Systematic approach to recruitment and selection,

Systematic approach to recruitment and selection, Systematic approach to recruitment and selection, and its efficacy in attracting diverse workforce within the equal opportunities employment legal framework Introduction In modern organizations, diversity management has become synonymous with fair and equal opportunities employment, even though traditional context of equal opportunities is closely related with legal aspects of treatments of potential and current employees. Today, diversity management activities are grounded in monitoring of direct and indirect discrimination and interventions to reinforce fair treatment of women, ethnic minorities, the aged and the disabled. Therefore, the fairness paradigm has become the benchmark for managing differences and must be congruent with business objectives. This paradigm emerged from the perspectives that organizations need a diverse workforce to re-think and re-define primary tasks related to strategies including organizational objectives, goals, markets, products and resource allocations (Cornelius, Gooch and Todd in Noon and Ogbonna 2001). Diversity management is different from equal opportunities, yet it is based on the same foundation. Equal opportu nities amplify policies and practices that reflect the external legal framework and offer chances for competition. In human resource management, this is usually inherent in the practices of recruitment and selection, and at times in training and development. The basic premise is to ensure that equal opportunities should be given to people who are in competition with each other for areas of employment and selection, regardless of their age, gender, race or disability. The objective is not to elicit equal outcome. When implemented within the organizational framework that follows systematic approach to human resources management, the fine line between equal opportunities and diversity management, at times, becomes blurred. Consequently, organizations are often found striving for a balance in maintaining diverse workforce within the realms of the equal opportunity laws to achieve equality and organizational strategic objectives. Given the blurring definition of diversity and equal opportunities in employment, critics find systematic approach to recruitment and selection less appealing as strategic human resource management component. Others argue that as a critical component of HRM, recruitment and selection accommodates for both external and internal environmental change. In the ensuing discussion, the researcher shall evaluate the extent of the validity of this debate, and determine how attractive systematic approach to recruitment and selection is in acquiring diverse workforce in organizatio ns, and how successful organizations have been in integrating equal opportunities practices. Critical Evaluation of Systematic Approach to Recruitment and Selection Recruitment and selection processes are essential for strategic HRM involving and including job identification, job description, interviews, selection and orientation. It involves complex techniques and skills that assist decision-makers in selecting applicants for achieving organizational objectives, as well as personifies the organizational values, culture, behaviour and discipline. Recruitment and selection processes are based on systematic evaluation of personal and professional values, interpersonal skills, problem solving ability, attitude and behaviour of candidates, and testing them whether their attributes are congruent with the organizational values and objectives. Testing the type of employees the firm is about to hire helps determine the type of personality and how to mould them to the organizational culture. Selection decision is often based on a host of factors pertaining to job match, ability, professional qualifications, personal abilities, as well as employee's personality to match with the organization (Cornelius, Gooch and Todd in Noon and Ogbonna 2001). This traditional approach (also known as systematic approach) has evolved over the years and become refined as strategic recruitment and selection processes. Traditional approaches to recruitment and selection in earlier organizations based on psychometric models often assess applicant's performance with job fit whereas in modern organizations the systematic approach to recruitment and selection processes is strategic in nature, even though the foundation of the system has remained congruent with traditional approach (Beardwell and Holden 2003). Experts (Beardwell and Holden 2003; Thornhill et al., 2000) believe modern systematic approach to resourcing organizations has harmoniously integrated overall organizational strategies and processes rather than merely focusing on job-specific criteria. As a result, recruitment and selection processes have strategic implications, starting from how resourcing offers competitive advantage in the short run to valuing employees as organizational assets. The processes are aimed at achieving organizational objectives aligned with long-term organizational strategic vision. Components of systematic approach to recruitment, which include job analysis, job descriptions, development of competence frameworks, identification of person specifications and accountability, as well as advertisement, executive search, and Internet recruitment provide alternatives and ease to the process of recruitment for organizational resource acquisition. Alternatively, traditional approach to selection has remained somewhat similar to the preceding methods. For example, earlier recruitment processes have heavily relied on evaluation criteria, reliability on validity of candidate information, techniques of interviews and psychometric tests. Selection has also been based on matching job types with work styles through simulated evaluation tests. Today these components of selection are conducted in the same