Research Articles Base: Medical Anthropology

Ethical Dilemmas of Registered Nurses

Introduction   In the medical field, there are several dilemmas that personnel such as doctors and nurses encounter in their daily tasks. These dilemmas challenge their moral and ethical fibre as well as their concerns of accountability in carrying out their professional obligations to their patients. This paper will look into the ethical dilemmas and issues of accountability that is associated with the role provided for by registered nurses. According to Buncombe (2000), a Registered Nurse is trained to cooperate with medical practitioners such as surgeons and health care teams in order to carry out safe medical processes with the most favourable outcomes for their clients. However, in engaging in these kinds of activities, the RNs are required to have the prescribed knowledge, capability, and the common sense necessary for clinical practice. For clarity and coherence, the discussions in this paper will be divided into several sections that would individually discuss the specific topics under consideration. Moreover, at the end of the discussions, the author will provide a summation and eventually provide a conclusion regarding the discussions presented throughout the body of the paper.      Professional Registration among Nurses   Being a part of the medical profession, nurses are inevitably responsible for the welfare of those that acquire the services of their medical facility. Considering this fact, it is imperative for them to adhere to specific norms and standards that will be able to help them more in carrying out their responsibilities. One such standard is the Code of Ethics for Nurses in Australia (ANC 2003). It increases these basic moral obligations of the profession and recognizes the fundamental principles for professional behavior. This underpinning statement text recognizes six Value Statements, two of which particularly makes out the requirement for continuing nursing education after the original training they have acquired in nursing school.  The third Value Statement recognizes that nurses encourage and sustain the condition of quality nursing care for all individuals, indicating that quality nursing care takes account of proficient care granted by suitably arranged nurses who cleave to constant learning and ongoing education as a way of preserving and increasing knowledge and skills.  The fifth Value Statement states that as morally autonomous professionals, nurses are answerable for their clinical decision making and have moral and legal responsibilities for the granting of harmless and proficient nursing care.   Another kind of standard that is also in practice in Australia is the ANC Code of Professional Conduct for Nurses. This recognizes that nurses are individually held responsible for the granting of safe and competent nursing care.  Consequently it is the duty of each and every nurse to uphold the competency essential for current practice. This obligation is acquired through continuing instruction to advance knowledge and skills relevant to individual practice conditions.   The Scope of Nursing Practice   In the case of medical institutions, they are presented with different legal obligations in terms of dealing with the rendering of the services that they offer. One of these includes their duty of care with their patients. The concept of duty of care has been greatly deliberated in the area of common law. Its particular issue is about the causality wherein individuals are affected by prior actions of another. This doctrine is largely influenced in the judgment wherein Judge Atkins delivered. (Donohue v Stevenson [1932] AC 52) In this case, a complaint by a consumer of bottled soft drinks was heeded by the House of Lords. Apparently the consumer held the manufacturer liable to the injury caused by the commodity. The problem at question was whether it was probable to salvage in tort, lacking a contractual bond, since it was not the purchaser that is diagnosed with the injury. The defendants’ line of reasoning was that suppliers’ legal responsibility to customers in tort for substandard commodities was basically unheard of to British law, and there was no lawsuit to be put on trial. The court case considered by the House concerned plainly whether there was, indeed, a case to be heard; there was no definite examination of the evidence. The House resolved, by a meager majority, that there was a case to be put on trial. It held that a principle could be extracted from preceding authorities that any individual could be legally responsible for injury to any other individual, given that particular circumstances were met. Judge Atkins noted that one must take reasonable care to avoid acts or omissions which one can reasonably foresee would be likely to injure his/her neighbor. In this context, the neighbor includes all persons who are so closely and directly affected by one’s act that he/she ought reasonably to have them in contemplation as being so affected when he/she directs his/her mind to the acts or omissions which are called in question. It is in this case that the neighbor principle of the modern law of negligence is established. In the context of the medical milieu, doctors are bound to exercise that degree of care and skill which could reasonably be expected of a normal, prudent practitioner of the same experience and standing. (1956) 1 DRY (2d) 502) The test is objective and will be elevated, as the case may be, to each and every specialty.   