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Why is Law and Ethics very important in Singapore? Not only here in Singapore but all throughout the world, nurses and healthcare professionals face several issues regarding law and ethics. Ethical decision is required by nurses daily in the care of patients. According to Singapore Nursing Board (1999), “All nurses/midwives are responsible for maintaining and enhancing the reputation of the profession. Nurses/midwives should act at all times in accordance with ethical healthcare practices, actively promote nursing ethics, and foster public trust and confidence in the nursing profession” (p.3). As nurses, it is our responsibility to act at the highest standard and must be based on the legal and ethical aspect.

This article is based on a case scenario. Mr Steven, an unconscious patient found on the road and was brought in to the Emergency department. Upon arrival, he became restless and the nurses retrained his body, arms, and legs while he kept shouting, “stop restraining me, I am not drunk. I just want to go off because my friend is waiting for me and stop touching my belongings.” In order to find out the identity of the patient, the nurse in charge of Mr Steven, Me, opened his bag and found a packet of ‘white powder’ with needles and syringe. He was then referred to the police.

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            This paper will focus on the clinical issues nurses face. It will also discuss the ethical principles, the standard of practice by the Singapore Nursing Board, the code of ethics and professional conduct and the legal issue relating to this case scenario. This assignment will include the use of restrainers in the hospital setting, the guideline and standard operation procedure. It will also explain why Mr Steven was referred to the authorities and discuss patient’s confidentiality and autonomy.

Ethics are fundamental in nursing. “Ethical directives are not always clearly evident, and people sometimes disagree about what is right and wrong” (Butts and Rich, 2016, p.3) Patients look to nurse’s integrity and adherence to ethical standards. As nurses, it is vital to that we develop trust and demonstrate empathy and compassion to all our patients. What are the ethical principle relating to Mr Steven’s case regarding restraining him. Is the nurse right to restrain him while he kept shouting? Is his autonomy respected? Are they right to check his belonging without his permission? What is patient confidentiality and privacy?

Physical restrains

When is the right time to use physical restraints on patient? A restraint should not be used to prevent falls of patient such on elderly but the decision to use restrains should be based on medical and psychosocial nursing assessment. On the other hand, restrains could cause physical or psychological trauma to patient. According to Griffith, R & Love, N. (2012). The Human Rights Act 1998 states that the use of restraint should be justified by a clear rationale. This should explain why other considerations are believed to override the individual freedom of action. Hence, the use of restrains should be the last resort. The benefit of using the restrains is that it can reduce the risk for harming himself or the healthcare staff. Then again, it can increase agitation and confusion this may lead to skin injury and restrict circulation.

Will the nurse be liable for negligence if she had not restrained the patient? The patient could potentially harm himself. The nurse should never breach the duty of care to the patient that will result in harm. Therefore, if she did her assessment and suggest that restraining is necessary at that point of time, she could consult the doctor in charge to order retainers for the patient. The nurse should at all time follow the guidelines and protocol from the institution to prevent any legal issues.

Autonomy. It’s the patient’s rights and wishes even if they do not agree with the treatment or procedure hence, the patient has the right to refuse retainers  but only if he or she is in a sound mind. In this case, the patient appeared to be drunk and was very restless. Beneficence is the duty to promote good and on the other hand non-maleficence is to prevent harm to patients.  As nurses, we want to prevent any harm that could potentially cause injury to the patient or to any of the healthcare professional at the same time promote safety to patient. What the nurse could have done differently in order to reduce shouting, the nurse could explain to patient or look for that friend the patient was talking about and he could assist them to keep the patient calm. If the family member is present a verbal consent should be taken. It should be explained to them the need for restrain. As mentioned earlier, the use of restrains should be the last resort.

Touching of patient’s belonging

According to the university of Toledo medical centre, (2015). When admitted, any patient belongings and valuables that are not sent home are noted and itemized on the Patient Belongings Inventory form that will be kept with the patient’s medical record. There are so many possibilities that this situation may end up. From the patient’s perspective, if the patient has nothing to hide and something important such as valuable information, this could help the patient’s condition. However, if the patient invokes his right not to check the bag, the patient may have something to hide or/ and the necessary information may not be passed down to receive appropriate healthcare team. Therefore, disrupting medical attention. Similarly, from the nurse’s perspective, any information that could be relevant for the treatment of the patient is the nurse’s responsibility to find out. In the event, if the bag had not been checked, contraband substance such as anthrax could possibly harm the patient or other healthcare staff.

            In order for nurses and doctor to proceed with any care for the patient, they should always refer to patient’s identity. According to Joint Commission International (2018) “International patient safety goal, IPSG 1, identify patient correctly, use at least two patient identifiers when providing care, treatment, and services.”. This can prevent error for medication and treatment to patient. This way the hospital can also trace and old medical records patient have that can assist them with his treatment such as medical history and allergy status. In the case the nurse did not take any verbal consent to look for his identity but it is understood that the nurse did that for the welfare of patient which is beneficence, to do good.  If the patient turn aggressive while asking for identity she could approach her manager for assistance in dealing with this situation or she could assess the belonging with another authorized person. By doing this, this has to be documented.

It was noted that there seem to be a white powder and syringes in the patient’s bag. This may relate to why patient came in aggressive. Singapore has one of the harshest laws on drug related offences. It is mainly governed by the Misuse of Drugs Act (MDA). According to Singapore law, anyone in possession or consumed of controlled drug will be punished in the code of law.

 

Conclusion 

In conclusion, putting myself in the scenario, as a nurse I would firstly reconsider the option to physically restraint patient. As shown above physical restrains should be the last option. As a nurse, I would try to let the patient calm down and approach it the situation in a different manner. Regarding patient’s belongings, there is always a grey area to how much a nurse can or should do. However ethically speaking, it is wrong to touch someone’s belonging without asking but if you feel there’s a threat to patient or healthcare professionals, you should alert the security or your head of department.

 

 

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