manner but often aided by the use of information technology systems and refined by integration of organizational objectives. Nevertheless, the fact remains recruitment and selection processes play critical roles in resourcing organizations and pooling of work skills. According to Beardwell and Holden (2003), HRM processes such as recruitment and selection are no longer viewed as the best-fit approach but have changed to resource-based view or best practice approach†. This makes them imperative for supporting corporate strategie s and organizational change management by acting as a lever for competitive advantage for organizations. Not only this, systematic approach to recruitment and selection has been set out to enable organizational management to establish frameworks for performance management. It is at this initial stage that managers determine roles, responsibilities, and performance outcomes to match with the most suitably skilled and motivated candidates for achieving organizational objectives. Moreover, basic principles for systematic approach to recruitment involve setting competitive framework for candidates to gauge future performance. For instance, evaluation and testing processes involve simulated tasks, psychometric tests, and validation of qualifications. It is through these simulated tests that managers gauge attitudes, behaviours, personality, and interaction with the candidates to determine job and candidate match. Selection is based on merit defined by the job specifications, individual commitment, and suitability for the positions within the company. The objectivity is to combine worker attr ibutes, skills, and abilities, and fit it within the organizational policies, procedures, and cultural frameworks, and thereby not to waste efforts and resources in conflict, power relations, subordination and normative institutional clashes in the future (Lucas 2003). In this regard, one could observe that systematic approach to recruitment, selection integrates external environmental factors like legal frameworks in policies, and procedures to ensure organizations establish a direct relationship with the candidates, job market and the legal environment. From this perspective, systematic approach to recruitment and selection processes is also said to have contributed to promoting and establishing trends for fair employment. However, critics do not have a consensus on fair distribution of representations of individuals where recruitment and selection processes are concerned. For example, Cornelius, Gooch and Todd (2001) are of the view that traditional equal-opportunity practices usually have unequal outcomes, depending on the culture of the organization, as well as the type of workforce required for the job. For example, gender and age discrimination are likely to become issues for unequal employment in industries where workers are required to be male of young age such as the logging industry. Commitment towards equal opportunity for fair representation of groups of individuals in recruitment and selection processes does not add value but rather hinders achievement of organizational objectives. Consequently, systematic approaches to recruitment and selection are not really effective in resolving strategic HRM issues pertaining to establishment of legal frameworks. Yet, one cannot deny the fact that organizations have not benefited from the systematic approach to pursue fair treatment and equal opportunities for employment. It is the essence of the systematic approach to recruitment, which takes into account of the changing environment, as well as business strategies that makes it dynamic, and thereby is effective in resolving management issues of diversity. Attraction of diverse workforce and implementation of equal opportunities employment There are many factors that are responsible for making an organization attractive for employees. Organizational reputation recognized for its fairness, culture, wage and talent pool, for example, are attraction for candidates. Similarly, job attractiveness is also dependent on the processes of recruitment and selection, and goals and ideology of the organization. In most organizations today, having a diverse workforce is no longer a luxury but a necessity and even a competitive advantage. A diverse workforce is essential in pooling skills and qualifications for achieving organizational strategic objectives in today's complex business environment (Sims 2002). Diversity, many claim, is distinguishable from equal opportunity as it serves the self-interest of organizations rather than social justice. It involves pursuance of policies that meet the demand of labour pool, and thereby gain the best qualifications from employees. It makes the economic justification for hiring individual s valuable in terms of business requirement, and labour market supply. It takes into account of the expressed need for employee satisfaction, which would lead to quality in productivity and increasing the talent pool direly required by dynamic organizations (Noon and Ogbonna 2001). Diversity is intrinsically linked with equal opportunity, according to experts (Thornley 2003). They argue that the labour market is typically characterized by competition where individuals compete for employment based on commutative justice. Free competition is prevalent and the reward for it is employment. Candidates vie for positions in organizations through display of qualifications, academic performance, ownership of skills, attitudes, and positive behaviours. Employers, on the other hand, form benchmarks for employment based on organizational requirements, policies and procedures in recruitment and selection. Employers are also mandated to follow government policy to benchmark wages, inflation and competitiveness for fair distribution of income and wealth. The government controls fair distribution of income by implementing policies of equal employment opportunities to eliminate