The Nmc Code Of Conduct Nursing Essay

The Nmc Code Of Conduct Nursing Essay Nursing is a profession regulated by the Nursing and Midwifery Council (NMC 2008). The NMC is an organisation set up by the Parliament to protect the public by ensuring that nurses and midwives provide high standards of care to their patients. These healthcare professionals are also accountable for their own actions. The body sets standards for education, practice and conduct as well as providing advice for nurses and midwives. The NMC also considers allegations of misconduct or unfitness to practice. Using the case study given, it shall be the authors aim to demonstrate the understanding of the NMC Code of Conduct suggesting ways in which it can be applied to practice. In order to comply with the NMC Code of Conduct of confidentiality, the patient to be discussed in this assignment will be referred to as Mrs X. Furthermore the author will explore the four main principles of the code relating them to issues arising out of the case study. The author will also demonstrate the understan ding of ethical issues arising, analysing and discussing autonomy, non-maleficence, beneficence and justice. The case study refers to an 80 year old woman with a hip fracture, admitted to a hospital ward from a nursing home and urgently added to the operation list. She is bedridden, with severe heart problem and in early stages of Alzheimers disease and appeared to be coherent and lucid as recorded. She agreed to have a hip replacement operation after the consultant explained the procedure. On her way to theatre, she changes her mind and the consultant was informed. The consultant insists on proceeding, citing a busy week ahead and commenting that these elderly confused patients dont know their own mind. According to the NMC Code of Conduct, a healthcare professional has a duty to care and protect the interest of those in their care regardless of age, gender, culture, religious and political beliefs. Mrs X is 80 years old but the professionals still have a duty of care and must protect her interests. An interview was carried out by the medical staff and the patient appeared coherent and lucid but Mrs X has changed her mind on route to theatre. This author will critically examine the procedures that followed. The consultant explained the procedure to the patient who agreed to have the operation. Thompson et al (1994) stated that communication is one of the fundamental aspects in nursing The consultant was informed of the patients decision to change her mind on the operation and responds stating that We will have to proceed. As a nurse one could argue that the consultant should respect this decision as going against it would be breaching the NMC code. Mrs Xs decision to change her mind on the way to theatre, not wanting to go ahead with the operation should be respected. Hope et al (2008) stated that a patients autonomy can result in conflict, raise ethical dilemmas and may not be straight forward. Autonomy is defined as the right to choose or refuse treatment .Beauchamp and Childress (2009). The consultant could also argue that he is working in the best interest of the patient but does this override the patients right to make her own decision? Beauchamp and Childress (2009) stated that individuals views and rights must be respected as long as these individuals thoughts and action do not cause harm to other people. The NMC makes a point of highlighting the point of advocating for patients. In this instance, the nurse faces the ethical dilemma of standing up to the consultant and advocating for the patien t in order to uphold the code. Thompson (2003, cited in Buka, 2008) suggests that ethics is a study of how people behave, what they do, the reasons they give for their actions and the justification behind their decision. The need to maintain professional boundaries as well means that nurses have to raise their points in a manner that does not destabilise the team. Each and every member of the healthcare team must act as the patients advocate and remind or challenge colleagues should they fail to practice according to standards, Hindle and Coates (2011). If any medical team members working with the consultant on Mrs Xs case are not in agreement with his decision to proceed, they should challenge or remind him of the ethical code stipulating that the patients decision must be respected. When healthcare professionals are faced with dilemmas, patients should always come first. Childs et al (2009) states that when considering our actions we are bound by NMC codes, standards and guideline s, for students guidelines set by their training institution by local standards and guidelines within the clinical practice area and by the law of the country. It is unprofessional and unlawful to force treatment on anyone. Although the consultant explained the procedure, one could argue that making information available is different from effective communication. Consent was given the first time but the patient later changed her mind. An exploration for her reason to change her mind should have taken place and at least inform the patient that the operation was going ahead and the reasons for going ahead. The wording used by the consultant could be a concern. We will have to proceed. We have a very busy week ahead; these elderly confused patients dont know their own mind. Carry on as usual. One could interpret that the consultant is suggesting that when people get old, they automatically become confused; which could be stereotyping amounting to discrimination which is against