This knowledge assessment is used by the assessor to assess the learner’s knowledge. This assessment forms one piece of evidence and should be used in conjunction with other forms of evidence in the assessment process.
The learner must answer each question with an appropriate response to achieve a satisfactory result.Unless otherwise stated, a suggested word count of approximately50-80 words is required for each question.
Short answer questions
Question 1a How would you define ‘the law’?
‘The law’ may be defined as a set of rules and regulations that are abided by the people in a particular country or organisation towards the healthy functioning of the said country/organisation ,
Non compliance of the same may attract penalties to the person involved.
Question 1b Give a brief definition for the following and give examples relevant to the nursing profession:
Civil law involves monetary compensation to the defendant in lieu to the harm done to them.
Eg: mal practices, insurance and personal injury law suites, employment disputes.
Common law is derived from common sense. A broad spectrum consisting of principles based on tradition , justice and common sense.
Eg Nursing registration , fitness to practice , code of conduct .
A law enacted by state legislature.
Eg Nurse Practice Act, Privacy Act
Question 1c Why is it important to have an understanding of the law and its impact on nursing practices?
Since nursing is an accredited and governed profession in Australia, it is important for nurses to have an understanding of the law and it’s impact on nursing . It makes working with patients with varying age groups and varying ailments easier and safer for the nurses. Moreover the knowledge that the nurses are abided by the law brings in a feeling of security and safety to the patient as well. The knowledge of the law and policies empower the nurse to care for the patients in a better way knowing what is right and what is wrong in each situation that arises during patient care.
Question 1d Using appropriate resource research the Court System Hierarchy in Australia and complete the following flow chart.
Question 2 Define and include penalties (if applicable) for not following the legal and regulatory acts/guidelines below as they impact on nursing practice
Duty of care
A legal and moral obligation to ensure the well being of individuals under one’s care.
Eg: Nurses to Patients, Teachers to students, Parents to children.
A nominee appointed to take decisions on behalf of an individual /organisation ,when the latter is unable or deemed in capable of taking those life style decisions.
An action or lack thereof resulting in harm to the individual under one’s care .
An act of ‘being the voice’ of someone under your care essentially towards their betterment or benefit , when they are unable to do it by themselves.
An act of depriving someone of their rightful entitlement by virtue of caste, creed, color,sex or any likely factors that can make that individual different.
Speaking publically or by social media tarnishing or maligning someone’s reputation by virtue of false/misleading claims.
Restraint (include reason why and correct application)
A medium with which a person’s freedom of movement is restricted. It can be verbal, physical, chemical or psychological in type. People are restrained generally when they pose a threat to themselves and/or others around them. Restraint should be the last resort as other means to deescalate the person should be tried first.
It is a broad spectrum term where the responsibility of an employee’s actions are deemed on the employer. The employer is held responsible for employee’s action unless proven otherwise. The best example would be newspapers held accountable for reports by journalists on delicate issues like religious tolerance.
The act of acknowledging and allowing an action to take place. The consent needs to be informed for it to be safe. Types of consents are verbal, written or implied.
Holding someone against their will in a confined area without any legal reason or authority.
Assault and battery
Intimidating or aggravated or abusive physical contact resulting in bodily harm or psychological agony to a person.
Encroachment of other person’s personal space or property without proper authority or consent.
Functions of the coroner
To confirm and certify the death of an individual within a jurisdiction and to do an inquest into the manner /cause of death of the individual.
The moral values that are inherent in an individual by virtue of which he/she conducts himself/herself in the society.
The moral values or ethics to be upheld while doing experiments or research on human beings /animals.
A person who has absolute power and freedom over his will and actions.
Beneficence and non-maleficence
Beneficence is an action by an individual in the best interest of another individual .
Non-maleficence is the way of not acting on things that would not benefit the other person .
The system/quality of being fair ,righteous, equitable and philosophically correct .
Speaking publically or by social media tarnishing or maligning someone’s reputation by virtue of false/misleading claims.
Accurate and factual truth.
Question 3a Access the following website: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Open the Code of Professional Conduct for Nurses PDF file and read Conduct Statement 5 regarding privacy and confidentiality.
Use the information from the Code of Professional Conduct for Nurses to complete the following statement. Include at least three points in your answer.
