Learning Outcomes

At the end of this module, you will be able to:

•LO1: develop an understanding and appreciation of the roles and responsibilities of

your own and other relevant professions in support of service users.

•LO2: analyse and discuss common ethical principles that are relevant to all
professional practices.

•LO3: examine and reflect upon how law guides and informs inter-professional
practice.

Assignment Brief

Summative Submission Date - 29th April 2019

“2500 word critical discussion from your professional perspective and that of other
relevant Professions on a significant episode of practice, where Ethical, Legal and
Professional issues are central to the delivery of care”.

Essay-Writing.jpg

- A case study is to be chosen from practice. This can be from later in Year 1 or from
your early placements in Year 2.

- A case study is an episode of practice that you have been involved in or observed,
that addresses areas of your modular content that is being assessed within your
assignment.

- Please note that your assignment is not a way to escalate or raise concerns
regarding poor or unsafe practice. You should raise this in the clinical area following
the correct procedures and at the time the incidence occurs. Any areas of poor or
unsafe practice highlighted in your assignment will be escalated further by your
facilitator/ named marker.

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- You should not use a case study that has previously been used and submitted as
part of a module assessment. This may result in Academic Misconduct.

- The three areas that need to be apparent are Ethical, Legal and Professional
Issues.

- Your assignment will be written in the third person: e.g. this case study will examine
rather than I will examine in this case study.

- You need to provide a critical discussion of your chosen case study focusing on the
ethical, legal and professional issues that are apparent and that have arisen from
this episode.

- You need to discuss this from your own field and professional perspective (Links to
an external site.)Links to an external site., but also from that of other relevant
Professions (Links to an external site.)Links to an external site. that were involved or
should have been involved.

- You need to be able to discuss how the law (Links to an external site.)Links to an
external site. and ethics (Links to an external site.)Links to an external site. and
elements of your professional practice have influenced either your care or
professional judgements within this case study, and why. This may and will differ
across Professions and you need to demonstrate an awareness of that within your
own practice. Explore and recognise inter-professional collaboration and the impact
a different professional perspective may bring.

- Think about what shaped your thinking and practice and what actions influenced
the decisions made, and the care delivered by the Multi-disciplinary team.

- You will need to draw on all module content.

- Wide reading will need to be evident, references and evidence to support your
critical discussion is crucial.

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- Please ensure that you are familiar with the level 5 descriptors for your academic
writing.

- Your assignment is to be uploaded in the format of a word document to the Canvas

course for 5HW025. If submitted in any other format this will not be marked and will
be a refer.

- Assessment grades and feedback will be ratified and available following the
Subject Board. Any grades before this date will not be ratified, therefore, may
change. Date to be confirmed.

- You can access your feedback via Canvas

- You will be given 1 tutorial for this assignment. You must liaise with your named
support tutor regarding this and the delivery of the tutorial. This may vary between
support tutors and can be face to face or an e-tutorial.

- Your assignment will be marking using anonymous marking.

- Tutorial time slots will only be given following the feedback from your proforma

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 5HW025 Frameworks for Professional Practice- Formative Assignment Proforma

Module learning outcomes

 LO1: Develop an understanding and appreciation of the roles and responsibilities of your own and
other relevant professions in support of service users.
 LO2: Analyse and discuss common ethical principles that are relevant to all professional practices.
 LO3: Examine and reflect upon how law guides and informs interprofessional practice.

Case Study description

John is a 74 year old man that was admitted to medical ward with severe confusion and has had a
fall. The paramedic brought John to A&E department he was admitted to a ward to treat him due
to having a UTI. John has been diagnosed of dementia. John has poor diet and always forgets to
take medications and skips meals regularly. He is a widowed and lives in a nursing home. The author
noticed that John couldn’t pass urine and so the author decided to check how much urine does John
had into his bladder by using of bladder scanner. The result was showing of urine retention. The
author told to the staff nurse about it. Therefore, the author, staff nurse and doctor catheterised
John.

