In recent years, there has been increasing number of the UK’s population that are classified as overweight or obese which is gaining immense amount of interest from all the healthcare professionals. Obesity is one of the factors that contribute in developing other conditions such as diabetes and cardiovascular diseases (Temple Health Jeans Hospital, 2012). Due to this, it is vital for the nurses to have enough understanding regarding obesity. Nurses play an important role as patient’s advocate and educator to facilitate patient with up to date information for patient to make a right decision regarding their own health. Obesity is a vast topic so in this essay I will particularly focus on adult bariatric surgery as a treatment …show more content…
option for obesity. This will help students to understand in depth about this issue and recognize the factors that could be useful in delivering good patient care in their future practice. This essay will initially introduce what bariatric surgery is, identify and then critically analyse some of the associated legal, professional and ethical issues supporting them with appropriate references. Later on, I will also be reflecting upon my experience using Gibbs (1988) reflective model.
Bariatric surgery alters the normal digestive process so that there is reduction in nutrients and calories absorption (MayoClinic, 2011). It is recommended for people with Body Mass Index (BMI) of 30 or over with other severe health issues. Although it is effective in treating obesity, there are some associated health risks. It is also straining NHS limited budget as these procedures are expensive therefore raises various legal, ethical and professional issues.
Identifying legal, professional and ethical issues
Bariatic surgery is associated with many legal, ethical and professional issues .Human Right Act (1988) and Mental Capacity Act(2005) are some of the legal legislations which supports individual’s autonomy and right of having informed consent. Equality Act(2010) is also one of the important legal issue which reinforces individual’s right to be treated equally.
The professionals issues include the codes and guildelines established by the National Health Services(NHS), Nursing and Midwifery Council (NMC) and National Institute for Health and Care Excellence (NICE) that all the healthcare professionals must abide by. Under those guidelines, the professionals have duty of care towards the patient. They are expected to act according to the patient’s best interest and at the same time should be accountable for their own actions.
Beauchamp and Childress (1994) four ethical principles based framework: Autonomy, Beneficence, Nonmaleficence and Justice will help to analyse the ethical issues related to bariatric surgery.
Legal and Professional Evaluation
According to Human Right Act (1998),people residing in UK have the full freedom and access to their fundamental rights some of which include right to life,freedom from torture and inhuman or degrading treatment (Liberty, 2013). Alongside, Equality Act(2010) also emphasises on treating everyone equally despite of having differences such as sex, race and religion. Mental Capacity Act (2005) is designed to enable individual to make their own decision if they are competent of understanding the provided information, the good and bad aspects of the chosen intervention such as bariatric surgery and give a valid consent. If the person doesnot have mental capacity of making their own decision, under this Act someone else can take decision on their behalf. Under these legal legislations, anyone as long as they wish should be eligible for receiving the bariatric surgery despite of the financial impact it has on NHS.
According to the Nursing and Midwifery Council (NMC), nurses are expected to abide by the legal and professional guidelines. In relation to providing bariatric surgery for an obese patient, although nurses might have their own view however under NMC code of conduct, nurses must not be judgmental and act to benefit the patient.
Alongside, National Institute for Health and Clinical Excellence (NICE) sets out the guidelines for physicians to provide safe and improved services. According to NICE guidelines, bariatric surgery is recommended for people with BMI between 35 kg/m2 and 40 kg/m2 along with other comorbidities if only the other non-surgical measures are unsuccessful (NICE, 2010). The growing number of people meeting NICE standards for bariatric surgery is putting NHS; publicly funded free health services under tremendous amount of pressure to stay within their budget. NMC and NICE supports on providing the effective interventions for minimizing patient’s health risk regardless of the cost. For instance if bariatric surgery helps patient with their other comorbidities too i.e. diabetes or arthritis they should receive the surgery as it is cost effective on long run. However because NHS fund is limited, despite of people meeting the NICE criteria for bariatric surgery NHS is restraining numerous surgery.
