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Reflective bank account of a recent legal incident

Nurses are faced with many legal or ethical dilemmas, the Nurse's Handbook of Laws & Ethics (1992) says that nurses should "integrate understanding of honest and legal aspects of healthcare and professional principles into medical practice". It's important to know what types of dilemmas nurses may face during their careers and how they may have been handled before. In this paper I will talk about one of these dilemmas in the form of a critical occurrence and put together the legal and moral problems, I am going to also give my own reflective thoughts to show learning and understanding.

As students nurse I've encountered a number of critical occurrences that I have wanted to reflect on to improve my practice. The critical event i am focusing on in this article handles issues of overlook, duty of attention and too little communication and awareness between pros and patients. Through this critical incident, I'll explore the problems from a specialist, legal and moral perspective. Exhibiting how through representation, I could learn both privately and professionally how to become a much better nurse. In this article I am going to discuss my understanding of reflection utilizing a reflective model. This will be accompanied by an research of the incident and what ethical and legal borders were crossed. Relative to the Nursing and Midwifery Code of Do (NMC 2008) all names and placement details will be concealed, and I will refer to the patient as Mrs. A at all times.

Refection is an important tool for a nurse, it offers a 'vehicle by which we can talk and justify the importance of practice and practice knowledge' Bulman and Schtuz (2004, p1).

There are two varieties of reflection, refection-in-action and reflection-on-action. Representation in action is 'to consider what one does whilst one does it; it is normally stimulated by delight, by something which puzzled the specialist concerned"(Greenwood, 1993). Schon (1987, p26) is convinced that the average person will 'Stop and think' and 'pause in the midst of action'. I do assume that this happens used and a benefit of this type of reflection could it be shows more smart thinking however a disadvantage could it be would take up valuable time when stopping to take into account your entire action.

Reflection on action is thought as "The retrospective contemplation of practice undertaken in order to discover the knowledge used in functional situations, by analysing and interpreting the info recalled" (Fitzgerald, 1994pp67). Reflection on action entails looking back in hindsight and turning the info from the occurrence into knowledge to make use of in the future.

Alternatively Boyd & Fales suggest representation on action is "The procedure of fabricating and clarifying the meanings of activities in terms of self with regards to both do it yourself and world. The results of this process is improved conceptual perspectives" (Boyd & Fales, 1983pp113). None of these views however take into consideration representation before action, even as we map out our works before we do them.

There are extensive reflective models that show how to think about situations properly and study from them, the one I've chosen for the intended purpose of my essay is Gibbs style of Reflection (1998).

Gibbs model Confronts professionals to consider their normal way of thinking and responding within the situation towards gaining insight into self and practice (Johns

2005 p18). It really is a simple model and motivates a clear description of the situation, it analyses the practioners' feelings, gives you help to measure the experience and maybe make sense of it all and it examines what you will do if the problem arose again. Gibbs model comes with all the key skills of representation. It is concentrated more on reflection on action, but with repetition it could be used to give attention to reflection in and before action.

Gibbs Model involves 6 phases: Level 1: Information of the function, Stage 2: Feelings and Thoughts (Do it yourself awareness), Level 3: Evaluation, Level 4: Analysis, Stage 5: Summary (Synthesis), Stage 6: Action Plan. I will proceed through each stage in relation to my critical event. The first stage is describing the event, my placement was on the busy community hospital that handled a variety of older patients who have there been for snooze and treatment or re-housing. Mrs A was a 70 yr old patient on the ward who was simply battling with orthopaedic problems. She possessed bone deterioration and acquired broken her calf terribly from a fall in her home, it was such a terrible break that she had to have her right knee in a complete cast from hip to toe. She had good use of her other limbs and was trained by the physiotherapists to employ a special stay and strap on footwear when aiming to walk. Mrs A found this extremely hard to do and over time she stopped seeking or even attempting to try and eventually stopped attempting to do anything for herself. Mrs A little by little started pressing the decision bell increasingly more to receive the nurses to help her with trivial things that often she could do or get for herself. The nurses who had been sometimes very busy believed this is of great annoyance, they would inform Mrs A that 'they acquired other patients to help, not simply her' and this she 'acquired to avoid pressing the bell so much'. Mrs A was certainly scared about slipping again and needed a bit if attention that was overlooked by the nurses and I witnessed a number of that time period, that the call bell would be migrated out of Mrs A's reach or wrapped around a peg behind her where she again could not reach it. This was a great be anxious if you ask me as what would happen if she do have an authentic emergency?