formal and informal discrimination based on gender, age, race and disability. In the UK, this practic e is regulated by the EOC and through legal Acts often tends to constrain organizations for implementing fair employment. Despite critical objections to the efficacy and strategic nature of systematic approach to recruitment and selection, management of organizations cannot deny the fact that HRM processes have integrated diversity and equal opportunities policies and procedures to avoid adverse effects of the law. The EOC has formulated laws such as the Employment Act 1989/2002, Sex Discrimination Act, Equal Pay Act, Disability Discrimination Act 1995, Race Relations Act 1976, Employment Relations Act 1999 and the Employment Equality Regulations 2003 to curb discrimination of applicants for employment based on their gender, race, age and disability. To ensure that these laws are implemented within organizations, organizations have started to invest heavily in HRM processes congruent with the prescribed legal frameworks set by the EOC and the government. For most organizations, investment in these processes are necessary for compliance, while for others it is the long-term objective-achievement efforts as they view making their organization attractive to potential talents a strategic activity in itself. Consequently, HRM processes have been devised based on objective testing of candidates. Recruitment and selection models used for evaluating job performance, personality tests, cognitive ability tests, as well as testing of job knowledge take into account of achievement and skill proficiency. Organizations no longer depend on individual interviewer impressions to select and match candidates based on qualifications matching with job criteria. Instead, candidates are being tested for their abilities, skills and knowledge correlating with job performance regardless of their sex, age, race or disability (Hough and Oswald 2000). Furthermore, organizations are also using integrity tests and self-reports to check reliability and validity of counterproductive work behaviours. These systematic methods of recruitment and selection are based on the premise that effective recruitment leads to smooth functioning of organizations and successful recruitment and selection is based on finding the right person with the right skills, expertise and qualifications for achieving organizational objectives and contributing towards organizational values. For this purpose, a fair and consistent system of recruitment helps lessen the burden of employee conflict, turnover, absenteeism and dismissals. According to the Workforce Development Plan (2004) in the UK, for organizations to develop leadership capacity in their respective industry, they must develop skills and capacity of workforce, organizational performance management framework, pay and rewards system and, most importantly, ensure that equal opportunity and diversity practices are aligned with the entire recruitment and selection processes. The focus on abilities and aptitudes, and not stereotypes, would help lead to fair judgements about individuals based on their merits rather than their gender, age, race or disability (EOC 2006). Conclusion From the above discussion, one can conclude that the strategic nature of the systematic approach to recruitment and selection has made it the ideal tool for today's organizations to gain a competitive advantage in acquisition of skills and a diverse workforce. Strategic HRM requires that processes be in line with internal and external factors affecting organizational dynamics. For this purpose, these processes have to be flexible to accommodate change in the business environment. Two of the main factors that have been affecting modern organizations are equal employment opportunities and diversity. Self-interest for competitive advantage, as well as legal mandates have motivated organizations to invest in HRM processes and techniques to promote diversity and equal opportunities employment. These are evident in the various techniques used in recruitment and selection tests, as well as policies for hiring candidates. The practice is not isolated but rather has become the benchmark for organizations to attract a diverse workforce and remain aligned with the legal framework. Despite critics’ arguments, one could conclude that the traditional approach to recruitment and selection in today's organizations is objective in providing the required competitive advantage and strategic edge for competing in the highly dynamic business environment. References Beardwell, I. Holden, L. and Claydon (2003) Human Resource Management A Contemporary Approach. Fourth Edition. FT Prentice Hall. Employers Organization for Local Government (2004) Workforce Development Planning Guidance Document – May 2004. Employers Organization for Local Government, Online accessed on 12 January 2007 from: http://www.idea-knowledge.gov.uk/idk/aio/4465769. Equal Opportunities Commission (2006) Recruiting Staff Guidance for Managers and Supervisors, May 2006. Equal Opportunities Commission. Hough, L. M. and Oswald, F. L. (2000) Personnel Selection: Looking toward the Future-Remembering the Past. Annual Review of Psychology. pp. 631. Lucas, R. E. (2003) Employment Relations in the Hospitality and Tourism Industries. Routledge: New York. pp. 84 Millmore, M. (2003) Just How Extensive is the Practice of Strategic Recruitment and Selection? Journal of Management pp. 87 Noon, M. and Ogbonna, E. (eds) (2001) Equality, Diversity and Disadvantage in Employment. Palgrave: Basingstoke, England. pp. 32. Sims, R. R. (2002) Organizational Success through Effective Human Resources Management. Quorum Books: Westport, CT. Publication Year: pp. 107 Storey, J. (1992) Developments in the Management of Human Resources, Oxford: Blackwell. Thornhill, A., Lewis, P., Millmore, M. and Saunders, M. (2000) Managing Change: A Human Resource Strategy Approach, Harlow: Financial Times, Prentice Hall. Thornley, C. (2003) Labour market policy and inequality in the UK in Industrial and Labour Market Policy and Performance: Issues and Perspectives (eds) Cofey, D and Thornley, C., Routledge: New York. pp. 83

