A reflective essay based on an episode of patient care.
rodrigo | December 3, 2012
WritePass - Essay Writing - Dissertation Topics [TOC]
This is a reflective essay based on an episode of care that I was directly involved in managing during a community placement. This episode of care will be analysed using up to date references, health care policies and relevant models. Issues and theories relating to leadership qualities and management styles will also be explored, taking into consideration any legal, ethical and political factors that may have impacted on patient care. Care delivery, delegation and prioritisation will be examined along with team working, risk assessment and patient safety. I will also take into consideration my role as a supervised student nurse and analyse the roles and responsibilities of those supervising me and what influence this has on my practice. These issues will be debated and questioned within the framework of leadership and management theory
In order that I could use this situation for my reflection the patient will be referred to as “Mrs A”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct (NMC, 2008), “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”
Starting an extended practice placement as a third year nursing student enables the student to develop their knowledge and skills in management and leadership ready for their role as a qualified adult nurse. During my extended practice placement there were many opportunities to develop these skills and manage my own caseload of patients and arrange many complex aspects of their care.
During this placement an 88 year old patient, to be known as Mrs A, was due to be discharged from a rehab centre following recurrent falls, issues with safety at home, and self neglect, the referral had been made by a concerned General Practitioner. Mrs A had spent the last 6 weeks receiving holistic multidisciplinary care, including; intensive physiotherapy, occupational therapy and nursing care. Mrs A had made much improvement and was able to safely administer her own medication.
One of the Physiotherapists called Ken, had commented during handover, that Mrs A had seemed confused during their session together, and asked if the nurses would go in and review her. Upon visiting Mrs A it was clearly evident that she was not herself, and seemed confused. Following discussion with my mentor I felt that Mrs A was not safe to administer her own medication. I recommended to the patient to let the rehabilitation staff administer her medication. Mrs A consented to this, thus reducing a great risk of Mrs A causing her-self harm. I delegated to the support workers to obtain a urine sample which was tested and confirmed that Mrs A had a urinary tract infection, antibiotics were prescribed by her GP. The team leader at the rehabilitation centre was informed of Mrs A’s infection and plan to handover the administration of her medication to them, she was happy with this decision and pleased that I had informed her.
This episode of care was managed effectively as the underlying cause of the patients confusion was discovered and treated, a risk assessment was completed and a referral was promptly made to medicine management and a dossett box was supplied to Mrs A, to help her manage her own medications safely. All members of the multi-disciplinary team were fully committed to the team approach to care delivery and this facilitated efficient and organised care delivery. The care delivered was patient-centred and teamwork was integral to providing this care.
First will be a discussion on the importance of self awareness and how this awareness enabled a more assertive and confidant approach to be made to managing patient care.
Self awareness must be considered as the foundation for management and is a vital skill and quality needed in leadership. If you wish to provide care that is of a high standard and improve your own performance as a skilled health care professional you need to manage the cognitive, affective and behavioural self in order to engage effectively in therapeutic relationships. Self awareness is the process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognising how they affect the care and services provided (Whetten and Cameron, 2010).
Without being self aware, recognising personal and cultural beliefs, and understanding interpersonal strengths and limitations, it is impossible to establish and maintain good relationship with co-workers and patients. Maslow’s Hierarchy of Needs Theory (1954) depicts self-actualisation at the highest level of the hierarchy of needs. This relates to the need to maximise potential and achieve a sense of personal fulfilment, competence, and accomplishment (Maslow, 1954). It is important as a student nurse to be completely aware of strengths and weaknesses, and to be conscious of any limitations, self-awareness helps to exploit strengths and cope with weaknesses (Walshe and Smith, 2006).
When organising and planning patient care it is vital to have effective management and leadership skills, this is part of every nurse’s role, and involves planning, delivering and evaluating patient care. These management responsibilities are part of every nurse’s role (Sullivan and Garland, 2010) and to exhibit these professional behaviours demonstrates their value to the organisation (Huber, 1996). To understand nursing management it is crucial to understand what nursing management is and the theory behind it.
Managers are defined as “a member of a specific professional group who manages resources and activities and usually has clearly defined subordinates” (Gopee & Galloway, 2009). Another definition of management is a process by which organisational goals are met through the application of skills and the use of resources (Huber, 1996).
Borkowski (2010) argues that Douglas McGregor made a significant impact on organisational behaviour and was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation. McGregor (1966) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2006) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).
Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businenessballs.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Businessballs.com, 2002).
