Critical Analysis of Gate-keeping as Monitoring and Supervision

Critical Analysis of Gate-keeping as Monitoring and Supervision

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October 2, 2013.


The case study RN as gate keeping as monitoring and supervision which has been undertaken by Dr. Jillian D Brammer gives a useful insight into the general training and supervising of clinical nurses. Through it, a critical analysis can be made. It is apparent that serious ethical and legal issues are raised and that they demand a sober and practical approach so that they can be fixed.

According to Dickson, Walker & Bourgeois (2006, pg 3) work ethics simply relates to opting to what is considered to be the right thing within a particular work premise or executing your duties in a manner that is in tandem with the dictates and demands of morality and decency. For instance the RN insists that her student should administer amino glycoside medication through an intravenous cannula, rather than the conventionally recommended way of diluting using a burette even when the student is completely prefers the latter method to the former. In fact, the RN further insists that the student pushes the drug within ten minutes without minding the health status and even the advanced age of the patient (Brammer, 2008, p 5). When the student insists that she must take at least 10 minutes to administer the medication, the RN walks off. From the three instances, serious issues that borders on ethics are raised. It is apparent that the RN ethical convictions real questionable from this case study, the student emerges top as the only person who upholds the principles of morality and decency.

If, say the student could have administered the drug as per the RN instructions, may be the patient could have developed complications given his advanced age and a frail body. This will have necessitated legal from the patient’s family members (Lyneham, Parkinson, & Denholm, 2008 p, 4). To this level, it therefore important for different health institutions to come up with measures of curbing such gross professional negligence and complacency aspects.

Autonomy is defined as the ability to act differently from others. From this case study and when viewed from the patient’s perspective, it is practiced in a manner that is prone to yield negative results than the real intended outcomes. A case in question is the blatant demand from the RN that her student administers amino glycoside medication within a minute besides using intravenous cannula rather the generally accepted and recommended way. Though this shows that the RN wants to practice some element of autonomy, however the results are likely to be fatal.

The benefits that are obstructed from the patient are; receiving quality and effective medication. Instead, the patient is at risk of receiving crude services that are real a threat to his health at worse his life. All these can be mitigated if proper monitoring and supervision mechanisms are put in place. Also, there need to be stringent disciplinary measures meted on those, like the RN who are found culpable to have flouted the law and other nursing standards.

Veracity refers to truth or accuracy when reporting or disseminating any information. In this case study, neither the patient nor his family members has been given accurate information as regards to how the patient is being treated and his general health standard. For instance, what deters the nurses from giving adequate information to the patient? Even when amino glycoside is administered in a questionable manner, the patient is not informed. In some cases, there can be genuine reasons as to why clinicians and nurses may opt to conceal some information from only the patient, but they must at least inform some family members. In the case study, there appears no genuine reason as to why information is not given either to the patient or to his family members.

Confidentiality simply means a set of regulations that binds one from divulging any sensitive information to any party considered any party considered an ‘outsider’ (Kingsnorth-Hinrichs, 2009, p 6). To some extent, some information ought to remain within the confines of a particular because if disclosed, the effects could be very catastrophic. However, there comes a time when confidentiality must be breached. From the case study, confidentiality is a real issue especially when the student discloses such sensitive information as to how he was made to administer amino glycoside medication to an old and frail patient using a method that is less recommended which even himself is opposed to and moreover in the shortest time possible.

According to Brammer (2008, p. 4) advocacy is defined as an act of backing and advancing a particular cause or conviction. From the case study, a good example of advocacy refuses to administer amino glycoside medication within a minute. The student is therefore advocating for the drug to be administered through the conventionally recommended method and when the RN insists on this method, the student backs down but believes that he has to take time while administering the medication unlike what the RN tells her. But this student is fortunate to have on her side an apt advocate who defends her cause and this promotes student confidence.

Some of the legal aspects and nursing standards are; proper administration of drugs as per the physician’s prescription, students to be accompanied with their tutors whenever they are treating patients and also there must be effective communication between the nurse/clinician and the patient or his family whenever there is need to change the form of treatment from the previous one. In the case study, these laws and nursing standards have been breached. For instance, there is no absolute dissemination of information from the facility management to the patient as regards hi state of health (Myrick & Yonge, 2005, p. 3). Two, the tutor walks off and leaves the student with the patient and finally, the RN tries to coerce the student to use a less recommended treatment method of administering amino glycoside medication through the use of intravenous cannula.

