Sultanate oI Oman

Ministry oI health
AL-Dakhiliya Nursing Institute



Critical Thinking
Exercises



Done by: Mahmood Hamed AL-khatri -
N.O. 486
Submitted to . Mr. Soud -


Case N.O 2:
What are the key ethical issues involved in a situation where
you know that your patient, on discharge will become
immediately non-adherent to the prescribed drug regimen?
%hereIore, strategies to encourage adherence must not only address
intrapsychic Iactors such as knowledge oI the regimen, belieI in beneIits
oI treatment, subjective norms, and attitudes toward medication-taking
behavior, but also environmental and social Iactors such as the
interpersonal relationship between the provider and the patient and social
support Irom Iamily members and Iriends.Health care providers who
employ a combination oI verbal and written instruction oIten see
enhanced levels oI adherence among their patients. %his is especially true
Ior disadvantaged populations and Ior individuals with low literacy skills,
who oIten beneIit Irom tailored educational messages regarding the
duration oI treatment, dosage, Irequency, or purpose oI medication.
Studies have also demonstrated that personalized Iollow-up on adherence
through the pharmacy results in increased rates oI adherence. A Iinal
intervention Iound to be quite successIul in improving and maintaining
high levels oI adherence to medical recommendations is that oI social
support, either Irom a health care proIessional or within one's personal
environment. Factors that increase adherence include perceived support
Irom the provider, patient satisIaction with the medical visit, and the
support oI Iamily members in the home environment.
a. Explore with the patient his or her health concerns
for not taking medication.
b. Discuss the benefits of taking medication as
prescribed.
c. Provide positive reinforcement for taking medication
as prescribed.
ReIerence: 8C?AL CCLLLCL Cl CLnL8AL 8AC1l1lCnL8S 14 rlnces CaLe Pyde ark London
pyrlghL 2009 8oyal College of Ceneral 8eglsLered charlLy no 223106 Co wwwrcgporguk SW7 1u
racLlLloners
Case N.O 3:
A nurse was directed by the operating surgeon to prepare 10
cocaine with adrenalin Ior administration to a patient Ior
tonsillectomy. %he nurse repeated and veriIied the order. A Iew
moments aIter injection was given the patient showed symptoms
oI convulsions and died. %he operating surgeon meant to say
10 procaine. %he nurse carried out the doctor order without
question neither veriIied the correctness oI the order.
As a nurse what is your legal and ethical responsibility. Is the
nurse accountable Ior the mistake.?
1he nurse ls accounLable for Lhe mlsLake
1o prevenL Lhls mlsLake
1Lhe nurse musL check Lhe 8lghL of medlcaLlon admlnlsLraLlon (8lghL
medlcaLlon paLlenL dose rouLe calculaLlon documenLaLlon)
2 Lhe nurse should recelve Lhe docLor prescrlpLlon ln a paper wlL docLor
slgneL char or reedlL from compuLer
3 lf Lhe docLor prescrlbed Lhe order verbally Lhe nurse musL ask Lhe
docLor Lo Saled agaln
4Lhe nurse musL carrled ouL Lhe docLor order wlLh quesLlon verlfled lL
Lo check Lhe correcLness of order



ccountability with responsibility is one of the functions of theatre practitioner in perioperative
environment. t is because the perioperative nurses are liable for the outcomes of patients
before, during and after the surgical experience. ccountability means the quality of being
answerable. From the accountability point of view it is found that perioperative nurses are
responsible for their decision and the outcomes of these decisions.
s a result, it defines the boundary of loyalty and duty of nurses and provides the rights of
patients regarding competent care. The knowledge, skills and experience in nurse's daily
practice support accountability and responsibility.

n every job there is the presence of responsibility and accountability and nursing is not out of
this rule. The patient has the right to know who will take care of them immediately before,
during and after his or her surgical experience. From the customer perspective it is expected.
The patients always feel to be served by the professional or registered practitioners. There
are some delegations by which these activities are performed in the operating theatre.

ccording to the UKCC code of professional contact, clause 4 states that in the exercise of
professional accountability, the registered nurse must, "cknowledge any limitations in your
knowledge and competence and decline any duties or responsibilities unless able to perform
them in a safe and skilled manner (Mark, n.d.)
The role of the nurses at the time of surgery is an interested factor for the health service
mangers keen to know what actually happens behind the closed doors of the operation
theatre. What is the exact role is important to identify and clarify from the perspective of legal
issue. The role of all healthcare professionals has changed over the last several years and
particularly the nurses have been affected.
The theatre practitioners sometimes have to play the role as a professional one. Sometimes
the surgeon do wrong thing in regarding to very crucial issues. n this case what the
practitioners can do? Do they have the qualification to retract these wrong steps?
The practitioners are to be said expert when they no longer rely on the rules and guidelines to
link their thinking and understanding the situation to take the appropriate action. So it should
not be the problem for the practitioners if they operate from a deep and intuitive
understanding of the whole situation. s a result an expert practitioner should be
professionally qualified and the activities show no difference with the other.
"[(ccountability refers to obligation and liability which come from professional regulations
arising from the NMC, the law on civil wrongs to patients and employment law covering the
relationship between employers and their employees. Dowling et al (1996) state that the NMC
is required by statute to regulate the standards of practice of nurses and advise nurses on
issues such as accountability. Negligence and battery are the two areas of civil law which
may involve nurses. (l-Hashemi, Feb 2007)
f the performance of the practitioner becomes usually a role performed by a doctor then it is
assume that the standard of the care is same. t is also true that the patient has the right to
know who assists in performing his or her treatment. So it is required to introduce them by the
doctor from the accountability and legal perspective. Then it only can become ethical and the
accountability of the practitioners is accepted.
The responsibility and roles of the nurse changes with the surgical techniques advance.
These nurses are known as perioperative nurse who reflect the range of their duties, whether
it is in hospital or in day surgery unit. They do it immediately before surgery, during the
surgery and also after the surgery while patients are recovering. Their do maintain their
responsibility by monitoring every patient's physical and mental well being before, during and
after surgery. Besides this, they focus on creating a better and safety environment and
manage patient care throughout the surgical care period (Oud, et. al., 2007). During the
surgery procedure the doctors get helps from the perioperative nurse; such as passing
instruments, sponges and other items (Foti, 2002). ctually the perioperative nurses act as
both scrub nurse and circulating nurse. The above activities are the result of scrub nurse. s
a circulating nurse, they do their work outside the field and handle the nursing care in theatre
(Hoffman, 3 June 2004).
They monitor the surgical team; assist in creating and ensuring a secure and comfortable
environment for the patient. Most importantly, until the patient are transferred to a ward or
discharged home, the perioperative nurse do their duty by observing and caring the patient.



pracLlLlonersphp perloperaLlve hLLp//wwwoxbrldgewrlLerscom/essays/nurslng/nurslng