“As an enrolled nurse I can protect client information and ensure confidentiality is maintained by”
• by using the information gathered from patients for professional purpose only.
• Informed disclosure to multi disciplinary team with patient’s consent .
• by using professional judgement on information disclosure .
Question 4a Using appropriate resources research Australian Health websites for information about Advanced Care Directives.
In your own words outline why advance care planning is important and what the relevance is for the enrolled nurse. Consider cultural and religious beliefs in your answers.
Advance care planning is an important aspect of patient care. Patients, family members and health care staff benefit from advanced care planning. It is better done when the patient has the ability to make own decisions and can convey them to the staff. It is then documented and kept with other documents related to the patient’s care.It can be revisited and amended as and when the patient needs it to be.
Advance care plan includes details of how the patient wants to be cared for if he becomes seriously unwell during his life. If he/she doesnot have the abi;ity to convey their wishes at that point advanced care directive acts as a great help. It takes the pressure off the immediate family members from having to make difficult decisions regarding their loved one’s care. It makes the care planning easier for the health care team as they are in the full know of what the patient wants to be done for him.
As an Enrolled nurse my primary objective would be to provide patient-centric care at the best possible level. If the patient is of a particular cultural/religious belief which prevents him from having certain procedures done to him and if he has mentioned them in the advanced care directive, it will enable me to perform my care duties for that patient well within the boundaries of my scope of practise in a safer way . I wouldn’t be hesitant to educate other staff members of the same as there will be a continuity of care established for the patient.
Advance care planning involves end of life care too. This would enable me to make the necessary arrangements based on the patient’s decision ,like sacrament of the sick if he is a catholic, tohave special hymns or prayers to be done at his bed side and advice the family and relatives accordingly. As a whole as an Enrolled nurse and as a part of the health care team caring for the patient ,I would personally find it beneficial for the patient and the staff , if there is an advanced care directive present for the patient.
Question 4b Briefly explain the role or meaning of the following:
Power of Attorney
Legal capacity given to a person to act on your behalf in your absence , for a definite period of time. Usually given to a family member or a close relative.
Enduring Power of Attorney
Legal capacity given to a person to take decisions and act on your behalf for an indefinite period of time or until your death ,when you are deemed incapable of making legal/financial decisions on your own.
A nominee appointed to take decisions on behalf of an individual /organisation ,when the latter is unable or deemed incapable of taking those life style decisions.
An advanced care plan or care directive that provides insight into an individual’s wishes and end of life care , once they become unwell or unable to decide for themselves.
Not for Resuscitation order
A medical decision collectively made by doctors , health care staff, patient and family as to not to perform any life saving procedures on a patient if she/he becomes acutely unwell.
Life prolonging treatments
Medical treatments involving antibiotics, oxygen therapy, ventilators or invasive procedures like NG and GI tubes, PEG feeds , that would prolong the life of a near death patient.
Question 5 Provide the website link where you can find information about the following:
The human right to access healthcare
National Safety and Quality Health Service (NSQHS) Standards 2012.
Question 5b Using https://www.legislation.gov.au find and document the latest version (year) of the following Acts, standards and legislation:
Age Discrimination Act ( 2011)
Australian Human Rights Commission Act (2018)
Disability Discrimination Act (2009)
Racial Discrimination Act (2015)
Sex Discrimination Act (2013)
Health Records Act (Commonwealth) (2017)
Aged Care Act (Commonwealth) (2018)
Carers Recognition Legislation (2010)
Criminal Code Act (Commonwealth) (2018)
Disability Discrimination Act (Commonwealth) (2018)
Privacy Act (Commonwealth) (2017)
Workplace Health and Safety (2017)
Question 5c Find two (2) websites that deal specifically with children and young person’s legislation in Australia
Question 5d In a short sentence, explain what EEO means
EEO stands for Equal Employment Opportunity . It means that the eligibility of a person for a job is not affected by his /her sex, caste, creed, color or ethnicity but by the virtue of his qualifications and experience and legal entitlement to live and work in the country.