The Legal Responsibilities of the Nurse in Relation to Drugs and Poisons   As nurses, they are also required to handle dangerous substances that require care and cautious provisions. These substances take account of drugs and poisons. Their duties are covered in the Drugs, Poisons, and Controlled Substances Regulations of 1995. To illustrate, Regulations 7(1) (b), 7A (1) (b), 8(1) (b) and 9 (a) of the said law have need of “all reasonable steps” to be acquired to determine the identity of an individual. In these directives, the expression “take all reasonable steps” is employed to offer adaptability of approach in accordance with the conditions. An objective examination has to be implemented to the specific conditions as to whether or not the procedures acquired were adequate. Such an examination would involve bearing in mind if the procedures acquired would be appropriate to those an ordinary capable individual, or member of the profession, would acquire if placed in that condition.   Commonly, for an individual to “take all reasonable steps to ensure a therapeutic need exists,” there are specific elements to be taken into account.  One is with regards to the individual who demands the provision of, or to the individual for whom it is planned to set down or provide the substance. Another is the medical or medication history of the individual. This would be to ensure that the right drug is given and that the patient is actually presenting symptoms or characterized state of the illness. Similarly, the need to be informed of any previous or existing drug therapy is required to avert any contra prescription to the drugs to be given. Moreover, indications of mistreatment or abuse of medicines/drugs should also be noted. With regards to the substance applied for or recommended to be supplied, its suitability for the treatment of the presenting symptoms or described condition, it’s possibility for mistreatment or abuse.   The moment an individual is familiar to the practitioner and the therapeutic requirement has been established beforehand, less effort may possibly be necessary in “taking all reasonable steps to ensure a therapeutic need exists”.  Nevertheless, for a new patient, a more methodical and systematic attempt might be necessary to suit this requirement, particularly where there is grounds to suppose drug abuse or misuse. In such conditions, “all reasonable steps” might take account of probing the patient; and verifying the patient’s account by getting in touch with the supposed preceding suppliers.   The Confidentiality of Patient Information & Possible Defamation   A patient is compelled to offer personal data to Registered Nurses and other health care professionals to facilitate the admission to health care. Nevertheless, revelation of personal data places the patient in danger of their confidential information being revealed. There are ethical in addition to legal requirements to guarantee that the patient’s right to privacy is preserved. Nurses protect information found out in the circumstance of a professional relationship, and guarantee it is shared external of the healthcare team simply with the individual’s informed consent, or as may be lawfully necessary, or where the failure to reveal would bring about considerable harm. All registered nurses are anticipated to maintain the health information of patients. It is the responsibility of all health care providers to guarantee that the privacy of personal information is upheld.     There may possibly be exemptions to the responsibility of maintaining the patient’s right to privacy. Under specific instances disclosure of private information may possibly be necessary. For example, the law necessitates a registered nurse to turn up assumed child abuse, particular infectious diseases, and discharge data under the influence of a court order. In the infringement of the legal and ethical duty to uphold confidentiality, the facility/department director or administrator is supposed to be notified. The moment personal information is revealed with no approval, the patient may possibly bring the case to court, a registered nurse could be filed a suit for negligence, infringement of privacy or defamation. A professional nursing licensing body/association may possibly provide disciplinary actions in opposition to a nurse claiming that the nurse has violated client confidentiality.   Professional Misconduct and the Possibility of Disciplinary Action   Another legal issue that they have to contend with is the probability of medical negligence. Since the RNs are now directly taking in hand with the medical operations to the patient, they are similarly subjected to this kind of legal problems. A lawsuit of this legal enormity has been significantly influential in deciding court cases regarding medical negligence. Clinical negligence is defined as several action or lapse which goes amiss of a criterion to be predictable of the reasonable man, in this context, the medical practitioner. It is indispensable to demonstrate that no matter what the nurse did or did not do fell below the benchmark of a convincingly knowledgeable RN in that discipline of medicine. The RNs will be able to protect the compensation claim effectively, if it can confirm that an accountable organization of highly regarded doctors in the related discipline would have functioned in an analogous approach. This connotes that a judge will examine verification from professionals and come to a decision whether the measures taken were apposite. In a clinical negligence case, it is posited that the burden of proof for the suit is laid on the hands of the petitioners.   