Ethical Evaluation
Ethics is the concept of what actions are believed to be right or wrong. Bariatric surgery is an ethically challenging issue as it is perceived as intervention for the self-caused condition i.e. obesity. Beauchamp and Childress (1994) states that the four ethical principles: Respect for autonomy, Beneficence, non-maleficence and Justice function as guidelines for moral behavior regarding the raised ethical issues in healthcare. According to Griffith and Tengnah (2010, p. 29), ‘Autonomy is about self-rule with no control, undue influence or interference from others.’ As bariatric surgery will impact person’s everyday life along with the risks, it is the person’s right to decide what to do with their own body therefore their decision should be respected. Schauer, Schirmer and Brethauer (2007) also agrees that the concept of autonomy embraces the notion that after been informed regarding the benefits and risks of the bariatric surgery, the patient has full right to take decision in accordance to their own values. However, Wheeler (2012) argues that whether the patient is mentally competent on understanding the effects of intervention is something that must be considered.
The principle of Beneficence states that health care professionals should act in ways to promote patient wellbeing. Beauchamp and Childress (1994) states that with the intentions of patient’s wellbeing, patient’s autonomous right may be breached if their choice is risky. Thus this principle may clash with the autonomy of patient in cases where the nurses’ believe that patient’s decision is non-beneficial. Similarly, Thompson (2007) also argues that when providing or avoiding an intervention is better for the patient then the minor disrespect to patient’s autonomy is totally justifiable. For example for 80 years old patient it might be better to avoid having bariatric surgery as there are greater risk factors also there is less chance of the patient getting the desired benefit. In such cases, under the principle of beneficence, it may be ethically right for the physician to breach patient’s autonomy and reject the surgery. It is important for the nurses to identify if the positives outweighs the negative for the patient. As a profession, nurses need to help patient make the right decision however it is ethically wrong for them force decision upon patient despite of it being beneficial.
Non-maleficence means do not harm which is duty of a nurse. According to Coran et al. (2012), the risks of harm before and after bariatric surgery brings in the theory of non-maleficence. Therefore it emphasises on the importance of proper assessment for appropriate treatment. In desperation people might neglect the possible complications of the surgery therefore it puts the healthcare professionals under ethical dilemma of how to protect the patient. The benefits of the treatment should be compared with the harm. It maybe ethically right to briefly harm the patient, if the benefit is greater at long run. UCSF (2008) also facilitates the statement mentioned above by arguing that physicians must not provide patient with safe however ineffective treatment as it have potential chance of harming the patient in future. However, Clark (2007) states that to know whether a decision taken is right or wrong is a complex process as there are many aspects such as if the medical treatment is beneficial or damaging, balanced or unbalanced to be considered which involves opinions from both patient and physician.
Bariatric surgery may also raise the issue of justice. According to Feinsod and Wagner (2008, p. 23), ‘Justice is a complex ethical principle, with meanings that range from the fair treatment of individuals to the equitable allocation of healthcare dollars and resources.’ NHS resources are limited and distributed according to the necessity and demands. Bariatric surgery is an expensive intervention and as there are many people eligible for the surgery, the new concept of distributive justice has been introduced by the NHS. Distributive justice concerns the fair distribution of scarce resources. (The Telegraph, 2010) It rationalise the idea of providing bariatric surgery to life-threatening cases only and to the once who has high and longer chance of beneficence. However sometimes, the intervention might prove to be inappropriate for the patient as they fail to achieve the desired effect which again result in misallocation of NHS resources. Applying the principle of justice within the healthcare setting can be challenging during numerous occasions. According to Mail Online (2010) article, the cancer patients are missing out on the vital drugs due to NHS spending more fund on obesity surgery. Hence, once again it raises question of justice. NHS has been taking new measures to fairly allocate the resources however Fry, Veatch and Taylor (2010) comments that justice is a principle that doesn’t always follow the concept of equality. Donnelly (2002) emphasises that although Distributive Justice advocates human rights, it is not an actual fundamental right. Therefore, if a patient’s desire for bariatric surgery cannot be considered as clinical need and is merely a cosmetic factor, it may be challenging to justify NHS expenditure in such situation.