Focus /care intervention for critical discussion

 Refusal of consent to catheterisation

Professional issues being discussed

Consider the relevant code and standards of governing bodies e.g. the NMC, GMC, HCPC etc.
 Nursing and Midwifery Council (NMC, 2018)
 NICE Guidelines
 The Royal College of Nursing (RCN)
 General Medical Council (GMC)

Legal issues being discussed

Consider how Acts of Parliament apply to your case study are utilised, for example: Mental
Capacity Act, Deprivation of liberty Act, Health and Social Care Act, Children Act, Mental Health
Act. Consider also guidelines produced such as the NHS Constitution and Department of Health.
 Human Rights Act 1998
 Mental Capacity 2005
 Department of Health (DOH)
 Medical Act 1983
 Mental Health Act 2007

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 Ethical issues being discussed:
Identify a framework/theories to discuss your ethical issues in relation to your patient, for
example the 4 principles of Biomedical ethics.
 Autonomy
 Maleficent
 Non-maleficent
 Justice

Identify other professionals involved in the care of your patient and their impact on care
delivery. You will need to discuss your role and that of the other professional involved in care.
Explore and recognise inter-professional collaboration and the impact a different professional
perspective may bring .
Consider you role and how other professionals support the delivery of care to your patient. This
should be supported by evidence.
 Doctors
 Nurses
 Clinical support workers
 Dieticians
 Physiotherapists

Facilitators comments

Signed: Date

Urine retention

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Learning Outcomes

At the end of this module, you will be able to:

•LO1: develop an understanding and appreciation of the roles and responsibilities of

your own and other relevant professions in support of service users.

•LO2: analyse and discuss common ethical principles that are relevant to all
professional practices.

•LO3: examine and reflect upon how law guides and informs inter-professional
practice.

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This case study will show the perception of the student nurse and other
members of of the health care team regarding delivery of care and legal,
ethical, and other professional issues. This case study will also help in analysing
the collaboration between the multi-disciplinary team, patient and family of the patient.
The multi-disciplinary team will include student nurse working with the guidance of
mentors: registered nurse, dietician and doctor, who are governed by General Medical
Council (GMC, 2014) to improve the delivery of care to the patient. The patient was
diagnosed with urine retention but refused to give his consent to undergo
catheterisation. According to The Code of Professional Conduct Guidance , The
Nursing and Midwifery Council (NMC, 2018), the name of the patient will remain
confidential and pseudonym should be used, in this case, the patient is
pseudonymised as John to protect the identity and treatment for health care. This case
study aims to focus on the patient and to demonstrate the professional, legal and
ethical issues that the members of the multi-disciplinary team are dealing with in
delivering care for patients who are suffering from urine retention.

John is a 74-year old man who lives with his wife. John have had episodes of sleeping
problems, he continuously goes to the toilet hence his wife couldn’t sleep. John’s wife
immediately phoned the ambulance service when John had a fall. The paramedic
brought John to A&E department where he was admitted to a medical ward, he is still
in the state of confusion and still continuously goes to the toilet. John had a medical
history of Urinary Tract Infection (UTI), Transient Ischemic Stroke (TIA), Dysphasia
and type 2 diabetes. In the assessment of patient, the student nurse checked his
weight and height to know his Body Mass Index (BMI), it turned out that John is
suffering from malnutrition. John looks very thirsty yet he’s sweating. The student
nurse checked the patient's blood sugar and it went back to normal 6.5. John went to
the toilet when he felt that he needs to pee. The STN assisted him to the toilet and
noticed that he couldn’t pass the urine which makes John agitated and frustrated. John
was under a terrible abdominal pain that caused him to act aggressively up to a point
that the STN had to calm him down. The STN informed the registered nurse about
John’s situation, that John was having urine retention. The STN have to inform John
first if he is willing to have his bladder checked, the patient agreed. The STN nurse
used bladder scanner to check the amount of urine in John’s urinary bladder. When
the result came out, it showed that there is a 896 ml of urine in his urinary bladder.
Therefore, the STN informed and delegated with the RN and STN to immediately
contact the doctor to come and catheterise the patient due to his pain and inability to
pass urine. The STN, RN and doctor explained the result to the patient and also asked
for his consent to perform catheterisation. John refused to undergo catheterisation but
his wife disagreed and wanted to continue the plan to catheterise John due to his
medical history of UTI.

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And Mention refusal of consent to catheterisation.

According to (___) , consent is the first important thing that is needed to be considered
before giving any treatment and health care to the patient. This has been supported
by (___) that consent should be gained before proceeding with any procedure so that
it’s clear that the patient is willing to continue without any hesitation, this will ensure
trust between the patient and multi-disciplinary team , who proposal of treatment
Department of Health (DOH, 2013). According to The Royal College of Nursing,
(RCN,20) it is very important to gain consent on every practice and patients have the
right to give information about their health problem all throughout. This is supported
by (NMC, 2018), which stated that giving consent will make the patient educated about
the procedure and can be able to throw some intervening questions that need to be
asked so that the health care providers will be well-informed. According to the Mental
Capacity Act (2001) that health professional should assume capacity…….Define
mental capacity……..

