HLTEN509B Apply Legal and Ethical Parameters to Nursing Practice Module 3

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Module Three: Ethics and Supporting Clients’ Rights

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HLTEN509B Apply Legal and Ethical Parameters to Nursing Practice Module 3

Ethics is a branch of philosophy dealing with the standards of conduct and moral judgement. Historically, nurses observed the principles of Medical Ethics, including avoiding personal judgements that might bias the treatment of clients. With the growth and development of nursing as a profession, and as an independent health care discipline, Nursing Ethics also evolved in recognition of the contribution nurses make to promote and protect the safety and wellbeing of clients assigned to their care.

Nursing Ethics recognises both the large, bioethical issues relating to the beginning and ending of a human life such as abortion and euthanasia but most importantly the ethical dilemmas nurses face in their daily interactions with their clients. These dilemmas not only focus on the client and their health care rights but also the rights of nurses to a safe workplace, including reducing risks of exposure to infectious diseases and occupational violence.

Please complete the following activities before attempting Quiz 3: Ethics and Supporting Clients’ Rights.

To complete the activities of this module, you will be required to access a range of internet resources. Please refer to each activity for available web links.

Activity 3.1

Code of Ethics for Nurses in Australia

The Code of Ethics for Nurses in Australia outlines the nursing profession’s commitment to respect, promote, protect and uphold the fundamental rights of people who are both the recipients and providers of health care (ANMC, 2008). The Code contains eight value statements, which are organised into four categories: self, person (health consumer), colleagues and community. Nurses and students are encouraged to use the value statements as guide when reflecting on the degree to which their clinical and educational practice demonstrates and upholds each of these values.

Access a copy of the Code of Ethics for Nurses in Australia from the NMBA Website. For each statement, provide an example as to how you, as a student nurse, can demonstrate or uphold the values in your training or clinical practice.

Value Statement Example

1. Nurses value the quality of care for all

2. Nurses value respect and kindness for self
and others

3. Nurses value the diversity of people

4. Nurses value access to quality nursing and
health care for all people

5. Nurses value a culture of safety in nursing
and health care

6. Nurses value informed decision making

7. Nurses value ethical management of

8. Nurses value socially, economically and
ecologically sustainable environment for
promoting health and wellbeing.

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Box Hill Institute, Centre for Heath and Community Services
HLTEN509B Apply legal and ethical parameters to nursing practice, Module 3: V2

Activity 3.2 Ethical Principles

Define the following ethical principles


Non – Maleficence


Resolving Ethical Dilemmas

Nurses must be able to maintain an effective process of care irrespective of how different a client’s value and belief system is to their own personal belief system. To resolve ethical dilemmas, it is recommend a decision making framework or theory be used.

Review the ethics chapter of your nursing text, and select an ethical theory that you think is
Activity 3.3

most suitable to health care. Please explain why you have chosen this theory.

Activity 3.4 Advocacy

In a nursing context, advocacy means that a nurse acts for and on behalf of a client. In acting as a client advocate, how can the nurse ensure they protect their clients’ right to self determination?

Mandatory Reporting – Children and Young Persons

In Victoria, mandatory reporting of child abuse was first introduced in the 1990’s. Under the Children, Youth and Families Act 2005, doctors, nurses, midwives, teachers, principals and police are mandated to report a belief on reasonable grounds that a child has been abused.

Activity 3.5 Visit the Department of Human Services website and search for Child Protection Practice Manual. Click the Intake link to view the Mandatory Reporting PDF, available at http://www.dhs.vic.gov.au/cpmanual/intake/overview-of-intake-of-reports-under-the-children,-youth-and-families-act/1122-mandatory-and-other-required-reporting

On what grounds may a reasonable belief be formed that a child needs protection?

Mandatory Reporting – Elder Abuse

When compared to child abuse, elder abuse receives far less attention. Elder Abuse is any behaviour or action within a relationship of trust that harms an older person. It includes financial, psychological, physical, sexual, social abuse and neglect.

In 2007, the Aged Care Act (1997) was amended to include the mandatory reporting of elder abuse. Residential Aged Care facilities must notify the Department of Health and Ageing and the police of any suspected unlawful sexual contact with a resident, or unreasonable use of force on resident of an aged care home.