In this paragraph, I'll discuss the next stage; my emotions and thoughts. When I first achieved Mrs A I unveiled myself and sat at attention level with her concerning build a good rapport, I possibly could sense she was nervous and so wished to make her feel comfortable. Each day we'd chat and although she was marginally challenging she was a pleasant lady who was never unpleasant or bad mouthed just lonely. The nurses would often complain about her and after voicing my judgment to my coach of how she just wished someone to talk to I was told she and the other nurses didn't have the time and Mrs A was 'selfish' for not realising they were busy and tired. I could understand the nurses concerns about experiencing all the patients and having the right chance but thought the attitude towards Mrs A was unfair. When I saw the nurses remove/move the decision bell I asked my mentor again why that was being done and she told me 'to stop her from having them constantly playing around after her ' when I asked imagine if a real disaster arose she didn't answer and thought too humiliated to ask again, this entire situation led me to judge my practice and the practice of these around me.

Evaluation is the 3rd stage of Gibbs (1988) model of reflection and the reflector must express what they feel was good and bad about the event. I understand that exhaustion is a common issue with nurses as alot work long hard days and nights sometimes without breaks, Van Dijk & Swaen (2008, p1136) declare that, 'Fatigue is a common complaint in the working inhabitants. About 20% of the working populace article symptoms that are categorized as the concept of tiredness. ' and I also recognize that fatigue can add toward problems in judgement and practice but I feel fatigue had not been a massive factor in Mrs A's treatment, it was more laziness on the nurses behalf rather than tiredness.

Stage four of Gibbs (1988) is an evaluation. (Will Expand)

In conclusion, level five of the Gibbs (1988) model, I know that nurses do not conceal patients call bells when they are getting tired or irritated at the patients persistent dialling but as I observed some nurses do. I will in future try to not let pressure stop me from doing the right thing and speaking up for a patient. I must make an effort to practice as easily as a can and do so in the patients best interest.

Within my action plan my purpose is to analyze further into how to help and deal with the 'patient looking for constant attention' and find books to help qualified nurses when working with the same problem. To conclude my reflection skills are suffering from through the production of this article. Using Gibbs model of representation has helped me to structure my thoughts and emotions appropriately. My level of awareness involving patients needs and emotions has been increased with the use of critical reflection. My competence, within this example, has been further developed and I now feel that my own and professional development is progressing. Making use of this reflective model has helped me to realise that my learning is something which I must be proactive in. Furthermore as a student nurse I've recognised that representation is an important learning tool in practice.

Reflection can help to develop understanding of legislations and ethics as when we reflect an occurrence, legal and moral issues may come up and be investigated thus new knowledge will be discovered and then found in regards to practice.

'Law affects almost everything we do' Judith Hendrick (2000, p1). Legislation is either created by judges(common legislations) or parliament(statute regulation). Statute regulation is started as a invoice or proposal made by the government, an individual MP or an associate of the home of lords, it is debated and then either approved or rejected with or without amendments. Statutes have been passed on most topics but some of those highly relevant to healthcare are; statutes establishing the NHS and modifying its framework and company and functions regulating the health care professions including the Medical Work 1983 for doctors, nurses, midwifes and health guests.

This is principal legislation as it places out basic guidelines for all in the UK to follow, supplementary legislation is laws made by an executive specialist under powers directed at them by principal legislation so for example the welsh set up have delegated power to put into action requirements set out in most important legislation. Common rules is law developed by judges through decisions of conditions in court. It really is predicated on precedent (legal concepts developed in earlier circumstances).

Statute law pieces out a platform for the NHS and common legislation sets out the law of the land but nurses are also governed by 3 different set of legal rules. Legal responsibilities to patients, Professional responsibilities to patients (imposed by the UKCC -will explain) and legal job relationship, this describes the employers right to have his personnel perform at a specialist standard and the personnel to have the right to be cared for properly.

This is exactly what I will include in the others of my article.

NHS Trust BREACH FROM THE CODE OF PROFESSIONAL Do: In this incident the next clauses are relevant:

Clause 1. Function always in such a manner concerning promote and secure the passions and wellbeing of patients and clients

Clause 2. ensure that no action or omission on your par t, or within your sphere of responsibility, is detrimental to the interests, condition or safe practices of patients and clients.

Clause 7. recognize and value the uniqueness and dignity of each patient and client, and react to their need of health care, regardless of their ethnic origins, religious values, personal attributes, the nature of their health problems or any other factor

Clause11. are accountable to an appropriate person or expert, having regard to the physical, mental and social effects on patients and clients, any circumstances in the surroundings of care that could jeopardize benchmarks of practice

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