Borkowski, N. (2009) Organizational behaviour, theory, and design in health care , USA: Jones & Bartlett Publishers
Cameron, K. and Whetten, D. (2010)Developing Management Skills, USA: Prentice Hall
Gopee, N. and Galloway, J. (2009) Leadership in Management in Heathcare, London: Sage Publishers
Huber, D. (2006) Leadership and Nursing care Management. 3rd Edn.USA: W.B Saunders Company
Maslow, A. (1954) Motivation and Personality, New York: Harper & Row
McGregor, D. (1966). The human side of enterprise. Leadership and motivation. Cambridge:
MA: The MIT Press.
Sullivan, E. And Garland, G. (2010) Practical Leadership and Management in Nursing, Essex: Pearson Education Limited
Walshe, K. And Smith, J. (2006) Healthcare Management, New York: Open University Press
Tags: free essay, management theory
Category: Free Essays, Health
Essay on Confidentiality Between Doctor and Patient
Every person has the right of keeping his/her personal information confidential especially about medical conditions. Medical information should be restricted only to the concerned doctor who is authorized to maintain the health record. However, in certain circumstances it becomes necessary for the physician to break this law if it is for the benefit of the patient. Patient confidentially can be described as; medical information should not be disseminated by the doctor and disclosed to any other person or organization until or unless there are specific circumstances requiring distribution of the information or permission has been obtained from patients for disclosure of information.
Thesis statement: it is the ethical and legal duty of doctors to maintain confidentiality of their patients, however, information can be disseminated with the permission of patients and when sharing of information becomes necessary due to seriousness of disease or saving life of the patient.
Proper Handling of Information
Patients generally anticipate that their personal and medical information will be kept secret by the doctors and as such it becomes obligatory for the doctors to perform the duty of confidentiality. All types of information shared by the patients and provided to doctors should be handled carefully and every possible measure should be adopted for protecting such information. In this regard, latest technological advancements are highly supportive for the doctors to maintain confidentiality. (Tingle 123)
The duty of confidentiality is, in fact, a binding contract between the doctor and patient, whether or not such contract is available in written or verbal form. This binding contract forms the basis of relationship between doctor and patient. Moreover, under this relationship it is necessary and compulsory for the doctor to provide care to the patient to the best of his/her capabilities supported by all necessary support available to the doctor. Even the patient is unconscious and care is being provided by the doctor, the contract about providing care and keeping confidentiality is enforced on both doctor and the unconscious patient. However, it should be noted that providing care by the doctor is not compulsory and the doctor has the option to refuse providing care due to any reason which he/she thinks is valid. Confidentiality between patient and the doctor is the basis of medical profession. The confidentiality element is also necessary due to ethical, legal, and moral obligations so that information is kept secret. However, passing or sharing information should be done by taking every possible precaution ensuring safety and security. Keeping confidentiality of the patient is not only the responsibility of doctor but also every one involved including hospital administration, staff etc. (Weber 197)
Public in general and patients in particular expect that not only doctors but also hospitals should undertake every possible precaution and adopt all measures to maintain confidentiality. In this regard hospital records should be maintained in such a way that any breach of confidence does not take place. Any doctor or hospital breaching this ethical or legal duty by disclosing information including medical records may face damages for such disclosure.
There are both legal and ethical considerations for keeping medical/personal information of the patient secret with some exceptions. Law requires maintaining record or information of the patient's health secret but if there is a serious threat to the life or health of a patient then disclosure of the information can be made. Ethical principles also requires that the doctor should try to maintain an accurate but sophisticated balance between the ethical requirement to maintain secrecy and disseminating information to save life or provide care to the patient. (Boyle 145)
In case it becomes ethically and legally a necessity to pass on the information then doctor should discuss the situation with the patient if necessary and also when patient is in the condition to discuss the issue of breaking secrecy. In some instances patient is also encouraged to apprise his/her medical situation to any other person, for instance if the HIV of a patient is positive then the patient should be persuaded to discuss this condition with his/her sexual partner so the related risk is shared between them. However, if the patent is not willing to share the information, then it is the ethical duty of doctor for disclosing information to the person who is exposed to risk. There are certain situations in which doctors should obtain opinion from other doctors. The doctor then should consult a trusted colleague who is expert in that area after getting permission from the patient. (Abrams 143)
Requirements of health insurance companies generally include the clause that patients should waive the condition of confidentiality and disclose the medical information to them when a claim for medical coverage is submitted. In case, a lawsuit is brought by the patient against a hospital or doctor for any particular reason, doctor is then allowed to provide related information and medical records as evidence required in the court. Furthermore, there are legal requirements in some states to disclose and share medical information by the doctors if there is a virus or disease that could harm general public and state should provide protection to the people. Doctors can release information about their patients without breaking law or breaching their ethical duty when patient allows doctors to disseminate the information to specific persons or organizations. In case there is an obligation for the doctors, in the public interest, to disclose information, such as a fatal virus that could spread to harm other people's health, then medical information can be provided to the concerned department after seeking legal advice to avoid any undue circumstances. (Kushner 177)
Ethical and Legal Duty
It is the ethical and legal duty of a doctor to protect the medical as well as personal information of the patient obtained for providing healthcare. This obligation is based on trust, faith, and confidence required in the contract between patient and the doctor. It is necessary that patient should disclose every information he/she has as concealing may result in the failure of doctor for providing care. However, while providing information to the doctor a consent, in written form, should be given to the doctor to release or share any medical information if becomes necessary. Moreover, all employees in the hospital are also required to maintain the confidentiality of patients.
