During a heavy drinking session with you one evening at your flat, a colleague and a friend whilst under the influence of alcohol stated in a conversation that on one occasion when she was nursing Julie, she did not stop Julie cutting herself with a razor blade nor reported it the nurse in charge of the shift because she herself has use cutting to cope when “things were rough” in the past and does not agree with her current care.

-- Anonymous, November 18, 2001

Answers

At all times let no action or ommision on your part place at risk the care offered to any patient

-- Anonymous, November 20, 2001

I think you must be carefull when making these jugdements in case the patient hurts her self?

-- Anonymous, November 20, 2001

According to the UKCC Code of Conduct nurses should do good and do no harm. In Julie's case the nurse should not let personal emotion or feeling put Julie's care at risk, for his priority is to make sure that Julie get the best care possible.

-- Anonymous, November 20, 2001

well according to the ukcc code of proffessional conduct, the duty of a nurse is to do good and avoid harm- this is the concept of beneficence and non-malifecence, and in this case I think my friend should have reported Julies behaviour because Julie is in hospital and she is there so that she can be helped. My friend should not have used her own experiences as a scape goat and a go ahead for her to leave Julie to hurt herself. more so this poses as an ethical issue as well as moral issue.

-- Anonymous, November 20, 2001

Dilemma 1 seems to be the most difficult ehicaldilemma to handle.

-- Anonymous, November 20, 2001

The nurse's duty of care as supported by the UKCC Code of Conduct should do good for the patient and not bad.The nurse in seeing Julie cutting herself she should have advised her to stop or at least educate her about the dangers of self harm.She/he should have told the other nurses about what had happened, continuity of care.

-- Anonymous, November 20, 2001

In this case my friend was wrong to bring in her personal feelings into the care of a client. In as much as it gives her the capacity to cope, the patient is in her care and caution should be taken in making decisions that affect the care given to the client.I would advise my friend when she is lucid to be more professional in future.

-- Anonymous, November 20, 2001

Her personal experience and choises should be divorced from her professional being. She should follow the care plans that have been formulated as a skeleton of care. This I will make clear to her when she is sober.

-- Anonymous, November 20, 2001

this colleague of mine should not have let her personal feelings interfer in the care she was giving to julie (she should have acted in a professional manner). if she did not agree with the current care she should have addressed this issue with the MDT.

-- Anonymous, November 20, 2001

At all times we should be guided by the duty to care and not let our own experience influence us not to report cases of self harm just becaise we felt better by cutting our self.

-- Anonymous, November 20, 2001

My friend unfortunately acted unprofessionally. In our position at all times, we have a duty of care to "act always in a manner as to promote and safeguard the interest and well-being of patients and clients" UKCCC Code of Practice (June, 1992)

She not only acting irresponsibly to Julie, but to herself as well. For, she has allowed her own feeling of countertransference to blind her judgement. Also, she witheld valuable information about Julie from the nursing staff involved in her care. The UKCC (1992) guidelines clearly state " ensure that no action or omission on your part, or within your sphere of responsiblitiy is detrimental to the interests, condition or safety of patients and clients." My friend I feel needs to address her own problems (therapeutic self) as she could allow Julie to self harm again which could be fatal for Julie. I would very sad for all concerned if my friend did not seek professional help.

-- Anonymous, November 20, 2001

The UKCC Code of Conduct 1992 states that, as a registered Nurse....,

Clause 1 - Act always in such a manner as to promote and safeguard the interests and well-being of patients and clients;

Clause 2 - Ensure that no action or omission on your part, or within your sphere of responsibility, is detrimental to the interests, condition or safety of patients and clients;

Clause 8 - Report to an appropriate person or authority, at the earliest possible time, any conscientious objection which may be relevant to your professional practice;

We have both a legal and a professional duty of care for patients and the courts could find a registered practitioner negligent if a patient, i.e Julie, suffers harm because my collegue has failed to care for her properly.

