Sunday, April 19, 2015

our dog was killed

Hi everyone

we had a terrible week
on the way to school last thursday we saw our dog a pure bred blue heeler who would have been 2 in september dead at our front gate and his collar was cut off and thrown a couple of meters from his body
of course we were in total shock
my 5 year old did not want to go to school
i didnt know what to do, i just stood there hoping some one would come along and stop to tell me what to do


Nursing and mandatory reportin in the Northern Territory


This report will look at mandatory reporting in cases of child abuse and neglect.  See Appendix one for the full report on Sarah a six month old baby who was abandoned by her family.  This report will look at the legislation involved, any legal breeches or offenses and protection afforded to those who report.  This report will identify the branch of law involved and any major ethical issues involved in mandatory reporting.  Lastly this report will suggest a risk management strategy to help eliminate or reduce any risks identified by this report.   In this paper a child is defined as a person less than 18 years of age.

 “There is no universal definition of child abuse but it is generally considered to be any sign of abusive act that causes physical or emotional harm to a child, or if a child is harmed because of an adults failure to provide adequate care (SA government, 2006, cited in Piltz & Wachtel, 2009).

In Australia the changes in reporting of child abuse has resulted in an increase in the number of cases reported (Hunter, 2008).   Mandatory reporting is a legal requirement to report suspected cases of child abuse and neglect (Department of Health and Families, 2010). Notification has been made mandatory for a couple of reasons.  By introducing mandatory reporting there is an acknowledgement of the seriousness of child abuse, a moral responsibility and legal obligation to protect children from harm and to prevent further abuse (Higgins, Bromfield, Richardson, Holzer & Berlyn, 2009; Northern Territory Government, 2010).  There is no national child protection legislation in Australia, each state and territory has different laws and requirements, mandatory reporting legislation is in place in all states and territories except Western Australia.  The legislation requires that nurses either as health professional or as adults report suspicions of child abuse (Piltz & Wachtel, 2009; Northern Territory of Australia Child and Protection of Children Act, 2009). Northern Territory of Australia Child and Protection of Children Act, 2009; section 20 (p19), states that

                When child is in need of care and protection

                A child is in need of care and protection (child is in need of protection) if:

a)      The child has suffered or is likely to suffer harm or exploitation because of an act or omission of a parent of the child; or

b)      The child is abandoned and no family members of the child are willing and able to care for the child

In the Northern Territory any person can report suspected physical, sexual, emotional, or psychological abuse as well as neglect and exposure to physical violence such as domestic violence between other family members on the grounds that they believe a child has or is likely to suffer harm (Higgons et al, 2009; Department of Health and Families, 2010; Northern Territory of Australia Child and Protection of Children Act, 2009).

 Northern Territory of Australia Child and Protection of Children Act, 2009 Division 3 General obligations about reporting, section 26 Reporting obligations states

1)      A person is guilty of an offence if the person :

a)      Is a health practitioner or someone who performs work of a kind that is prescribed by regulation; and

b)      Believes, on reasonable grounds, any of the following:

(i)                  A child has suffered or is likely to suffer harm or exploitation;

(ii)                A child aged less than 14 years has been or is likely to be a victim of a sexual offence

(iii)               A child has been or is likely to be a victim of an offense against section 128 of the criminal code; and

c)       Does not, as soon as possible after forming that belief, report (orally or in writing) to the CEO or a police officer:

(i)                  That belief; and

(ii)                Any knowledge of the person forming the grounds for that belief; and

(iii)               Any factual circumstances on which that knowledge is based.

Maximum penalty:     200 penalty points

In the case of Sarah it is neglect which occurs “when a parent is unable or unwilling to provide for a child so that the child can develop normally” (Department of Health and Families, 2010).  Neglect can occur in the following ways – failure to provide food, clothing, shelter, medical and other health care, education, attention, appropriate supervision and at its worse abandonment of a child (Department of Health and Families, 2010).  In the Northern Territory it is a legal requirement that the staff report this incident, the staff involved can seek advice from senior staff members but they cannot delegate this responsibility, it is the staff on duty and that have had contact with the child that must report the incident (Department of Health and Families, 2010).    If Registered Nurse’s Ben and Julie fail to report this instance of serious neglect they can be held liable and legal action can be brought against them (Department of Health and Community Services, 2010).  Failure to report child abuse is a crime under the Northern Territory of Australia Child and Protection of Children Act, 2009. An offence against this act is an offence to which part 11AA of the criminal code applies (Department of Health and Families, 2010).  There are penalty points (monetary fine) or jail time, depending on the offence (Department of Health and Families, 2010).   There is a maximum penalty of 200 penalty points for failure to report child abuse (Northern Territory of Australia Child and Protection of Children Act, 2009.)   Criminal law is the body of rules with the potential for severe penalties as punishments for failure to comply; this will depend on the offense and can include jail, probation, parole or fines (McIlwraith & Madden, 2009).  Criminal law is typically enforced by the government where as civil law is usually enforced by private parties (McIlwraith & Madden, 2009).  A criminal act is an act which is committed by a person that violates a law which is punishable by the government, civil law on the other hand has nothing to do with punishments and the police force but exists to enable us to resolve disputes and differences of a personal and property nature that arise between members of a community that they cannot resolve themselves (McIlwraith & Madden, 2009; Staunton & Chiarella, 2008).   The Australian Federal Parliament and the Parliament of the Northern Territory are two of the bodies that set out legislation documents which are obligations, rights, penalties and procedures that bind citizens or a particular group of citizens (McIlwraith & Madden, 2009).  These bodies pass law in the form of statues or acts of parliament, such as the Nurse and Midwifery Act and the Northern Territory of Australia Child and Protection of Children Act (McIlwraith & Madden, 2009).  It is an offence to breech these acts and the penalty will be set out in the act, these offences are often triable in a magistrate’s court that is without a jury, and are considered minor criminal offences (McIlwraith & Madden, 2009).  Major criminal offences would include murder, rape, serious assault, armed robbery and would be tried in a supreme court usually with a jury (McIlwraith & Madden, 2009). 