Another important thing to consider is the causation of the suit. It is deemed indispensable to ascertain that the failure by the medical practitioner in reality instigated the damages complained by the petitioners. The claim of negligence among medical personnel such as the RNs needs to satisfy three elements in order for the claimant to collect the appropriate damages. These include the duty of care, breach of the duty, and the causation of the injury. The first element denotes that the claimant has to prove that he/she has been admitted to a hospital where the defendant doctor have supervised his/her stay in the said medical facility. The second element implies that the claimant has to prove that the medical practitioner that attended to him/her have failed to comply with the appropriate standard of care required of the doctor. This is normally labeled as the Bola Test. ( Hospital Management Committee)   The test states that the standard of care obligatory of a RN is that of the customarily trained RN exercising and professing to have that skill. He requires not possessing the uppermost professional skill. Nonetheless, it is adequate if he practices the common skill of a common proficient RN exercising that particular discipline. Moreover, it also denotes that an RN who had acted in conformity with a practice established at the time as appropriate by an accountable body of medical opinion accomplished in the particular type of treatment under consideration was not responsible of negligence simply because in attendance was a body of competent professional opinion which might espouse a dissimilar method. On the other hand, the last element should also be satisfied. This means that the claimant should establish that the cause of the current injury is triggered by the negligence of the medical practitioner involved. (Hospital Management Committee) Another determinant of negligence among medical practitioners is when a blunder of judgment may possibly, or may possibly not, be deemed negligent; it depends on the characteristics of the blunder. If it is one that would not have been made by a convincingly knowledgeable professional acknowledging to have the degree and category of dexterity that the defendant held himself out as having, and performing with average care, then it is negligent. If, conversely, it is an inaccuracy that a man, performing with average care, may perhaps have made, then it is not negligent. ( [1981] 1 All ER 267)         Conclusion   The role of the registered nurse has been thoroughly discussed in the body of the paper. This is to present the responsibilities and important duties that the RNs have to contend with in his/her line of work. In presenting the kind of work they assume, it is apparent that they are similarly in charge of the life of the patient once they are going under the knife. Their technical skills are required to keep the medical team’s performance without glitches and thus ensuring the safety of the patient.   In this context, the study has also presented that with the RNs extended function, they are also subject to concepts like duty of care and accountability. Along with this kind of responsibilities are the sanctions of medical negligence that they could be charged once they have not performed at par with what is required of them by the medical institutions. These are the dilemmas that a regular RNs face in his/her line of work. These are the problems in which the safety of the patient is still the central component.   In looking into the discussions above, the presence of an RN in the medical team has apparently provided a positive impact on the outcomes of the medical operations. In this manner, the patient makes the most of the extended function that these registered nurses are willing to undertake. Nevertheless, the continuous vigilance of these nurses to constantly upgrade the skills and educate themselves persistently regarding the advancements in medical technology is still necessary and indispensable. Credit:ivythesis.typepad.com

Ethical Dilemmas of Registered Nurses

Introduction In the medical field, there are several dilemmas that personnel such as doctors and nurses encounter in their daily task...

MEDICAL DECISION SUPPORT SYSTEM

Medical Decision Support System   Introduction             Today’s generation has provided different fields of study a number of advancements and developments that not only entail making work and jobs easier, but making it faster and more accurate. The discovery and invention of many different applications of technology and science in different fields have provided many individuals with significant and relevant benefits, which helped each field flourish and become very helpful to any individual in the society. This is specifically observable in the field of medicine, which is particularly significant in the diagnosis and treatment of different diseases. The relevance of technology to medicine has already been evident, through the application of computers and advanced technological equipments used in the diagnosis and treatment of certain diseases, such as cancer and heart diseases. Its application has also been observed in most especially in medical, healthcare, and genetic researchers, which pose great discoveries and breakthroughs that would benefit each and everyone in the society. In this regard, technological decision support systems, such as computer systems are relevant and significant breakthroughs in the field of medicine. Decision support systems, such as computer systems are regarded to speed up medical and patient care decision making that would benefit medical clients needing medical and healthcare services.   Problem Statement             What impacts do these computer systems have on medical decision making and patient care, and who bears responsibility for (mal) functioning of the system?   Objectives of the Paper: Reasons for Interest             This paper aims to help increase knowledge and information regarding computer decision support systems and its effects in the medical and healthcare field. The specific reasons for interests or objectives of this paper can be summarized as follows:   1)     To know what clinical or medical decision support systems are; 2)     To determine the effects of using medical decision support systems; 3)     To find out what ethical issues and codes are involved in the use of medical decision support systems; 4)     To determine the different legal issues involved; 5)     To cite specific examples or situations of its use; and 6)     To deduce relevant conclusions and recommendations   General Background             To be able to further understand and make relevant conclusions on the ethical and legal issues regarding medical decision support systems, it would be important to shed light on what is a medical or clinical decision support system, including its uses, benefits, and relevance in the medical and healthcare field. Such concepts and understandings are important to take note of, as these would enable one to draw ethical and legal delimitations of the use of medical or clinical decision support systems.             