the law. This could be taken to suggest that the consultant is of the assumption that the elderly are confused and dont know whats good for themselves and so should have decisions made for them. Patients are supposed to be treated with dignity, respect and as individuals considering their physical, psychological and social care with decisions made in partnership with clinicians, rather than by clinicians alone according to DOH (2010). Hendnrick (2004) defines consent as the permission given by patient voluntarily, without pressure, force or manipulation or undue influence. The NMC emphasises that healthcare professionals must seek consent from their patients otherwise they might be liable to be charged with assault or battery. The consent could either be in writing or verbal. In the event of a law suit, such documents and discussions can then be used in courts of law. Although Mrs X had given consent for the operation to proceed, health professionals should respect the withdrawal of consent. Proceeding with the planned operation against Mrs Xs wish amounts to violation of her rights and the nurse has a duty to highlight this aspect. The Mental Capacity Act (2005) was established to empower and to protect vulnerable people in making their own decisions. In particular, this was to safeguard those who lack capacity and those who have difficulties in making decisions because of illness, disability and those with mental health problems. The mental capacity act has four main principles of capacity: A person must be assumed to have capacity unless it is proved otherwise. Mrs X should be deemed to have capacity as she was interviewed and appeared coherent and lucid. Any act or decision taken on behalf of someone lacking capacity must be in the persons best interest. The consultant could argue he was working in the best interest of the patient. In the event that Mrs X lacks capacity, an advocate could be appointed to act on her behalf. An unwise decision is not to be taken as a lack of capacity. Even though Mrs X changed her mind and appears to have made an unwise decision, this should not be seen as lack of capacity. Until all practicable steps have been taken to help someone make a decision without success, they cannot be treated as lacking capacity. The consultant did not exhaust all efforts to help Mrs X in her decision making as no interaction took place after she changed her mind. The consultant took it upon himself to make the decision and dismissed Mrs X as an elderly confused patient who does not know her mind. The Mental Capacity Act (2005) has a test for capacity which states that a person lacks capacity if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of or a disturbance in the functioning of, the mind or brain. It does not matter whether the impairment or disturbance is temporal or permanent (Brammer, 2007). A person is unable to make a decision for himself if he is unable to understand the information relevant to the decision, to retain the information, to use or to weigh up that information as part of the process of making the decision, or to continue the decision (Brammer 2007). Section 3 of the act states that if the patient can retain information relevant to the decision for a short time only, this does not necessarily mean she cannot make a decision. When Mrs X changed her mind the consultant should have respected this decision because she was capable of retaining information for a while, had thought it through and decided she did not want to proceed. The Mental Health Act (1983) covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters. The act empowers authorities to detain those diagnosed with a mental disorder in hospital or police custody and have their disorder assessed or treated against their wishes, known as sectioning. Mrs X was diagnosed as having early signs of Alzheimers disease. This disease is a form of dementia, a neurologic disease characterized by loss of mental ability severe enough to interfere with normal activities of daily living. It usually occurs in old age, and is marked by a decline in cognitive functions such as remembering, reasoning, and planning. As Alzheimers disease is a progressive illness with no recovery, it is not applicable to use the Mental Health Act (1983) because whether or not treatment is given for the disease, this will not improve the decision making capacity of Mrs X. The General Medical Council clearly stipulates that healthcare professionals ought not to discriminate but should treat those in their care fairly based on their needs. The consultant is going against the GMCs code of conduct when he ignores the patients wish to discontinue with the operation. The GMC emphasises that patients have the right to change their minds on decisions.