NSG2HEL Healthcare Ethics and Law – Nursing Accountability & Professional Negligence

Accountable practice means being able to explain, on the law and on your professional standards, why you did what you did. This assessment asks you to analyse a clinical scenario as a regulator, a court, or a coroner might.

You are asked to analyse the legal and professional issues that arise in one of the two scenarios below. Through the use of relevant literature and resources, demonstrate that you have engaged in a critical analysis of the legal and professional issues you have identified.

Assessment Requirements

1. Identification of legal and professional issues Identify the legal and professional issues in your chosen scenario and articulate the rationale for each issue you identify.
2. Analysis of legal and professional issues Undertake a critical analysis of the scenario and discuss the most relevant legal and professional concepts in relation to it, using appropriate literature, legislation, case law and professional standards.
3. Structure and organisation Include an introduction, body and conclusion with appropriate sections. The essay is expected to be well structured, with coherent and logical presentation of key ideas.
4. Written expression, presentation and referencing Present the essay with minimal spelling, grammatical and typographical errors. Effective use of literature should be evident, with appropriate paraphrasing. Use APA 7th edition for in-text citations and the reference list.

Jurisdiction

Analyse the scenario under Singapore law, and against the SNB Code for Nurses and Midwives (2 April 2018).

Where Australian or Victorian law offers a useful contrast, you may include it, but it must be clearly labelled as comparative and must not stand in place of the Singapore position. Seven marks are allocated to jurisdictional accuracy.

Scope

The focus of this assessment is legal and professional, not ethical. The scenarios raise ethical questions as well, but confine your discussion to the legal and professional dimension. Ethical analysis was assessed in Assessment 2.

Suggested Approach

• Include a correctly filled-out title page with your student ID details.
• Choose only one of the two scenarios below.
• Provide a brief introduction and conclusion.
• Sub-headings may be used.
• A minimum of ten credible sources is expected, including relevant legislation, case law, SNB standards, and peer-reviewed literature.
• Apply your analysis to the particular facts of the scenario rather than discussing the law in the abstract.
• Approximate time on task: 22 to 28 hours.

Scenario Options

Option A: Pauline

• Background: Pauline has just graduated from her nursing course. She recently secured a position in a large public hospital in a new graduate program. She is a mother to a 3-year-old boy and a 6-month-old girl. Her husband also works shift work so that they can accommodate their childcare responsibilities together. However, they are both exhausted and do not have time to spend with each other very often due to their conflicting shift work. Pauline is currently working her first night duty rotation. She has recently worked several double shifts, as the hospital has been short-staffed and she is trying to pay off her student loans.
• Scenario: On a particularly busy night, Pauline accidentally administers a second dose of an anti-hypertensive medication to one of her elderly patients, Olive, who has mild dementia. The medication error occurred as Pauline did not check to see if the drug had already been signed as given on the medication chart. She reviews Olive’s medical history and notes that her blood pressure is usually quite high.
• Pauline then decides not to inform anyone about the error, as she is concerned that it might reflect poor performance in her new role. She does not inform Olive, as she feels it might cause Olive to be anxious if she tells her that she has made a mistake. However, Pauline is worried Olive may get dizzy from the second dose of the medication. She goes to Olive and states firmly that she must stay in bed for the next 6 hours.

Option B: Mr. George

• Background: Mr George is a 69-year-old male patient with minimal English-speaking abilities. He had been admitted to hospital following a mechanical fall in which he fractured his left hip. He had surgery and was recovering well on the ward. Mr George has a history of Alzheimer’s disease, dementia, and urinary incontinence.
• Scenario: Due to urinary incontinence, Mr George buzzed every hour and requested to go to the toilet. Nurse Jaimie helped Mr George without any assisting devices; however, Jaimie had been informed during handover that a gutter frame should be used when mobilising Mr George. Nurse Jaimie stated that it was not the first time she had cared for Mr George and that she knew what she was doing.
• After assisting Mr George four times, Nurse Jaimie started to get impatient. At the same time, she needed to care for another patient who was in pain and had requested analgesia. She decided to put Mr George in an incontinence pad against his wishes. While she was doing so, Jaimie disconnected the buzzer to give everyone a break and suggested Mr George remain in bed.
• Mr George was uncomfortable in the pad and pressed the buzzer a few times, but no one came to assist him to the toilet, as it had been disconnected. He decided to go alone to the toilet, and fell and broke his left femur on the way to the bathroom.

