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AC 1.1: Use the case study provided and explain three ethical dilemmas faced by health and social care professionals. Do not forget to include NMC/HCPC professional guidance and Human Rights Act. (300 words)
AC 2.1: Analysis of two examples of good and poor practice in case management. (200 words)
AC 3.1: Use the case study provided where restrains are used and explain the ethical implications of using these restrains to manage patents’ safety, making reference to the NMC. (100 words)
Case study:
Staff Nurse Pickard (about the use of restraint/coercion)
Professionals
Key concerns
Staff Nurse Pickard was dreading her day on the care of the elderly ward. In Bay 3, a four-bedded unit, there was a lady, Mrs Patel, who had had a stroke. She was known to have vascular dementia. She kept on trying to pull out a nasogastric tube, so in the multidisciplinary team meeting it had been decided that it was in her best interests for restraints to be used and her hands were tied down with big gloves on.
Mrs Patel seemed to hate it and spent the whole day shouting, albeit what she shouted did not make any sense. It was agreed that the restraint of her hands should only be for the shortest possible time. But Staff Nurse Pickard did not agree with the decision because it seemed to be against her human rights. The bay had another lady in it with dementia, who had been a bit of a “wanderer”, but they had found an armchair which she seemed to be comfortable in and which she could not get out of, which made life easier. She didn’t complain.
Meanwhile, Mr Abode, from Bay 4, was always coming into Bay 3 and he would start trying to take the gloves off Mrs Patel. When the staff tried to explain to him that he wasn’t allowed to undo Mrs Patel’s hands, he would get quite agitated and threatening. He’d pushed one of the male nurses yesterday and used foul language. Mr Abode is said to have Alzheimer’s disease, which makes it diffi- cult to reason with him. As he was involved in a confrontation overnight, the doctors have added lorazepam and haloperidol to his drugs, if he requires them, for agitation.
Some of the staff are glad about this and have decided that the key thing will be to get him to take the drugs early, before he becomes too worked up; because then there is more chance he’ll take it by mouth rather than having to be restrained to give him an intramuscular injection. Staff Nurse Pickard feels that it would be sad to have to use force and might be humiliating for him even though, having been a nursing assistant in the dementia ward of the old hospital, he has probably used restraint on his patients in the past. All in all, it looked like it could be a trying shift.
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