NURS13140
NURS13140
Law and Ethical Considerations
in the Profession of Nursing
Workbook
2024
Unit Coordinators
Craig Morris, Danielle Le Lagadec and Scott Harris
NURS13140
Law and Ethical Considerations
in the Profession of Nursing
Workbook
2024
Unit Coordinators
Craig Morris, Danielle Le Lagadec and Scott Harris
Edition 2024, Term 1
Published by Central Queensland University Queensland, Australia.
COMMONWEALTH OF AUSTRALIA
WARNING
This workbook has been developed on behalf of Central Queensland University pursuant to section 195AVB of the Copyright Act 1968 (Cth) (the Act).
The contents within the workbook may be subject to copyright laws under the Act.
CRICOS Provider Code: 00219c
Academic Authors:
Developed by: Craig Morris
Reviewed by: Dr Danielle Le Lagadec and Scott Harris
Table of Contents
TOC o "1-3" h z u About this Workbook PAGEREF _Toc158112129 h 4Module 4 - Professional Negligence & Duty of Care PAGEREF _Toc158112131 h 6Module 5 - The Nursing Profession: Care, Interventions & Consent PAGEREF _Toc158112132 h 8Module 6 - Risk Management: Workplace Health & Safety, Indemnity & Insurance PAGEREF _Toc158112133 h 10Module 7 - Legal and Ethical Implications of Skill Mix, Scope of Practice & Staffing Practices PAGEREF _Toc158112134 h 13Module 8 - Back to Basics: Documentation, Confidentiality, and Mandatory Reporting PAGEREF _Toc158112135 h 15Module 9 - When Things Go Wrong: Coronial Inquiries PAGEREF _Toc158112137 h 18Module 10 - Applying Ethical behaviours in different Contexts PAGEREF _Toc158112138 h 20Module 11 - Mental Health Contexts PAGEREF _Toc158112139 h 22Module 12 - Social Media Review PAGEREF _Toc158112140 h 24
About this Workbook
The workbook forms Assessment item three for NURS13140. The content in this workbook is divided into nine modules covering material from week 4 to week 12. The exercises in the workbook will require you to use research and locate relevant academic resources to complete each module.
Due date: Wednesday, 29 May 2024 at 1800 hours (AEST, Brisbane time), Week 12
Assessment Item 3: Written assessment
Weighting: 60%
Length: Approximately 2000 words
Aim
This assessment aims to develop the knowledge of ethical and legal issues pertaining to nursing practice in Australia.
Instructions
Please follow the steps below to complete your assessment task:
This workbook consists of 9 modules representing the learning material from weeks 4 to 12. Each module consists of several tasks/activities.
You are required to download the workbook document and complete all tasks/activities using this document as your template.
Some activities require short answers to questions; others require the application of the theory to a given scenario. A suggested word count has been indicated for some of the activities.
All your responses must be based on credible evidence derived from peer-reviewed literature or credible websites. Please provide references as indicated.
Please abide by the rules of academic integrity, and work independently. This is NOT a group assessment.
Please submit your completed workbook as an MS Word document.
Literature and references
In this assessment, where references are required, you must use contemporary references (<5 years) to support your discussion as noted below. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks, and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing or the Australian Association of Social Workers.
Requirements
Use a conventional and legible size 12 font, such as Times New Roman, with 2.0 line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word).
Write in the third-person perspective.
Use formal academic language.
Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online CQU APA Referencing Style Guide.
We recommend that you access your discipline-specific library guide: the Nursing and Midwifery Guide and Social Work and Community Services Guide.
For information on academic communication, please go to the Academic Learning Centre Moodle site. The Academic Communication section has many helpful resources, including information for students with English as a second language.
Learning Outcomes:
Demonstrate an informed understanding of the basic concepts and principles that underpin Australian healthcare law.
Analyse and reflect on healthcare problems and identify relevant ethical and legal issues.
Develop a broad and coherent body of knowledge of how legislation, policies, frameworks.
Module 4 - Professional Negligence & Duty of Care
Activity 1: Define medical negligence and outline the four elements.
(2 mark)
Reference:
Activity 2: Define the term tort and explain the importance of understanding torts as a healthcare professional.