It has been reported that the concept of computer-based diagnostic and other decision support systems for patients or clients are difficult to separate from the more general area of consumer health informatics. Consumer health informatics represents a diverse field devoted to the development, implementation, and research on telecommunications and computer applications designed to be used by consumers to access information on a wide variety of healthcare topics. This technology, both hardware and software, is part of a growing trend toward empowering consumers to take a more active role in their own healthcare and to provided the necessary information to enhance their decision making. Today, more than ever, consumers are using information technology either as a substitute for traditional physician-based medical information or as a supplement to the information provided by healthcare professionals in the course of clinical encounters ( 1999). Likewise, such importance can also be determined and pinpointed in the perspective of medical or clinical health professionals, who regard computer-based systems as essential and beneficial in their practice. Computer-based systems are beneficial in terms of generating alerts and reminders for clinical or medical healthcare professionals, most especially in terms of a busy schedule and large amounts of load. It provides diagnostic assistance, as the use of computer-generated findings and examinations would essentially provide better diagnosis and treatment to clients. The use of computer-based support systems would also provide therapy critiquing and planning, which would allow medical or clinical healthcare professionals with the opportunity to continually critique appraise and improve their planning strategies. Such computer-based support systems also enable image recognition and interpretation, which not only assist medical or clinical healthcare professionals in the diagnosis but also in the treatment of diseases. The number of its uses makes one to become overwhelmed by the operation of the computer-based support system. In this regard, it is essential to know what a medical or clinical decision support system is.             A medical or clinical decision support system or CDSS is defined as software that integrates information on the characteristics of individual patients or clients with a computerized knowledge base for generating client-specific assessments or recommendations designed to aid clinicians and/or patients in making clinical decisions. Work on such systems has been under way for decades with minimal impact on healthcare delivery. Interest in clinical decision support systems has grown dramatically during the last decade. However, in part because of the promise such systems hold for assisting clinicians and patients in applying science to practice ( 2001). This definition excludes electronic textbooks, hypertext and text databases, as these require the user to formulate and conduct the search and do not attempt to synthesize search results into a report which applies specifically to a particular client. It also excludes computer-based teaching and learning tools, which are designed to enhance a clinician’s knowledge, not assist them with specific client management decisions. It is possible to gain access to some decision support system using the Internet or the World Wide Web. However, most Internet sources, being passive do not qualify as decision support systems. Finally, because they do not contain medical knowledge or give advice, computer systems, which acquire, process or communicate client data, clinical data systems are also excluded, though appropriately organized data can improve medical decisions (. 1997).   In addition, decision support systems or also called decision aids, consist of a store of medical knowledge, or knowledge base, and a reasoner a computer program, which uses two or more clinical findings to select, display, or apply relevant facts from this knowledge store. To obtain advice or information from a clinical decision support system, it must be provided with client data such as the age, clinical findings, diagnosis, current medication, test results, and the like. Such data may be entered by the clinician or obtained from a clinical data system, directly or via a network connection (. 1997). The applications of clinical decision support systems assist clinicians and patients with three types of clinical decisions, namely, preventive and monitoring tasks, prescribing of drugs, and diagnosis and management ( 2001).   