Introduction
Nurses experience a lot at their line of duty, ranging from conflict with workers to problems with nurses, some of which can involve considerable emotional investment. This paper discusses an emotional touchline I experienced after witnessing an incident in the workplace involving a conflict between a nurse and a patient that turned ugly. Specifically, the paper highlights the effects of the experience on my professional paradigm.
Description of the incident
An incident I witnessed one day at the workplace triggered an emotional arousal within me that caused me to reconsider my profession as a nurse. Lucy (not her real name) had presented herself to the hospital, where I was employed, because of experiencing psychological difficulties. She was diagnosed by psychiatry with borderline personality disorder and had sought help following an inability to cope with the bereavement of her foster carer. She started indulging in excessive alcohol drinking to cope with the death and experienced challenges caring for herself. Specifically, she decided to visit the hospital after she overdosed with diazepam that her general physician had prescribed her. At the hospital, she arranged an informal admission on an acute ward and accepted half-heartedly a care plan that limited her leave to avoid assessment per the Mental Health Act (MHA). An unexpected change in the nurse in charge preceded the incident; the key staff unexpectedly took a sick leave.
After changing the nurse in charge, Lucy engaged in a strong dispute with the new nurse-in-charge regarding the amount of leave the former nurse staff purportedly agreed with her to extend to six hours, constituting a change in care plan. The nurse providing care at the place of the key nurse disagrees, claiming a lack of evidence to indicate the alleged review of the care plan. The patient became agitated when the nurse objected to allowing her the leave extension she asked for because of a lack of written proof of the agreed change. The patient got upset with the decision and started shouting at the nurse and other staff, expressing her frustration with the care. The nurse-in-charge informed Lucy of the decision to suspend her leave due to concern about her mental state. At this point, the client threatened to leave the hospital, but she is restrained, which increased her agitation and frustration, and expresses it by screaming, sobbing, and aggression towards members of staff. She even directed her frustrations to furniture in the day room, at which point the staff used approved physical holds to escort Lucy to the extra-care suite and coerce her to take oral PRN haloperidol before discussing her release from the extra-care suite. The incident moved me, and I empathised with both the attending nurse and the client. The nurse was faced with a situation requiring her to decide between submitting to the request of the client and observing the nursing code of practice as outlined by the NWC and the rules of the MHA, regarding the autonomy of the patient about the treatment modality (Department for Constitutional Affairs 2007).
The effect of the experience
The experience made me reconsider my view of the entire nursing practice, regarding nursing guidelines, legal and ethical dilemmas, and decision-making, as well as the rights of the patients. I especially considered the meaning of patient-centred care, because some guidelines state that a patient has a voice in choice of treatment (Ulrich et al., 2010). Therefore, the incident raised the question of when does a nurse's decision count more than the wish of the patient.
Given the myriads of policies and laws guiding the practice, some circumstances can confuse a nurse in terms of deciding which rule holds in a given situation. In my opinion, the nurse was cautious against putting her job on the line in case she took leave and harmed herself while on leave, at which point the nurse risks legal charges for negligence. Therefore, the nurse-in-charge was keen at protecting her job at the expense of the happiness of the patient.
Another issue that emerges in the incidence is that of effective communication between nursing staff (Casey & Wallis, 2011). The key worker who took a sick leave acted unprofessionally by failing to leave clear communication regarding a change in care plan, as alleged by the patient, in my opinion. However, I empathize with her effort to act for the best interest of the patient (Chiovitti, 2011), even if it contradicts the immediate wish of the patient (Mandal, Pannmbath & Parija, 2016). In this case, Lucy's interest was to be granted a leave extension from 3 hours to 6. However, she did not make clear for what she needed an extension. On the other hand, the decision by the nurse to withdraw the leave was justified, since she could not foresee what harm may befall Lucy's case, the nurse submitted to her request for a leave extension (Ashmore 2015).
An equally important question that emerged from witnessing the conflict is how the nurse established that Lucy was incompetent given that Lucy brought herself to the hospital rather than by assessment per the MHA (Department of Constitutional Affairs, 2007). Lucy had shown competence by raising the issue of leave extension, indicating that she could communicate her decision. The Mental Capacity Act 2005 (Brown, Barber & Martin 2009) accords all adults the right to decide what is best for him or her as long as they are competent.
Discussion of What I have learned
I have a couple of things from this experience that triggered me to review, take a deeper look into my understanding of the nursing practice and the law and regulation guiding it. I learned that I need to understand better variables that constitute incompetency and determining if a patient is competent or not (Aston, Wakefield & McGown, 2010). The patient has a voice in the decision regarding her treatment (Buchanan, 2004). The law grants a patient the right to decline a care plan, but the nurse had refused to submit to the patient's request to have the leave increased. Moreover, I learned that certain situations may present a clash between the nursing code of ethics and specific legislation, at which point it is expedient to take a decision that ensures the good of the majority consistent with utilitarianism.
Conclusion
This emotional touchline helped put in perspective very essential aspects of nursing practice. It taught the need to balance between the mandate of the nurse and the right of the patient to decide treatment. Although nurses must always act in the best interest of the patient, the former should take into account the perspective of the patient. The client came to seek help from the hospital because she trusted the staff to act in her best interest. However, a disagreement arose due to communication breakdown caused by the first nurse. Besides, the nurse-in-charge should have reconsidered the request and discussed it with the patient to eliminate the misunderstanding.
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