Legal Issues in Health Care

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A patient must give their consent to undergo any examination or have any treatment. The patient must make this decision after gaining all the relevant information from the nurse or doctor. The NMC (2010) instructs nurses to provide all relevant information to the patients about their treatment, nurses should then be sure that the information given is clear and understood. By giving consent the patient is then agreeing to the treatment or observation to be carried out. There are various types of consent ranging from written to non – verbal consent.

Another legal aspect which influenced this care situation was safeguarding. At the time of Robert’s assessments, it was shown that Robert was vulnerable, due to the delirium from a Urinary Tract Infection and Dementia. According to the NHS UTIS’S can cause a change in people’s behaviour including their mental state. (NHS,2014). All nurses under the guidelines from the NMC have the responsibility of safeguarding all patients in their care. Furthermore, hospitals have their own policies and procedures regarding the safeguarding of vulnerable adults. The hospital at which Robert was staying at suggest that there is a statutory obligation in which the trust have to protect adults from any harm or exploitation, every patient should expect to have privacy, dignity, independence, feel safe and protected and be treated in a safe and effective clinical area (SWBH,2015). Staff should be aware of how they report any concerns that they have by following the correct procedures. Hudson (2003) states that nurses caring for individuals with dementia should report any signs of abuse and neglect to the correct people within the trust. The NMC uses a particular guide to show that individuals dignity should be at the core of their care, in this paper it suggests that when people enter hospital patients can become vulnerable, therefore feeling as though they are losing their rights. (Dignity Ward, 2010)

Alternatively, a legal aspect to focus on are the Act’s that underpin nursing a vulnerable adult. The Human Rights Act and The Mental Capacity Act provide opportunities for people using healthcare services and their careers or advocates to challenge a culture where professionals decide what is best for patients in their care. The NMC also states that even if somebody lacks capacity they should still be at the centre of the decision making process to provide holistic care, also ensuring the person’s best interests are met. (NMC, 2015). The student nurse made sure that Robert always had a say in his care and was always at the centre of the process. The Mental capacity act ensured that if Robert was deemed to not have capacity at the time, he would have had a decision made in the best interests of him. The act states that a person cannot assume an individual lacks capacity due to “a condition of his, or an aspect of his behavior, which might lead others to make unjustified assumptions about his capacity.” (Mental Capacity Act 2005). Working in conjunction with the Human Rights Act which sets the legal frameworks for the United Kingdom it promoted Robert to have a say in whether he wanted the care the student and nurse where offering, throughout all of Roberts care the student ensured all information was kept confidential in compliance with the Data Protection Act (1998).

When communicating with any patient it is important to build a therapeutic relationship, Steele, (2010) states to know and understand any patient, communication is vital. Which is supported by the concept of a therapeutic relationship which is perceived as three important domains of care being physical, psychological and emotional. (Pelzang, 2010). When building a professional relationship with Robert the student nurse used a communication technique created by Gerad Egan (1988). Egan created an acronym for body language when communicating with patients. So that practitioners could actively listen to their patients, when the student nurse spoke to Robert she opened up her body language leaning forward and maintaining eye contact promoting Robert to feel as though somebody was listening to him.

Using S.O.L.E.R alongside a communication model V.E.R.A helped the student nurse to build a rapport with Robert. When speaking with Robert the student nurse tried to understand what the underlying meaning of Roberts concerns about getting to his leg dressing changed, the student nurse took the statement Robert was saying at face value and said that she would try to assist him with removing the ants from around his wound, to use validation is key to developing therapeutic relationships, where the nurse is supportive. (Rogers, 1961) The student nurse observed Roberts non-verbal communication as well as verbal and could see he was upset, the student nurse replied to Roberts comment with “You sound a bit concerned, do not worry”. The student at this point was trying to connect with Robert by being empathetic to what he was seeing at this point. When reassuring Robert, the student told him that “everything would be ok and that he was safe” and then asked him if he wanted to let the nurse look at his wound, to which Robert consented. By communicating with Robert in this way it helped to him to calm down and reassured him that he was safe in the hospital environment.

A Therapeutic relationship was maintained between Robert and the student nurse, by the student nurse being empathetic to Robert, empathy is seeing something from somebody else’s perspective. Kirk (2007) proposes that when an empathetic response is given it can at times produce comfort to the patient that their concerns are being listened to and therefore promote a feeling of shared understanding. (Kitwood,1997) When Robert was relaying information to the student nurse, the student maintained an open posture and actively listened, she then responded to Roberts information by stating things such as “that cannot have been nice for you, I am sorry to hear that”. Empathy is important in therapeutic communication and should be shown through verbal, non-verbal and emotional communication skills (Welch, 2005).

In summary, this paper has considered a scenario which enforced the value and beliefs of why person centered care and the therapeutic relationship between the patient and nurse in practice is important. The core components of person centered care the therapeutic relationship, have been discussed with reference to the legal aspects which underpin nursing practice as they relate to the present scenario. The process enabled the student nurse to build a good rapport with Robert which permitted the nurse to gain Roberts trust, leading to the consent from Robert to change the leg dressing.