Ethical and Legal Issues in nursing Essay

The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. The purpose of this assignment will be to critically discuss an episode of care encountered whilst on clinical placement. The episode of care involves the covert administration of medication to an elderly patient. The decision to covertly administer the medication will be critically assessed in this assignment. The Gibbs(1988) reflection model will be used to guide the discussion. The discussion will also consider the legal, ethical and professional issues surrounding covert medication. In the mental health sector, medication non-adherence remains a serious health-care problem with far-reaching ramifications for patients, their relatives and health-care professionals. Harris et al. (2008) found that between 40 and 60% of mental health patients fail to adhere to their medication treatment plan. This number increased to 50 and 70% for elderly patients with dementia, and between 75 to 85% among patients with schizophrenia and bi-polar disorders. In such cases, where the patient’s well being is at risk and the treatment is essential, health-care professionals may resort to disguising medications in food and drink. The medication is crushed or liquefied and mixed with foodstuff. This practice of concealment is called covert medication(NMC,2008). By covertly administering medication, the patient consumes a drug without the required informed consent. The Gibbs(1988) reflection model has been chosen for the purpose of this assignment as it allows the author to reflec t and think systematically about the episode of care. The initial stage of Gibbs’ reflective cycle is ‘Description’; in which the author is required to describe the events which occurred. In order to comply with the NMC(2010) code of conduct and guidelines on patient confidentiality, the patient will be called Mr Walker. Mr Walker, an 80-year-old service user was temporary placed at the respite care home. Mr Walker had severe dementia, and was  unable to communicate effectively. He frequently resisted all essential nursing care. Mr Walker’s medical history also included hypertension and angina. He was prescribed blood pressure medication (enapril tablets) to stabilise his blood pressure and to reduce the risk of stroke and heart attacks. He was also prescribed diuretics and medication to prevent further angina attacks. Mr Walker frequently refused to take his medication; spitting out the tablets and refusing to swallow. The nurse in charge, concerned about the deterioration of Mr Walker’s health, considered the option to covertly administer his medication. The MDT held a meeting and reached the decision to covertly administer Mr Walker’s medicat ion. The second stage of the Gibbs’ reflective cycle is ‘Feelings’, requiring the author to briefly discuss her reactions and feelings. The author felt the decision to covertly administer medication was morally correct and ethically permissible. The author refers to the deontology ethical theory to support her thoughts and feelings. The NMC code of conduct considered by Beckwith and Franklin(2011) as a model of rule deontology states that all health-care professionals should â€Å"safeguard and promote the interests and well-being of patients†. The act of covertly administering medication could therefore be deemed morally correct. The practitioners intended on acting in the best interest of Mr Walker irrespective of the consequences of their actions (breaching patient autonomy). Their actions promoted and safeguarded Mr Walker’s health and well-being. Husted (2008) argues that from a deontological point of view, violating an individual’s autonomy is sometimes necessary to promote the individual’s best interest. In this case it could therefore be ethically permissible to covertly administer medication without Mr Walker’s consent. The medication is essential and promotes Mr Walker’s long-term autonomy and safeguards his health and well-being. Similarly, the ethical princip les of beneficence and non-maleficence could be used to justify the use of covert-medication (Wheeler 2008). The principle of beneficence is an ethical principle derived from the duty to provide benefits and to consider the benefits of an action against the risk. According to Masters(2005), health-care practitioners have a professional duty and an ethical obligation to carry out positive actions with the aim of safeguarding their patient’s health and well-being. With this notion in mind, covert medication could be morally justified if it safeguards the  welfare of the patient. In this case, the discontinuation of medication would have had a detrimental effect on Mr Walker. Thus administering the medication covertly was in accordance with the principle of beneficence. In this case, one could also argue that the medication was actually acting as an autonomy restoring agent (Wong et al,2005). Mr Walker’s autonomy was restored in that he was relieved of severe pain. The medication also worked by improving his quality of life. Several studies on the chemical and physical restrain t of aggressive dementia patients also often show a preference to covert medication (Treolar et al,2001). Covert medication is often considered the least ‘restrictive’ and ‘inhumane’ way of administering medication when considering alternatives like physical and technical restraint to administer medication by force (Engedal,2005). Such alternatives to covert medication are unsafe and can have long lasting negative psychological effects on the patient (Wong et al, 2005). However, covert medication is not without its shortcomings. The team was deceiving Mr Walker, an already confused, poorly, frail, weakened and vulnerable