Introduction and Circumstances After working with a resident for a couple of weeks, I got the chance to know her pretty well and understood that her safety was really important to her. I also got to know that she was someone who wasn’t afraid to push her call bell whenever she needed something (some would say it was “annoying”) which I always encourage my residents to do. At the beginning of the shift, before morning care began, I heard my client screaming from her room. As I entered her room, she was so hysterical I could barely make out what she was trying to tell me. It was to the point where she wouldn’t allow morning care to be done, which was unlike her. As I was sitting with her for a while, she had calmed down enough for me to start her morning care, but I didn’t fully understand the reasoning for her outcry. As I am providing care for my resident, I reach over into her bedside table, I see her bed alarm sitting in her drawer and next to it was her call bell unplugged and rolled up in her nightstand with no way to reach it and I knew immediately. As a resident who relied on the nursing staff to provide all aspects of her care for her, her life line and her rights to be protected from abuse and neglect was taken away (GLTCA, 2019). A call bell that is in every residents’ rights to have, something that provided her comfort and eased her anxiety was gone. In addition, after I reported the incident to other members of the health care team on the floor, some casually entered the resident’s room and plugged in her call bell like it was not a serious issue. There was a later talk of prescribing medication to ease her anxiety, instead of spending time with her to realize the source of the problem or finding ways to improve her anxiety without having to use medication to do so. Patient Consequences My resident was classified as a fall risk because she was known for climbing out of her bed and her wheelchair if she needed to use the bathroom, that alone put her at risk for injuring herself. Removing the alarm on her bed and moving her call bell out of reach added stress and anxiety on my resident increased the chances of her trying to get out of bed without assistance. My biggest concern was the unknown of how many times this happened to my resident in the past, and the conversation of medication to treat her anxiety without taking to time to know and understand the resident. Patients should expect to obtain quality care which is provided in a safe environment, in situations like this it decreases the trust the resident has in the health care team and puts the residents at greater risk of unnoticed falls and injuries. Conflict with Personal Values and Beliefs Values influence behaviour on the basis of personal views that a certain action is correct in a certain situation and identifying your personal values and the values your patient has can enhance the way we advocate for our patients (Perry & Potter, 2014). In this situation, I experienced moral distress which is, according to the Canadian Nurses Association (CNA) “when nurses are unable to act according to their moral judgment. They feel they know the right thing to do, but system structures or personal limitations make it nearly impossible to pursue the right course of action” (CNA, 2017). I knew the right thing to do was to notify someone from the registered staff about the situation. I knew the resident I was working with could not fully verbalize her needs and needed someone to be her voice and advocate for her and her rights while being in the care of the health care professionals. The constraint was being a nursing student, not knowing proper steps of reporting and the feeling of potentially being criticized by the registered staff for voicing my concern for the safety and well-being of my resident.This made me very upset and it was difficult seeing my resident so distraught. Being a nursing student, we do not always feel like we can approach staff members with certain concerns without being treated differently. I felt like it was my responsibility to take accountability for the safety of my resident. Thinking back on this situation it has taught me how important it is to know your patients, especially in a situation where they cannot speak or advocate for themselves. It has also taught me that having the patient’s best interest is more important than getting acceptance or approval from the people you work with. Of course, having a good relationship with the interprofessional team is ideal, however, I would refuse to put the safety and well-being of my patient at risk for the feeling of acceptance by someone I work with. We are taught to always advocate for our patient’s, but it is unfortunate that we also have to prepare ourselves for being mistreated by other members of the staff. Knowing that I did the right thing for my resident and maintained my commitment to her made it easier for me to not allow the actions of staff to interfere with caring for my residents. If I face being in this situation again I would not change how I handled the situation, I would always advocate on behalf of my patient, especially when it comes to their safety. I would however be more prepared with reporting a similar situation and I would try and change the way a situation like this is handled.Ethical