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Scenario selected for analysis – option B – Mr George

Introduction

The main focus of analysis in this essay is on evaluating the professional and legal responsibilities of Jaimie in providing care for Mr George, a post operative patient with dementia and limited English proficiency. The important areas being analysed are failure in mobility assistance, patient communication, consent and call-bell access under Singapore law and Singapore nursing board (SNB) code for nurses and midwives.

Identification and analysis of legal and professional issues

Care negligence and duty of care – it is the primary duty of Jaimie to provide safe nursing care to Mr George, but this particular duty is breached by ignoring the hand over instruction to use a gutter frame and assist them without the prescribed mobility aid. The consequences of unsafe mobilisation are also evident from subsequent fall and fracture. In a case study on Pappa v National university hospital Singapore Pte Ltd [2023] SGHC 70, the case of negligence was noted by the high court in respect to hospitals that involved supervision and access to a call bell contributed to a fall. This situation is highly relevant in the given scenario of Mr George.
Failure to follow professional standards – the professional standards being not followed as evident from the action of Jamie to disregard the handover information and established mobility requirements. According to the SNB code, principle 5 clearly requires responsible and accountable nursing practice, while principle 6 calls for competent and evidence based care and principle 10 emphasizes on effective team work and communication. The statement given by Jamie that she already knew how to care for Mr George does not justify ignoring documented clinical instructions.
Patient autonomy, consent and dementia -The case scenario indicates that Mr George was put into an incontinence pad which he was not willing to wear, and it reflects the ignorance of his expressed preferences and involved personal care without consent. According to the mental capacity act 2008, section 3 assumes that individuals have decision making capacity while Section 4 States the situation when a person lacks capacity and section 5 establishes the test for evaluating decision making ability. In the given scenario, it is wrong to assume that Mr George lacks capacity only because he was having Alzheimer disease or dementia. It is important that the ability of Mr George should be evaluated to make a decision, and the communication should be carried out using appropriate language support.
Disabling the call bell and patient safety – The safe nursing practice was completely ignored from disconnecting Mr George call bell. As a result of this, George was not able to request assistance and it ultimately created a foreseeable risk of an unsupported fall. It has also compromised his ability to access timely nursing care and subsequent desire to reach the toilet independently result in a fracture.
Language barriers and communication – Mr George was not proficient in English and Jaimie should have considered an appropriate interpreter to explain the care options available to Mr George. As per the SNB Code principles 1 and 2, there is a requirement to respect patient’s needs, rights and autonomy.
Professional misconduct and regulatory accountability – Singapore nursing board can perform investigation with respect to complaints on negligence or misconduct. The disciplinary outcomes as per section 19 includes warning, censure, financial penalty, suspension or cancellation of registration or enrolment. The action by Jaimie could therefore result in professional investigation and disciplinary action.

Critical evaluation of negligence

The evaluation of professional negligence at Singapore Court is performed using professional standards and the principles established in Bolam v Friern hospital Management Committee [1957] and Bolitho v City and Hackney Health Authority [1998]. In the given scenario, the failure of Jaimie to follow prescribed mobility procedure and disabling the call bell would require close examination against accepted nursing practice. It is also likely that the hospital would face vicarious liability for negligence and it would depend on the proof of duty, breach, causation and damage.

Conclusion

The action by Jaimie clearly indicates serious failure in professional accountability and patient safety. There is a foreseeable risk of injury from ignoring mobility instruction and George’s wishes, and also from disabling his call bell. It is important for the nurses to provide competent, safe and accountable care as per Singapore law and the SNB code. This particular incident in the scenario exposes the nurse as well as the hospital to professional and civil liability.

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The analysis of the case scenario involving nursing negligence, patient safety, informed consent, professional accountability and Singapore nursing laws revealed important findings about the negligence by the nurse and the consequences that need to be faced. With professional nursing experts in Singapore, you can get help with your nursing assignment involving customised case scenarios. By visiting our nursing assignment help page, you can get a professional expert for your assignment. Not only with nursing, get complete support with assignments across subjects by visiting our assignment help page in Singapore. Also refer to the samples of nursing assignments written by our experts to know more about them.

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