(ref) Nurses are required by the NMC Code of Conduct to express compassionate attitudes in their careers (Byrne and Byrne 1992). Nurses act as advocates for patients and as such can be described as special and unique to other health care professionals as they spend more time with the patients (Norman and Ryrie 2004). They are expected to develop a nurse-patient relationship which must be kept professional. It is also a nurses duty in accordance with NMC to educate the patient. Mrs X should have been educated and made aware of the advantages and disadvantages of the operation. The principle of non-maleficence is one which seeks to avoid intentional harm. Mrs X does not wish to undergo the procedure so to agree with her wish would be harmful although proceeding may harm any existing relationship between the healthcare professionals and the patient. What then happens if for instance the procedure does not go according to plan? Operations to correct hip fractures in the elderly are common and to abstain from conducting them would result in a lot of pain and discomfort not to mention the immobility issue. It is common knowledge that bedridden elderly patients if not moved regularly will develop pressure sores (Onslow 2005). The principle that requires action which benefits the patient is known as beneficence. To effect such an action sometimes medical professionals have to ignore the wishes of the patient if they can prove the patients incapacity to consent. While respecting the right of Mrs Xs treatment refusal, capacity test should be done to find out if she is capable of making her own decision. If Mrs X lacks capacity, then the medical staff should seek consent from the relatives or Independent advocates (Tingle and Cribb,. 2008). The ethical difficulties are compounded by such cases as the Canadian case of Malette v Schumann. The claimant came to hospital after being involved in a road accident. The doctor went ahead to perform blood transfusion despite the nurse having found a card in her pocket stating that she was a Jehovahs Witness and never to be given a blood transfusion. Later, on recovering the claimant won $20,000 of damages (Tingle and Cribb, 2008). The doctor was charged with battery. Mrs Xs wish not to proceed with the operation may be well founded and give grounds to litigation. The outcome of the operation also plays a major part in determining whether the decision to go ahead and operate is a good one or not. On tacking this assignment l learnt that establishing the patients consent is very vital for any action to be justifiable carried out. The consultant did manage to convince Mrs X to agree to undergo the procedure after talking her through it. He unfortunately could not accept her change of mind sighting her age as the problem. I felt that Mrs X hadnt been given enough time to ponder the idea of undergoing the procedure. She has been admitted to the hospital ward and urgently added to the list. I thought because she was in pain, she was not thinking straight and was pressured into giving consent. Looking back l now feel the consultant wanted the hip fracture operation to proceed as soon as possible as this would in turn ensure speed recovery. Looking at her age, I would like to think that the sooner she got operated on the quicker the recovery. He had the patients interest at heart. At the time l felt team work and better communication would have brought about better decision. The team members should have objected or aired their feelings against the consultants wish to proceed without consent. The positive was that if Mrs X was operated on, the pain would easy and she would then be mobile, which would be good for her heart. Taking the age issue into perspective the sooner she underwent the procedure the sooner she was expected to heal. The negative was that if anything went wrong, bearing in mind Mrs X had severe heart problem, the whole team would be in trouble. When Mrs X changed her mind about undergoing the procedure the issue should have been addressed properly since consent is fundamental in a patients care. A meeting between the medical care professionals to look into the reason of change of plan, if need be, a mental capacity test taken as is warranted under the Medical Health Capacity Act. In nursing the interests of the patients always come first. I think communication is vital in nursing. Communication is very important when dealing with patients in nursing. The consultant did not act as a professional when Mrs X changed her mind that she is not ready for the hip operation. I was not comfortable with his response as it sounded harsh, commanding and unprofessional when he was informed of Mrs X decision I have learnt that team is important in nursing and healthcare professionals should always respect the rights of their patients and consent is at the centre of every action. The author has explored the professional, legal and ethical implications of the case study provided. It has been identified that although the NMC provides guidance and regulates the nursing profession, the onus is on the practitioner to make decisions based on the guidelines. Although the nurses and doctors may be working together, it has also been noted the two professions are governed by two different bodies and therefore have different codes of ethics although some of the codes could be similar. The NMC code of conduct is often updated as the code sometimes conflicts with other policies and procedures from employment and the law. Nurses should ensure they are up to date with any changes and guidelines within this body (Beech 2007). Because of the trust accorded nurses by society (gained through recognition of nurses expertise) and the right given the profession to regulate practice (professional autonomy) individual clinicians and the profession must be both responsible and accoun table Hitchcock et al (2003). The basic ethical principles of beneficence, nonmaleficence, justice and autonomy which are among the ethical principles that influence decisions in health care ethics have been explored and applied to the case study. The Mental Capacity Act (2005) has also been discussed and identified as the main legal instrument relating to this case study. It is crucial that nurses understand how the law influences nursing practice, particularly in relation to anticipating lack of capacity Hindle and Coates (2011).

