State Regulation and Nursing Standards
A - State Regulation and Nursing Standards introduction. State Regulations and Nursing Standards Nurses who are currently licensed to practice in the State of California are required to adhere to title 16, California Code of Regulations. Under the section of Standards of Competent Performance, part 6, a registered nurse “Acts as the client’s advocate, as circumstances require, by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to take informed decisions about health care before it is provided”.
In this scenario the emergency room physician, Dr. K, had determined that the patient, Mr. E, is suffering from lung congestion, would need immediate medical intervention in order to survive. Based on Mr. E’s diagnoses, Dr. K thought that Mr. E may not understand the urgency of the required medical intervention. Dr. K asks the nurse to speak to the patient’s brother, Mr. Y, who is the authorized person to make medical decisions for him when he is not able to. In addition, Mr. E has an advance directive on file indicating he did not want a ventilator or cardiopulmonary resuscitation.
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The previously stated Code of Regulations implied that the nurse should be an advocate for the patient in improving his health through direct and indirect means. A nurse can positively affect a patients health by direct contact and interaction and also indirectly by providing vital information on the patient’s options and status. In this scenario, the nurse should follow the code of regulations by relaying all information to the patient’s family. This action can ensure that a decision is made with all available information. Nursing Codes of Ethics According to the American Nurses Associations Code of Ethics (ANA) provision 1.4, “respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination” (Nursing World, Code of Ethics). By means of self-determination, it means the patient rightfully exercised autonomy, and his rights to decide on the continuity of treatment during emergency situations. The Code of Ethics requires the nurse to follow the wishes made by the patient and enforce them base on the directions given in the advance directive. In this scenario, the patient, Mr. E chooses to be withdrawn from life-sustaining measures in the event of an emergency.
By placing him on a ventilator, it strips away his right to autonomy and violates his rights as an individual. Furthermore, to act upon oneself in making decisions against the advance directive is unethical. In the end, the hospital and its staff can face legal actions because an advance directive is a legal binding document. In this case, Mr. Y probably has no idea that his brother, Mr. E already has an advance directive established at an earlier date. Nevertheless, Mr. Y is on the power of attorney to make medical decisions in the event that Mr. E is unable to do so.
It’s a difficult situation because Mr. Y has to think about whether his personal beliefs coincide to that of his older brother, Mr. E’s. Knowing the fact of existing DNR order, should Mr. Y refuse treatments in honoring his brother’s wish? Or, should he intervene and agrees to life-saving measures recommended from his physician? Complication of the Advance Directive The complication in this scenario regarding the advance directive is that even though one is already in place from Mr. E, he also placed his younger brother Mr. Y on the power attorney to make decisions for him.
This fact posts an issue to the situation because there are two advance directives in place to dictate the use of medical intervention during emergency situation. In this scenario, Mr. E’s DNR order should be honored; however, because he also placed his brother on the power of attorney, decisions can be made to go against his wish. Furthermore, due to Mr. E’s current medical condition and known delayed mental status, he is not able to provide a clarification on the decision to life-saving measures and to which of the two advance directive should be followed in the event of an emergency.
D. HIPAA Violations There are several violations against HIPAA that took place in this scenario. First, Dr. K violated Mr. E’s privacy because he should not have disclosed Mr. E’s health condition with Ms. H, patient’s niece without prior consent. HIPAA prohibits the disclosure of confidential health information without the prior consent from the patient. In addition, there were bystanders around during their discussion of Mr. E’s condition; others might have heard their conversation. HIPAA recommend the discussion of health information be conducted in private and secure manner.
Second, The nurse should not have discussed Mr. E’s dilemma and health information to nurses who work in other parts of the facility, even though the patient might be transferred to their unit at a later time, however, because they are not part of the team that directly provides care to him at the moment, it is considered as HIPAA violation. E. Profession Conduct of Nurse The nurses’ conduct in this scenario is totally unacceptable and against policies. First, the nurse providing care to Mr.
E should not have any discussion of her patient with nurses working in other unit because they do not have direct patient to provider relationship. It is an unacceptable behavior and in direct violation to the patient’s privacy rights. Second, the three nurses who were involved in the conversation made unprofessional statements regarding Mr. E’s mental status and medical condition, which degrades him as a patient and an individual. Furthermore, a nurse mentions that no one pays attention to HIPPA while another nurse is completely unaware of its existence.
The step that the nurse should take in this specific scenario is to respect the patients as a dignified individual and provide honest care without prejudice regardless of their mental and physical state. According to American Nurses Association (ANA), “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual” (Berman, Snyder, Kozier and Erb 2012). Furthermore, the nurse should take initiative on educating themself on the latest healthcare policies, including HIPAA, an important body of regulation in safe guarding patient’s privacy rights.
As ANA Codes of Ethics also states, “The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development” (Berman, Snyder, Kozier and Erb 2012). The steps I will take in this scenario using ANA Code of Ethics as stated above is first by approaching Mr. Y and explain his brother’s current medical condition. I will also inform him that his brother already has an advanced directive in place and wishes for no medical intervention during time of emergency. The reason for this action is so Mr.
Y can better understand the situation and make decision accordingly. The second step I will take is to inform nurses during lunch meeting that their comment is unprofessional. As professional nurses, we must respect the dignity and individuality of Mr. E. Furthermore, I will encourage them to find out about HIPPA, a body of regulations protecting client’s privacy. Lastly, the final step is self-evaluation and improvement. As a nurse, I should not withhold legal decision made from Mr. E to his brother Mr. Y and follow the regulation set by HIPAA and the agency.
References: Title 16, California Code of Regulations. (online) Available at: http://www. rn. ca. gov/regulations/title16. shtml#1443. 5. (Last Accessed 12/07/2012) Code of Ethics for Nurses With Interpretive Statements. (online) Available at: http://www. nursingworld. org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics. pdf (Last Accessed 12/06/2012) Berman, A. , Snyder, S. , Kozier, B. , & Erb, G. (2012). Kozier & erb’s fundamentals of nursing: concepts, process, and practice. Upper Saddle River, NJ: Prentice Hall.