individual. In the Dickens et al(2007) study, many patients expressed this view of covert-medication as an act of deception. They considered covert medication as an extremely coercive practice violating their personal rights. This resultantly damaged the therapeutic nurse-patient relationship and patients felt they were no longer in a safe, therapeutic environment. The nursing ethical principle of non-maleficence is similarly relevant to this discussion. It requires practitioners to safeguard their patients’ welfare by not inflicting pain or harm (Koch et al,2010). This requirement poses serious ethical dilemmas. It is difficult to uphold this ethical standard as all forms of medical intervention entail some element of harm. Koch et al,(2010) suggest that perhaps for the harm caused to be ethically permissible it should be pr oportional to the benefits of the medical treatment. The author thus feels that covert medication in Mr Walker’s case could be ethically justified under these ethical principles. The author will now focus on the ‘Analysis’ stage of Gibbs’ reflection model. Here, the author will critically analyse the events which occurred including the decision making process and the decision itself. The author will firstly discuss the issue of consent in relation to covert medication. The covert administration of medication is indeed a complex issue. It derives from the  essential principles of consent and patient autonomy which are deeply rooted in the UK statute, common law and the Human Rights Act 1998 (Lawson and Peate,2009). The UK law clearly considers bodily integrity a fundamental human right; a mentally competent adult has the right to refuse medical treatment regardless of how essential the treatment is to their health and well being (Kilpi, 2000). The freedom of choice which is reinforced by the ethical principle of respect for autonomy is an important right. The NMC(2008) further highlights in the Code that it is the nurses’ professional, legal and ethical duty to respect and uphold the decision made by the patient. If a nurse administers covert medication to a mentally competent individual, the nurse will be acting unethically (disregarding autonomy) and in breach of the law which could constitute grounds for trespass, assault or battery (NICE,2014), as shown in the cases R v SS [2005] and R v Ashworth Hospital [2003]. Thus practitioners have a professional, legal and ethical duty to respect the autonomous wishes of each patient. In Mr Walker’s case an MDT meeting was held prior to the covert administration of medication to consider Mr Walker’s lack of consent and his mental capacity to consent. The MDT consisted of: the general practitioner, psychiatrist, junior house officer, nurse-in-charge, home-manager, occupational-therapist, physio-therapist, speech and language therapist, pharmacist, dementia nurse specialist, student nurse, and two relatives. By holding an MDT meeting, the practitioners were acting in accordance with local policies and guidelines. The NICE(2014) guidelines state that health-care practitioners have a legal duty to investigate and take into account the patient’s wishes, as well as the views of their relatives, carers and other practitioners involved in the patient’s care. By consulting with the relevant parties, the decision made will be, â€Å"based on what the person would have wanted, not necessarily what is best for their physical or mental health†(Latha,2010). Latha thus argues that decisions based on the patient’s wishes show some respect for the patient’s autonomy and are much more ethical than isolated decisions to covertly administer medication. As such, a failure to consult the relevant parties may constitute a breach of legal, professional and ethical duty as shown in the Gillick v West Norfolk  Health case (Nixon,2013). However, the Dickens et al, (2007) study shows that nurses frequently administer covert medication without any prior discussion with the MDT, relatives or even the pharmacist. Such practice has led to some nurses being disciplined and charged with various offences (Wong et al,2005). Under UK law, covert medication could be legally justified and considered ethical if the patient is admitted to the hospital under the Mental Health Act (1982). It could also be justified if it is shown that the patient lacks capacity under the Mental Capacity Act(2005). The MCA(2005) introduced the 2 stage capacity test. This 2 stage-capacity-test was used by the MDT in Mr Walker’s case. The MCA test required the MDT to consider whether Mr Walker’s cognitive impairment rendered him mentally incompetent to make treatment decisions. The physician used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini-Mental Status Examination tool (MMSE) to assess Mr Walker’s cognitive function and his capacity to consent. The MacCAT-T interview tool was used to assess Mr Walker’s ability to (1) understand his medical condition and the benefits/ risks of the medical treatment (2) his ability to appreciate this information (3) his reasoning ability and (4) his ability to communicate and express his decision. The results showed Mr Walker as mentally incompetent and lacking the capacity to consent. Mr Walker was (1) unable to understand the information given to him regarding his treatment (2) he was unable to retain or weigh up the information given to reach a decision (3) he was unable to communicate his decision effectively even when encouraged to use non-verbal communication such as blinking or squeezing a hand. The Mini-Mental Status Examination (MMSE) tool was also used by the physician to assess Mr Walker’s cognitive function. Mr Walker following the assessment scored a low score of 12 on the MMSE. The MDT provided further clinical evidence (screening tools, clinical data, memory tests , medical imaging results).There were some disadvantages associated with using the MacCAT-T assessment tool. The MacCAT-T tool itself does not give ‘cut off