Are there professional issues that need to be discussed?

The code discusses the treatment of people under you care. The entire first section of the code is called “Prioritising people”. This states the absolute importance of treating people as individuals and with respect.

 This is further discussed in point 1.3 of the code which states “avoid making assumptions and recognise diversity and individual choice”. This is directly related to the case of Izzy as one of the nurses makes comments that violate this part of the code. It is a professional standard that the nurse must respect Izzy’s decisions and treat her like any other patient even if her own personal beliefs are different to Izzy’s.

Another standard set out in the prioritising people section of the code is point 2.4 “respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care”. It is obvious in this scenario that Izzy has taken this step herself and has likely had a huge amount of thought around her treatment. The nurse who comments negatively about Izzy is not respecting Izzy’s right as a patient to make her own decisions about her healthcare.

As the other Nurse who overhears the nurses negative comment it is important to remember point 3.4 of the code. “act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care”. The nurse making comments is displaying potentially discriminatory attitudes. This is most definitely is a professional issue and the code goes on to say that this must be challenged.

Point 4.4 may apply to the nurse who has made the comments in this situation. tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care. If this nurse has such an issue with these procedures it may be possible that she may remove herself from that environment or even the entire surgical area, if she wishes. However, this must be done openly and In a professional way that informs all around her including the patient.

Although this may be situational and may not 100% relate to this case I personally think is it important to recognise point 14.2 “explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers”. Although this refers to physical harm or mistakes within care I feel that if Izzy or any of her friends/family has heard these comments it would be appropriate for the nurse involved to follow this part of the code as though she had caused physical harm.

In a latter section of the code “promote professionalism and trust” another relevant point around this matter is made. Point 20.2 “act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment” is very similar in many ways to point 1.3 however speaks more of how a professional should act at all times. Again the nurse making the negative comments has not treated Izzy fairly and has potentially discriminated against her with these comments. This breaks the professional values set out in point 20.2 and undermines the entire “professionalism and trust” section of the code.

 What would you do?

As the nurse who hears these comments I would follow recommendations made in point 3.4 of the code and I would act as an advocate for Izzy and challenge her attitudes. This may be in the form of a quick, unofficial word with her in which I may just need to remind her of the code and how that may make Izzy feel. Hopefully at that point that would be all I need to do however if the nurse continued in her practice it may be necessary to inform her manager/ a person of authority who can give her a more formal warning around her conduct.

As the nurse making the comments it may be important for me to read the standards set out in points, 1.3, 2.4 & 20.2 and then adjust my practice based more strictly on the code. However if Izzy has heard these comments or anyone related to Izzy’s care has heard them, eg colleges, family etc it may be important to adhere to point 14.2 of the code and apologize to these people, let them know why I had done such a thing and how it will be corrected. 

If it were a more extreme case of clashing ideologies or if that nurse felt she could no longer work in this environment then she may want to follow the guidance of point 4.4 of the code and request to be transferred or at the bare minimum to not be involved in those procedures in future.

What about the patient?

Izzy’s rights as a patient are enshrined throughout the code. Points 13., 2.4 & 20.2 of the code highlight how she should be treated while in care and in the presence of all NMC registered professionals. If she feels that this nurse is not respecting her rights then Izzy has good grounds to make a complaint. It may also be reasonable to request that another member of staff or even a whole new team of staff take over her care for the remainder of her stay. �

(Tingle and Cribb, 2014)

- Utilitarianism decides whether actions are morally right or wrong depending on the effects or consequences. The decision which is acted upon the one with the best overall outcome. 

- Deontology refers to the duty of obligation of an individual to do what is morally/legally correct within that society. E.g. looking after children and not committing murder. 
- Kant's theory was focused mainly around 'fulfilling our duty' rather than the good/bad consequences of the actions.

- Feminism is based around women's rights due to equality of the sexes

- Religious individuals follow rules and guidelines set out via their religious leaders, teachings and scripture to ensure their actions are morally right. E.g. A Christian would follow the teachings of Jesus/God and the Bible. 

(http://www.iep.utm.edu)

Section 4 of the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990) provides a right of conscientious objection which allows health care professionals to decline to participate in a termination of pregnancy. This right is limited only to the active participation in the termination of pregnancy where there is no emergency with regard to the physical or mental health of the pregnant woman.  So the nurse who does not agree with the termination as it is Izzys second time can refuse to not participate therefore maintaining patient rights and making sure the individual care is not effected by differing views, they must inform their employer at the earliest opportunity in order to refuse participation. 

 Every woman seeking a termination has the right to confidentiality so the health care professional should not be discussing the information as it is a breach of confidentiality as there is no emergency in which a referral needs to be made to another member of staff. So the nurse is breaking the confidentiality guidelines by discussing Izzys second termination with other members of staff.