Activity 3.6 For older adults living in the community, the key to prevention is developing community awareness. For older adults living in the community, what strategies can they put into place to protect themselves from becoming a victim of elder abuse?
Activity 3.7 Office of the Public Advocate

The Office of the Public Advocate (OPA ) “is an independent legal body established by the Victorian State Government to protect and promote the interests, rights and dignity of people with a disability” (OPA 2013). The OPA operates according to the principles outlined in the Guardianship and Administration Act 1986, including the principle of best interest. This principle differs from individual or client advocacy because it may result in an outcome that the person with a disability does not always agree with or what is in their

“best interests”.

These outcomes may include decisions about lifestyle, finance and/or medical treatment.

View the Office of the Public Advocate, Victoria website, view the Take Control Video, and answer the following questions.

Web address www.publicadvocate.vic.gov.au/publications/225/

A) List the 3 kinds of enduring powers of attorney

B) What is the process for appointing an enduring power of attorney for someone who has become incapacitated and has not appointed their own power of attorney?

C) How does a medical power protect the interests of clients who have become incapacitated from sudden and severe illness/injury?
Life and Death Decisions – Medical Treatment Act 1988

The Medical Treatment Act 1988 “encourages community and professional understanding of the changing focus of treatment from cure to pain relief for terminally ill patients”

Department of Health, Victoria 2013).

To answer the following questions, visit the Victorian Government, Medical Treatment Act website at www.health.vic.gov.au/mta

Activity 3.8

Clink the link: How the Act Works to view a copy of Refusal of Medical Treatment Certificate (Competent Person). How is Medical Treatment defined in the Act?

In 2003, the Victorian Supreme Court handed down a landmark judgement in case bought to it by the Office of the Public Advocate. The judgement clarified the relationship between medical treatment and palliative care.

Activity 3.9 What was the decision made about artificial hydration and nutrition delivered by a surgically inserted tube into the stomach (PEG tube)?
Respecting Patient Choices

In 2002, the Austin Hospital (Victoria) launched the Respecting Patient Choices – Advanced Care Planning program. This program “provides a quality-assured system of discussing, recording and documenting a patient’s preferences for their future healthcare, in preparation for a time when they might not be able to competently contribute to their end-of-life decisions. It is frequently (but not always) about end-of-life medical treatment” (Respecting Patient Choices 2012).

Activity 3.10

Visit the Respecting Patient Choices website, click on the professional’s – more information link and answer the following questions.

A) What is the fundamental doctrine in relation to advanced care planning?

B) What ethical principles form the basis of advanced care planning?

Advanced Care Planning

Visit the Respecting Patient Choices Website, review the advance care planning
Activity 3.11

documents for Victoria, and answer the following questions.

A) List and explain what may be included in an Advanced Care Plan

B) How, would you as Enrolled Nurse, support a client to make future health care decisions?
Life and Death Decisions – Not for Resuscitation

A Not For Resuscitation (NFR) order is a medical order that involves an informed decision making process between a client or nominated substitute decision maker and the treating medical doctor.

Generally, there are three major rationales for a NFR order

1) No medical benefit

2) Poor quality of life before resuscitation

3) Poor quality of life after resuscitation

Historically, the NFR order was a plan document stating a client’s choice not to be resuscitated in the event of a cardiopulmonary arrest. The order generally did not include any directives as to either the treating medical doctor’s plan of care or client’s choices for care in the event of a significant deterioration in clinical condition. For health care professionals this type of documentation created many ethical and legal dilemmas as to how to respond to a client experiencing a sudden deterioration in their clinical condition with a valid NFR order. Was the client for palliative management and symptom control or was the client for active treatment and investigation of the cause/s of the sudden deterioration?

In recognition of this dilemma, and associated clinical issue of failing to respond to clinically deteriorating clients, documentation about resuscitation status and the decision making process are now being revised. In 2010, Queensland replaced its ‘Not Resuscitation Orders’ with Acute Resuscitation Plan Forms. It is now procedure in all Queensland health facilities to document recommendations for resuscitation and other associated important information, including cultural preferences on these forms (Queensland Government 2009).