Presidency Essay -- Essays Papers

Presidency Although it is often said that the President of the United States holds the most powerful office in the world, this does not mean that he is able to decide very much for himself. The American Constitution, which was adapted in 1789, clearly states the Separation of Powers. Thus, the president makes up only one third of the government, namely the executive branch. He is also controlled by a complex system of checks and balances, which makes sure that he (or any of the other branches, for that matter) does not become too powerful. We will now have a look at the different problems which may be facing a recently elected president, and then discuss to what extent his powers are important. The first and foremost problem is that the president does not necessarily have a majority in Congress behind him. As the American system of government is non-parliamentary, the president is elected by the people, not by Congress, Thus there may very well be, as there is at the moment, a Democrat as president, with a Republican majority in Congress. The president will then have to do a lot of negotiation and adaptation, to be able to get new laws through Congress. He will not be able to follow the politics entirely of his own liking. But even if the president is supported by a majority in Congress, this does not mean that everything is necessarily fine. Since there are only two important parties in the USA, the representatives from each group make up a far from homogenous mass. Conservative Democrats may very well support the Republicans in many cases, and liberal Republicans may support the Democrats. President Clinton experienced the trouble connected to this in the years 1993-94, when he faced a Democrat, but nevertheless relu... ...e power of the President (sic)is great if he can use it; but it is a moral power, a power activated by persuasion and discussion." The president will always have to co-operate in order to achieve something. If conflicts arise between him and Congress, for example, trouble is in the horizon. This happened in 1995, when President Clinton refused to sign the national budget proposed by Congress. The entire government came to a stand still for a couple of weeks, and then Congress had to back off. They were not strong enough to override Clinton's veto (they would have needed a 2/3 majority). And of course, as already mentioned, the president exercises an immense influence on political life. Therefore, despite all the elements which may pester his existence, the president could rightly be called the most powerful man of the US, and thus, in today's situation, of the world.

Life and Works of Gregory Crewdson Essay

Gregory Crewdson was born in Park Slope, a neighborhood of Brooklyn, New York. As a teenager, he was a member of a punk rock group called â€Å"The Speedies† that hit the New York scene and sold out shows all over town. Their hit song â€Å"Let Me Take Your Foto† is a signal of what Crewdson’s true calling would be later in life. The same song was used by Hewlett Packard to advertise its digital cameras. In 1985, Crewdson studied photography at SUNY Purchase, New York. He proceeded to get his Master of Fine Arts degree from Yale University and taught at Sarah Lawrence, Cooper Union, Vassar College and Yale University where he has been on the faculty since 1993. Crewdson is represented in New York at the Luhring Augustine Gallery and in London by the White Cube Gallery. His listings of selected exhibits of his works alone cover more than two pages. Crewdson also has three photography books entitled â€Å"Hover† published in 1995; â€Å"Twilight† published in 2003; and â€Å"Gregory Crewdson† published in 2005. The last was a collection of his works from 1983 to 2005. Today, Gregory Crewdson continues to work on his craft and he continues to teach because â€Å"teaching is ideal for an artist because he gets to learn what the next generation are doing, what they’re reading, what they’re listening to, and to talk about form and composition†¦. We end up talking about everything else -galleries, the market. Everything but the art itself. † There wasn’t a lot of material on Gregory Crewdson’s transition from being a member of the band to being a serious and celebrated contemporary photographer. However, in an interview conducted by Ana Finel Honigman for Kultureflash, the photographer-artist revealed that his photographic themes and influences came from varied sources such as his father’s work as a psychoanalyst to his fascination with films especially those made by Alfred Hitchcock. He also stated that he is influenced by Orson Welles and Cronenberg. Furthermore, Crewdson revealed during the interview that he is fascinated by all films irregardless of genre, but that his fascination seems to be more with the lighting and â€Å"ambience† of the theatre as a controlled environment and outlet