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Legal and ethical issue for professional practice

Legal and ethical issue for professional practice

Legal and ethical issue for professional practice
QUESTION
Need to demonstrate critical analysis in this assignment. This involves exploring the where, what, when, why, and how of incidences at Winterbourne from a legal, ethical, and professional perspective. *Remember that none of these events happened in a vacuum and that there were multiple reasons for them
Legal and ethical issue for professional practice

ANSWER
Introduction
The use of manual approaches in restricting the freedom of movement of an individual has received mixed feelings from both nursing professionals and the public (Sethi et al., 2018). Physical restraint is used in several situations where the patient may be identified as aggressive and in the event that an individual is suspected to be linked to criminal activity. This essay seeks to provide more light onto the idea of physical restraint. It will discuss on the professional, ethical and legal implications of physical restraint. Identifying the relevant legislation to explain further the idea of physical restraint, its position legally and instances it may be applied will give insight on the perceived seriousness of the matter. The Mental Capacity Act of 2005, amongst other acts and regulations will be identified and discussed. A critical focus will be placed on the cases of physical restraint that arose from Winterbourne View Hospital in Bristol, England. This was a mental health facility that focused on patients with learning disabilities and autism, but was closed due to gross misconduct and unprofessionalism.
The main reason for the introduction of physical restraint in hospitals was to prevent patients from falling during treatment or surgery (Giacco, 2018). They were also applied in cases where the patients were expected not to wander around. Patients who were identified as a risk to themselves were restrained physically to prevent them from self-harming. Nurse practitioners are expected to protect their patents from harm, therefore, physical restraints, when used well, help in achieving the key roles of nurses. Nurses in the United Kingdom are guided by a code of ethics that dictates their responsibilities and expectations when dealing with patients (Sethi et al., 2018). Patient safety is key in ensuring a high quality of care and treatment is achieved. It is imperative that one considers understanding the Mental Capacity Act (MCA) (2005) and Nursing principles suggested by the Nursing and Midwifery Council. The Mental Capacity Act requires that individuals be restrained only in the event that it is necessary by proving, beyond any reasonable doubt, that it is for the best interest of the patient (Giacco, 2018). Physical restraint should be done only in a way that does not infringe on an individual’s freedom of action and personal rights (Clayton, 2018). The Nursing and midwifery council identifies principles that dictate the nature of relations and code of conduct of registered nurses.

Ethical Issues That Arose Out of Physical Restraint Cause Harm to Patient in Winterbourne View Hospital
The case in question is an issue of ethical misconduct on six staff members at Winterbourne View Hospital in Bristol, where they were recorded assaulting and mistreating adults’ individuals with mental health problems. The patients are identified as individuals with mild to strong mental disorders that are associated with learning disabilities and autism (Allen, 2018). The staff acted against the required ethical guidelines and did not uphold the nursing code of conduct required of them. The expose, aired by the British Broadcasting Corporation (BBC) identified several extreme situations the patients were exposed to (Willis, 2020). The staff tasked with the duty of taking care of patients and helping them out were shown to have been abusing and assaulting them, thus, going against various ethical and legal requirements and guidelines.

Extended Hours of Physical Restraint
The patients at Winterbourne View Hospital were placed there under the Mental Capacity Act (2005) as they needed specialized care and management (Clayton, 2018). The majority of the individuals at the facility were notably far from home, thus, were in a vulnerable state being far away from their friends and loved ones. They were held for long periods of times with some patients spending more than three years continuously at the facility. This might have caused them mental anguish and stress from being separated from family for long lengths of time. Physical restraint on these individuals was caried out regularly, even in unnecessary situations, with them being restrained for long periods of times (Clayton, 2018). A good example is a case where a family showed evidence that their son was restrained a total of forty-five times in a period of only five months without showing signs of aggression or possibility of causing self-harm (Frankova, 2019).
The nurses at the facility went against the principles of the Nursing and Midwifery Council as they did not prioritize people and did not apply effective nursing practice (Willis, 2020). The nurses also did not safeguard patient safety as they engaged them in practices that hurt them both physically and emotionally. With these shortcomings, the staff also did not promote professionalism and trust in their practice. They went against the expected principles of operation. Nurses are expected by the council to show commitment to the code of professional standards, hence, translating to confidence and trust for the facility and general practice (Hollins et al, 2019). The case affected the reputation of Winterbourne View Hospital and led to its closure. According to the SNB, physical restraint shall only be administered in the least number of times possible and the patient involved in the decision-making process to ensure the least time possible is applied; it ensures a patient-centred approach.

Poor Physical Restraint Techniques
The techniques applied by the staff at Winterbourne View Hospital were poor and did not have the ability to improve the situation in the facility (Willis, 2020). Nurses in mental care units need special skills in managing situations that may escalate. Through evidence obtained through various reports conducted after the expose, the staff at the mental healthcare facility were not adequately trained to identify the severity of a situation and evaluate the best measure for intervention to apply. The lack of proper physical intervention and restraint skills led to the staff using forceful or violent measures, thus, causing emotional and physical harm on the patients; this includes psychological and physical skills to reduce violence, aggression and ensure efficiency in operations (Allen, 2018).
Physical intervention techniques such as Maybo and MAPA are vital (Barnoux, 2019). The Maybo physical intervention technique applies dynamic risk assessment techniques and uses safe and less aggressive techniques in de-escalation of heated situations or violence. The use of a less violent approach meant that the situation will be de-escalated without causing harm and giving room for the patient to learn from the situation. The Management of Actual or Potential Aggression (MAPA) approach to physical intervention focuses on behaviour management and teaches nurses to easily identify and respond to anxious and violent behavior. In physical restraint, holding, touching and presence can be used to reduce the tension in a situation (Clayton, 2018).