After critically evaluating the main legal, professional and ethical issues associated with adult bariatric surgery, I think that the question of whose judgement is right is still unanswered. In regards to legal and professional issues, it is healthcare professional’s duty to respect the patient’s fundamental rights and deliver best possible care. The ethical theories are all based upon doing well for patient therefore they are right in their own perspectives. Although, there are still some conflicts raised when it comes to the issue of patient’s autonomy and patient’s beneficence, the final decision made should be upon collective discussion of patient and relevant healthcare professionals. The NHS distributive justice measure of allocating resources to more deserving group of people is rather sensible as it impossible to fulfil everyone’s medical needs. Nurses are considered as first point of call for the patient, therefore it is essential for nurses to be aware regarding the ethical decisions and act according to the legal and professional guidelines.
Reflection
I will be using Gibbs Reflective Cycle (1988) from Oxford Brookes University (2011) website as it has clear and precise structure which allows an individual to evaluate and make an action plan to improve their performance in the future practice.
Description: Our group consisted of seven members. At first we discussed on the topics that might be relevant for this module. As we came up with few ideas, the final topic was chosen through voting. The topic we all agreed to choose was, ‘Should the NHS be treating obese patient?’ There was no leader appointed as we thought it was not really necessary. We broke down into smaller sub groups so that each can focus on the appointed task. Half of the group members were mostly involved in the creating media article and the other half in the script writing for presentation.
Feelings: I was quite happy and comfortable as I knew everyone in my group. The members were all helpful, encouraging and supportive. Although I was good at obtaining research materials, giving and receiving feedback, getting engaged at the group discussion and finishing the given tasks, I felt that I was not able to come up with any interesting ideas on how to present our topic. Although performing a debate was something very new to me, I was very excited. I was confident during my rehearsal and felt that I could perform well on the actual day. On the presentation day, I started off well but in the middle I forgot few of my lines which made me nervous and stutter on my remaining lines. I felt that it was only me in the group who was not able to give 100% during the representation which was upsetting.
Evaluation: The best aspect of this process was having opportunity to work individually as well as in a group which has enhanced my research skill along with communication skill. Throughout each session, the assembled information was discussed thoroughly within the group. ‘Effective communication occurs when messages are understood by others as intended’ (Schuster and Nykolyn, 2010, p.12)’. The Deming’s principles of management were considered during the whole process in order to remove any barriers so that the best outcome could be achieved (Mbsportal, 2012). There was effective communication within the group and we were all able to contribute by giving advices and raising any concerns creating a sense of unity.
Also associating Drucker’s concept of leadership which focuses that the team’s autonomy and involvement during the whole process is significant in order to achieve an improved result, we all had equal input in planning, evaluating and implementing the task (Training, 2008).
Despite the unity within the group, there was slight lack of communication between the subgroups which caused confusion on who was to complete the delegated task. Another bad factor was the shortage of time which limited our ability to access furthermore resource.
Analysis: I used Tuckman’s (1965) model which consists stages of forming, storming, norming and performing to understand the process of group formation.
During forming, group members’ thoughts were kept forward, the desired goal was acknowledged, specific role and responsibilities were delegated with members’ consent.
During storming stage, as each group members had different opinions, the clashes regarding different viewpoints also occurred. The dilemma of whose information material to be used and whose to be taken out was something that caused inner conflict within the members. However the storming period wasn’t too lengthy as the members were able to communicate through to resolve the
issue.
During norming, there were no furthermore conflict. The team member helped whoever was struggling to meet deadline for their appointed task. There was mutual understanding and essence of team work present during the further process.
The group members were fully satisfied with the performance. Although there were both good and bad phases during the process, the group was able to cooperate and achieve targeted goal.
Conclusion: In retrospect, the presence of good team work between the members had enabled us to achieve our goal (Ward, 2013). During this process I have learnt that I tend to learn more from the others when being involved in a group and contribute when supported by the encouraging team members. I think appointing a leader would be something my team would consider in the future as that would help to take decisive decisions.
Action Plan: In the future, I would get involved in presenting new ideas to the team. This experience has made me realise to consider time management for making the best use of the limited time I had.
Reference
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