healthcare professionals. The development of a strong relationship between healthcare providers and patients is essential for developing patients’ trust in healthcare provision and ensuring ethical and legal principles that build patient confidence.

However, the capacity to build such relationships was limited in the acute mental health ward as staff nurses were not paying attention to the assurance of the NMC code of conduct and breaching the patient’s confidentiality.

In addition to this, patients in the ward are also required to be engaged in numerous therapeutic sessions, including educational sessions, and other therapeutic activities that can help understand mental illness (Doherty, Coyle, and Matthews, 2010).

However, such sessions were quite limited in the acute mental health ward as consulting, educational, and other therapeutic sessions were not provided in the acute mental health ward.

The engagement with other professionals to support therapeutic activities was so minimal that it was a shame that the healthcare professional were promoting their services.

For a person like Mr. Smith to be dismissed with laughter, it was evidence of how people from certain communities were viewed by nurses and other healthcare professionals at the warden in order to secure their image in front of new healthcare professionals and conceal serious issues from higher authorities to secure their jobs.

Lastly, I was disappointed with the nursing approach because of the apparent disregard of ethical considerations when dealing with Mr Smith. Some authors such as Harvey et al. (2015) state that acute mental health settings are designed to restrict choice, and autonomy.

In this case, the writer argued that the focus has always tended to be that of “compliance” as opposed to active user “engagement.”However, this should not imply a violation of patient rights, such as the right to confidentiality or informed consent(Merakou et al., 2001).

In the ward, there was limited user engagement, breaching of patient’s anonymity and confidentiality as the case of Mr Smith shows, which resulted in less empowerment of patients. There were limited activities to engage patients and demonstrate how they can enhance their wellbeing once they leave the hospital.

There was also a lack of care involvement, especially from people from the black community like Mr Smith. Instead of gaining informed consent, there was a high prevalence for “compliance,” in which case the ethical protocol of informed consent was compromised.

It reflects that ethical principles, including beneficence, justice, and autonomy, were not considered by nurse staff while caring for Mr Smith in the acute mental health ward. Beneficence ensures kindness and mercy with a strong connotation of respecting patient and doing well with the patient(Gardner, Fedoruk, and McCutcheon, 2012).

These principles were breaching in the case of Mr Smith that I have witnessed during my placement. Nurses are professional, and in their calling, they are expected to ensure quality for all patients while maintaining their credentials, ethical standards, and competencies (Harrison and Hart 2006).

There was no therapeutic relationship with Mr Smith, as the staff nurse dismissed him without listening to his concerns. This is problematic for nurses when they fail to listen to their patients, affecting later engagements with them. In Mr Smith’s case, this was evident because he refused to talk with the staff nurse when she came later to find out why he had gone to the office.

In this case, had the staff nurse given Mr. Smith more respect and attention, he could have felt like someone valued by the hospital(NMC, 2015). Besides, listening to Mr. Smith would have opened a door for active engagement with him.

However, the approach of the staff nurse left him feeling rejected and less valued by the hospital staff. The NMC (2015) states many of the care standards that should be provided to patients such as Mr Smith.

One of the standards of conduct is being kind to considerate to patients while taking care of them(NMC, 2015). The failure by the staff nurse in these two areas speaks of the professional lapse at the ward. If nurses focus on providing care while following the code of conduct, there would be fewer problems when taking care of patients(NMC, 2015).

Sympathizing with mental health patients and showing a keen interest on their welfare can help alleviate signs of anxiety and make the patient feel comfortable(Bailey et al., 2015).

Mr Smith’s attitude as informed partly by attitude of the staff nurse to shout him down and refuses to listen to his concerns. According to Clement  (2012), nurses should always strive to prioritise patients’ needs and preferences under their care. On their part Kelly and Tazbir (2013) stated, “Nurses should give priority to activities that they know are most likely to make a difference in patient outcomes” (p. 327). Moreover, Clement (2012) states that nurses should keep up with a variety of human behaviors that might occur while taking care of patients while at the same time doing their best to deliver quality care.

From an ethical perspective, the treatment given to Mr. Smith was unethical and demeaning. The staff nurse failed to demonstrate respect, anonymity, and confidentiality to the warmth to the patient.

There was a lack of compassion and Mr. Smith was treated with less dignity, against the code of conduct for nurses and midwives. According to Stein-Parbury (2009), with respect comes to a deeper concern for patients and their needs.

From a legal perspective, the legal implication of breaching a patient’s confidentiality is that staff nurses are legally bound to assure the patient’s confidentiality and anonymity. If they failed to do this, then the patient can claim against staff members and hospitals under common and statutes law of England and Wales.

Moreover, from a professional perspective, it was observed that staff nurses are not complying with NMC conduct of conduct and breaching anonymity and confidentiality of the patient that has professional implications for the hospital’s reputation and patient-staff relationship.

Now What

There are several implications for me as well as my colleagues. Firstly, it should be noted that, in
becoming an efficient nurse, some improvements must be considered in order todevelop skills
and knowledge that would be required for future practice. It is important to treat patients with
respect, and dignity at all times. The rationale for doing so is to ensure good outcomes for the
patient and overall nursing practice.
Secondly, nurses need to ensure patients are placed at the centre of care while respecting
their right to confidentiality (Williamson and Daw 2013). The disclosure of personal health
matters without the patient’s consent goes against the Mental Health Act and the guidelines
provided by NMC (2008; 2015) on patient confidentiality. If this situation is not changed, it is
highly likely that legal suits would be instituted against the healthcare facility for breach of
confidentiality. In addition, the possibility of losing patients to other healthcare facilities is
probable if the situation does not change. As I have witnesses, poor and malpractice in the acute
mental health wardmy responsibility is to discuss this case with the higher authorities of hospital
in order to address the concerns that Mr. Smith had regarding the breaching of his patient’s
rights.
10
If I am faced with a similar situation in the future as a student nurse, I will take a different
approach as opposed to the one taken by the staff nurse. I will take time to listen to the patient
complain while maintaining a good eye contact. After hearing the matter, I would reassure the
patient that “all will be well” and that he would be attended to shortly by a qualified professional
to assess him and provide a plan of care. In essence, I will prioritise the patient because doing so
would help achieve the desired goals for the patient and the nursing practice of ensuring
wellbeing and care for patients(NMC, 2015).However, I realise that I will require more skills,
competencies and knowledge to deal with a similar future situation. In this case, I will invest
more in reading about dementia, which will enable me to recognise patients with different mental
health needs and how they should be taken care of in the future practice. In doing so, I will be
able to develop my knowledge of dementia and the care required to manage the disease and the
complexities that might occur when dealing with mental health patients like Mr. Smith as centre
of my creativity in this reflection. From these action plans, I have developed a personal
development plan (SMART) to support my professional development in mental health care as a
‘StudentNurse’.

 

Reference

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Clement, I. (2012). Management of nursing services and education. London: Elsevier Dimond, B. (2011). Legal aspects of nursing. 6th Ed. Harlow: Pearson Doherty, G., Coyle, D. and Matthews, M. (2010). Design and evaluation guidelines for mental
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