Normally disclosure of a patient’s information would result in a breach of confidentiality.  This is taught to all nursing students and often reinforced in the workplace.  The Professional Code of Conduct for Nurses 2010 recognises, that nurses have a “legal and ethical obligation to protect the privacy of people requiring and receiving care” (p4).  This is in conjunction with the Guidelines to the National Privacy Principles 2001, however it is recognised that nurses may be required by law to disclose certain information (Code of Professional Conduct for Nurse in Australia, 2010).  However as Julie and Ben did report  as set out in the Community Welfare Act, s14(2); “ a health professional making a report in good faith or with the reasonable belief that a child has been abused will not be in breach of confidentiality”  (Department of Health and Community Services, 2010).  See also section 26 of the Northern Territory of Australia Child and Protection of Children Act, 2009

Protection of person making report

1)      A person acting in good faith in making a report under section 26 is not civilly or criminally liable, or in breach of any professional code of conduct:

a)      For making the report; or

b)      For disclosing any information in the report.

 

Grounds for suspension or cancellation of nursing registration includes the conviction of a criminal offence and professional misconduct (McIlwraith & Madden, 2009). McIlwraith and Madden, 2009 list the following   case - Failure to properly assess and treat injuries to child medical board of South Australia v Christpoulos (2000) SADC 47 (Australian Health and Medical Law Report), p416, it was determined that the Doctor was guilty of unprofessional conduct for failing to report suspected child abuse, failure to report can also leave a health professional open to civil action based on breach of statutory duty and negligence (McIlwraith & Madden, 2009).   A criminal conviction does not necessarily lead to disqualification; the registration bored will carry out an enquiry.  Under section 22 of the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008 – Entitlement to Registration or Enrolment - an applicant is entitled to be registered or enrolled in a category of registration or enrolment to which the application relates if the relevant board is satisfied that the applicant  ....

                (f) is of good character”

B. Harper (2010, pers. comm., 10th may) a registered Nurse with the Northern Territory Nursing and Midwifery Board states that each individual case is reviewed separately and that the Board will decide if that nurses good character has been called into question, and if yes what will the penalties be in terms of registration.  Professional misconduct means an unsatisfactory professional conduct of a sufficiently serious nature to justify the removal of the nurse from the register, such conduct includes failure to comply with any professions set out in the nurse and midwifery act or if knowledge, skill or judgement possessed falls below the reasonable standard expected of a nurse with an equivalent level of training or experience (Nurse and Midwifery Act, 1992).  Negligence is the failure to use reasonable care it can consist of action or inaction i.e.: failure to report child abuse.  A person is negligent if they fail to act as a ordinary prudent person would act in the same circumstances, criminal negligence requires a greater degree of culpability than civil negligence (Staunton & Chiraella, 2008).

Sarah was treated and admitted to hospital.  Under the Northern Territory of Australia Community Welfare Act , 2007,section 15a), a person in charge of a hospital can detain a child in hospital for up to 48 hours for the purpose of examination and treatment.  Under this act Family and Child Services (FACS) must be notified of the child and examination and treatment as soon as practical.  Once FACS has been notified they then become responsible for further protection and maintenance of the child as well as notifying the family members (Department of Health and community services, 2010).