(2 mark)
Reference: ..
Activity 3: Application Activity.
Maitland Hospital is a major tertiary hospital located 32 kilometres from the city with 498 beds and provides specialist healthcare to the surrounding township of Maitland and Northfield. The evening shift has just commenced, with registered nurse (RN) Galop accepting the role of the triage nurse, as she has worked in the hospital for the past 11 years. Although it is a Thursday evening, it is hectic as two nurses and a registrar have called in sick. The after-hours nurse unit manager stated that he could not replace the three absent staff members and requested the shift coordinator to allocate additional beds to the current staff. The Emergency Department (ED) waiting room is filling quickly, and RN Galop feels overwhelmed as she usually works in the orthopaedic ward and is unsure who to contact for additional support.
At 2137 hours, Mrs Sharp presents with her 4-month-old infant, Daniel, who has a 3-day history of gastroenteritis. Using the Children's Early Warning Tool (CEWT), RN Galop examines Daniel and assesses that he is alert, slightly tachycardic (172 b/min), respiration rate is 42 breaths per minute, oxygen saturation is at 98% on room air, temperature of 38.1 degrees Celsius and scoring a total of four on the CEWT. Registered nurse Galop triages the infant as a 'mildly urgent' case and directs Mrs Sharp back to the waiting room to await further consultation as the intern is busy. During the consult, Mrs Sharp outlined that Daniel is still breastfeeding regularly and has had multiple nappy changes throughout the day.
At 2155 hours, RN Fantle, a recent graduate RN with no ED experience, is sent from the Cardiac Ward to relieve RN Galop so she can assist in the airway management of a patient brought in by ambulance. A brief handover was provided in the resuscitation area. Registered nurse Fantle sees Daniel asleep in his mother's arms and does not want to disturb the infant. Mrs Sharp indicates to RN Fantle that she believes Daniel is getting worse. Registered nurse Fantle tells Mrs Sharp that it "should not be too long now before a doctor can review your baby" and proceeds back to the triage office.
At 2218 hours, as RN Galop returns to triage, Mrs Sharp rushes to the desk, saying she cannot wake Daniel up. A MET call is initiated, and Daniel is transferred to the resuscitation bay. Daniel was successfully resuscitated; however, required intubation and spent three weeks in the Paediatric Intensive Care Unit. Unfortunately, Daniel experienced a brain injury due to hypoxia and was subsequently diagnosed with hypoxic-ischemic encephalopathy. The paediatrician advised Mrs Sharp that Daniel will experience developmental delays and the brain injury may cause cerebral palsy, which will require additional support for the remainder of his life.
Discuss the issues in the above scenario with reference to the four elements of the tort of negligence. Did the RNs breach their duty of care towards Daniel? Why/why not?
(6 marks, 150 words)
References: .....
Module 5 - The Nursing Profession: Care, Interventions & Consent
Activity 1: When is it NOT advisable to have written consent from a patient?
(1 mark)
Where doubt exists about the patient's capacity to consent to medical treatment.
When the health care professional is uncertain of the patient's age.
Any health care that carries a significant risk to the patient.
When the health care that is to be provided is controversial.
Answer: .
Activity 2: Explain what an Advance Health Directive is and what the health practitioner must consider when deciding whether an advance decision applies to a proposed treatment.
(2 mark)
....
Reference:
Activity 3: Application Activity.
Donna is an 80-year-old widow living alone with her chihuahua since her husband died from cancer six years ago. Each Tuesday afternoon, Donna attends the local church to assist in caring for the rose garden, something her husband used to do for many years. Before walking to the church, Donna decided to take her chihuahua Benny outside; however, as she exited, Donna slipped on the stairs, fell on her side, and was unable to stand. Her neighbour Michael witnessed the fall, called 000, and requested the Queensland Ambulance Service (QAS) to attend to Donna immediately. When the paramedics arrived, they observed a shortening of her right leg, which was rotated outwards and severe swelling.