Legal Issues That Arose Out of Physical Restraint in Winterbourne View Hospital
Almost all activities carried out at Winterbourne View Hospital were exposed to legal issues by the time its end was closing in. The staff at the facility violated the personal and human rights of the patients, went against provisions in the Medical Capacity Act of 2005, the nursing code of practice and other acts, regulations and laws that related to criminal behavior in the work place; eleven members of staff were found guilty of criminal acts against the mental health patients and received sentences (Giacco, 2018). The Mental Capacity Act of 2005 requires that the mental health nurse ensure the patient is in a position to make a decision for themselves and help them in making a solid decision, where possible (Gray, 2021). One is also not supposed to treat a patient treat a patient as if they cannot make a solid decision on their own; in the event the nurse is forced to make one for the patient, it should be in the patient’s best interest (Senasinghe, 2018).
Poor physical restraint goes against the new Mental Health Act of 2015 as it violates the rights of mental health patients (Barnoux, 2019). According to the act, the patient and their family should be involved in the decision-making process at every stage. This will ensure the goal of personalized care is achieved thus, minimize anxiety or possibility of violence occurring. Children and young individuals with learning disabilities or autism should be offered extensive guidance and support in their daily activities. Through application of necessary interventions, legal issues can be avoided and prevented through the appropriate application of proper physical restriction strategies (Joyce et al., 2021).

Professional Issues That Arose Out of Poor Physical Restraint
Poor physical restraint at Winterbourne View Hospital brought about issues on the expected professional conduct of the nurses as stipulated on the NMC code of conduct (Willis, 2020). The principle of prioritizing people requires that nurses treat other people as human and uphold their dignity and listen carefully and respond to any concerns raised. These were not followed at the hospital as evidence shows the staff did not give a chance to the patients or their families to air concerns. Use of force in physical intervention and long periods of unjustified physical restraint show the lack of respect for people and not upholding their dignity as fellow human beings (Joyce, 2020).
Preserving safety in mental health facilities involves undertaking critical and vital action in the event there are any concerns that need to be addressed (Oostermeijer et al., 2021). Safety of the patient involves active duty in engaging with them, understanding their situation and ensuring the disease management plan chosen serves their best interest. At the Winterbourne facility, the staff did not engage in activities that actively promote patient safety. Neglect was exercised in the facility and ignorance played a major role in worsening the internal environment in the hospital, for the patients. Aggressiveness was practiced by caregivers in physical restraints and lack of consideration is evident as they were restrained over unjust issues. This made their mental conditions worse, rather than improve; improving their ability to learn and help manage autism was the main goal of the patients being taken to the facility.
Professionalism and trust is a delicate principle and should be carefully implemented to ensure longevity of operations in a healthcare facility (Eales, 2020). This principle requires one cultivating their behavior and interactions in a way that upholds the reputation of the nursing profession. Through proper moral conduct, leadership and integrity, the nurse can be a source of reference and inspiration to others (Ye et al., 2019). Patients also feel satisfied with the quality of care in such a situation. Staff at Winterbourne View Hospital did not carry-out practice with the required level of professionalism, thus break the trust of patients, their families and the entire society, leading to its closure.
The SNB code identifies principles that dictate in the best approach in carrying out activities for nurse practitioners (Gray, 2021). They should respect other people’s privacy, rights, values and autonomy. They should also be dignified in their practice and uphold a high level of accuracy and competency. Professionalism and self-regulation create a positive impact on their professional standard, while they should apply collaborative effort in decision-making and practice (Joyce et al., 2021). The staff at the hospital did not practice this, thus, cause anguish to the entire internal system.

Consideration of How These Episodes Could Have Been Avoided
According to Allen (2018), the episodes could have been avoided from the start by constant monitoring of the patients through collaborative efforts by the family, commissioners and the staff at Winterbourne View Hospital. It is important that teamwork be applied when dealing with individuals affected by mental health issues as each professional or individual involved understands the patient differently (Wilson et al., 2018). Collaboration allows the collection of extensive information on the patient and more ideas on how they can best manage the mental disorder (Read, 2021). Regular visits from all suggested participant groups would have helped also keep the staff in check; a government supervisor on progress and quality assurance would have ensured the proper intervention measures are used and physical restraint avoided in situations where it wasn’t necessary. Continuous staff training helps in the development of vital mental skills that the staff could have used to solve any anxious situations or violent outbursts (Oostermeijer et al., 2021).

Conclusion
The Winterbourne View Hospital was a mental health facility where approximately 48 individuals had been taken to have their learning disabilities and autism problems addressed (Giacco, 2018). They were considered hard to deal with in the normal society, thus, taken to the facility with the hope they would come out better men. Unfortunately, trauma and stress undergone by these individuals led to some getting worse and 27 of the 48 required more assistance to forget the stress experienced. Physical restraint is an important part of health care that was easily misused at the health facility. This brought about ethical and legal issues that could have been easily avoided, thus, leading to the closure of the Winterbourne View Hospital. The essay has provided an in-depth discussion on the issue and provided insight on various principles, acts and requirements on nursing regulatory bodies in carrying out nursing practice.

Legal and ethical issue for professional practice

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