Registered Nurses: Clinical Scenario
Registered Nurses offer various services to consumers of healthcare in different given settings. There are various things that nurses do on an everyday basis that give very unique health care contributions whereas the team members can do many more others. Nurses use a variety of approaches when dealing with the need for the holistic health of the people who receive their services. Putting into consideration the wide nature of this discipline, registered nurses undertake many different roles to meet the client’s health care needs at any given time. In this section, I will talk about the various roles of Registered Nurses that help them ensure that their patients receive the very best from them. Nurses all over have at one point with the challenges of ethics in their day to day patient care. The health care environment today is quite demanding for our nurses due to the shortage of staff. There might be occurrences of ethical issues in any healthcare where there is a question of wrongness or rightness when making decisions and at the same time looking at the patient care benefits. Every member of a healthcare team can have effects from ethical decisions since they address the exhausting nature of their work (Ulrich &Zeitzer, 2011).
First and foremost, Registered Nurses are the primary caregiver. When talking of nurses as caregivers, this shows that they practice nursing in their field as a science. The nurses offer interventions to meet the families and the patients’ physical, spiritual, environmental, and psychosocial needs with the use of critical thinking skills and nursing processes. Registered Nurses are obligated to offer direct care to patients in every health care setting and agency. They should also take various roles in the prevention of illnesses and health maintenance and promotions (Australian Nursing and Midwifery Council, 2006). The nurses in the scenario try being caregivers by suggesting the addition of paracetamol syrup to ice cream for Bethany to take her medication indirectly. Secondly, the other role of Registered Nurses is to coordinate or lead. This can be considered as a very unique role. This is because; this role rotates around the psychosocial assessment and physical assessment of the patient, the coordination of care, support, and education from being in charge of the diagnostic work of the patient to helping them transverse through the system of the hospital. The nurse coordinator is described as a very valuable resource for the family and patient and is also the contact point throughout the patient’s hospital stay (ANMC, 2006). The Nurse Coordinator is also in charge of keeping the competencies of the clinics and taking part in the ongoing activities that positively contribute to self developments and other professional cares. The third role of Registered Nurses is to act as a patient advocate. The importance of this is to help in making sure the decisions of every patient are respected and assist in boosting the autonomy of the patient. Patient advocacy consists of the relationship between the nurse and the patient to acquire self-determination and to protect the rights of patients. The advocate of a patient majorly deals with patient empowerment via the nurse patient relationship. This nurse speaks on behalf of patients who have unmet needs which most probably will not be met unless the nurse intervenes. This nurse expresses the interests of the patients and tackles them as her own needs. In the scenario, the medical team tries to meet the needs of Bethany and that is why we can see Jade trying to talk to her mum and explaining to her the ongoing situation.
The fourth role is nurse educators. The role of nurse educators is to teach the patient and his family. In the setting of a hospital, as the educator of the family and the patient, the nurse educator gives information about the patient’s illnesses and educates them on the needed medication, rehabilitation, and treatment. They are also the ones who help the patient in understanding ways of dealing with the changes of life that come with the chronic illnesses they are having and how best they can handle home setting cares when it is needed. The fourth role is the nurse as a collaborator. Collaboration helps in the improvement of patient outcomes. Teams of multidisciplinary need collaborative practices and nurses play a very important role as a team leader and at the same time a team member. Collaboration needs nurses to understand, respect, and appreciate other health professionals and what they have to give. They are also expected to be in a position to elaborate on other people like family the patient’s nursing needs. A nurse’s collaboration with families and patients is also a very essential factor because, when the families and the patients are involved in the care plan from starters, it is considered a very good way to make sure they cooperate and are willing to work to have the very best patient outcomes (Framptom et al., 2013). There is a lot of collaboration in the scenario as it can be seen the medical team is doing everything they can to ensure Bethany gets the required treatment. Listed below are the ethical issues that Registered Nurses in their day to day activities in the health care settings.