The QAS officer took Donna's vital signs, secured the hip with a splint, and immediately took Donna to the Emergency Department (ED) at the nearest hospital. During the travel to the hospital, Donna was alert, oriented and cooperative and had a Glasgow Coma Scale (GCS) of 15. During the consultation with the orthopaedic surgeon, Donna was informed that she had a fractured right hip and would require immediate surgery. Donna acknowledged her injury but told the orthopaedic surgeon that she did not want the surgery and wanted to die with dignity. The orthopaedic surgeon attempted to persuade Donna, explaining that she would have no quality of life and that the hip could take months to heal, including the loss of independence and increased risk of falls. Nonetheless, Donna continued to refuse the surgery and stated she had a good life and that the fall was a sign that it was time to be with her husband. The nursing staff contacted her son Jason, who was listed as Donna's next of kin on her medical records.
Jason was advised of the situation by the perioperative nursing staff and consented to the surgery for his mother. The surgery was scheduled with the orthopaedic surgeon, and the RN advised Donna of the plan and completed the pre-operative checklist. Donna stated, "I don't want an operation. I've heard how many people die from broken bones and decided it's my time! You say my son gave his permission but has no right to speak for me. I said no, and I mean no! Leave me alone and let me die in peace!"
Questions:
How would you apply the elements of informed consent to this scenario? Was the consent obtained valid?
(3 marks, 75 words)
......
References: .
How would you apply the Guardianship and Administration Act 2000 (Qld) to this scenario?
(4 marks, 75 words)
....
Reference: ....
Module 6 - Risk Management: Workplace Health & Safety, Indemnity & Insurance
Activity 1: In Queensland, if a person renders first aid in good faith during an emergency, are they liable for any harm the casualty sustains from their act?
(1 mark)
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Reference: .
Activity 2: Section 129(1) of the Health Practitioner Regulation National Law 2009 (Qld) states all practising registered health care professionals must have indemnity insurance. Why is this important?
(1 mark)
...
...
Reference: .
Activity 3: Application Activity.
After two years of working at the Emergency Department (ED) at Maitland Hospital, you can take some much-needed leave and have booked a two-week holiday to fly to Perth to see your family and visit your school friend Louise at Margaret River. Your suitcase is packed and in your vehicle, and you have arranged to leave your car at the airport. You have finished your morning shift and drove to the Maitland Airport, arriving just in time to catch your flight. You had planned to change into casual attire at the airport, but due to arriving late, you decided to stay in your hospital scrubs and check in and grab a quick coffee before boarding.
Shortly after take-off, an announcement is made requesting that any medically qualified passengers make themselves known to the cabin crew. You are tired, as you just did nine shifts straight, and you want to relax and enjoy the flight, so you ignore the announcement made by the cabin crew. The passenger beside you calls out to the cabin crew, stating, "Here! Over here! There's a medical person here!". The cabin crew asked if you could accompany them to the front of the plane, which you agreed to do.
On arrival, you observe a passenger lying on the cabin floor. They are unresponsive, their airway is clear, and there is evidence of cyanosis. You ask if a defibrillator, oxygen, and PPE are available in the plane's medical supplies, which the cabin crew provide for you. You commence cardiopulmonary resuscitation as there is no shockable rhythm. You advised the cabin crew that this was an emergency, indicating the pilot should make all efforts to land immediately as medical attention was required urgently. You suspect the person has an acute cardiac episode. You provide resuscitation for the next 15 minutes, upon which the passenger spontaneously returns his pulse. The plane lands back at Maitland Airport, where he is transported by ambulance to Maitland Hospital.
What common law, legislation or guidelines are relevant to this scenario? State and discuss.
(8 marks, 200 words)
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References:
Module 7 - Legal and Ethical Implications of Skill Mix, Scope of Practice & Staffing Practices
Activity 1: There are two levels of supervision: direct and indirect. What is the purpose of direct supervision? Provide one example.
(2 mark)
..
Activity 2: What is the difference between scope of practice and personal competency?
(2 mark)
..
..