Question 5e The Health Practitioner Regulation National Law, as in force in participating States and Territories, establishes a national registration and accreditation scheme for health practitioners. Using the following website, list the practitioners that the national registration and accreditation scheme covers.https://www.ahpra.gov.au/
• Aboriginal and Torres Strait Islander Health Practice
• Chinese Medicine
• Medical Radiation Practice
• Nursing and Midwifery
• Occupational Therapy
Question 5f Read each case study and identify which Act the scenario relates to, and state what the implications may be and what actions need to be taken.
Information to assist your answers can be found in the following websites
Health Practitioner Regulation National Law (NSW) No 86a
Poisons and Therapeutic Goods Act (NSW) 1966 and Regulation 2008
Workplace health and Safety Act (NSW) 2011
Coroners Act (NSW) 2009
Case Study 1
A client complains of severe pain and asks the nurse for a different drug to that which has been prescribed by the doctor.
Identify which Act this case study relates to and its implication for the nurse’s actions.
Poisons and Therapeutic Goods Act (NSW) 1966 and Regulation 2008
The nurse is not authorised to dispense off uncharted medications to patients as the nurses can’t prescribe medications on their own. The nurse who is guilty of this can be subjected to fines,imprisonment or have their registration to practice revoked .
Case Study 2
During a hospital accreditation survey, the surveyor discovered that one registered nurse and one enrolled nurse in the facility did not have current Nursing and Midwifery Board of Australia authority to Practise.
Identify which Act the above case study relates to and consider the implications for the nurse and the employer.
Health Practitioner Regulation National Law (NSW) No 86a
The nurses should be registered with the regulating authority for practising in healthcare facilities. If found guilty of not complying with the regulatory authority regulations their right to practise will be revoked and their names will be added to the cancelled practitioners register.
The employer would essentially face legal difficulties and fines for being non compliant with the regulatory authority’s policies on employee’s registrations before allowing them to work .
Case Study 3
A nurse attempts to move a heavy client up the bed without using available lifting equipment.
Identify which Act the case study relates to and the possible implications of the nurse’s actions.
Workplace health and Safety Act (NSW) 2011
This is a clear case of non compliance with work health and safety. The nurse is inevitably putting herself and her patient at risk.She can get injured and become unable to work , The work place insurance will not cover the damage as she was expected to follow policies and was adequately trained .
If the patient gets hurt, the nurse becomes solely responsible for that and due disciplinary actions or even legal suites can be made against her by the affected patient or his family, which will have due implications on her renewal of registration in the future.
Case Study 4
A client on your ward has died sixteen hours following an emergency appendectomy under general anaesthetic.
Coroners Act (NSW) 2009
An inquest would be done to confirm the cause and manner of death by the coroner as it was an unnatural death. Any medical negligence would be brought up during the process and can lead to the related staff members being tried in court and convicted if found guilty.
Question 5g Access: www.legislation.nsw.gov.au , select “search” to find the Coroners Act 2009 (NSW)
Refer to the Coroners Act Division 1 “Cases in which inquest is to be held” and find which circumstance the above case study relates to.
State in full, the circumstances that apply to this scenario.
• The patient died in the hospital following a non critical surgical procedure under general anaesthesia from which no complications were expected.
• The cause and manner of death needs to be confirmed as a medical officer has not ascertained the death.
• Unnatural and sudden unexpected death.
Question 6a Give an example of how you may apply each of the value statements in the Australian Code of Ethics for Nurses to your practice as an enrolled nurse. Referring to the information in the Code will assist your answer http://www.nursingmidwiferyboard.gov.au/
Nurses value quality nursing care for all people.
As an enrolled nurse I believe in accessibility of care for all irrespective of all the differences in the society. I will ensure that the Patient needs are addressed as a priority and patient satisfaction is the ultimate goal. I will plan my day effectively so as I can provide ample time for each and every patient of mine.
Nurses value respect and kindness for self and others.
I will always be respectful towards my patients and my co-workers. I will not do anything that would cause my head hang in shame. I will treat all my patients with respect and dignity at all times. I will be empathetic with my patients and their families. I would do anything within my scope of practice to help my patients and colleagues.
Nurses value the diversity of people.
I will try not to judge anyone based on their physical appearance . I will not be biased to any one particular category of patients. I will understand the different cultural and social background of patients and behave accordingly to make their stay in the hospital as comfortable as it could be.
Nurses value access to quality nursing and health care for all people.