Currently, Victoria had no standardised resuscitation status documentation. However, documents are being reviewed and changes implemented. Some of these changes
include title such as Resuscitation Plan and the inclusion of criteria for which a medical emergency response or MET call maybe activated if a client’s condition was to suddenly deteriorate.

Activity 3.12 Access a copy of Austin Health’s Resuscitation Plan, and outline the decision making process for a non – competent client who is to be offered life prolonging treatment. PDF available at www.safetyandquality.gov.au/wp-content/uploads/2012/02/Austin-Resuscitation-Plan.pdf
Open Disclosure

“Open disclosure is the process of open communication with a patient, and or their family/support person, following an adverse or unexpected event that may or may not result in harm to the patient” (Depatment of Health, Victoria 2011).

Adverse events also known as incidents maybe classified as severe resulting in permanent injury or death or minor including a near miss. In regards to the open disclosure process, minor events require a low level response for example, a fall without injury. This requires the nurse to report an event to their supervisor, and with their supervision inform the client and/or the support person that an adverse event has occurred.

High response events need to be reported to an organisation’s Clinical Risk Manager who can coordinate the response and ongoing support for all parties involved. In coordinating a high level response, the Clinical Risk Manager should select the most appropriate senior clinicians to be involved in the open disclosure discussions with the client and/or their support person.

Regardless of the level of response required, it is always important to remember to provide a consistent team approach to the open disclosure process, and to avoid blaming, criticising, arguing or seeking to prove that you were right.

Activity 3.13 Visit the Victorian Government Website and download a copy of the Open Disclosure for Victorian health services – A guidebook. What are the three elements of open disclosure?

Activity 3.14 Principles of Open Disclosure

List and explain the eight principles of open disclosure


Australian Health Practitioner Regulation Agency 2012, What we do Available URL:

Australian Nursing Federation, 2010 ANF Mandatory reporting guide, Available URL:

Australian Nursing and Midwifery Council 2002, National competency standards for the enrolled nurses Available URL:< http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx>

Australian Nursing and Midwifery Council 2007, Delegation and supervision for nurses and midwives, Australian Nursing and Midwifery Council, Canberra

Australian Nursing and Midwifery Council 2008a, Code of professional conduct, Available URL:

Australian Nursing and Midwifery Council 2008b, Code of ethics for Nurses Available URL:

Australian Nursing and Midwifery Council 2010, Professional boundaries for nurses, Available URL:

Coroners Court Victoria,2010 Coroners Court of Victoria: Information of health professionals, Available URL: < http://www.coronerscourt.vic.gov.au/home/medical+processes>

Crisp, J and Taylor, C 2009 Potter and Perry’s fundamentals of nursing, third edition, Elsevier, Sydney

Department of Health, Victoria 2011 Open disclosure for Victorian health services – A guide book, Available URL:

Department of Health, State Government of Victoria, 2012 Medical Treatment Act 1988, Available URL:

Department of Human Services, Victoria Child protection practice manual: Mandatory Reporting, Available URL:

Fitzroy Legal Service, 2012 The law handbook 2013: your practical guide to law in Victoria, Available URL:

Funnel, R Koutoukidis, G and Lawrence, K 2008 Tabbner’s nursing care, fifth edition, Elsevier Sydney

Nursing and Midwifery Board of Australia, 2013 Functions of the board, Available URL:

Office of the Public Advocate,2013, Office of the Public Advocate, Available URL:

Queensland Health, 2009 Resuscitation planning, Available URL:

Respecting Patient Choices, 2012b Ethics and advanced care planning, Available URL:

Respecting Patient Choices, 2013 Respecting patient choices for professionals, Available URL: http://www.respectingpatientchoices.org.au/index.php?option=com_content&view=article&id=19&Ite mid=20
Contact www.kimsharma.co.in for best and lowest cost solution or
Email: solvedstudymaterial@gmail.com
Call / What’s App: +91 82907-72200 (Call/WhatsApp) or +91 88003-52777 (WhatsApp Only)

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