The stakeholders are; patients, hospitals, nurses and doctors. It is obvious that these groups have different interests. For instance, the interest of patients is to get quality and satisfying services from doctors, nurses, clinicians and other hospital staff. Doctors and other medical practioners have interest of providing quality services, accumulating experience, sharpening their skills and also building on their CVs.  Hospital managements have targets of being recognized as quality service providers hence promoting public confidence in them (Curtis, Bowen & Reid, 2007, p. 5).

It must be emphasized that all the stakeholders have something to lose in an event the others don’t do their part effectively (Curtis, Bowen I& Reid, 2007). For example, what can a patient stand to lose if a nurse or doctor errs when treating him? Or what will happen if the general public looses confidence in a particular hospital? In the first question, the patient can develop complications that can even threaten his or her life. In the second case, hospitals stand to lose their operational ability These interests are very significant and it is they that define these stakeholders. As a result of this, each stakeholder must do what they can to safe guard their interests that are dear to them. These interests are very powerful and legitimate especially if pursued through ethical manner. The problem at hand is professional negligence and complacency at a nursing training centre is real and very urgent. If it is not solved in time, it will degenerate into a more serious problem in the facility. The way the RN operates, she appears to be busy elsewhere and this could be the reason as to why she instructs the student to bypass the recommended way of administering amino glycoside and deploy a method that will take less time. This is what must be discouraged at hospitals. Doctors, clinicians and nurses must understand that, unlike machines that can be fixed, human bodies should not be used as specimen (Sulosaari, Suhonen & Leino-Kilpi, 2010, p. 4).This problem when perceived from an alternative ethical pedigree; say the RN walking on the student and leaving her with the patient is very unprofessional and totally unacceptable as Curtis, Bowen & Reid (2007, p. 5) noted.

From the case study, a number of conflicts can be cited. There is a conflict between the RN and the student as pertains to the time that amino glycoside should be administered. The RN instructs the student to administer the medication within a minute yet the student is convinced that, the medication ought to give the drug slowly so as to minimize discomfort to the patient who she describes as ‘old and frail.’ There is also a second conflict between treatment options. Amino glycoside medication can be administered in two ways: diluting it in a burette before giving it. It can also be administered intravenously through the use of intravenous cannula. Whereas the former is conventionally recommended, the latter is not. One of the ways of minimizing these conflicts like that between the student and RN is through a consensus between the two and as regards the treatment options; there ought to be clear guidelines on when each should be used (Scott-Tilley, 2008, p.7).

Deans (2005, p. 4), argues that ethical concepts are ideas that can help stakeholders within an organization to come up with best practices that abide by the moral demands and standards of that particular organization. Some of the ethical concepts that can guide the management are: Virtue and action. Virtue ethics normally border on ‘we should be’ whereas action ethics dwells on what must be done. From the case study, it is important that the management, through various policies promotes virtues and in situations like the case of the student and the RN, the management must take real while interrogating the effects of such action. This will depict the hospital management as a caring health provider (Jones, 2009, p.9).

Some of the legal frameworks that can assist the management in handling such gross professional conducts are; terminating the contracts of employees like the RN who are not adhering to the professional codes of conduct when dealing with patients and this will limit the number of legal suits arising from mistakes of RNs against the training facility (Axley, 2008, p.11).

The decision that must be taken as regards the issue from the case study is to suspend the NR pending investigations into claims of professional negligence and complacency that she demonstrated. The guiding principles of efficient monitoring and supervision in the training facility have promoted positive learning experiences. These are balanced when students are efficiently supervised and allowed to have an alternative approach to issues. The decision to suspend the RN pending investigations can be communicated through the training facility board of directors. The board will have an opportunity to deliberate on the best way of addressing the issue so that to safeguard the interests of the training facility.

In summary, there ought to be efficient monitoring and supervising of the training of nurses so as to produce highly skilled and positive minded medical practitioners.


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