Quoting a famous case; Donoghue Vs Stephenson (house of lords, 1932), Lord Atkin when he defined the duty of care, said that: "You must take reasonable care to avoid acts or omissions which you can reasonably foresee would likely to injure your neighbour. Who then, in law is my neighbour? The answer seems to be persons who are closely and directly affected by my act that i ought to have them in contempplation as being so affected when i am directing my mind to the acts or omissions which are called in question".

Professionally, the UKCC's Professional Conduct Committee could find my colleague guilty of misconduct and remove them from the register if she/he failed to care for Julie properly.My collegue has failed to fufil the above identified clause' of the Code of Professional Conduct and i acknowledge that this is a difficult situation to deal with. i will have to make my collegue aware of the sections of the Code of Professional conduct when she/he is sober and encourage him/her to report this incident to the nurse in charge such that a incident form can be filled in. the incident form is a protective measure for the organisation, my colleague and the client, in case Julie's parents want to make a complaint.If my collegue does not agree with the current care for Julie; clause 14 state that, "Assist professional collegues, in the context of your own knowledge, experience and sphere of responsibility, to develop their professional competence and assist others in the care team, including informal carers, to contribute safely to a degree appropriate to their roles". In this respect, my colleague would have 'no leg to stand on' if she used the defence that she let julie cut herself with a razor blade because she herslf has used cutting to cope when "things were rough" in the past.As a registered practitioner, you are personally accountable for your practice,and if my collegue does not take the relevant steps to inform the nurse in charge, i will have to do it for him/her.This will be based on the principle of Beneficence and Non-malificence.

-- Anonymous, November 20, 2001

According to the UKCC 'Code of Conduct', Nurse should have the duty to report Julie's self harming. I know it is easier to say than done. It need reflection & supervision when nurse find difficult in the work.

-- Anonymous, November 21, 2001

I feel that my colleague did a good thing to respect the client wishes of selfharm .It is a way of coping with life for Julie as far as it is not detrimental to her physical health. But, i feel that the incident should have beeen reported and documented in line with the UKCC code of professsional conduct

-- Anonymous, November 21, 2001

The care and management of the mentally ill offers many examples of potential ethical dilemmas of practice, having said that, in this instance it was wrong for my collegue to withold information about a client in her care simply because she does not agree with her current care.Her experiences should be kept as far away from her work as possible because if all nurses implement what worked for them before on patients it will be very chaotic and disastrous.

-- Anonymous, November 22, 2001

According to the UKCC code of conduct my colleague has been very unprofessional and has also become non-therapeutic. She should work with Julie according to the careplan Julie and the Mdt agreed on. If she does not agree with current care she should raise this with the team. My colleague should not allow her own experience and feelings come in to the work place as this becomes non-therapeutic for herself and for Julie. I will advise her to talk about this during her clinical supervision and also reflect on her actions.

-- Anonymous, November 22, 2001

The fact that my colleage does not agree with julie`s current care,biases the whole thing from the start. Though she might have had the very best of intentions,if anything had gone wrong she was going to be wholly accountable for letting julie cut herself without a go ahead from the mdt and the neccessary precautions to be take if one was to therapeutically cut themself. its such a huge dillema for nurses because we are human hence we are not immune to letting our emotions control our decision making sometimes.my friend was wrong in letting julie cut herself and not report it.for me i would say my friend saw in herself julie, hence quick to sympathise

-- Anonymous, November 22, 2001

The ukcc code of professional conduct says nurses should act allways in such a manner as to promote and safeguard the interests and well being of patients--this did not happen in this case--what if on another ocassion julie self harms herself to a point of near death or even death? she definately did not act professuionally and in accordance with the ukcc.she should herself seek professional help and talk to the charge nurse.

-- Anonymous, November 22, 2001

i think that my friend, although she has a valid point, she handled it in the wrong way, she should have advocated for julie in the right settings and stated her case backed with research evidence maybe things would have turned out otherwise.