scores’ to clearly ascertain the boundary between capacity and incapacity. This is certainly a limitation. As shown in the Palmer et.al. (2002) study, this can lead to some patients with low scores being wrongly assessed as lacking capacity. The MacCAT-T tool also fails to recognise the emotional aspects of decision making (Stoppe, 2008). It assumes that people only rely on a  rational, analytic, rule-based thought process to make decisions. Breden and Vollman (2004) thus argue that, â€Å"the restriction to only logical rationality runs the risk of neglecting the patient’s normative orientation†. Other factors including situational anxiety, severity of the medical condition, medication could also impact on a person’s ability to articulate their decision making process. Furthermore, assessment tools like the MacCAT-T tool, largely depend on the clinician’s ability to carry out a clinical interview with the patient. It requires the physician to make an isolated evaluation and decision. Isolated judgements and evaluations can be unreliable as they can be influenced by factors such as subjective impressions, professional experience, personal values, beliefs and even ageism as shown in the Marson et.al. empirical study (Sturman,2005). In the study only 56% of physicians who participated in the capacity assessment of patients were able to agree on a capacity judgement. Many physicians found that they were unable to agree due to differences in medical experience, personal beliefs and subjective impressions. Such empirical evidence certainly questions the reliability of capacity assessment tools. Following on, effective communication skills were essential at this first stage of the capacity assessment as the team was required to consider whether Mr Walker was likely to recover capacity. Effective communication is certainly important in such MDT settings as, â€Å"effective communication, which is timely, accurate, complete, unambiguous, and understood by the recipient, reduces errors and results in improved patient safety† (Bretl,2008). Several studies have shown ineffective communication as a contributing factor in medical error cases (Rothschild, 2009). Through effective communication, each member of Mr Walker’s MD team understood the discussion at hand and was thus able to contribute new suggestions and solutions. The team implemente d communication skills such as negotiation, listening and goal setting skills.The MDT with input from Mr Walker’s relatives concluded that a best interest decision would have to be made on Mr Walker’s behalf. The general practitioner made it clear that the best interest decision would have to comply with the UK legal framework. The European Convention of Human Rights (ECHR) requires the medical treatment given to be respectful to the patient (Pritchard, 2009). In discussing Mr  Walker’s case, it was firstly established (during the medication review), that the treatment in question had both ‘therapeutic necessity’ and ‘therapeutic effects’ for the patient. The MDT when making a best interest decision also considered the risks and benefits of treatment in accordance with the ECHR requirements. The ECHR states that the medical treatment should not be given in a sadistic, inhumane or degrading manner (Human Right Review,2012). Similarly, the NICE(2014) guideline states that the harm that would be caused by not administering the medication covertly, must be greater than the harm that would be caused by administering the medication covertly. This requirement was satisfied by the practitioners in Mr Walker’s case. An in-depth risks and benefits assessment was carried out. The pharmacist’s input was essential at this stage. The pharmacist presented an evidence-based argument; discussing the essential medication with medical necessity. The pharmacist also provided guidance on the most appropriate form of administration; for example he suggested prescribing enapril in its liquid form (enaped). The pharmacist also provided guidance on the most appropriate method of administration; for example; not mixing the medication with large portions of food or liquid. Following this discussion with the pharmacist, a best interest decision was made to covertly administer Mr Walker’s medication. It was important for the MDT to consult with the pharmacist. The method of crushing, smashing tablets or opening capsules which is a commonly used when covertly administering medication is an unlicensed form of administration (NMC, 2008). It can inflict harm by altering the therapeutic properties which can cause adverse reactions and fatalities. When using this unlicensed method of administration, the practitioner is also unable to establish whether the patient has received the prescribed amount. If the patient is not receiving the correct dosage required for his treatment, the treatment is ineffective (Wong et al,2005). The pharmacist should therefore be consulted with. However, as demonstrated by the McDonald et al,(2004) study pharmacists are rarely consulted with. In the study, 60% of nurses working in UK care homes admitted to crushing tablets on each drug round to help patients with swallowing difficulties without firstly consulting with a pharmacist. Fortunately, in Mr Walker’s case, the pharmacist was able to provide guidance on the most appropriate method of administration. Following on, in such cases where the patient is  proven to lack capacity to consent to medical treatment, the Mental Capacity Act promotes the use of ‘best interest decisions’. In Mr Walker’s case, the MDT reached a ‘best interest’ decision to covertly administer his medication. However, there are some problems associated with the practice of relying on ‘best interest decisions.’ Baldwin and Hughes (2006), highlight the numerous problems associated with making best i nterest decisions. In their empirical study, Baldwin and Hughes found that practitioners and relatives often evaluate a patient’s quality of life differently. The results showed the poor performance of relatives and practitioners at predicting patients’ medical treatment preferences. Differences in cultural backgrounds, professional experiences, values and beliefs mean that decisions made may actually go against what the patient would have wanted. The failure to consider the patient’s values and believes was found to be a common occurrence in the Dickens et al,(2007) study. In this study, 18% of the nursing staff interviewed admitted that they would be willing to covertly administer medication to even those patients with capacity to consent, regardless of their values and beliefs, if the treatment was essential for their well-being. The legal framework in the UK was indeed established with the aim of safeguarding the welfare of the incapacitated person. However, with such results, it remains unclear the extent to which health-care professionals are actually adhering to the legal requirements. The Mental Health Foundation(2012) argues that the MCA, â€Å"needs revising to enable more effective ‘best interests decisions’ by health and social care staff.† In its investigation, the Mental Health foundation found that although a large number of health-care staff found the MCA to be an effective tool in ba lancing the ethical principle of autonomy and safeguarding patients lacking capacity, 63% of health-care practitioners felt the definition of mental capacity was not made clear, with many expressing the view that the legal framework does not â€Å"encompass the complexity of capacity assessments in practice† (MHF, 2012). The Griffith (2008) study and the Roy et al. (2011) further found that due to this lack of understanding, a large number of mental-health patients were wrongly assessed as lacking capacity, depriving them of their personal rights. These results suggest that health-care professionals perhaps require further training and education about the legality and practicalities of covert  medication. When used without the correct legal safeguards in place, covert medication undoubtedly becomes an extremely paternalistic unlawful and unethical practice. Following the anonymous ‘best interest’ decision to covertly administer Mr Walker’s medication. The decision making process was clearly documented; the mental capacity assessment, the best interest decision, method of administration (stating explicitly that the least restrictive method will be used) were all documented in Mr Walker’s care-plan and medication-chart. Accurate documentation and record keeping is essential as it safeguards service users’ human rights and ensures that health care professionals follow the legal framework as well as local policies and guidelines. Article 6 of the HRA, ‘right to a fair and public hearing’, also requires clinical records to be comprehensible, clear and concise so that they can be referred to if needed in a fair and public hearing. Following the MDT meeting, Mr Walker’s care plan was frequently discussed and reviewed by the MDT in monthly formal review meetings in compliance with local policies and guidelines. NICE (2013) guidelines state that it is important to frequently review covert medication decisions. Each individual is different and an individual’s mental state and capacity can change over time. By carrying out the monthly formal review meetings, the practitioners safeguard their client’s rights by ensuring that covert medication is still the most appropriate, lawful and ethical method of administration. In conclusion, the nurses of today certainly practice in a complex health care system. It is thus essential for nurses to have a good understanding of the ethical principles which underpin good nursing practice. In the nursing literature, nurses are often described as the â€Å"moral agents† of the health-care system (Sellman,2011). This means that nurses should value ethical reasoning; acting in such a way which balances good intentions against risk and the best outcome. Through good ethical reasoning nurses are able to promote patient comfort, patient’s safety, ease suffering, and promote patient welfare to enhance recovery. The covert administration of medication should therefore not be an isolated decision, it should comply with the legislation, ethical principles, local policies and guidelines. Bibliography The National Institute for Clinical Excellence, (2014). Managing medicines in care homes. [online] NICE. Available at: http://www.nice.org.uk/media/B5F/28/ManagingMedicinesInCareHomesFullGuideline.pdf [Accessed 17 Apr. 2014]. Beckwith, S. and Franklin, P. (2011). Oxford handbook of prescribing for nurses and allied health professionals. 1st ed. Oxford: Oxford University Press. Breden, T. and Vollmann, J. (2004). The cognitive based approach of capacity assessment in psychiatry: A philosophical critique of the MacCAT-T. Health Care Analysis, 12(4), pp.273–283. Bretl, A. (2008). Patient safety rounds. 1st ed. Oak Brook, Ill.: Joint Commission on Accreditation of Healthcare Organizations. Nursing and Midwifery Council, (2010). The Code. [online] NMC. Available at: http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAnd- Midwives_LargePrintVersion.PDF [Accessed 16 Apr. 2014]. Dickens, G., Stubbs, J. and Haw, C. (2007). Administering medication to older mental health patients. Nursing times, 103(15), pp.30-31.Engedal, K. and Kirkevold, O (2005). Concealment of drugs in food and beverages in nursing homes: cross sectional study. BMJ, 330(7481), p.20.Equality Human Rights (2012). Article 3: Freedom from torture and inhumane and degrading treatment or punishment. [online] Available at: http://www.equalityhumanrights.com/uploaded_files/humanrights/hrr_article_3.pdf [Accessed 12 Apr. 2014]. Gibbs, G. (1988). Learning by doing. 