for the film as a work of art. Looking at his works of photography, Crewdson have the same â€Å"cinematic† feel and a pervasive feeling of gloom or foreboding. Gregory Crewdson also mentioned that â€Å"You can never get away from your self as an artist or as a person. Invariably themes and issues always resurface and make themselves evident in some form or another†. In stating this, Crewdson have confirmed some of his audiences and reviewers’ comments that his photography seems to reflect portions or aspects of his life – which he actually denied in the interview despite the statement. He insists that he feels protective about his work while still in progress often showing it to only a handful of people but once an exhibit has been decided on this body of work, then he totally disengages or makes himself â€Å"unattached† from his photography. Looking at some of Gregory Crewdson’s work, you can find series of photographs with the same theme or even title that has continuity and differences in light and perspective. Like his work entitled â€Å"Brightview†, â€Å"Long Clumps of Beetles†, â€Å"Maple St. †, â€Å"Man in Woods† and many others. His work â€Å"Brightview† has a woman whose back is turned to the audience but she seems to be holding a light towards the road. This is a two series photograph and has two light perspectives to it. The same goes for â€Å"Long Clumps of Beetles† and â€Å"Maple St. . With â€Å"Man in Woods†, I saw four photographs of the same title but again, it has the same subject but photographed in different lighting staged for the effect and perspective or angle. Gregory Crewdson has retained the â€Å"cinematic† feel of his photography from his first published work in 1995 through 2005. He makes use of elaborate and â€Å"pre-fixed† sets that reminds his audience of Hollywood type productions – only instead of film, the image and moment is captured in still photographs. In another interview with The Guardian, he said that all his photographs were shot during twilight; he revealed that â€Å"My photographs are about the moment of transition between before and after†¦ Twilight is evocative of that. There’s something magical about the condition. † The effect of his twilight shots amidst the backdrop of a set that blends in the dark hues of the night with semblances of dark purple, and dark blue, the effect is almost eerie and oftentimes, surreal. The emotion is always embedded with tension and the message one gets from looking or trying to make sense of his photographed images is one of an unfinished moment. It is the same feeling you get when you are watching a cliffhanger movie and then suddenly the movie stops a few seconds before the resolution of the conflict or tension. Gregory Crewdson’s photographed images also leaves a lot to the audience’ own personal imagination and interpretation. He iterated that he purposely leaves his images â€Å"unresolved† because these are moments that he sees and remembered from days past. These are â€Å"captured memories† that was kept hidden in his memories somewhere but that he could only remember flashes and specific instances – but not the entire picture, hence, the â€Å"unresolved† feeling of these images. The artist-photographer wants to keep it that way. In his photograph series entitled â€Å"Maple St. †, there is a car in the photograph that always seems to be in the middle of the street with a door wide open and lights are emanating from both within the cab and floodlights from the electric posts. In â€Å"Maple St. 1†, the car seems to be semi-parked in the road curving to the right. There seems to be a figure in the car and one of the doors is wide open. The tires on the back seems to be flat, and as always, darkness is creeping in and the glow of the light coming from the electric posts gives a creepy, foreboding feeling. There is a house nearby but there is no road ahead – the image looks likes a dead end street and huge trees dwarfs the car. It is actually remindful of scenes from serial killer movies when somebody is about to be killed – the â€Å"just before† moment. The tension is pervasive and the mood, â€Å"hanging†. The same tension appears in the 2nd installment of the â€Å"Maple St. series† of photographs. The angle and perspective is more from the right angle and the glow or flood of lights seems to be coming from above – like in Steven Spielberg’s movie, â€Å"The Close Encounter of the Third Kind† when the alien spacecraft was hovering about and lights flooded the side of the house. The same light effects were used and the feeling is surreal and anticipating of what is about to happen – again, the â€Å"just before† moment is captured in the image. Another photograph series that can be compared to the â€Å"Maple St. † series is that of â€Å"Man in the Woods† series. I saw series numbers 1, 2, 3, and 4. The 1st photograph of the series comprise of what appears to be the middle of the forest