Applications of Clinical Decision Support Systems: Examples             Contributors to the body of knowledge of applying computer systems to clinical practice include the several sites where hospital-based, medical decision support have been implemented and studied. Among the leaders in these efforts have been groups at the Regenstrief Institute in Indianapolis, Columbia Presbyterian Medical Center in New York, and Beth Israel Hospital in Boston. Examples of applications include decision support tools that critique medication orders and the system for identifying life-threatening laboratory results, which are described using the HELP system used and developed by the members of the Department of Medical Informatics of the University of Utah ( 1999). Another significant application of medical or clinical decision support system is evident in pediatrics. Clinical decision support systems in pediatrics were focused on diagnostic recommendations. Pediatric decision-support can be provided by any computer system that deals with clinical data and medical knowledge to help deliver client-specific advice. Laboratory systems that flag abnormal values, immunization registries that issue vaccination reminders, and automated pediatric electrocardiograph or ECG interpretation are just a few examples of the use of system in common use today. In addition, the development of a pediatric anti-infective decision-support system program that was integrated into the hospital information system in Utah is one specific application of the use of the medical or clinical decision support system. It has been emphasized that the use of the tool in a pediatric intensive care unit or PICU was considered beneficial to patient care by the clinicians, reduced the rates of erroneous drug orders, improved therapeutic dosage targets, and was associated with decreased costs per client ( 2005). Moreover, a specific study emphasizes the significant and relevant application of medical or clinical decision support systems in the hospital setting. This specific study indicates that through the CDSS, a large medical database of over 2000 intensive care patients containing 98 fields of clinical and administrative information on patients admitted to the ICU was collected and inputted, with some retrospective chart review. In the used system, up to seven medical diagnoses and multiple procedures can be recorded, with auxiliary space for free-form comments. Significant events in the ICU course of the client and complications that occur can also be placed and noted in the system ( . 1997).   Impacts on Medical Decision Making: Ethical and Legal Issues             From previous discussions, it can be perceived that the use and applications of medical or clinical decision support systems prove to be beneficial and advantageous in the hospital setting and in the medical field. This is because the use of such systems focuses on the efficiency and efficacy of providing accurate diagnosis and treatment to different diseases and ailments of many patients or clients. It also assists medical or clinical healthcare professionals in targeting accuracy in terms of detecting causes of diseases, which may not be initially diagnosed. It provides medical and clinical healthcare professionals with less time finding clinical records, thus, having more time to make rounds and see the condition of their patients or clients. The use of such a system also gives opportunity to medical professionals and clients alike to gain knowledge through access to the system, thus, further understanding medical conditions. Lastly and most importantly, guidelines and information are computerized, thus, organized and retrieval of information is easier. In this sense, the system can greatly assist with the diffusion of guidelines and information into practice ( 1999). However, despite such positive effects and advantages, still, a number of negative impacts can be pinpointed, which can be perceived as both ethical and legal issues related to the use of the system. Such ethical and legal issues raise questions on the effects the use of the system would have on the decision-making of both medical professionals and clients, and on the malfunction of certain systems.             Ethical Issues – Ethics in the medical practice is defined as the science or study of morals, and refers to how individuals determine what is good for the flourishing of people in society, and what rules individuals need to prevent people from being harmed (. 2000). Using this definition, ethical issues in both client and medical professional perspective would be emphasized. Primarily, an ethical issue that is related to the welfare of clients is the issue on empowerment and self-efficacy. Empowerment can be thought of as the process that enables people to “own” their lives and have control over their destiny, and is closely related to health outcomes in that powerlessness has been shown to be a broad-based risk factor for disease. On the other hand, self-efficacy is a patient’s level of confidence that he or she can perform a specific task or health behavior in the future. Several clinical studies have shown self-efficacy to be the variable most predictive of improvements in patients’ functional status ( 1999). In this regard, letting recovering patients or clients to use such a system may offer either a positive or negative feedback from the client, as he or she may feel either neglected or perceived as independent by the medical practitioner. Although autonomy is given to provide independence to the client, it would still be ethical and morally right to assist the client as long as he or she is confined in the premises of the medical institution.             Another ethical consideration is the issue on the privacy and confidentiality of the information provided by the client. It has been reported that more than half of the hospitals in the United States are implementing electronic patient record systems. The National Research Council has estimated that the healthcare industry spends as much as billion annually on information technology, an amount that is expected to grow by 20% per year. The importance of collecting, electronically storing, and using health information is undisputed. However, the problem is systemic and arising out of the routine use and flow of information throughout the health industry. Healthcare information is primarily transferred among authorized users, wherein the information is not only used for patient care and financial reimbursement, but also for medical, nursing, and allied health education, for research, social services, public