John agreed and had a meeting with the MDT to discuss the benefits of the ongoing
treatment and be able to come up with the best ideas using the shared information
among the team. According to (Goodman and Clemow, 2010); (Sexton and Baessler,
2016), the MDT can be interpreted as healthcare professionals who work together as
a team to help and provide the patient’s needs and to improve the quality of care.
However, there are other options that can be done to acquire a consent, if the patient
isn’t able to make a decision due to sickness, it is stated in the Mental Capacity Act
(MCA, 2005) that a patient is expected to have the capacity to give consent except
when the condition wouldn’t allow him to. The consent will justify the result that will be
shown and will determine if the patient is capable to make a decision. According to
(___), this is to support patients who may lack a sound mind to make decisions when
it comes to allowing deliverance of care and treatment. However, according to
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Beauchamp and Childress (2013), ethics are collections of beliefs that create moral
ideas that influence the healthcare professionals in making decisions in giving
treatment to the patient. Beauchamp and Childress have invented the 4 principles in
making decisions which sometimes healthcare professionals may use in dealing with
difficult situation in providing patient care. According to (Beauchamp and Childress,
2013) these are the 4 principles of ethics: autonomy, beneficence, non-maleficence
and justice which can be considered as the principle models that has been established
in 1977. (Beauchamp and Childress, 2009) Before making the final decision, the
doctor must consider these 4 principles. (Beauchamp and Childress, 2013) the patient
has the right for autonomy and be self-determined that can make him believe that he
still has the ability to perform his own moral responsibility. (Beauchamp and Childress,
2013); Bedford and Jones (2014) stated that this method helps to encourage the
patients to be self-determined to undergo any test, procedure or treatment with their
consent and cooperation in making a decision. This is supported by (Mason and
Laurie, 2013) and stated that this autonomy is a very important advantage in the
medical law. According to (Jie, 2015), healthcare professionals have the
responsibilities to respect patient’s confidentiality and apply this into the process by
asking or informing consent. This is supported by The NMC (2015) to protect and give
respect to patient’s interest whether he wants to carry on or refuse the procedure. The
non-maleficence is the idea of not doing the patient any harm. (Bradford and Jones,
2014). The beneficence will be explained as the delivery of care for the patients and
the support of making improvements to achieve a better quality of life (___). On the
other hand, if MCA principles acknowledge that John have the mental capacity to
refuse to his treatment then the MDT wouldn’t be able to continue the procedure (___).
Therefore, if John wasn’t giving clear information then the decision will create
arguments that may affect the autonomy of the patient or refusal of treatment.

There are other concepts of aspects for ethics such as deontology and utilitarianism
of perspective. Immanuel Kant (1742-1804) was the pioneer of this theory known as
Deontology, he argued that the concept of doing what is right and what is wrong will
be according to what is stated in the rules. In suggestion of (Tschudin, 2003),
deontology can sometimes be called as non-consequentialism, it requires to perform
the right thing to do regardless of the condition or consequences. The right theory will
be another aspect of deontology which can give effort to promote the opposition
including contradictory of utilitarian arguments, also, to promote human equality and
because the community needs to be ethical and equal. The Theory of utilitarianism is
supported by Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873) This
theory focuses on the consequences of activity or action. In addition, utilitarianism
defines into greatest happiness and greatest number for focusing on consequences
of action. This can contribute to NMC (2018) for giving an evidence-based practice.
Ethics will influence the care in different ways and this can be applied into MDT by

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deciding what approach they should do. This can explained the situation of John by
refusing to give his consent for catheterisation, the healthcare providers could have
promoted the patient’s autonomy by letting John participate in the decision making.
They could have preserved the duty of care and avoid negligence.

The Human Rights Act (1998) has specific support for giving the preferences and
feelings of individuals into account in making decisions.

(Bedford and Jones, 2014) stated that if the treatment contrasts to the preference of
the patient then this can lead into a criminal offense. According to (Mason and Laurie,
2013) this can create argument due to patient’s refusal and the patient’s
underestimation of the treatment to improve the quality of life of the patient. According
to (Mughal, 2014), if the patient has the capacity to make decision for treatment then
the healthcare professionals must respect that.(___) It is also stated that the
healthcare professionals are responsible to support and protect patients by
emphasising the importance of the principles of non-maleficence and beneficence and
focusing on the benefits it will contribute to treat patients. John’s participation in
making the decision will give him benefit to share with the informative doctor and MDT
as working together as a team to improve the quality of his life. In the case of John,
the non-maleficence gives the MDT to do actions by protecting John and makes sure
that he will not abuse himself. The RN ethically takes action to consider by making
sure that the referrals to dietician have been completed and this giving John’s life a
value.