Theories Related to Patient safetyBioethics is the best ethical theory that fit with my situation along with following the practice standards outlined by the College of Nurses of Ontario (CNO). Following the practice standards reflects and clarifies the values within the nursing profession and what is expected of us as we are practicing (CNO, 2002). The bioethical theory is based on reason, commitment and outcome. Bioethics is the moral decision making in health care that should be guided by four principles: autonomy, beneficence, nonmaleficence, and justice (Perry & Potter, 2014). Autonomy is having the ability to make choices for yourself that should be based on full understanding, free of controlling influences (Perry & Potter, 2014). In my situation my resident had the mental capacity to make her own decisions with regards to her care and safety. In this case she was able to choose her way of communication that made her feel safe and decreased her anxiety if there was a situation that needed immediate attention. Following the incident, I made sure the staff was aware of her choices. I also placed a note on her white board above her bed to ensure any staff that provided care for her knew that her choice was to have her call bell within her reach at all times when unsupervised.Beneficence means doing or promoting good for others. It speaks directly to the duty or obligation. Being committed to doing good aids in guiding challenging decisions between the treatment and the risk to a patient’s well-being (Perry & Potter, 2014). As nurses we are obligated to provide safe, effective and ethical care and to be an advocate for residents/patients who cannot advocate for themselves. My resident has the right to have a way to communicate with the nursing staff for any reason at any time, removing that from her did not have the patient’s best interest and well-being in mind, which in turn caused her anxiety and distress. Having the patient in my care at the time, it was my responsibility to advocate and be her voice and to ensure the registered staff and management was aware of the seriousness of the situation.Nonmaleficence is the avoidance of harm or hurt. Health care professional balance the risks and benefits of a plan of care while aiming to cause limited harm to a patient (Perry & Potter, 2014). When initiating a plan of care for all resident, their safety should be the number one priority. In this situation it could have resulted in an incident that caused unnecessary harm to the resident. Justice involves respecting the rights of others, distributing resources fairly, and preserving and promoting the common good (Perry & Potter, 2014). Every resident has different needs; however, every resident deserves to be treated equally. It was within their rights to have access to a way of communicating her needs to the staff involved in her care. It is unethical for the residents to not have a say in every aspect of their care, including their safety. As nurses we are obligated to provide quality care without abandoning, neglecting and abusing patients. Nurses need to take action when any fellow staff members provide care that can put a client at risk or abuse to patients in any way (CNO, 2019).Definition and Purpose of Patient SafetyWorld Health Organization’s (WHO) International Classification for Patient Safety defines patient safety as, “the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment”. The purpose of having safety standards in place is to ensure that we as nurses provide a high standard of care for patients while reducing the risk of adverse events. Identifying a risk before an adverse event occurs maintains the trust our patients have in the health care team. In order to provide quality care to all patients we must meet and exceed all patients’ requirements and expectations. According to the Long-term Care Act (LTCA), to ensure safety needs are met a call system is essential to ensuring the safety of the residents and all systems must be accessible, visible and usable by all residents (2007).ConclusionIn conclusion, in order to deliver care with the best interest of our patients first, patient safety should be our top priority. Applying our own morals and values in nursing can assist with examination of our own practice along with following the bioethics including autonomy, beneficence, nonmaleficence, and justice. As nurses we must report incidents and recognize that being silent is condoning unethical behaviour, take any necessary actions to prevent safety incidents and follow practice standards, best practice guidelines and policies that are in place to minimize risk to injury and increase the safety of all residents who are in our care (CNA, 2017). References:A Guide to the Long-Term Care Holmes Act. (2007). Retrieved from http://www.hqontario.ca/Portals/0/Documents/pr/ltc-mohltc-ltcha-guide-phase-1-1206-en.pdf Canadian Nurses Association. Code of ethics for Registered Nurses. (2017). Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactiveCollege of Nurses of Ontario. Practice Standards. (2002). Retrieved from https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf\Potter, P., Perry, A., Stockert, P., & Hall, A. (2014). Canadian fundamentals of nursing (5th ed.).
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