-- Anonymous, November 23, 2001

Truth telling, no matter what, is very paramount in nursing. Deontological view of actions in care must always be adhered to. Thus, any action which seems to compromise the proper care of patients must not be entertained.

-- Anonymous, November 23, 2001

According to the UKCC code of conduct nurses should do good for the patient and no harm.The nurse should report and document clearly Julie self harming. Nurses will need reflection and supervision to deal with difficult issues

-- Anonymous, November 23, 2001

As a nurse it si duty to always act inthe the best interest of the patient.This is no ecception.

-- Anonymous, November 23, 2001

Staff should not be judgemental. According to UKCC code of conduct all individulas should be treated with respect, dignity despite their race or religion. It appears here that staff were letting counter- transference takes over their therapeutic engagement.

-- Anonymous, November 23, 2001

When she sobers up my immediate concern is that my friend receives the help she needs. I have a personal as well as professional responsibility to fulfil. However, with a professional responsibility, I will make clear to my friend that her behaviour is not acceptable, and that in future, I will have an obligation to discuss this with the ward manager.

-- Anonymous, November 23, 2001

My colleague was wrong in not reporting the incident to the nurse in charge. I believe my colleague must have been acting on the paradigm of the wounded healer but he's also accountable for his actions. He thus has to report every incident to the nurse in charge for the appropriate action.

-- Anonymous, November 26, 2001

My colleague was wrong by not reporting the incident.As a healthcare professional she is suppose to be concerncerned about the well-being of Julie but in this case she chose to neglect her. She was suppose to work together with the rest of the MDT even even she does not agree with the current care. She could have discussed it with the MDT if she did not agree with the current care.

-- Anonymous, November 28, 2001

My colleague was wrong because his acts and ommissions could be detrimental to Julies health.However since he shared this issue with me I would advise him to explore it further with his clinical supervisor and understand that honesty is the best policy and learn to work as a team.

-- Anonymous, December 06, 2001

Counter- tranference should not let my colleague become judgemental of a patient who is vulunerable like Julie. This is in line with the UKCC (1992) Code of Practice Clause 7, which states that nurses should recognise and respect the uniqueness and dignity of each other and respond to their needs I feel my colleague need to adressed her own inner-most feelings (therapeutic self) or seek clinical supervsion to assist her to carry an effective ralationship with Julie.

-- Anonymous, December 09, 2001

According to UKCC code of conduct 1992, clause 1 states that nurses should "act in such manner as to promote and sefaguard the interests and well-being of patients and clients." Based on the code od conduct, the nurse is acting wrong in not informing the time about Julie's cutting. On the other hand she probably was taken for granted this situation, because she cut herself as well. In this case, the nurse also is in need for help, and the friend who heard it, shoul take serious in helping her friend and also informing /reminding her the UKCC code of conduct.

-- Anonymous, December 14, 2001

l believe my friend's omission was an act which goes against the ukcc code of conduct as it put the life of julie at risk. l also think there is an issue of counter transference which my friend needs to be made aware of and advised to take the most appropriate actions to show her objections to julie's care

-- Anonymous, February 09, 2002

I believe the reason nurses train for three years is to ensure any of their actions are for the better of the client. I therefore wouldnt agree that my friend`s interests and beliefs should not regarded in any form.

-- Anonymous, February 21, 2002

i think this individual`s beliefs should be allowed to intefer with the patient`s right to receive care

-- Anonymous, February 21, 2002

You should be careful l think as long she expresses her emotions there shouldn't be a problem but make sure she does it properly.

-- Anonymous, February 23, 2002

I THINK AS A NURSE IT IS IMPORTANT THAT ONE SHOULD ADHERE BY THE UKCC GUIDELINES ,WITHOUT GETTING CARRIED AWAY BY PERSONAL EMOTIONS,DEMON TRATING A PROFESSIONAL APPROACH AT ALL TIMES.

-- Anonymous, March 12, 2002