Activity 3: Application Activity:
Michael, Craig, and Tracey recently graduated as registered nurses (RNs) and have accepted a position at South Maitland Nursing Home. Although they have less than six months of nursing experience, they were all placed on an evening shift together. The South Maitland Nursing Home has 60 beds, with 40 residents in the medium care unit and 20 in the dementia unit. The afternoon shifts are always busy, and the facility only employs two aged care workers per shift to assist the nursing staff. On this shift, Tracey was allocated the team leader position and must carry the facility after-hours phone, allocate meal breaks for the staff and liaise with the on-call doctor when required. The North Maitland Nursing Home is approximately 30 kilometres away. It is a 20-bed low-care facility with two RNs, each with over 12 years of nursing experience, with Fiona having completed a masters in nursing (Leadership and Management) two years ago. The policy for Maitland Nursing Home is that staff at the South Maitland Nursing Home is to contact the team leader at the North Maitland Nursing Home if any issues should arise.
Question:
Comment on the skill mix, staffing ratios, and supervision capacity at South Maitland Nursing Home.
In terms of improvement to the staffing, what would you recommend and why?
(6 marks, 150 words)
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..
References: ...
Module 8 - Back to Basics: Documentation, Confidentiality, and Mandatory Reporting
Activity 1: You are employed at the Maitland Hospital as a clinical nurse (CN) in the paediatric ward. You were completing an admission of a 6-year-old male child and noticed extensive bruising on the abdominal region with some swelling around his right elbow. The parents state that he is accident-prone and said he fell; however, the child's clinical record identifies that this is his third admission in 13 months.
Question:
Does the CN have an obligation to make a mandatory report about this? Why or why not?
(1 mark)
..
Reference:
Activity 2: Under the National Law, a person is a student if they are enrolled in an approved program of study. Under the National Law, a mandatory notification can be issued against a nursing student for what issue? Who can make the notification?
(2 mark)
..
..
Reference:
Activity 3: Application Activity
It was a busy shift, with three admissions and two discharges and you were looking forward to going home when the shift coordinator asked you at another colleague, Daniel, to help lift a patient who had fallen in the bathroom whilst showering. You and Daniel raised the patient and successfully put them back into bed; the patient reports they sustained no injuries and are embarrassed. Daniel says he felt a 'twinge' in his lower back but tells you it's all good; he will let the shift coordinator know before going home. The next morning, you are both on a morning shift, and you ask Daniel before handover whether his lower back is any better and if he had reported the incident to the shift coordinator. Daniel states that he could not be bothered as the paperwork would take ages to complete and that he took one of his wife's 5 mg oxycodone tablets when he got home. Daniel states he has the box with him at work and will take two tablets shortly prior to showering the patients.
Question:
Comment on the registered nurses actions and discuss how this impacts safety in the ward environment.
(3 marks, 50 words)
..
References: ...
Activity 4: Application Activity
Ben is a four-year-old boy who presented to the Emergency Department (ED) at 2030 hours with a dislocation. His mother brought him to the hospital. He is now in the ward following surgery overnight to reduce shoulder dislocation. His file has limited information, as this appears to be an isolated incident. It was now 1000 hours the next day, and the parents had not arrived at the ward. You are the student nurse doing a three-week placement at the Maitland Hospital and have been asked by your supervising nurse to assist Ben with showering and changing into some hospital pyjamas; following that, you are to complete all the remaining paperwork admission paperwork.
While showering Ben, you notice unusual marks on the child's back and buttocks. Ben is unable to explain how these marks occurred. When you ask Ben about his shoulder injury, he says he "fell off his bike". While dressing Ben, you also notice that he has headlice. You give Ben a new toothbrush to perform mouth hygiene, and he asks, "What's this?" While helping Ben brush his teeth, you notice that he has signs of dental decay and his gums are bleeding.
Question:
What action should you take as a nursing student and why?
(4 marks, 75 words)
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References: ..
00Module 9 - When Things Go Wrong: Coronial Inquiries
Activity 1: What is a coronial inquiry and its purpose?
(2 mark)
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References: ..................................................................................................................................................
Activity 2: The Coroners Act 2003 (Qld) outlines a healthcare-related death if after the commencement, the person dies at any time after receiving health care. What are the two reasons?
(2 mark)
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References: ..................................................................................................................................................