health, regulation, and litigation, and for commercial purposes such as the development of new medical technology and marketing ( and  2002). In this regard, the privacy and confidentiality of the information provided for by a client is not entirely kept in the system. This must not be so, as any information provided for a human being has an intrinsic value that should regulate a moral action affecting it ( 2006). Thus, confidentiality and privacy serves to be threatened with the use of such a system. In relation to confidentiality and privacy issues is data dredging and data fishing. Data dredging occurs when a database is subject to analysis that was not part of the original clinical trial protocol, which data fishing is action that seeks to obtain a result if the analysts try long and hard enough. Both processes allow greater use of existing data, which are improper and unprofessional ( 2002). Such processes are ethical issues to consider as use of private information are being done without the consent of the concerned individuals. Lastly, the decision-making process of medical practitioners is also considered one of the ethical issues. Some medical or healthcare professionals might have the perception that such systems were designed and implemented as autonomous systems that replace human judgment, thus, making their jobs easier. In this regard, the right of a client or patient to obtain the best form of treatment or service is being compensated.             Legal Issues – Computers and software raises conceptually fascinating and important practical questions about responsibility and liability. Further, the question whether a decision support system is a medical device needing governmental regulation is a source of tension and debate. In both domains, scientists, clinicians, philosophers, lawyers and government and policy officials must grapple with a variety of knotty problems. The intersection of medicine, computational decision support and law has been addressed mostly in speculative terms. The use of decision support systems is not widespread enough to have stimulated legislation or illuminating precedent. Moreover, medicine and computing share little in the way of a common legal history, thus, the legal differences between them are striking. Medicine is tightly regulated at all levels, wherein most healthcare providers are licensed, and a rigid hierarchical system is the norm. Yet, computer systems and companies are created in a totally unregulated competitive environment in which “software piracy” is common, standardization is in its infancy, licensing is a method of transferring trade secret software, and companies begin in garages ( 1999). In this regard, it can be perceived that because the field of medicine and the field of computers may be far ahead from each other, it would be difficult to apply legal matters that would combine both fields. However, in the issue of the use of medical or clinical decision support systems, legal issues that combine both fields would be relevant. Primarily, the overriding legal issue related to computational decision support is liability for use, misuse or even lack of use of a computer to make or assist in rendering diagnoses ( 1999). It has been emphasized that the use of the system may increase a physician’s consultation time, thus decreasing the time spent on direct patient care. However, although the use of the system may improve efficiency in terms of data recall, an erroneous system provides erroneous information and guidance, which has the potential to cause broad deleterious impacts ( 2001). In this sense, the legal issue that must be taken note of is the misuse of the system, which may breed opportunist medical practitioners that are only in for the additional consultation fee and not for providing effective and efficient services to clients. In addition, overpricing may also be one legal issue, as medical practitioner may place additional charges on their services. The development and frequent updating of system software is also likely to be very expensive ( 2001), thus, some medical practitioners may generate an idea of charging extra fees for their own benefit. Because of this, in the United States, tort law holds providers of goods and services accountable for injuries sustained by users. Such accountability is addressed by either the negligence standard or the strict liability standard set by hospital authorities. The negligence standard applies to services, and strict liability applies to goods or products ( 1999).   Conclusion and Recommendation             From the discussion, it can be deduced that the use of the medical or clinical decision support system would be significantly beneficial and advantageous on the part of both the medical practitioner and the client. As mentioned earlier, such systems focus on the accuracy and efficacy on providing diagnosis and treatment of patients, which is the goal of the field of medicine firsthand. However, the different ethical and legal issues presented in previous discussions may somehow hinder the perceived benefits of the use of such systems.             In this regard, several recommendations can be provided, such as providing additional education and information regarding the use and misuse of computer-generated systems in order to maximize its potential. Another recommendation is for medical practitioners to become well informed regarding the needs of their clients, regardless of socio-economic status. Lastly, it would also be helpful if privacy and confidentiality issues would be addressed through laws that would protect the information provided by clients.     References Credit:ivythesis.typepad.com

MEDICAL DECISION SUPPORT SYSTEM

Medical Decision Support System Introduction Today’s generation has provided different fields of study a number of advanc...

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