Clinical Scenario

You are required to watch the assessment 2 video, available on Bb in the Assessment Items folder> Assessment 2: Recorded Presentation. There is also a transcript of the video available below.

Content

The overall aim of this presentation is to demonstrate your knowledge and understanding of the unit content listed:

• Possible ethical dilemmas associated with the clinical scenario

• Utilitarianism and Deontology

• Beneficence, Non-Maleficence, Autonomy, Justice (distributive justice)

• Capacity/ legal capacity and competence

• Consent/ the elements of informed consent

• Veracity (truth-telling) 

• Fidelity

• The Tort of Negligence/ Components of Negligence/Acts and Omissions

• Duty of Care/ Scope of Practice

Your task is to develop a professional, recorded presentation with which to educate your peers in the clinical environment and to demonstrate your understanding of the unit content. To do this you will create a synthesis using the relevant unit content (the legal and ethical concepts specified above), linking it to the relevant and specific areas of the content of the video and the relevant nursing legislation e.g. The Registered Nurses’ professional codes and standards). Ultimately, this will demonstrate your knowledge of the relationship between the unit content, the clinical environment and professional legislation. A synthesis means the combination of components, or elements, to form a connected whole: combine the information within your presentation, categorising the concepts and presenting them as themes rather than presenting concepts one by one, and demonstrating relationships, similarities or conflicts as the case may be. For example, we have discussed the two main ethical theories of Utilitarianism and Deontology. You may decide to discuss them together linking the relevant aspects of the video/clinical scenario as the basis for the discussion but ensuring that you demonstrate your knowledge of those concepts. DO NOT DEMONSTRATE YOUR KNOWLEDGE OF CLINICAL EXPERTISE: THIS IS ABOUT LAW AND ETHICS. You will also need to link how this relates to the relevant aspect of nursing legislation e.g. the RN Standards for Practice or the ICN Code of Ethics for Nurses. In doing this you will provide an analysis: a detailed examination suitable to inform your peers in the clinical environment.

Consider that the audience have watched the video already or even have a copy of the transcript in front of them (the transcript of the video is available with the video). Do not waste valuable time repeating the content of the video in isolation from the other information required or as an introduction. However, remember that when you introduce a concept/topic/theme consider that your audience knows nothing. Do not assume they know what you mean and so, consider how you will define/explain this information so that they understand (hint …………use the relevant part of the video/clinical scenario, along with your definition/explanation taken from the evidence, to help explain). The marker needs to know that you know, and that you can explain it to a fellow peer!  Also, you may find it useful to use the Model for Ethical Decision Making to aid your planning.

You will be assessed on the quality of the application of theory (unit content) to practice and the quality and depth of the analysis presented. You will also be assessed on your ability to support your discussion with evidence from appropriate literature, including the quality and relevance of that literature. There is a minimum of 10 references required, although you should read widely and incorporate that reading into your presentation. The more you read, the more evidence you will find to weave into your analysis and support your ethical and legal claims. References for this presentation should be within 5 years of publication only, other than when referring to the latest version of legal and professional documents, which may be older than 5 years e.g. The ICN Code of Ethics for Nurses, 2012 (This is the latest version and still in use). References should be from a valid source (peer reviewed journals, government organisations, and professional online websites and resources e.g. Department of Health, Nursing and Midwifery Board of Australia etc.). All must be relevant to Australia. References should support ethical and legal/professional information as opposed to clinical information.

Introduction 

Mavis Donaldson’s a beautiful, elegant lady, loved and cherished by all her family and friends. To me and my brother she’s our wonderful Mum. Mum’s always been in pretty good health although lately has been getting up feeling a little bit dizzy, and recently she fainted and had a fall at home. She went into hospital two days ago for a bladder infection, which had left her a little bit confused, but she was alright. 

I got a call late last night after I had come home from visiting at hospital, they told me mum had been found on the floor in the ward and banged her head. We told them mum gets a bit shaky when she gets up, and they said they would check on her regularly. 

I know they are really busy on the ward, but why weren’t they keeping an eye on her like they should have been. The nurses weren’t even around when she fell. She was found by another visitor. And why didn’t they look after her properly afterwards. They just put her in bed and left her there. 

It was hours before they realised something was wrong. They took her to surgery for a clot in her brain and now she’s really sick in intensive care. Its just not fair! 

Case Notes 

On the evening when Mrs Donaldson fell, there was a registered nurse co-ordinator and six other nurses working on the busy ward of 33 patients. Some of whom were very sick and required a lot of looking after. The nursing team was made up of enrolled nurses, agency nurses, one from a different department and one who had been called in to do an extra overtime shift. 

When she was reviewed by the doctor after her fall, the nurses were instructed to do half hourly nursing observations on Mrs Donaldson. Unfortunately, only two lots of observations were recorded in the nursing records. And then apparently nothing for almost two hours, where Mrs Donaldson was found unconscious. 

She was rushed to the intensive care unit for specialist management, and found to have a very large bleed inside her head. Despite every effort, Mrs Donaldson never regained consciousness. 

She later died in the intensive care unit, with her grieving daughter by her side.

Inquest  

At the inquest the coroner stated “that if the nursing staff, had done their nursing observations as prescribed, it is likely that Mrs Donaldson’s bleed would have been picked up earlier and early treatment, may have saved her life”. 

After Mrs Donaldson had fallen, the ward nurse co-ordinator was concerned there were not enough nurses to cope with the increasing workload. At that time, hospital policies had changed, and the authority to put on extra staff, was removed from nursing management and given to the general manager. 

The effect of these policies, were to secure extra staff, a chain of phone calls was required that ended up with a very senior staff member, who was not a clinician.

When the ward nurse co-ordinator rang her nurse manager to ask for extra nursing help, she was told “that it is not available”

In his conclusion the coroner wrote, “Nursing staff deficiencies contributed to both the fall and the failure to do observations; the total number of nurses was too low, the proportion of agency and overtime nurses and nurses from a different area in the hospital were too high, and the nursing skills mix was problematic. This situation was compounded by barriers to calling in additional nurses if patient acuity required it. This was not a one-off situation but a representation of a nursing staffing crisis at the Hospital at the time. 

Mrs Donaldson’s death may well have been preventable.