Accountability and Responsibility Which are Key Concepts in Healthcare

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This essay is going to discuss accountability and responsibility. These concepts are going to be related to scenario ward 6 (see appendix). The focus will be on the accountability and responsibility of the health care assistant (HCA) and student nurse in the scenario and will be discussed, looking at how they relate to the key issues surrounding this patient. Confidentiality is one of the key factors in the scenario as there is a clear breach of trust. It will look at how the law protects the workers in question and how it protects the patient and their human rights. The focus will be on whether the healthcare assistant has broken the law or whether it is in the patient’s best interest.

However, these concerns cannot be ignored and also the patient is at risk of falling so will look at the risks and the patient’s safety on her return home as she is a high falls risk. The student nurse has been assigned to care for the patient under supervision so will look at the responsibilities of the student to the patients safety and how the student would be accountable if anything was too happen after discharge if the responsibilities have not been met, It will also look at the importance of record keeping and how that could protect the student nurse if they were made accountable to anything in the patients care. The concept which closely follows confidentiality and patient risk and safety is the patient’s autonomy. Autonomy is protected by the law. It will look at the mental capacity act and the rights of the patient.

Accountability is defined by the NMC (2015) as using professional judgement and skills to make decisions based on the best interests of the patient. Decisions are made based on evidence for best practice and must be able to justify any decisions they make and their actions at all times. To be accountable to the nursing profession, you need to be accountable to yourself too. Reflective practice is important as it is a way of accounting to yourself for thoughts and actions to improve the quality of care provided. Caulfield (2005) explains that there are four pillars that make up a framework of accountability these are professional, ethical, legal and employment. Professional accountability is based on promoting the wellbeing and welfare of patients and to work within a framework. Ethical accountability will come from own values and beliefs.

Society has moral restrictions on what is acceptable for a nurse to do in ethical practice. Legal accountability is a major area as it is a set of rules and regulations and there are clear punishments if the rules are not followed. Employment accountability is the contractual arrangement to do duties that are expected to be carried out and the employer will expect duties and responsibilities to be carried out safely. Having this framework provides clarity about the limits on responsibility in all nursing situations. The NMC Code of professional conduct (2015) states that a nurse is answerable for there actions and omissions, regardless of advice from others. Healthcare workers are accountable through five areas and that includes record keeping, confidentiality, evidence-based practice and risk management. Student nurses must not work past their level of competence and must report to their mentor or senior nurse any concerns. Student nurses are accountable to their higher education institute, the trust they have placement at as well as their mentor. Responsibility is the obligation to carry out tasks using professional judgement. Walsh (1997) believes there should be a clear distinction between accountability and responsibility.

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Accountability involves having a clear explanation for actions and being transparent and logical in any decisions that have been made. He believes that responsibility means performing tasks accurately and delegating tasks to competent workers. Any tasks the HCA does they are responsible to do the task properly and must be confident that they are trained and competent or they are accountable to the patient and their employer if it is done wrong. The nurse may delegate a task, but it is the person who is doing its responsibility to tell them they are not confident. It is also the responsibility of the trained nurse to only delegate tasks to those that are competent. The NMC (2015) says only delegate tasks and duties that are within the other person’s scope of competence, making sure that they fully understand your instructions. For the student nurse the NMC code (2015) says that for every task that is delegated they must be adequately supervised and supported so they can provide safe and compassionate care. Someone who is accountable is completely responsible for what they do and must give a good reason for doing it. The nurse is accountable for the decisions and actions of the worker who has been delegated the task.

Confidentiality applies to all healthcare workers including students and healthcare workers. The HCA gossiping with a neighbour about a patient is a breach of trust and against the law. The HCA is responsible for their actions and omissions and is accountable to the patient for breaching their trust and the patient could sue the HCA for compensation. The HCA is also accountable to their employer and to themselves and needs to acknowledge their mistake. They are responsible for anything they do or do not do and must be prepared to answer for their decisions. The code (2015) says that healthcare professionals should respect the persons rights to privacy and that the person should be informed about how and why information is used. However, it also says to share necessary information with other health care professionals only when the safety and public protection override the need for confidentiality. In the case study (see appendix) the student nurse has the responsibility to report the healthcare assistant (HCA) as it is a breach of the patient’s confidentiality as the HCA has been discussing the patient with a neighbour the HCA is accountable for this breach of trust (NHS England confidentiality 2016).