The DOH (2015); NICE (2015) allows the patient to get involved in the care, know the
recommended medications to take. John's decision to refuse the process of his
treatment proves the MDT to be non-maleficence. Ann has been refusing the
procedure of the MDT’s duty of care which helps healthcare providers to agree and
give consideration to John’s autonomy and also his ental capacity. According to (___) ,
the justice is granted in order to be fair specially in supporting the patients to have
equal rights in all procedures. It is important that this case study acknowledges and
understands the 4 principles of biomedical that have been explained. Having a consent
and autonomy is imperative and will be beneficial to both healthcare providers and
patients. According to (Selinger, 2009), consent is just frictional and if within the
legislation, the patients have the right to refuse the procedures (___). The ethical
principle for autonomy will be informing to the right to consent patient. To make sure
the ongoing procedure is clear to be understood by the patient. However, there is still
conflict to the legislation by sharing ethical values. By respecting John’s autonomy
then the MDT have to act in accordance with the principle of non-maleficence by not
getting harmed by retention of urine in his bladder. The doctor needs to build a
therapeutic relationship with John so that it will be beneficial and easier for him to
deliver care and sympathy. The 4 principles of biomedical give important impact to the
patient by following the steps of these principles to help in organising the procedure.

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Dimond (2009) argued that there are other emergency situations where the procedure
needs to continue without consent due to reasonable and emergency treatment for the
patient, hence promoting the patient’s best interest. According to (Edwards, 2010), the
patient can confirm and refuse the medical procedures even it may affect to improve
their health.

In conclusion, to maintain the ethical, legal and professional integrity in continuous

deliverance care for the patients (GMC, 2013; NMC, 2018). The case of John has
been analysing the connection between the principle of ethics and the challenge to
maintain the correct use of each principles. Making decision in accordance to the
ethical issues may add into the framework to promote the best plan possible to treat
the patient. The case study has been assessed I’m accordance to the legal aspects
by informing consent such as giving MCA 2005 principles, which may help the
healthcare professional for guidance and management of John’s refusal of consent to
give consent to catheterisation. The NMC Code and human rights must be considered
for making he right decision into the situation, thus, can help to raise the principles of
ethical, professional and legal issues. The collaboration of inter-professionals team
will give John the important duty of care to support him to gain his best interest. By
providing supports and follow-up that involves the MDT, this will give the patient value
and this can be a big help for achieving and promoting John’s quality of life. In addition,
the record-keeping will contribute for the organised entries such as date and time of
the ongoing treatment that needs to be accurate and clear so the patient will
understand.

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Mental Capacity Act. The Mental Capacity Act (MCA) is designed to protect and
empower people who may lack the mental capacity to make their own decisions
about their care and treatment. It applies to people aged 16 and over.

Refusal of consent to catheterisation

Human rights

Deontology and ut

Autonomy freedom of choice

Negligence to law

Interprofessional

References: Double check the references

NS Not sure about the reference or which one should be put

General Medical Council (2013) Good Medical Practise. [Accessed 12th December

2018[.Available at: <http://www.gmc-uk-org/guidance/good medical practise.asp.>

Goodman, B. and Clemow, R. (2010) nursing and collaborative practice: A guide to

Inter-professional and Interpersonal working. 2nd edition. Exeter, England: Learning

Matters. [Accessed: 12 October 2018]

Beauchamp, T.L. and Childress, J.F. (2013) Principles of biomedical ethics. 7th ed.
New York: Oxford University Press.

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Mason, J.K. and Laurie (2013) Mason and McCall Smith’s law and medical ethics.9th

ed Oxford: Oxford University Press [accessed 15 November 2018]

Mental Capacity Act (2005) The code of practice. [Online]. [Accessed 25th October,
2018].

Bedford, S. and Jones, E. (2014.) Should practitioners override patient choices?

England: Limited.

Beauchamp, T.L. and Childress, J.F. (2009) Principles of biomedical ethics. 6th ed.

New York: Oxford University Press.

Jie, L. (2015) The patient suicide attempt-an ethical dilemma case study. International

Journal of Nursing Sciences, 2 (4),pp.408-413.

Mughal, A.F. (2014) Understanding and using the Mental Capacity Act. England:

Macmillan Publishing.

Selinger, C. (2009) The right to consent: Is absolute? Available at:

http://www.bjmp.org/content/right-consent-it-absolute . [Accessed 1st November,

2018].

Edwards, M. (2010) Communication skills for nurses: A practical guide on how to

achieve successful consultations. London: Quay.

Burgess-Jackson, K. (2013).Taking Egoism Seriously. Ethical Theory & Moral

Practice, 16(3), pp.595-614. [Accessed: 12th April 2019].

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