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Ward 6 – A discussion and reflection on accountability and responsibility

The purpose of this essay is to discuss the concept of accountability and
responsibility in relation to the scenario ward 6 (appendix 1)
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She has no major health problems, however,
she does have a body mass index (BMI) of 18
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Her husband passed away four years ago, since then she has
lived alone
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This essay will discuss confidentiality, patient autonomy along with patient
safety and risk
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The author will be reflecting as the student nurse
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Confidentiality was chosen as one of the main issues as it is an important
factor when building a professional relationship between the healthcare
provider and patient
...
Fowler
(2013) expresses trust develops and is earned as the relationship
progresses
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Beauchamp and Childress (2008) argued human
beings are autonomous having a right to self- determination
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Patient safety and risk is present in all aspects of practice
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However,

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management involves identifying risks that may harm the patient and

patients’ can to decline these measures once fully informed if they have
capacity
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2000)
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The
ethos of nursing is based on promoting the welfare and well-being of patients
at all times (Caulfield, 2005: P4)
...

Hunt (2005) goes further giving a broad definition of accountability: ‘the
readiness to give an explanation or justification to relevant others for ones
judgements, acts or omissions when called upon to do so’
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Nursing involves accepting and demonstrating responsibility
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Bovens (1998) supports this claim by defining responsibility
as a dimension of accountability
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Griffith and Tengnah (2010) go
further, stating accountability means ‘being answerable to a higher authority
for your actions’
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Secondly is a deterrent function

involves in work, public and their private lives
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The last function,
an educative function allows other professionals to learn from the mistakes
and misconduct of others, any nurse called to account has their case heard
in public therefore, reassuring patients only the highest standards of practice
will be tolerated (Griffith and Tengnah, 2010)
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The aunt explained neighbours who had
tried to engage with Mrs Green had not been welcomed however, they have
noticed Mrs Green maybe a victim of her own self neglect, potential evidence
for this is a low BMI as she has no major health problems to account for this
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She explained there were
broken windows, peeling paint and bags of rubbish piled up in the garden,
the aunt described the house as not being ‘fit for an animal’
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RCN (2008a) proposed
a definition of dignity: ‘Dignity is concerned with how people feel, think and
behave’
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Griffith and Tengnah (2010) go further by saying maintaining
the confidentiality of a patient is a fundamental element of professional
conduct and ethical practice
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The common law of
confidentiality means people have a right to expect information given to a
healthcare professional is only used for the reason it was given but also that
it will not be disclosed without permission
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All healthcare professionals are bound by the common

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law derived from custom and judicial precedent rather than statutes (Oxford

law of confidence, although healthcare assistants aren’t bound by a
professional regulatory body they are covered by their contract of
employment, all NHS contracts include a confidentiality clause (O’Dowd,
2011)
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Siviter (2008) backs this up by saying as a student, you
are not yet ‘accountable’
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The student nurse could also encourage the healthcare assistant
to speak to the nurse in charge about what has happened, this would show
that the HCA is aware that she breached confidentiality, as the HCA isn’t
accountable she will be subject to disciplinary procedures through her
employer
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The
student nurse could offer to go with the HCA and act as a support, showing
that she is professional and acting as a role model
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However, this support must never compromise or be
at the expense of patient or public safety’
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This should be done as
soon as possible to prevent the information being distorted, NMC (2009)
state ‘records should be factual and not include unnecessary abbreviations,
jargon, meaningless phrases or irrelevant speculation’
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As the student nurse is not

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communication’
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McGowan (2012) states nurses are subject to numerous ethical and legal
duties in their professional role, including the imperative to maintain patients’
privacy and confidentiality
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Confidential information
can be disclosed if the patient or another person is at risk of harm
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In the
situation of Mrs Green, it would be lawful to share the information received
with other healthcare professionals such as doctors and occupational
therapists as there is a possibility she is a vulnerable adult therefore, it would
be in the interest of her safety
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Safeguarding adults is an integral part of patient care and a legal
responsibility of all healthcare professionals (Betts et al, 2013)
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They may have a mental or physical disability, an illness or be
elderly’
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They elaborate further by saying ‘nurses must take all reasonable
steps to protect people who are vulnerable or at risk from harm, neglect or
abuse’
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There were also reports of her falling in the village which
required help to get up
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This would also be an
opportunity to assess Mrs Green’s capacity, in law it is presumed adult
patients have the capacity to make decisions, unless there is evidence they
do not (Mental Capacity Act, 2005)
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The Mental
Capacity Act (2005: S
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The
awareness of a healthcare professionals ethical and professional obligations
can make them uneasy about the implications of following a patient’s wishes,
especially if they refuse potentially life-saving treatment (Taylor, 2013)
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It is fundamental that the student
nurse and registered nurse find out about her social situation, and whether
she has any input from others i
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carers or family members and how she
manages with shopping and cleaning
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Both the student nurse and registered nurse would have a
responsibility to involve the physiotherapists and occupational therapists in
order to offer support if they felt this would be beneficial to Mrs Green’s
return home
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Madsen and Fraiser (2015: P54) communicate, patients should
have a sense of control over their life, to have that they need to understand
the possible sequelae of electing different routes
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Traditionally, the doctor did what he thought was best
for the patient without giving them a choice, this was known as paternalism
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‘A
relationship where you encourage active involvement of the individual
promotes their autonomy and ensures they are better able to understand
their situation and take active steps to participate in their care’ (Nicol
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Faulkner (2001) emphasises that nurses have a responsibility to
promote and encourage patient independence by respecting their
involvement in planning their care
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On the other hand, if Mrs Green is deemed not to have capacity healthcare
professionals will need to refer to the Mental Capacity Act (2005)
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Mughal
(2014) states ‘the Mental Capacity Act exists to safeguard patients who lack
mental capacity to make decisions for themselves and the healthcare
professionals who care for them’
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Beneficence is the deliberate bringing about
of positive actions or interventions (Hawley, 2007)
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The meeting
will act in the best interest of Mrs Green with the outcome being the less
restrictive, the Mental Capacity Act (2005: S
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which it is needed can be as effectively achieved in a way that is less