As much as the struggle to keep and protect the right of patients is the most common ethical issue nurses face, it is identified that the inadequacy of nurses is the major struggle in the health care facilities. Without enough staff in these facilities, it is kind of very hard to fulfill professional practices ethical standards. Understaffing has a higher chance of preventing nurses from achieving most of their responsibilities for example protecting the patient’s rights. In the health environments of today, there are a lot of demands for the nurses to offer high care quality and handle costs with the little resources they have (Ulrich & Grady, 2011). In the given scenario, as Jade walks in the facility, we are made aware that there are not enough members of staff and therefore had to work with the shift coordinator. They are just two people but the number of patients Jade and the nurse coordinator are to take care of is six. It is therefore not easy for Jade and her team to give the full attention the patients need as they are 6 patients with different health needs to be taken care of. One patient who has a lot of needs can consume most of a nurse’s time till she forgets about the other patients.
The second ethical issue I will talk about is the protection of patient rights and this is considered one of the most important tenets in this profession. When we talk about this, international and national ethical conduct codes emphasize the importance of serving the best interests of patients. Nurses are expected to engage in hard ethical conversations and it has been reported that newly graduated nurses undergo more stress as compared to the older nurses (Harrington and Smith, 2012). It has previously been reported that most nurses are very confident when addressing their decisions on ethical issues and are always ready to address them. Others however have always almost felt powerless and very un-influential when handling ethical issues with other people. The sense of powerlessness comes in situations where a nurse knows the perfect action to take but cannot do so because of the situations at the time (Corley et al., 2012). In the given scenario, Bethany’s mum denies her daughter a chance to get treatment for her chest pains and her upcoming ALL. Her right to treatment is further denied when Jade decides to reveal the hospital’s intentions to get full custody of the little girl so that no family members could come to see her during her treatments. Bethany is to be given drugs for her treatments but that cannot happen because of her mother’s strong beliefs. The hospital staff hence feels very powerless since there is totally nothing they can do to convince the mum of the importance of allowing Bethany to take her medication.
The act of decision making requires the application of critical thinking skills for an individual to be able to choose the very best available options to manage risks and address the needs of a patient. They are accountable for every clinical decision they make for their safety, effectiveness, and quality. In decision making, accountability is the capability of the nurses to be accountable to their patients, family, and the law for the effects of their actions and even be able to explain, defend and justify their decisions. Nurses are responsible for every action when in practice and they should always be able to justify at every given time their actions (Nursing and Midwifery, 2008). The act of decision making also needs thinking skills to practice judgments in evaluating the different available benefits of the options to be chosen from and choosing the best to be acted upon. In our case, the doctor opted for the option of adding some paracetamol syrup to the ice cream for Bethany to take to help reduce her temperature. As much as it did not work, it was the best available option at the time. Also, it can be seen that they are planning on having full custody of Bethany during her treatment because the beliefs of her mum are not helping with her chest pain. This is the best way to help the little girl acquire the needed treatment peacefully without her mother’s beliefs coming in her way. Jade, on the other hand, thinks discussing what is going on with Bethany’s mum would help convince Hector to allow Bethany to take her medication but it does not.
The scope of practice gives a definition of services that every qualified nurse and professional is considered competent enough to undertake and is permitted to perform. In the nursing profession, the scope of practice and the standards of nursing talks about who, where, why, when, how, and what of nursing practice. Who comprises of the Registered Nurses who have received the required education and title to practice the career of nursing. In our clinical scenario, who comprises Jade, the nurse coordinator, and the two nurses she meets at the lift door. The second one is what. In nursing practice, this is the optimization, protection, and promotion of abilities and health; illness and injury prevention; healing facilitation; easing of suffering via the required treatments after diagnosis, and the individual and family care advocacy. In our case, what are Bethany’s illness and the attempt to reduce and treat her despite the failed attempts to minimize her pain? Her mother does not support any kind of medication so it becomes kind of hard to control her temperature or treat her chest pains.
