Legal and Ethical issues in nursing

Topics: Ethics, Nursing, Autonomy Pages: 7 (4194 words) Published: October 22, 2014

Ethical and Legal Issues in nursing
The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. The purpose of this assignment will be to critically discuss an episode of care encountered whilst on clinical placement. The episode of care involves the covert administration of medication to an elderly patient. The decision to covertly administer the medication will be critically assessed in this assignment. The Gibbs(1988) reflection model will be used to guide the discussion. The discussion will also consider the legal, ethical and professional issues surrounding covert medication. 

In the mental health sector, medication non-adherence remains a serious health-care problem with far-reaching ramifications for patients, their relatives and health-care professionals. Harris et al. (2008) found that between 40 and 60% of mental health patients fail to adhere to their medication treatment plan. This number increased to 50 and 70% for elderly patients with dementia, and between 75 to 85% among patients with schizophrenia and bi-polar disorders. In such cases, where the patient’s well being is at risk and the treatment is essential, health-care professionals may resort to disguising medications in food and drink. The medication is crushed or liquefied and mixed with foodstuff. This practice of concealment is called covert medication(NMC,2008). By covertly administering medication, the patient consumes a drug without the required informed consent.  The Gibbs(1988) reflection model has been chosen for the purpose of this assignment as it allows the author to reflect and think systematically about the episode of care. The initial stage of Gibbs' reflective cycle is 'Description'; in which the author is required to describe the events which occurred. In order to comply with the NMC(2010) code of conduct and guidelines on patient confidentiality, the patient will be called Mr Walker.  Mr Walker, an 80-year-old service user was temporary placed at the respite care home. Mr Walker had severe dementia, and was unable to communicate effectively. He frequently resisted all essential nursing care. Mr Walker's medical history also included hypertension and angina. He was prescribed blood pressure medication (enapril tablets) to stabilise his blood pressure and to reduce the risk of stroke and heart attacks. He was also prescribed diuretics and medication to prevent further angina attacks. Mr Walker frequently refused to take his medication; spitting out the tablets and refusing to swallow. The nurse in charge, concerned about the deterioration of Mr Walker's health, considered the option to covertly administer his medication. The MDT held a meeting and reached the decision to covertly administer Mr Walker's medication.   The second stage of the Gibbs' reflective cycle is 'Feelings', requiring the author to briefly discuss her reactions and feelings. The author felt the decision to covertly administer medication was morally correct and ethically permissible. The author refers to the deontology ethical theory to support her thoughts and feelings. The NMC code of conduct considered by Beckwith and Franklin(2011) as a model of rule deontology states that all health-care professionals should "safeguard and promote the interests and well-being of patients". The act of covertly administering medication could therefore be deemed morally correct. The practitioners intended on acting in the best interest of Mr Walker irrespective of the consequences of their actions (breaching patient autonomy). Their actions promoted and safeguarded Mr Walker's health and well-being. Husted (2008) argues that from a deontological point of view, violating an individual's autonomy is...


Bibliography: The National Institute for Clinical Excellence, (2014). Managing medicines in care homes. [online] NICE. Available at: http://www.nice.org.uk/media/B5F/28/ManagingMedicinesInCareHomesFullGuideline.pdf [Accessed 17 Apr. 2014].
Beckwith, S. and Franklin, P. (2011). Oxford handbook of prescribing for nurses and allied health professionals. 1st ed. Oxford: Oxford University Press.
Breden, T. and Vollmann, J. (2004). The cognitive based approach of capacity assessment in psychiatry: A philosophical critique of the MacCAT-T. Health Care Analysis, 12(4), pp.273--283.
Bretl, A. (2008). Patient safety rounds. 1st ed. Oak Brook, Ill.: Joint Commission on Accreditation of Healthcare Organizations.
Nursing and Midwifery Council, (2010). The Code. [online] NMC. Available at: http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAnd-
Midwives_LargePrintVersion.PDF [Accessed 16 Apr
Gibbs, G. (1988). Learning by doing. 1st ed. [London]: FEU.
Hughes, J. and Baldwin, C. (2006). Ethical issues in dementia care. 1st ed. London: Jessica Kingsley Publishers.
Husted, J. and Husted, G. (2008). Ethical decision making in nursing and health care. 1st ed. New York: Springer Pub. Co.Koch, S., Gloth, F. and Nay, R. (2010). Medication management in older adults. 1st ed. Totowa, N.J.: Humana.
Latha, K. (2010). The noncompliant patient in psychiatry: The case for and against covert/surreptitious medication. Mens sana monographs, 8(1), p.96.
Lawson, L. and Peate, I. (2009). Essential nursing care. 1st ed. Chichester, West Sussex, UK: Wiley-Blackwell.
Leino-Kilpi, H. (2000). Patient 's autonomy, privacy, and informed consent. 1st ed. Amsterdam: IOS Press.
Macdonald, A., Roberts, A. and Carpenter, I. (2004). De facto imprisonment and covert medication use in general nursing homes for older people in South East England. Ageing clinical and experimental research,16(4), pp.326-330.
Masters, K. (2005). Role development in professional nursing practice. 1st ed. Sudbury, Mass.: Jones and Bartlett.
Nixon, V. (2013). Professional practice in paramedic, emergency and urgent care. 1st ed. Chichester, West Sussex: Wiley-Blackwell.
NMC, (2008). Standards for medicines management. [online] Available at: http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf [Accessed 16 Apr. 2014].
Pritchard, J. (2009). Good practice in the law and safeguarding adults. 1st ed. London: Jessica Kingsley Publishers.
Rothschild, A. (2009). Clinical manual for diagnosis and treatment of psychotic depression. 1st ed. Washington, DC: American Psychiatric Pub.
Stoppe, G. (2008). Competence assessment in dementia. 1st ed. Wien: Springer.
Sturman, E. (2005). The capacity to consent to treatment and research: a review of standardized assessment tools. Clinical psychology review, 25(7), pp.954-974.
Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411.
Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411.
Wheeler, K. (2008). Psychotherapy for the advanced practice psychiatric nurse. 1st ed. St. Louis, Mo.: Mosby Elsevier.
Wong, J., Poon, Y. and Hui, E. (2005). I can put the medicine in his soup, Doctor!. Journal of medical ethics,31(5), pp.262-265.
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