1st ed. [London]: FEU. Griffith, R. and Tengnah, C. (2008). Mental Capacity Act 2005: assessing decision-making capacity 2. British journal of community nursing, 13(6), pp.284-293.Harris, N., Baker, J. and Gray, R. (2009). Medicines management in mental health care. 1st ed. Chichester, U.K.: Wiley-Blackwell. Hughes, J. and Baldwin, C. (2006). Ethical issues in dementia care. 1st ed. London: Jessica Kingsley Publishers. Husted, J. and Hust ed, G. (2008). Ethical decision making in nursing and health care. 1st ed. New York: Springer Pub. Co.Koch, S., Gloth, F. and Nay, R. (2010). Medication management in older adults. 1st ed. Totowa, N.J.: Humana. Latha, K. (2010). The noncompliant patient in psychiatry: The case for and against covert/surreptitious medication. Mens sana monographs, 8(1), p.96. Lawson, L. and Peate, I. (2009). Essential nursing care. 1st ed. Chichester, West Sussex, UK: Wiley-Blackwell. Leino-Kilpi, H. (2000). Patient’s autonomy, privacy, and informed consent. 1st ed. Amsterdam: IOS Press. Macdonald, A., Roberts, A. and Carpenter, I. (2004). De facto imprisonment and covert medication use in general nursing homes for older people in South East England. Ageing clinical and experimental research,16(4), pp.326-330. Masters, K. (2005). Role development in professional nursing practice. 1st ed. Sudbury, Mass.: Jones and Bartlett. Mental Health Foundation, MCA Code of Practice needs revising to enable more effective best interests decisions to be made. (2012). MHF News Archieve, [online] p.1. Available at: http://www.mentalhealth.org.uk/our-news/news-archive/2012/12-01-31/ [Accessed 12 May. 2014]. Nixon, V. (2013). Professional practice in paramedic, emergency and urgent care. 1st ed. Chichester, West Sussex: Wiley-Blackwell. NMC, (2008). Standards for medicines management. [online] Available at: http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf [Accessed 16 Apr. 2014]. Palmer, B., Nayak, G., Dunn, L., Appelbaum, P. and Jeste, D. (2002). Treatment-related decision-making capacity in middle-aged and older patients with psychosis: a preliminary study using the MacCAT-T and HCAT.The American journal of geriatric psychiatry, 10(2), pp.207-211. Pritchard, J. (2009). Good practice in the law and safeguarding adults. 1st ed. London: Jessica Kingsley Publishers. Rothschild, A. (2009). Clinical manual for diagnosis and treatment of psychotic depression. 1st ed. Washington, DC: American Psychiatric Pub. Roy, A., Jain, S., Roy, A., Ward, F., Richings, C., Martin, M. and Roy, M. (2011). Improving recording of capacity to consent and explanation of medication side effects in a psychiatric service for people with learning disability: audit findings. Journal of Intellectual Disabilities, 15(2), pp.85-92.Sellman, D. (2011). What makes a good nurse. 1st ed. London: Jessica Kingsley Publishers. Stoppe, G. (2008). Competence assessment in dementia. 1st ed. Wie n: Springer. Sturman, E. (2005). The capacity to consent to treatment and research: a review of standardized assessment tools. Clinical psychology review, 25(7), pp.954-974. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411. Wheeler, K. (2008). Psychotherapy for the advanced practice psychiatric nurse. 1st ed. St. Louis, Mo.: Mosby Elsevier. Wong, J., Poon, Y. and Hui, E. (2005). I can put the medicine in his soup, Doctor!. Journal of medical ethics,31(5), pp.262-265.

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Macbeth Witches Influence on Macbeths Decisions

Macbeth: Witches Influence on Macbeth s Decisions In the Shakespearean play, Macbeth, the witches influence on how Macbeth made his decisions played a crucial part in contributing to his eventual destruction. The witches were trying to create chaos by prophesying to Macbeth in order to get him to act. They planted the seed of evil in Macbeth s head that grew to dominate his mind. But it was Macbeth who made the choices that determined his fate. He was not forced to kill Duncan nor any of his other victims. But after he murdered Duncan, Macbeth lost his sanity. The witches were easily able to control his mind. They made him believe that he was invincible, and then he willingly continued to fight when he knew that it would mean his†¦show more content†¦Now that the witches have succeeded in bringing out Macbeth s evil qualities, they are ready to finish their plot and make sure that Macbeth follows his destiny to his downfall. With Hecate s guidance, the witches plan to lead Macbeth to his death by making him feel overconfident. Macbeth goes to seek the witches in a dark cave. When he finds them, they present him with three apparitions. The first apparition appears as an armed head that says, Macbeth! Macbeth! Macbeth! beware Macduff; / Beware the thane of Fife. The second apparition is a bloody child that tells Macbeth, Be bloody, bold, and resolute; laugh to scorn / The power of man, for none born of woman / Shall harm Macbeth. Finally the third apparition, in the form of a child with a crown on his head, holding a tree, tells Macbeth that he Shall never vanquished be until Great Birnam wood to high Dunsinane Hill / Shall come against him. Macbeth now feels assured that he cannot be killed because he assumes that all people are born of a woman, and it is impossible for a forest to move. He could never have guessed that the apparitions meant that Macduff did not have a natural birth and that the English would use trees as camouflage. This false confidence Macbeth was given was extremely important to allow him to make his final decisions that resulted in his defeat. The apparitions made an effect on Macbeth and he acts foolishlyShow MoreRelatedWitches, Lady Macbeth and Macbeths Responsibility for Macbeth’s Downfall1490 Words   |  6 PagesWitches, Lady Macbeth and Macbeths Responsibility for Macbeth’s Downfall Shakespeare’s tragedy, Macbeth shows the downfall of a wrongfully crowned king. But his downfall is not solely due to himself. There are other characters in the play that are part of his downfall. If it weren’t for them, the play would not work. They are part of a chain, one leading to another. 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