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The nurse obtained consent from the patient and this illustrates evidence- based and professional practice

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Documented

Notified prescriber MDT

Organisational Policies and Procedures followed

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Standards framework for health boards and trusts in Wales (MARRS) implemented through local policies and procedures (AWMSG, 2015).

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Standards framework for health boards and trusts in Wales (MARRS) implemented through local policies and procedures (AWMSG, 2015).

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4.3 a.  Formal Health board procedures must be followed in case of  medicine refusal

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Professional Guidance on the Administration of Medicines in Healthcare Settings (RPS, RCN, 2019) 

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Professional Guidance on the Administration of Medicines in Healthcare Settings (RPS, RCN, 2019) 

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Example of Health board procedure -                           Covert administration of medicines Policy (NHS, 2017)

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Example of Health board procedure -                           Covert administration of medicines Policy (NHS, 2017)

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An adult with capacity has the right to refuse treatment.

An unwise decision must be respected.

No one else can give consent on behalf of a competent adult.

Exemption - competent patients refused consent for treatment detained MHA (1983)

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5.2 Refusal of medicine -alternative approaches

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5.2 Refusal of medicine -alternative approaches

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regular (documented) attempts to encourage patient to take the medicine

different time or nurse

different formulation (patch ,disperse tablet)

documentation of the refusal in patient record

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MHA (1983) Code of Practice for Wales ( Gov. Wales, 2016) 

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MHA (1983) Code of Practice for Wales ( Gov. Wales, 2016) 

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Obtained valid and informed consent - legal and ethical principle (DH, 2009)

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Obtained valid and informed consent - legal and ethical principle (DH, 2009)

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freely  written,verbal, non- verbal

with provided evidence- based information for the  patient

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The patient is competent (MCA, 2005) admitted informally (MHA, 1983) and have legal right to refuse medicine and treatment  The nurse respects patient right to make decision about treatment. In addition of using alternative approaches as explaining  about the medication and discussion for the reasons of refusal. This demonstrates nursing practice in accordance with the organisational and legal law and  person - centred and evidence-based care.

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MCA (2005) Code of Practice ( Department of Constitutional Affairs, 2007) 

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MCA (2005) Code of Practice ( Department of Constitutional Affairs, 2007) 

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An adult has the right to make own decisions and must be assumed to have capacity unless proven otherwise.

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Registered  healthcare professionals involved with medicine administration must act all the time with respect to

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Registered  healthcare professionals involved with medicine administration must act all the time with respect to

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accountability

professionalism

professional judgement

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NMC Code - points supporting the scenario.

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NMC Code - points supporting the scenario.

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1. Treat people as individuals and uphold their dignity.

2. Listen to people and respond to their preferences and concerns.

4. Act in the best interests of people at all times.

7. Communicate clearly.

9. Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues.

18. Advise, prescribe,, administer medicines within the limits of your training and competence. In accordance with the law, NMC Code and other relevant policies.

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Principles of nursing practise (RCN, 2020).

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Principles of nursing practise (RCN, 2020).

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Principles of nursing practice | Royal College of Nursing

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The eight Principles are used to describe what everyone, from nursing staff to patients, can expect from nursing.

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Principle A - Nurses and nursing staff treat everyone in their care with dignity and humanity. this can be done by understanding their individual needs, ensuring that they show compassion and sensitivity, and provide care and respect patients equally.

Principle E - Nurses and nursing staff value the communication process as they assess, record and report on treatment and care, handle information sensitively and confidentially, including information regarding medication.

Principle B - Nurses and nursing staff take responsibility for the care they provide an understanding of actions carried out – they carry out these actions in a way that is agreed with their patients, and the families and carers of their patients, and in a way that meets the requirements of their professional bodies and the law.

Principle H - Nurses and nursing staff lead by example, develop themselves and other staff, and influence the way care is given in a manner that is open and responds to individual needs, which is shown through interactions between the nurse and student throughout the scenario.

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3 of the 6 C's in relation to the scenario

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3 of the 6 C's in relation to the scenario

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Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say. It is essential for ‘No decision without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.
Care is our core business and that of our organisations; and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us and our work. People receiving care expect it to be right for them consistently throughout every stage of their life.
Competence means all those in caring roles must have the ability to understand an individual’s health and social needs. It is also about having the expertise, clinical
and technical knowledge to deliver effective care and treatments based on research and evidence.

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Legislation's a nurse needs to be aware of :

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Legislation's a nurse needs to be aware of :

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The Mental health Act (1983)
The Mental Capacity Act (2005)
The Human Rights Act (1998)

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The nurse used her advocacy skills to empower and educate the patient with information on how her medication works. This helped the patient to make an informed decision about her health. 

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The nurse used her advocacy skills to empower and educate the patient with information on how her medication works. This helped the patient to make an informed decision about her health. 

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NMC 2018, educates professionals to act as advocates by assisting patients access information and support about their care so that they will be able to make informed decisions.

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On reflection - The nurse used both an authoritative and facilitative approach in communication. In addition of interpersonal communication skills used for creating therapeutic and trustful relationship with the patient. This demonstrates evidence-based practice and patient-centred care in accordance with the professional Code of practice (NMC, 2018). 

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On reflection - The nurse used both an authoritative and facilitative approach in communication. In addition of interpersonal communication skills used for creating therapeutic and trustful relationship with the patient. This demonstrates evidence-based practice and patient-centred care in accordance with the professional Code of practice (NMC, 2018). 

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Authoritative: Informative and confronting.

Facilitative: Catalytic and Supportive.

In addition of the NMC requirement for clear and effective communication  (NMC, 2018)

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1)      The Health and Social care Act 2012- Promotes the involvement of patients and carers in decisions about their care and treatment to enable patient choice.

2)      The Health Foundation is an independent UK charity committed to promoting person centred care supporting people to develop the knowledge, skills and confidence they need to more effectively manage and make informed decisions about their own health and health care. They released ‘Person centred care made simple’ in 2016 as an overview for person centred care written for health care professionals and those who use the NHS.

3)      NMC code of conduct- (2) Listen and respond to their preferences and concerns which can be achieved by: working in partnership with people; by recognising and respecting the contribution that people can make to their own health and wellbeing; to encourage and empower people to share in decisions about their treatment and care; to respect, support and document a persons right to accept or refuse care and treatment; to respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care.

4)      The NHS choice framework. This document details the government’s commitment to giving patients greater choice and control over how they receive their healthcare and their commitment to empowering patients to shape and manage their own health and care. It explains when you have choices regarding your care and treatment, where to obtain further information to help you choose and how to complain if you’re not offered a choice.

5)      RCN principles of nursing practice. Describes what the public can expect from nursing practice in any setting.  Principle D- Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions and helps them make informed choices about their treatment and care.

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Implication of bad practice

Failure to follow good practice guidelines might result in putting patients at risk of abuse or neglect.

Delay in recovery process

Nurses can be struck of the NMC register and lose their job.