The nursing profession is underpinned by many professional, legal and ethical issues that are vital for safe practice and ensure the best interest of patients are being met. The three main principles this essay will discuss are accountability, informed consent and dignity. Nurses are governed by legal and professional requirements that protect the safety and wellbeing of patients but also have ethical considerations that arise when delivering nursing care.
The Nursing and Midwifery Council (2008) state as a nurse you are personally accountable for actions or omissions and must be able to justify behaviour. If the NMC find behaviour unacceptable, they have the power to remove registration from nurses. Nurses are individually accountable, legally and professionally for their own standards of care and should only practice within their scope of competence and ability, knowing their limitations.
The NMC requires nurses to keep their knowledge and skills up to date ensuring they use evidence based practice (NMC 2008). This means that nurses can effectively make decisions about the delivery of care in difficult circumstances using sound clinical knowledge and skill enabling nurses to account for decisions they make.
Patients trust that nurses will do them no harm. This means that nurses have a moral and professional obligation to act appropriately such as washing hands and wearing gloves, gaining consent and maintaining dignity, learning anatomy and using current evidence based practice. Savage & Moore (2004) highlight four areas of accountability; accountability to the public, accountability to the profession, accountability to the patient and accountability to employers. Nurses are governed by professional, legal and ethical frameworks such as NMC standards and codes of professional conduct, moving and handling guidelines and local policies. These frameworks are put in place to protect patients and assist nurses in delivering safe and effective care.
Patients have a legal right to refuse examinations, procedures and treatment. Nurses should always respect patient’s wishes even if they are declining something that is beneficial to there health. Consent provides nurses with justification for treatment and if a nurse touched a patient or carried out a procedure without valid consent then they can be sued for battery (UK Clinical Ethics Network 20101).
Expressed consent can be either written or verbal. Implied consent can be presumed by a patient’s actions or used in an emergency situation (Pozgar 2005). Consent should be given voluntary and never be forced upon. Patients also have the right to withdraw consent at any time making it illegal to proceed.
Consent needs to be “informed consent”, this requires information to be given to the patient regarding the treatment and should include factual details, benefits or risks, potential complications and alternatives available (Aiken 2004). Nurses gaining consent on someone’s behalf should only do so if they are qualified to provide sufficient information and answer any questions regarding the procedure. Nurses can be held negligent if key information is not given when obtaining consent.
Nurses need to ensure consent has been made by someone who is competent and has the legal capacity to give consent. The (Adults with Incapacity (Scotland) Act 2000) defines incapacity as incapable of decision making, communicating decisions, understanding decisions and retaining memory of decisions. If someone is unable to give consent then it should be gained by someone who authorisation, maybe a guardian or proxy directive. Cognitive abilities can be affected by factors such as learning difficulties, dementia and neurological conditions. The law allows decisions to be made on behalf of a person, if they are incapable of making decisions as long as it is in the best interests of the person.
Dignity The RCN (2008) defines dignity as “how people feel, think and behave in relation to worth of themselves and others”. Nurses can promote dignity by taking time to understand people and find out what makes them feel valued. Dignified care means involving individuals in their care, giving them confidence to take control and make decisions about their care.
Gallagher, Li, Wainwright et al (2008) carried out extensive research into dignity and have analysed the findings and identified four key dignity promoting factors: environmental care, staff attitudes and behaviour, culture of care and specific care activities. Environmental care is a huge obstacle when trying to maintain patient’s dignity as wards can be of mixed sex and can be overcrowded. They may also have poor facilities such as ill fitting curtains. Staff attitudes and behaviours can promote dignity by treating individuals with respect and consideration, not treating people as if they are objects and by having sympathy and compassion. Culture of care is important in delivering dignified care, individual beliefs and cultures should be respected. Specific activities of care such as personal hygiene and toileting should be carried out with privacy and respect and modesty should be protected.
Nurses need to develop an understanding of dignity in care and develop the necessary skills to make people feel comfortable and dignified in the care they receive. If dignity in care is absent it can lead to patients feeling distressed or embarrassed and causes unnecessary suffering. Dignity is a basic human right and should be a main priority when carrying out all nursing activities.
Nurses are in a privileged position as they are trusted with the health of others. This comes with tremendous responsibility and nurse need to ensure that they are competent to deal with the professional, ethical and legal issues that arise in nursing. Nurses are accountable for their own practice and should make the interest of their patients their first concern. If nurses do not act in a professional manner and do what is ethically right there can be serious repercussions to both the nurse and individuals in their care. Professional, ethical and legal principles are not straight forward and continual learning and reflection is necessary to progress and improve as a nurse.