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To conclude, accountability is a fundamental part of nursing it involves being
answerable and being able to justify decisions made at a later date if
required
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Although a student nurse isn’t accountable they
are deemed responsible, they should act as a role model to others and work
within a professional manner
...
Whilst maintaining confidentiality it is also
important to ensure the safety of the patient is maintained, if a patient has
capacity this can be a straight forward process of explaining the risks and
benefits of decisions that need to be made
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The Mental Capacity Act (2005) will need
to be followed for a patient lacking capacity to ensure the patient and staff

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involved are kept safe
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Mrs Emily Green is an 83
year old lady who has been admitted following a fall whilst out buying
groceries in her local village shop, she suffered minor cuts and bruising as a
result
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You are a student nurse working on Ward 6 and have been allocated to look
after this patient – she has been an in-patient for 5 days and has been
investigated thoroughly to exclude any potential underlying causes of her fall
(infection, neurological problems, cardiac issues, blood pressure etc)
...
2
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You are sitting in the staff room having your morning break with a Health
Care Assistant (HCA), she tells you her Aunt lives in the same village as Mrs
Green and that she was talking to her Aunt just last evening about the
patient
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Those
neighbours who had tried to engage with Mrs Green had not been welcomed
but described the house as being in very poor condition, broken windows,
peeling paint and bags of rubbish piled in the back garden
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appalling that the hospital were sending Mrs Green home and that the house

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to assistance from passers-by
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L and Childress, J
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Principles of biomedical ethics
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Oxford: Oxford University Press
Betts, V
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‘Safeguarding
Vulnerable Adults’
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28 (38) pp37-41
Bovens, M (1998)
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New York: Cambridge University Press
Braine, M (2006)
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Nursing
Standard
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P56-65
Caulfield, H (2005)
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Oxford: Blackwell
Publishing
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Accountability in nursing: six strategies to build and
maintain a culture of commitment
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Empowerment in policy and practice
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nursingtimes
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article [Accessed: 27
March 2015]
Fowler, J (2013)
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Part 8: confidentiality and records
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22 (19) pp1196
Griffith, R and Tengnah, C (2010)
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2nd edition
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Hawley, G (2007)
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Essex: Pearson Education Limited
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Ethics and accountability
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freedomtocare
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htm#definition [Accessed: 30 March

making in clinical practice’
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29 (31) pp50-51
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Madsen, C and Fraser, A (2015)
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‘Patients Confidentiality’
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32 (5)
pp86-88
Mental Capacity Act (2005)
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legislation
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uk/ukpga/2005/9/pdfs/ukpga_2005009_en
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F (2014)
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Nursing Times
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Nursing adults with long term conditions
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Nursing and Midwifery Council
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Confidentiality
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nmc-uk
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The Code: professional standards of
practice and behaviour for nurses and midwives
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nmc-uk
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pdf [ Accessed: 19 March 2015]
O’Dowd, A (2011)
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Available at:
http://www
...
net/whats-new-in-nursing/unison/hcas-and-patientconfidentiality/5000408
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Available at:
http://www
...
com/definition/english/common-law [Accessed:
13 April 2015]
Pearson, A
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Nursing models for
practice
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Oxford: Butterworth-Heineman
Royal College of Nursing (2008)
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rcn
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uk/_data/assets/pdf_file/0009/78696/003034_pdf

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what do I need to know?
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RCN: London
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The Student Nurse Handbook
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London:
Elsevier Limited
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‘Consent to treatment part 1: determining capacity to
consent to treatment’
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109 (43) pp12-13
Torjesen, I (2008)
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Available at:
http://www
...
net/1732771
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Law, Ethics and Professional Issues for Nursing: A

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reflective and portfolio-building approach

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