The third scope is where. This talks about any case where there is a patient needing care. From the given scenario, where is Bethany an 11-year-old girl diagnosed with Acute Lymphocytic Leukemia and had had recent developments of chest infections that were serious? She definitely needs a lot of care to get them ALL and the chest infections under control. Fourthly, when is the next nursing scope. This is defined as every time there is nursing knowledge need, expertise, and compassion. The given scenario explains the nurse’s needs to help the 11-year-old and is feeling compassion for her because her mother refuses to allow her to get treatment. The nurses at the lift express their need to force Bethany to take the drugs without the knowledge of her mother. Lisa also tries to make Jade sneak some paracetamol to Bethany when her mum is in the washroom as much as she refuses. The doctor also asks Jade to put some paracetamol in ice cream for Bethany to help reduce her temperature. Lastly, we have why. This explains the need to acquire the very best and positive outcomes in patients. The medical team knew the situation and had even gone for a court order to force the mother to give Bethany up for care and then prevent her from contacting her while under treatment.
Teamwork and interdisciplinary issues from a newly Registered Nurse’s perspective and leadership roles may include good and very effective communication. This refers to communication between the members and making them feel like they could do both listening and speaking out what they want not forgetting the ability to resolve problems affecting the team (WHO, 2014). Jade should have told the team about her plan to try to reassure Bethany’s mum by telling her about the team’s plan to acquire custody of her daughter and let her receive treatments. The team would have brought their mind together and come up with a better way to convince her to let her daughter get treatments. The second issue is to understand and respect the roles. It is of importance for each member to understand the roles of other members and have a better understanding of how these roles are of negative effects on the patient’s life (Leathard, 2013). The doctor clearly tells Jade that she would not be able to understand their doctoral responsibilities and respects that as a newly Registered Nurse. Thirdly, a shared goal is also another principle of effective teamwork. This includes the patient and where considered appropriate members of the family; should work towards getting the best results and improving the patient’s state (Mitchell et al., 2012). In our case, there is no shared goal from the mum as she does not allow her daughter to take any medication due to her religious beliefs.
Jade should have agreed to give Bethany paracetamol syrup without the knowledge of her mother or even adding it to the ice cream as much as she did not take it because it was to assist in bringing down her temperature. As much as Jade’s intentions of telling Bethany’s mum about the medical team’s plan to take custody of her daughter and ban her from coming to the hospital might have been to persuade her to allow her daughter to get treatments, she should have first discussed it with other team members to get everyone else’s opinion and come up with the best option for the little girl. Effective communication is a very important practice that every team member should work on. It was therefore very wrong for Jade to do that without the consent of other team members.
Australian Nursing and Midwifery Council (2006). National competency standards for registered nurses. Nursing and midwifery board of Australia.
Cook G., Gerrish K., Clarke C., (2013). Decision making in teams: Issues arising from two UK evaluations. J Interprof Care.
Framptom S., Guastello S., Brady C., (2013). Patient-centered care improvement guide. Communicating effectively with patients and families. Planetree, Inc and Picker Institute.
Gair G., Hartery T., (2010). Medical dominance in multidisciplinary teamwork: A case study of discharge decision making in a generic assessment unit. J Nursing Management.
Harrington S., & Smith T., (2012). Ethical decision making by individuals in organizations: An issue contingent model. Academy of management review.
Leathard A., (2013). Interprofessional collaboration: from policy to practice in health and social care. London Brunner-Routledge.
Mitchell p., Wynia M., Golden R., et al., (2012). Core principles and values of effective team-based healthcare discussion. Washington DC Institute.
Ulrich C. & Grady C., (2011). Doing good with limited resources: is it good enough in the provision of quality clinic care? Clinical scholars reviews.
Ulrich C., Zeitzer M., (2011). Ethical issues in nursing practices. The Penn center guide to bioethics. Spring Publishers.
World Health Organization (2014). Being an effective team player.