Nurses should “promote, protect & uphold the fundamental rights of people who are both the recipients and providers of health care” as per the Code of Ethics Australia (p1) (www.anmc.com.au).  Failure to report child abuse would be unethical.  In Sarah’s case if this neglect were to continue for the long term it could result in failure to thrive (with no organic cause), Sarah could engage in criminal acts and risk taking behaviours such as drug and alcohol abuse as she got older, and poor school attendance (Northern Territory Government, 2010).  In Sarah’s case the neglect is glaringly obvious in some cases child abuse and neglect particularly that which does not show physically is not always easy to identify (Northern Territory Government, 2010). Penalties imposed on nurses force mandatory reporting which can overburden the system with notifications that may not prove to be substantial but cost substantially and be time consuming for services that are targeted at the most at risk families and children (Piltz & Wachtel. 2009; Freed & Drake, 1999).   The nurse must take into account the fact that reporting does not necessarily make the child safe and in actual fact can cause further harm to that child (Piltz & Wachtel. 2009; Freed & Drake, 1999).  Nurses find there are some barriers to reporting child abuse, in small communities nurses can be worried about community and family members finding out who made the report and this can potentially impact on their personal lives especially if the family in question reacts or retaliates in an aggressive manner (Piltz & Wachtel, 2009).  Reporting could also alienate the family/community members from attending the health service (Piltz & Wachtel, 2009).  Also there is the ethical responsibility to protect a patient’s confidentiality (Piltz & Wachtel, 2009).

  In order to help nurses make a decision they can turn to ethical theory.   Beneficence – health care should benefit the patient and on the other side of the coin – non maleficence which is to do no harm (McIlwraith & Madden, 2009).  In terms of mandatory reporting there are also two sides to the coin.  Reporting abuse can benefit by potentially keeping the child safe, allowing the offender to get treatment or punishment and by decreasing the incidence of abuse, allowing the reporter the satisfaction that they may have prevented further abuse (Freed & Drake, 1999).  However reporting can also violate the principle of non-maleficence by causing retribution of the victim or others , reporting may cause the victim future discrimination and legal, financial and emotional abuse (Freed & Drake, 1999).  Nurses should promote patient self determination the ethical principle of autonomy (McIlwraith & Madden, 2009). Mandatory reporting takes this away as the nurse is legally obligated to report (Freed &Drake, 1999).  Justice refers to equal access to health care and benefits available (McIlwraith & Madden, 2009).  In terms of mandatory reporting – what gets reported who will receive services and what services will be available, is still being worked out, if the system becomes overburdened those at serious risk may not receive the services they need (Freed & Drake, 1999; Piltz & Wachtel, 2009; Ainsworth, 2002).

Mandatory reporting has been introduced into the Northern Territory with little education for nurses on child abuse, the signs and risk factors, the legislation regarding reporting and the nurses requirements in regards to reporting  (Piltz & Wachtel, 2009; Ainsworth, 2002).  Further education is needed to help reduce confusion and unease about reporting (Piltz & Wachtel, 2009).  It has been suggested that there is over reporting due to the mandatory reporting legislation which has overburdened the system (Piltz & Wachtel, 2009; Ainsworth 2002),   further education will give the nursing staff confidence in recognising child abuse and reporting it, some child services are regarded with unease, and subsequently there is a poor working relationship between these services an health professionals (Piltz & Wachtel, 2009; Ainsworth 2002).  Education about the services need to be provided and an understanding of how they work and what happens once child services becomes involved may ease nursing staffs view of child services and help them to see the help the children will be receiving.  A regular in-service or meeting between the nursing staff and child services staff to help ease relations is needed. Education can be provided through university, in services, staff meetings, included in mandatory training and folders in the workplace.  More research is needed to evaluate the level of nurses understanding and develop essential training services and reporting guidelines.

In conclusion mandatory reporting of child abuse is a legal and ethical issue for nursing staff.  Improved education and a good working relationship with child services will go a long way toward helping nurses understand and cope with the legal and ethical consequences of reporting child abuse.

 

reflective blog on what you beleive and what you know


Reflective blog – Ethical issues and Human rights week 1

What do you believe and what do you know?

There are things I believe are real or not real, but I don’t know if this is case.  I believe fairies don’t exist but I don’t know it, there is no evidence to suggest they do but then there is no evidence to suggest they don’t exist either. Things I know to be real I can’t believe they are not, as by knowing it there is irrefutable evidence in my world – for example I know my name it is on my birth certificate I can’t not believe it.

In other words what I believe in I don’t necessary know however it doesn’t work the other way around, what I know I have to believe – I cant no believe it and I don’t think it would make sense to know something but no believe it I don’t think any logical person could do that – I know the walls in my house a painted a off white colour I simply cannot believe they are any other colour

This was an interesting question because I had never thought of it before; I have learned that knowing and believing are different concepts.

How do I know what I know?

I’m constantly learning – reading, studying attending courses, but the foundation of my knowledge and beliefs came from my parents, and extended family.  My early school years contributed greatly then my later school years and friends. As I got older what I could see on TV and read for myself increased my knowledge.  For me what my parents taught me matched in with school and my friends were all like minded in their views of the world.  Teachers challenged me to think and research to expand my knowledge during my tertiary education.

I’m studying Anthropology because I want to know why people do what they do, having thought about this exercise I can see people do what they do because of what they know and what they believe.  How they come to this knowledge depends on whether they experienced it or were told it by others.  These concepts are all linked.