I will stand by the right for healthcare act at all times. I will provide the best quality nursing care to all my patients irrespective of their socio-economic situations. I will work closely with the multi disciplinary team so as to ensure that all needs of my patients are addressed while they are in my care and once they go home post discharge.
Nurses value informed decision making.
I will keep myself up to date with the modern technology in medicine and with various disease conditions. I will attend in house trainings and education development programs. I will stress the importance of evidence based nursing care and will make sure that my patients and their families are aware of all the decisions made about the patient’s care. I will provide patient and family education on topics that require patient’s consent . I will attend the case conferences and bed meetings to actively participate in the planning of care for my patients so that I can advice them better.
Nurses value a culture of safety in nursing and health care.
I will not fall prey for the bullying culture or intimidation of any sort. I will address the matters of concern with the appropriate authorities in a timely manner. I will respect my patients and co-workers and will form a healthy working relationship with everyone. I will ensure that the patients feel safe and well looked after no matter what backgrounds they come from.
Nurses value ethical management of information.
I will give utmost importance to patient confidentiality. I will follow the guidelines strictly for open disclosure and for documentation. I would encourage transparency of care with patients .
Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing.
I will do my part for a green foot print by kerbing pollution . Appropriate waste disposal techniques will be followed. I will encourage my colleagues and patients and families to follow suit. Equally important is to minimise the amount of waste generated. I will try my level best to curtail the amount of waste by using the resources effectively and wisely . I would encourage others to do the same there by saving the facility funds that can be utilised on better things.
Question 6b Access http://www.nursingmidwiferyboard.gov.au/ and click on the Registration and Endorsement tab/re-entry to practice.
Locate the self-assessment for Enrolled nurse questionnaire and provide the link. You do not need to complete this questionnaire.
Define “recency of practice” and list types of evidence that this would require.
Research how many Continuous Professional Development (CPD) points/hours are required to maintain your Enrolled Nurse registration.
Recency of Practice
It is a strategy to ensure that the registered health practitioner is competent and can effectively work in their field of practice .this is done by making sure that they have practiced in their chosen field of work recently and has kept in touch with their profession. The types of evidence for recency depend on the profession, the level of experience of the practitioner and, if applicable, the length of absence from the field.
The applicant needs to provide evidence of practicing at least 450 hours in the past 3 years.
The types of evidence include:
• a service statement from employer
• pay slips
• income statement for the year, and
• other documents showing the hours and dates worked.
CPD points/hours required for EN registration 20 hours
Question 7a Answer the following questions using the decision making model from the nursing and midwifery website.
How has your own upbringing influenced your beliefs?
How do you think it will influence your response to situations requiring ethical decision making?
I was born in a devout Christian family and I am a practising Christian even now. The fact that I was born in a country diverse with its population and religious beliefs ,I am neutral to religious propaganda of al sorts and don’t differentiate people based on their religion or caste. This will help me with my decision making skills in nursing. I have travelled extensively and was fortunate enough to live with people of varying ethnicities and cultural beliefs. I have a part in me that helps me to adjust with any sort of cultural or ethnic backgrounds everywhere. I don’t feel awkward or odd while dealing with people of the above said backgrounds. This is an added advantage to my nursing skills when it comes to decision making at work. I am not prejudistic or judgemental and I am open to reasoning so as to arrive at a mutually beneficial ground for both the patient and myself.
The most important person in a healthcare facility is the patient as per my belief . They are the main reason why that facility is there and we as nurses are working there. So it is important that the patient gets all the appropriate considerations while he is there. The patient does not have to change his moral and ethical viewpoints to be in a hospital , but it is the duty of the staff to adjust and adapt to the patient so as he /she benefits from being in the hospital. As an enrolled nurse I would be open to learning to improvise on my knowledge of a particular culture or religion so as the patient can benefit from my care.
Question 7b For each of the following describe the issue, and how or why it may cause a moral or ethical dilemma for some staff.
Abortion (termination of pregnancy)
Abortion is legal in certain countries and can be sought after if the mother’s life is in danger in certain others. People even opt for the pregnancy to be terminated if there is an abnormality in the foetus during the anomaly scans. The religious and cultural values of certain people who are caring for those patients can conflict with the interest of the patient . For eg in devout Christian countries like Ireland , abortion was not allowed until recently .
