HEALTH FORUM

Hi, a quick bit of guidance on this situation would be appreciated, as I
need it for an essay :o)



I was working on a surgical ward in the UK and half way through a shift,
just before lunch was told that a patient who had been waiting for a week
for her op could go down to theatre in the afternoon. I immediately made
her NBM and told the Nursing Assistant working at my end of the ward. I
also hung a Nil By Mouth sign above her bed and explained the situation to
the patient.



About 20 minutes later I found the patient happily eating lunch. Her Op had
to be cancelled and was delayed by about 3 days. The meal had been given to
her by an agency Nursing Assistant, who had not worked with the patient that
day and had not seen the NBM notice. The patient seemed to have a degree of
short-term memory loss.



Question is, who is responsible for the patient being fed? Me, or the
agency NA?



Any tips would be cool.

Bruce Hopkins asked:

In the context of writing an essay there are professional, legal and ethical
aspects, depending on the essay guidelines.

Professionally, the NMC Code of Professional Conduct has clauses that relate
to minimising risk to patients and being accountable for the actions of
other team members etcetera. These would be used by the NMC to decide on
professional misconduct of the nurse.

Legally, there are common law issues that relate to the duty of care and the
tort of negligence. The patients barrister may argue that the nurse and the
HCA were in breach of their duty of care. For example, that the nurse should
have informed everyone on duty at that time who may have come into contact
with this patient, about the patients nil by mouth status, especially since
the patient was forgetful and therefore at greater risk in these
circumstances. Lawyers would argue whether just placing a sign over the bed,
and telling one other person on duty, was sufficient in these circumstances.
The patients barrister may argue that since this is a surgical ward, where
pre-operative fasting is commonplace, and the administration of an
anaesthetic to a patient who has taken food can have dire consequences, that
this patient was vulnerable, and the HCA was not familiar with the patients
care, that the nurse should have done more that he/she did, and the HCA
should have verified that the patient could have food.

Ethical issues would relate to beneficence, non-maleficence etcetera.

Good luck with the essay. Please let me know what mark I get.
--
Eddie
http://www.freeinformationcentre.co.uk

An afterthought .... the nurse and HCA would also be accountable to their
employer in relation to the contract of employment.

--
Eddie
http://www.freeinformationcentre.co.uk

Bruce Hopkins ...

You, I take it, are the nurse.
The HCA is not. The HCA is an assistant to you.

Who was in charge of the ward?
Who told the HCA to serve lunches, and what guidelines was she given (har
har).
Were you aware of the wards relaxed attitude to lunch serving?
Who knew (or didnt) that the patient seemed to have a degree of short-term
memory loss

The can, I suspect, belongs to you, or, if you are lucky, the nurse in
charge.

On nursing issues, the buck stops with a nurse - and its probably about
time a lot more nurses realised that!


Andrew Heenan
Real Nurse
http://www.realnurse.net/

Bruce Hopkins wrote in message
news:GPP4e.14097$kr.12171@newsfe1-

Hi Bruce!

I would have thought that the NBM notice would have been on the patients
notes, and also this information should have been communicated during the
handover process - even for HCAs.

Thanks!

VickyMouse

British Nurse Resources - www.britishnurse.com - *NEW for 2005-2006*

Andrew Heenan wrote in message
news:d333jg$p2q$1@news8.svr.pol.co.uk...

In the UK, the HCAs dont work as Nurses Assistants but just as an extra
pair of (often autonomous) hands on the ward.


I would guess the ward sister?


This should have been communicated during handover.


Responsibility for the patients health and care, sure - but you cant stop
rogue HCAs?

VickyMouse

British Nurse Resources - www.britishnurse.com - *NEW for 2005-2006*

So wrong.

HCAs are NOT autonomous; a registered nurse is responsible for care -
including lunch.

Not ideal, perhaps, but thats the way it is.

If you cannot protect patients from rogue HCAs (ie HCAs who have not been
helped, taught or supported), then you are in the wrong job.
--
Andrew Heenan
http://www.realnurse.net/

Andrew Heenan wrote in message
news:df6d98$6pb$1@newsg3.svr.pol.co.uk...

Re-read the post. Its correct, and agrees with your point of view.


There is a difference between whether they should be, and whether they are.
Go look in any NHS Trust and you will see autonomous HCAs.


The way it is. Most Trusts are under staff shortages and HCAs end up doing
work that they shouldnt (and sometimes leaving work undone that should be).


Indeed. Without wanting to sound patronising - have you tried it?

If affirmative, then try it while youre looking after one ward and HCAs are
left on their own to look after another. Then complain because there are no
Nurses around to support you. Then try being responsible for an unsupervised
HCA.

If negative, sign yourself up to work for an NHS Trust for a day :)

Mike
www.britishnurse.com