Legal Issues in Health Care

Legal issues in care are significant in order to underpin the practice of nurses when gaining consent if faced with the issue of a patient refusing care. This assignment also seeks to show how legal issues are vital features when providing and maintaining person-centred care when carrying out day to day interactions with patients. Every nurse within the United Kingdom must comply with the guidelines which are set out by the Nursing and Midwifery Council Code of Conduct, (NMC,2015). Although the main focus of this assignment is constructed around legal issues, some aspects will interlink with professional and ethical matters. Under the Data Protection Act (1998) all names within this assignment will be withheld. Any individuals involved will be given a pseudonym, to protect their confidentiality.

The focused scenario examines an event situated in clinical practice involving Robert, a student nurse and a registered nurse. Robert is a Seventy – six-year-old man, who was diagnosed with dementia three years previous to this admission. Robert lives at home with his wife and had been admitted onto the ward due to having a fall and experiencing increased confusion. On the day Robert had been admitted the nurse and student nurse wanted to change a dressing on Roberts leg, this was so that it could be noted the width and dimension of the wound and to see if infection was present. Upon arrival to any ward within the NHS nurses have to carry out different assessments to establish every individual’s conditions, and to monitor them during their stay on the ward. Brooker & Waugh (2007) states "If nursing care is not written down then it did not happen".

Both members of staff introduced themselves to Robert and gained permission to address Robert by his first name, Robert consented by nodding his head. The student nurse then asked Robert how he was feeling. After this the student asked Robert if she could have a look at his bandage and explained that the bandage should be changed on that day to stop any infection occurring and to promote healing. Robert refused to have his bandage removed and seemed quite agitated when the registered nurse tried to explain to Robert that she needed to look at it, “it is a basic principle of the law in the United Kingdom that a mentally competent person has the right to refuse treatment” (Dimond, 2008 AND PAGE NUMBER)

The NHS Constitution (NHS Choices, 2015) sees respect, dignity and compassion at the core of how patients are treated alongside the person centred care framework which facilitates the care of the patient by providing holistic care, when working with Robert the student nurse ensured that person centred care was provided by asking Robert throughout what he wanted and how he felt.

Patient centred care was promoted by the student nurse re-reading the assessments that were carried out when Robert was admitted onto the ward. Legally all staff within the NHS have to keep records of all interactions with patients. When the student nurse and nurse had carried out their assessments they had consent from Robert to ask him questions, The NMC (2015) provide a base line which must be followed when a new patient is admitted onto the ward, the assessments carried out included risk assessments, moving and handling assessments, continence assessments and dietary assessments. By carrying these out it enables everybody involved in Roberts care to establish a care plan which is suitable for his needs. The Royal College of Nursing supports this statement stating that keeping accurate and clear records filled within a short time period after interaction with patients it enhances the communication within the multidisciplinary team regarding the care of the patients. (The Royal College of Nursing, 2014).

Another aspect of planning the care of patients as timely as possible is that it can reassure dementia patients that they remain in control of their care and can also make them feel valued, ensuring that holistic and person-centred care is maintained throughout the patients stay. (May et al. 2007). When providing individualised care for Robert the student nurse followed Roper, Logan and Tierney’s model “The activities of daily living” (1996), The student nurse used this model to assess Roberts independence level in the areas of daily living and to help determine interventions that could promote Robert to become more independent, one way in which this was done was by making a referral to physiotherapy about Roberts unsteadiness hopefully promoting Roberts mobilisation over time. Within the model, there are twelve factors that influence the activities of living, by assessing Robert’s needs individually when he first arrived at the ward the student nurse and nurse ensured that Robert was being treated holistically.

Interlinking this model with Kolcaba’s Theory of Comfort Model (1990) It enabled the student nurse to provide individualised care for Robert, this model focuses on the process of assessing a patient’s comfort needs, the student nurse assessed Roberts needs throughout this scenario by adapting Roberts care plan if and when he stated that his pain had deteriorated or improved. The student nurse also informed the named nurse when Robert had stated he was in a lot of pain, as Robert was prescribed pro - re nata analgesic medication. By updating the care plans it provided a person- centred approach to the care provided also ensuring that the policies and procedures were being followed.

When working with Robert the student nurse introduced herself again as Grealy et al (2005) proposes that dementia patients are likely to forget and become distressed if they aren’t made aware of whom people are if they are not familiar with them.  The student then explained to Robert that he was in the hospital and his family would shortly be visiting as the student nurse felt this might reduce some anxiety levels which Robert had developed. It is suggested that “friends and family, can help a person with dementia to feel valued and included”. Whilst the nurses maintained to monitor Roberts distress and anxiety levels, they decided to give him some space.

There are many legal issues which underpin nursing care, one of the issues is ‘consent’ within the code of conduct it highlights the need to obtain properly informed consent and ensure it is documented, before carrying out any act. (NMC,2010). If any mentally competent adult is touched without giving their consent they have the right to sue for trespass against the person (Dimond, 2008). The process by which nurses gain consent must be transparent and demonstrate their accountability.  Dimond (2008, p.139) advises that although written consent is the best form from a legal perspective “there is no specific requirement that consent for treatment be given in any particular way”.