The main issue the staff faces with organ donation is conditional and directed deceased organ donations. The family or NOK of the deceased might keep a directive that the organs should be donated to a particular community or a religious group. This can put the staff in an ethical and moral dilemma.
This subject has to be dealt with a fine toothed comb as Euthanasia is illegal in Australia. The main dilemma the staff face would be the wanting of the patient and or the family to end their suffering as there is no cure for their condition. The staff morality is torn between the patient’s plight and the legal aspects of euthanasia . The knowledge that they can put an end to the patient’s suffering by the flick of a switch and the legalities preventing them from doing so is stressful. Having to explain the helplessness to the pleading patient/family is nerve wracking .
The religious belief of the staff member involved along with their culture also acts as a stressor.
Stem cell research
Difficult dilemmas arise regarding sensitive downstream research, consent to donate materials for human Stem Cell research, early clinical trials of human Stem Cell therapies, and oversight of human Stem Cell research. The religious beliefs play an important role in evoking these dilemmas. The divine origin theory and the biblical and other religious books and teachings and the inherent upbringing in faith in a religious order can all put the staff members involved experience difficulties.
Question 8a In the following case study, do you consider that Katrina acted appropriately and why. Refer to “Professional Code of Conduct” in your answer.www.nursingandmidwiferyboard.gov.au.
Nurse Katrina finds herself very attracted to one of her clients. She creates opportunities to spend extra time with him and thinks about him when off duty. Her preoccupation with this client begins to interfere with her other nursing duties. The client begins to make sexual advances towards her when they are alone and she is tempted to respond as the attraction is mutual. Katrina realises that she is losing control of the situation and is crossing a professional boundary. She seeks the help of an experienced colleague for advice.
In my opinion the nurse in the question flawed the ‘Professional code of Conduct’ by developing personal feelings for her client . She was wrong to dedicate extra time for the patient and thereby intimidating the patient resulting in sexual advances from him. She forgot about her Duty of Care to other patients by spending more time with this particular patient .
In saying that , she had the late realisation of her duties and her professional obligation to her clients , which is a good thing . She was right to confide in an experienced colleague about the situation and to have sought help.
Question 8b Nurses need to be aware that clients will have certain expectations of the care they will receive from a health service. A list of these expectations is presented in a NSW Department of Health Policy titled ‘NSW Patient Safety and Clinical Quality Program’ in Section 4. This document may be viewed in full at the following website http://www.health.nsw.gov.au/policies/pd/2005/pdf/PD2005_608.pdf
What do you think a patient requiring treatment from a health service might reasonably expect?
Appropriate treatment in a timely manner , for their disease condition.
They should get the best care available for their illness .
They should be treated with respect and dignity.
Transparent communication with everyone involved in their care.
The staff looking after them have appropriate skills for doing so .
The team responsible for their care are efficient and have all the necessary resources for implementing quality care.
That they feel safe and protected in the health care facility .
That there is a working feedback system about their care ,which they can make use of at any time .
An effective complaints and grievances addressal system in place .
A governing body to oversee the functioning of the health care staff and the facility.
Question 8c It is important to handle client complaints with sensitivity and in line with organisational policies and procedures. Let’s take a look at an example of a client complaint: The nurse answers the call button and is informed by the client that they wish to complain about the noise in the ward during the night.
How would the nurse would best deal with the complaint?
Complaints may be received in person, over the telephone or in writing. Staff at
all levels must accept complaints and know what action they can take to resolve
With complaints received verbally staff should:
• Give a calm explanation of what happened if they do know why it happened.
• Offer an apology if warranted.
• Encourage the complainant to discuss their concerns with the relevant Clinician or other staff.
• Speak to the relevant clinician or other staff on behalf of the complainant.
• Advise the complainant of the complaint management process.
• Know when to refer the complaint on.
• Comprehensively record the conversation and concerns, along with all the
necessary details (names, addresses, and hospital numbers, identified
• If possible, provide a copy of the completed record to the complainant to ensure they agree that it is factually correct.
• Advise them of the appropriately identified person if they wish to send any written correspondence.
• Commence action on the complaint if within the scope of practice .
Question 8d Enrolled nurses need to be aware that social media policies exist. Access the social media policy on the nurses and midwifery website, and give four examples of information that should NOT be posted.