with a round white light emanating from the upper half of the woods glowing like a bright moon and its bright rays covering the entire image through the tall tress and foliage. There is a structure on the right side of the picture that appears to be aluminum or piece of reflective metal and it reflects back light from it. A figure is perched on the third step of a ladder facing the square aluminum or piece of metal. The figure is situated at the right hand corner of the picture. There is also one tall fallen tree that cuts across the image. Meanwhile, the 2nd of the series shows a different angle of the figure – still perched in the 3rd step of the ladder, but now the perspective is from the left side or middle left of the image, the square piece of aluminum or metal is still there. What is absent here is the moon like glow from the bright light in picture #1. The fallen tree is also present and the angle of the entire image is a bit further away from picture #1. There is a fog-like atmosphere in the entire image. The 3rd installment photograph has a perspective further away from the bright lights and the whole scene. Nowhere can you see the figure anymore or the square aluminum or the ladder. Not even the broken tree is present. It appears to be taken much further away from the 1st and 2nd images but it seems to be approaching these images. The 4th image consists of a car with its headlights on (bright) and the it illuminates what lies ahead of the car – which are mostly abandoned boxes surrounding a dug portion of the earth in the middle of the woods. The wood clearing which was illuminated (somewhat) by the headlights appear to an area that has been dug – it resembles a would be grave. The car is surrounded by tall tress and the thick foliage barely permits any other light to come through. The same creepy feeling is there and sense of foreboding that something is about to happen. All four installments of the series appear to be flashes of a movie scene. One take or scene after the other in the case of scene 1 to 3. But the fourth image seems to be a totally different scenario – although still in the woods, and the same â€Å"unfinished† or unconcluded† feeling is left with the viewer. Gregory Crewdson, like the personalities that have influenced him – Steven Spielberg and Cronenberg, Alfred Hitchcock and Twilight Zone, David Lynch and his psychoanalyst-father, all have left their indelible mark in the world of art and their specific or chosen realm. Gregory Crewdson refuses to be categorized into any particular genre. Lastly, his influence can also be continuously reappear as seen in his former students who have now created their own brand of thematic photography. But his mark and specific signature of â€Å"twilight themed† photographs have already made an indelible and distinct mark in the contemporary world of photography throughout the world.

Rethinking The Growing Female Prison System - 1622 Words

Women’s population in the prison system is growing vastly, and continues to grow. Julie Ajinkya (March 8, 2013). Rethinking How to Address the Growing Female Prison Population. Retrieved from www.americanprogress.org/issues/women/news. According to the center for progress from the years 2000 through 2009 the number of women incarcerated in state or federal prisons rose by 21.6 percent in comparison to 15.6 percent increase for men. Majority of the women in the prison system struggle with, mental illness, histories of physical and sexual abuse, drug addiction, poverty and a lack of education. These are all contributing factors as to why these women end up incarcerated. This also means that our society still chooses to punish these criminals rather than heal and rehabilitate these offenders. The offenders get pushed away in to the criminal justice system instead of receiving the services they need that could help them live healthy, secure, and productive lives. In the boo k George, E. (2010). â€Å"A Woman Doing Life; Notes from a Prison for Women† R. Johnson (Ed.). New York, NY Oxford University it explains a story of a women’s perspective inside prison looking out. She explains her highs and lows in the prison and the relationships she has with the corrections facility and its employees. When it comes to women in prison this has an alarming affect to the people that are associated with these women such as, family members. Majority of the women in prison have minorShow MoreRelatedThe 19th Century : The Nineteenth Century1333 Words   |  6 Pagesdeployments to the Middle East, the scars left from battle will change a youth socially and emotionally causing them to make poor life decisions and wind up on the wrong side of the law as did their ancestors. Early proponents of separate juvenile systems, whose theory was the reformation of delinquent youth, ushered in the Reformist movement. 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