NURS2004 Inquiry For Professional Practice - Mr Alphonse Martinez Case Study - Miss Mary Jane Case Study - Nursing Assessment Answer

NURS2004 Inquiry For Professional Practice Mr Alphonse Martinez and Miss Mary Jane Case Study Nursing Assessment Answer

Assessment Task:

The purpose of this assignment task is to identify the principles of professional nursing practice, outline the ethical and legal frameworks for professional practice and apply the Ethical Decision Making Framework to a complex scenario to establish an ethically and legally sound decision. Remember to incorporate evidenced-based practice in relation to quality patient care. You MUST include in your referencing 4 (four) or more of the following;

•  Health Practitioner Regulation National Law Act 2010 (WA)
•  NMBA Registered Nurse Standards for Practice 2016
•  NMBA National Code of Conduct for Nurses 2018
•  ICN Code of Ethics for Nurses 2012
•  NMBA Nursing practice decision flowchart 2013

Model for Ethical Decision-Making

Please use these headings when writing your case study
 The word count provided is only an example – it also shows the weighting of the importance of each section. (Please do not put the word count within the text of your work – the word count goes on the title page)

1. Clearly state the problem: this should not be any more than 150 words (this is your introduction)
Consider the problem within its context; ethical, medical,social and legal considerations. This should be a very brief summary of the issues as you see it – extract the issues:

o What is the ethical ISSUE-what is the decision about?
o What is the medical condition, just state this in a few lines
o What is the social situation of the patient -is the person dependent, do they have support?
o What appear (prima facie) to be the legal issues? Is it assault; is it the application of an Advanced Directive or informed consent for example?

2. Get the facts: this should not be any more than 350 words
Here you need to find out what are the facts of the case; what is the medical condition & history,
examination, relevant tests (investigations), define the medical condition what is the
pathophysiology of the condition/s – use scientific references
o What is the prognosis?
o What are the implications of the condition/s -for example is it acute, chronic, and
degenerative? What type of progression or prognosis might be expected?
o Are there any alternative treatments?
o What social factors might have an influence – family input, social interaction
3. Consider the four principles: this should not be any more than 300 words
o You need to define each principle and relate the principle to the patient
o Autonomy: what are the patient’s preferences?
o Beneficence:what benefits can be obtained for the patient?
o Non-maleficence: what are the risks and how can they be avoided?
o Justice: how are the interests of different partiesto be balanced?

4. Identify ethical conflicts: this should not be any more than 300 words What are the ethical conflicts? To promote autonomy are we in conflict with beneficence
(Autonomy vs Beneficence). Explain why the conflicts occur relating this to the patient and how they may be resolved. Ref to the ICN Code of Ethics in this section

5. Consider the Law: this should not be any more than 450 words Identify relevantlegal concepts and laws and how theymight guide management.

•  Consider: the Practice Standards – how they apply to the case study ie (NMBA Standards 2016)
• o How does duty of care apply to the patient?
•  How does the Practice Standards relate to the Act?

 You need to use the Acts (legislation) that apply to the case study for example:
o Consent to Treatment – Age of Majority Act
o Human Tissue and Transplant Act

6. Making the ethical decision: this should not be any more than
o Clearly state the clinical ethical decision and justify it eg:
o Specify how guiding principles were balanced and why ( i.e. justify the decision). Use the information that you have in the Law and Get the Facts section to support your decision. MUST Reference
o Take responsibility for the decision & provide alternative management – reference this!

7. Evaluate the decision and discuss the legal relevance and importance of accurate documentation: this should not be any more than 150 words

o Identify how you would evaluate your decision-what is our fundamental tool for establishing the efficacy/outcome of an action/decision? – here you will research what does the literature say about evaluation – also use the NMBA Standards 2016

o State where you would document and why it is a fundamental practice in healthcare. Here you will research what the literature says about evaluation – also use the NMBA Standards 2016.

Case Study 1               Mr. Alphonse

Mr Alphonse Martinez1 a retired Italian man, married, his wife is also retired and they have two grown up sons who still live at home. They are a close family who go to church every Sunday. Mr Alphonse had just recently made an Advanced Health Directive (AHD) that stated if he had another serious heart attack that he was not to be resuscitated. His wife and two sons were opposed to his Advanced Directive and instructed the staff to take no notice of the AHD.

Alphonse has been discharged from the coronary care unit (CCU) and placed in a step-down cardiac ward following his myocardial infarction (MI). While he had been in CCU the staff had felt that he had exaggerated his chest pain. That is, when they asked him to rate his pain from 0 – 10 he sometimes stated that it was 12 or 14. In response staff reacted in a rather disapproving manner.

During the first evening on the cardiac ward Alphonse asked Mark, one of the student nurses on clinical practice, to contact the hospital priest to come and see him and give him the last rites. Mark did so immediately and then went back to sit with Mr Alphonse. Later Mark’s clinical supervisor (RN) called him to one side and asked why he was sitting with Mr Alphonse. Mark (student nurse) replied that Mr Alphonse was anxious and so he was sitting with him. The RN asked Mark “do you think you could be making him more anxious by sitting with him?” Mark replied that he didn’t think so, and he was only doing so until the priest came.

The RN then asked why the priest was coming, and Mark said that Mr Alphonse had asked for the priest, and so he had contacted him to come. The RN then said to Mark, “did you not think you should have told me what you had done” With that Mr Alphonse’s buzzer went and, turning to go back into the room, the RN and Mark saw Mr Alphonse have a cardiac arrest. Resuscitation was commenced on Mr Alphonse.

Case Study 2       Miss Mary-Jane

Mary-Jane is 14 years old; her parents are newly separated and they both work. She has three younger siblings and Mary-Jane does a lot of the child minding. She has been complaining of abdominal pain, moderate now severe and has some vaginal spotting (bleeding) for the past 24 hours. She presents to the emergency department at her local hospital with her parents who are concerned about their daughter. Mary-Jane is looking pale, sweaty, light headed, nauseated and has some stomach bloating. You have taken her base line observations on admission and they are: temperature 37.8C, pulse 118bpm, BP 90/50, Respirations 28bpm, shallow breathing. A possible diagnosis would be an ectopic pregnancy, and to rule this out a pregnancy test is essential. As the student nurse together with the Registered Nurse caring for Mary-Jane consider the legal and ethical issues; that being consent, confidentiality and mandatory reporting of sexual abuse these and others issues will need to be considered for Mary-Jane.

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