Personal information about patients.
Personal information about colleagues,
Official information for the work-related purpose it was intended.
Information that could potentially result in victimisation, harassment or bullying.
Question 9 Access the site http://www.health.nsw.gov.au and using the search area view the NSW Health Open Disclosure Guidelines (2007)
Briefly describe the key features of these guidelines.
The key feature of this policy includes:
-Minimum requirements for implementing open disclosure within NSW Health Services.
-Defines and describes what open disclosure is and in what circumstances is it required.
-Outlines the parts of the open disclosure procedure – clinician disclosure and formal open disclosure.
-Summaries the steps in the formal open disclosure process.
-Outlines the roles and responsibilities for NSW Health staff in relation to open disclosure
– Includes open disclosure as a key element of the early response to a patient
Safety incident ,involving the patient and/or their support person.
Question 10a Using the following information, make an appropriate entry that could appear in the progress notes.
Mrs Samantha Wells
78 Old Rd
Lake view 2002
DOB 24th March 1945
It is Saturday 12th November 2016 at 1030. You have just showered Mrs Wells. She had red marks on her left ankle and needed you to help with most of the shower and dressing. You told the RN about the marks. Mrs Wells is not helpful refusing to sit in the chair after the shower and insisting she needed to go back to bed. You help her back into bed. You return in 40 minutes and Mrs Wells is happy to sit out of bed for lunch- so you help her into the chair.
12/11/2016, 10:45 . Received the care of 78 yr old lady this morning. Assisted Mrs. Wells with personal hygiene this morning. She was assisted with most of her shower and dressing as the patient was unable to help herself with showering and dressing. During the shower it was noted that the patient had red marks on her left ankle. Barrier cream applied to the redness. rN notified of the same. Post shower the patient declined to sit in the chair and wanted to go back to bed . Patient’s wishes respected and assisted back to bed.
11:15, Spoke to Mrs. Wells and she was feeling a lot better and relaxed. Agreed to sit out in her chair for lunch. Red marks on the left ankle still persistent. Assisted the patient into her chair and told her that will be back to her when the lunch is served. ….Georgi Mathew (ENS).
Question 10b Outline the reporting process for the following:
Mandatory reporting is a strategy to identify and deal with the abuse or neglect of young members of the society , which may otherwise be hidden or go un detected or un reported .The legislation mandates all the people in the society to be watchful , at all times, towards the well being of the younger people in the society and report any untowardly actions aimed at them by an individual or a group of individuals . Every person is morally responsible to report such incidents. The legislation provides the reporter with anonymity and safety from disclosure. Any person can report an act of atrocity towards a young one and they do not essentially have to be mandatory reporters.
If an individual feels that a child is being subjected to, or is at a risk of significant harm by the actions of another individual or group of individuals, it must be reported as a child abuse. The abuse can be physical, sexual, psychological or even ill treatment or neglect from the hands of another person. The incidents related to domestic violence aimed at the child which can be harmful and can affect the child in an adverse way should be reported as it falls under child abuse .
Elder abuse can be ‘a single or a repeated act or lack of action in any relationship which has an element of trust which causes harm or distress to an elderly person.’ It can be physical, mental, sexual or financial abuse .Compulsive reporting is an element of comprehensive reporting of elder abuse that will prevent such incidents in the future .
Question 11 Access the video https://www.youtube.com/watch?v=fS0V96tIUx4 and answer the following questions
Do you think it is important for the nurse to have the opportunity to discuss / debate moral and ethical issues related to client care and why?
Nurses are ethically and legally bound to protect the privacy and confidentiality of people receiving their care. However, in certain instances disclosure of information is essential to provide competent care. This must be done after seeking consent from the consumer or their representative. Professional judgement needs to be upheld where nurses recognise that they may be required by law to disclose certain information for professional reasons.
If you were concerned about the care being given to, or withheld from your client, where would you go for advice or guidance?
In that instance, I would go and speak to the nurse in charge of the shift or Refer back to the policy on open disclosure. The open disclosure process begins with clinician disclosure. The process may progress to formal open disclosure for any patient safety incident, as determined by the Director of Clinical Governance (DCG) and/or the Facility/Operations/Service Manager, the patient and/or their support person.