Healthcare staff are bound by the Confidentiality: NHS Code of Practice 2003. The Human Rights Act (1998) refers to an individual’s “right to respect for their private and family life, for their home and for their correspondence”. The NHS code of practice (2003) explains that Information given in confidence must not be disclosed without consent unless there is a justifiable reason. The HCA did not inform the patient and there is no justifiable reason for her to do so as the patient has no underlying health problems and it is based on opinion. Any information should not be speculation, personal opinion or offensive so should not be recorded in the notes as it is not accurate. In the NMC Code (2015) of professional accountability the nurse must protect confidential information, and this includes the student nurse. However, the code (2015) also states that it is necessary to share information with other healthcare professionals only when the interests of patient safety and protection override the need for confidentiality. In the scenario (see appendix) the patient has capacity and the state of the house is her personal choice. (2013) says that sharing information if it is in the best interest of the patient and is just as important as protecting confidentiality and should be supported by employers, regulators and professional bodies. However, in the case of the case study it is not appropriate as the patient has no underlying health issues and has autonomy.

There is a clear link between accountability and autonomy. Autonomy is an important factor in the ward 6 scenario as the patient has capacity and she has no underlying health issues. The mental health act (2005) states that if a person is deemed to have capacity they have a right to make a decision even if it is presumed an unwise decision. It is an individual’s right to choose what happens to them, their preferences, lifestyle choice and values. It is given to those with capacity to make decisions for themselves. Autonomy allows choices to be treated with respect. Caulfield 2005). The student nurse and other healthcare workers must not interfere with the decision-making process even if it means the patient will suffer or if it shortens their life. (Caulfield 2005). Under supervision the student nurse has a responsibility to escalate any concerns for patient safety and make clear and accurate record of this escalation and the patient’s wishes. If this is not recorded clearly and accurately and also counter signed by the trained nurse the nurse will be accountable for the actions of the student nurse for any mistakes in the patients care. The nurse also needs to witness anything they are counter signing (RCN 2017). The code (2015) says that is important to recognise and respect the contribution that people can make to their own health and wellbeing and work together to get the best outcome for the patient. The student nurses responsibility to the patient is to respect, support and document their right to accept or refuse care and treatment (code 2015).

Risk and patient safety is one of the key issues in the scenario and the student nurse under supervision has a responsibility to assess and escalate these concerns. Effective patient assessment is important to the safety, continuity and quality of patient care, and fulfils the nurse’s legal and professional obligations in practice. (marsden) Patient assessment is patient focused. It provides baseline information, so a plan can be put in place and any escalations to the right people. Staff will need to be aware of their legal obligations and responsibilities, the rights of the different people involved, and the diversity of the people they are working with. Provide clear evidence by accurately recording with the trained nurse counter signing so they are not accountable. The student nurse under supervision is responsible for ensuring that an initial assessment is completed when the patient is admitted. A care plan completed identifying her needs. It is the responsibility of the student nurse to raise concerns to the mentor if they are being asked to practice beyond their experience and training according to the NMC code (2015). The student nurse under supervision needs to acknowledge and act on all concerns raised to them, escalating and dealing with these concerns taking reasonable steps to protect people who are at risk from harm or who need support which in the patient in the scenario there are concerns about her living conditions that need to be investigated.

To conclude, accountability and responsibility are very similar but in nursing, there is clear distinction and there needs to be for the safety of the patient. The law, ethics, employment issues all wrk together to form a framework against which clinical issues can be considered. A worker has the responsibility to work within their competencies and all worker have a duty to abide to confidentiality laws.

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