Activity 3: Application Activity
A newly graduated registered nurse in a major teaching hospital in Brisbane was doing her graduate rotation in the intensive care unit. On this day, she injected Dilantin oral suspension into the central venous line instead of the nasogastric tube. Consequently, the patient had a cardiac arrest and died.
Questions:
How would you apply the definition of a reportable death to this situation? Is it a reportable death, and which category does this fit and why?
(3 marks, 50 words)
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References: ...
You have been asked to care for the deceased patients body. How would you prepare the deceased patients body for the morgue?
(3 marks, 50 words)
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Reference: ................................................................................................................................................................
Module 10 - Applying Ethical behaviours in different Contexts
Activity 1: What are the two classifications of tissues for transplant purposes?
(1 mark)
References:
Activity 2: What are the five ethical principles of a living donation?
(1 mark)
References:
Activity 3: Application Activity
For years, Mrs Bateman, an 85-year-old lady, has experienced severe, agonising pain due to rheumatoid arthritis. Dr Smith has been her treating doctor for the last 23 years and promised Mrs Bateman he would not allow her to suffer. After many unsuccessful pharmacological and non-pharmacological pain interventions, Mrs Bateman begged Dr Smith to end her suffering. After careful consideration, Dr. Smith visited Mrs Bateman at her home and administered a large dose of potassium chloride. Mrs Bateman died shortly after.
Questions:
How would you apply the principles of euthanasia and assisted suicide to this scenario? What are the ramifications under Queensland-based law?
(4 marks, 100 words)
References: .
How could Dr Smith have worked within the boundaries of the Voluntary Assisted Dying Act 2021 (Qld) to assist Mrs Bateman with her situation?
(4 marks, 100 words)
..
.
References: .
Module 11 - Mental Health Contexts
Activity 1: What is an involuntary patient, and do you have the power to search patients when admitting them to an authorised mental health facility?
(2 mark)
Reference: ..
Activity 2: Describe and explain the difference between a Forensic client and a Classified client according to the Mental Health Act 2016 (Qld).
(4 marks, 50 words)
Reference: ..
Activity 4: Application Activity
Kye and Leah are 22 years old and have been friends for the past seven years. For the past three years, both Kye and Leah have lived with the mental health condition of schizophrenia and have, in the past, experienced acute psychotic episodes, including auditory and visual hallucinations. Kye and Leah have good home and social support, and their symptoms are well managed by their prescribed psychotropics. Kye maintains his employment as an administration manager for a building company, and Leah is at university studying for a Bachelor of Arts degree. Both Kye and Leah have early warning intervention plans and see their psychiatrist every four months and a community mental health nurse monthly. Lately, Leah has been mixing with a different group of people and has indicated to Kye that she has not been taking her medication as it makes her too tired and has caused her to gain 13 kilograms in weight.
In their infrequent contact, Kye often notices that his friend has been "all over the place" and not organised with her university studies and missed their planned get-togethers last Tuesday and Wednesday evening. On Tuesday, at 1720 hours, Kye went to Leah's residence, a small block of units next to a shopping centre. During his visit, Kye notices Leah speaking about strange and incomprehensible events and responding to unseen stimuli. Leah throws rocks at nearby parked cars, thinking someone is trying to run her over. Kye dials 112 on his mobile, which connects to the 000 operator and requests an ambulance. Kye provides information about Leah's mental state and the issues Leah is experiencing with the 000 operator. Both an ambulance and the police arrive at the scene 15 minutes later.
Question:
Discuss possible implications for this situation
(4 marks, 75 words)
.
...
.
References: ..
Module 12 - Social Media Review
Activity 1: List two types of social media you use frequently. Estimate how much time you spend on a weekly basis on these two platforms and discuss why you use those two social media platforms. Critically analyse what you, as a healthcare professional, would consider to be the benefits of social media when used for health purposes. As a healthcare professional, do you foresee any issues with using social media platforms for health purposes? Why/why not? This should be a deep and thoughtful reflection of the benefits and problems arising from using social media as a healthcare profession. You need to support your arguments/discussion with credible references. Please remember to abide by the rules of academic writing.
(20 marks)
Reflection (300 words)
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References: ........
You have now completed the workbook. Submit by Wednesday, 29 May 2024, at 1800 hours via Moodle.