Hospital policies should also be designed and implemented to protect the medical/personal information provided by the patient. The duty of doctor to maintain confidentiality extends to all information obtained directly or indirectly from the patient. Hospital staff involved in keeping confidentiality includes; receptionists, nurses, practice staff, and managers. The contract of secrecy is even applicable after the death of patient. In routine course of business, doctors and hospitals receive requests to release information about their patients from employers, insurers, courts, solicitors, and police; however, the decision to disclose information should be made with due consideration and consultation with legal experts. Furthermore, law also obligates doctors and hospitals to maintain the confidentiality of patients.
For the purpose of maintaining trust and confidence in the doctor-patient relation, it is obligatory for the doctors not to release the genetic or inherited information to anyone including family of the patient without obtaining his/her consent. However, in the case of genetic diseases, doctors should persuade and encourage their patients the significance of disseminating information to at least family members. It is the ethical duty of doctors to inform family members about the genetic risk carried by the patient even if the patient is not willing to disclose the information. For this purpose, it is necessary that doctors, prior to establishing a relationship and initiating healthcare, should obtain the consent of patient to disclose the genetic information to the family members. However, it is pertinent to highlight, that the general rule of maintaining confidentiality should be observed and considered by the doctors as a legal and ethical duty. The disclosure of information about patient's health due to seriousness of disease or saving life of the patient is not banned by law and an ethical duty of the doctor. The doctor, in this case, should try his/her best for obtaining consent of the patient being an ethical duty to pursue patients.
Problems Faced by Doctors to Release Medical Information
Currently, doctors are increasingly being sued by the patients for breaching the relationship requiring maintaining confidentiality and releasing information without the consent of patient. Doctors, therefore, take every possible precaution to avoid any undesired circumstances. Studies have shown the fact that in cases where opinion of other doctors or medical experts is required doctors prior to obtaining medical opinion; sought legal opinion causing a critical delay in providing care to the patients. To resolve this issue, federal as well as state governments have enacted certain laws to ensure confidentiality and also highlighting the situations in which information can be shared without the consent of patient. Some states allow disclosure of medical information in specific conditions and without consent of patients. According to the acts, the information can be provided to other medical experts and also to sources that provide financial assistance to the patient. Furthermore, information can also be provided to researchers and families under particular circumstances. (Jonsen 209)
Discussions have been in the paper about the delicate matter of keeping confidentiality by the doctors about medical conditions of their patients. Although, it is the ethical and legal duty of doctors to keep entire information confidential obtained for healthcare of the patients, there are circumstances in which it becomes necessary to disclose the information. These exception circumstances have also been discussed in the paper.
Abrams, Fredrick Doctors on the Edge: Will Your Doctor Break the Rules for You Sentient Publications, 2006, p. 143
Boyle, Philip Getting Doctors to Listen: Ethics and Outcomes Data in Context Georgetown Univ Pr, 1998, p. 145
Jonsen, Albert Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine McGraw-Hill Medical, 2006, p. 209
Kushner, Thomasine Ward Ethics: Dilemmas for Medical Students and Doctors in Training Cambridge University Press, 2001, p. 177
Tingle, John Patient Confidentiality XPL Publishing, 2002, p. 123
Weber, Leonard Profits before People?: Ethical Standards and the Marketing of Prescription Drugs, Indiana University Press, 2006, p. 197