In the given scenario, as an Enrolled Nurse (EN) working at a primary health care clinic, I am tasked with supporting a client dealing with alcohol dependence and exploring various options for addressing this issue.

QUESTION

You are working as an EN at a primary health care clinic. You have been supporting a client to access information on options for addressing alcohol dependence and are providing a range of outreach contacts including Alcoholics Anonymous; Beyond Blue; Drug and Alcohol Services SA; and general GP referral.

Your supervising RN asks you to explain your approach, including an evaluation of the programs you have identified. She also asks you whether the client has been formally diagnosed with Alcohol Use Disorder. You acknowledge that they have not. The RN asks a GP to join you and you sit together to determine what the best next step for this client will be.

You recognise that as an EN you have a scope of practice, code of ethics and duty of care to uphold.

The GP asks you to ensure that the client is referred for assessment by a doctor before accessing outreach services. The RN suggests that there may be options for the client to engage in services without a formal diagnosis, and the GP argues that this would disadvantage the client, should they require medical intervention.

As an EN, and taking into account your Ethics, Code of Conduct, Duty of Care, and other legal, ethical, and professional factors, what would you say and do, and why?

•How to manage GP and RN conflict.•What would be do to solve it•What we believe is bestWhat standard of practice it aligned with legal and ethical practice

ANSWER

In the given scenario, as an Enrolled Nurse (EN) working at a primary health care clinic, I am tasked with supporting a client dealing with alcohol dependence and exploring various options for addressing this issue. It is important to navigate this situation while considering my scope of practice, code of ethics, and duty of care, all of which are pivotal in providing ethical and effective patient care.

Approach and Evaluation of Programs

I would begin by explaining to my supervising Registered Nurse (RN) the approach I have taken with the client. I have provided the client with information about outreach contacts, including Alcoholics Anonymous, Beyond Blue, Drug and Alcohol Services SA, and general GP referrals. These options cover a spectrum of support, from peer-based groups to professional medical interventions. I would then evaluate each program:

Alcoholics Anonymous: A well-established peer support group that offers a safe space for individuals struggling with alcohol dependence to share their experiences and receive guidance from those who have overcome similar challenges.

Beyond Blue: While primarily focused on mental health, Beyond Blue offers support to individuals with substance use issues, including alcohol dependence, by providing resources, helplines, and online forums.

Drug and Alcohol Services SA: A professional service that offers specialized treatment, counseling, and medical interventions for individuals dealing with substance use disorders, including alcohol dependence.

General GP Referral: Referring the client to a general practitioner allows for a comprehensive medical assessment, which can lead to a formal diagnosis and recommendations for suitable interventions.

Handling Conflict Between GP and RN

In addressing the conflict between the GP and RN regarding the necessity of a formal diagnosis for accessing outreach services, I would initiate a collaborative discussion to find a balanced solution that aligns with ethical practice and the best interest of the client. I would approach this situation as follows:

Open Communication: I would foster an environment of open communication where both the GP and RN can express their viewpoints without judgment.

Review of Options: I would present the different options available to the client, highlighting the benefits of each. This would include emphasizing the importance of medical assessment but also acknowledging that certain outreach programs can provide immediate support.

Shared Decision-Making: I would propose involving the client in the decision-making process. This would allow the client to express their preferences and concerns, ensuring they feel empowered and included in their care plan.

Ethical Considerations: I would remind both the GP and RN of the ethical principle of patient autonomy, respecting the client’s right to choose the level of care they are comfortable with, while emphasizing the importance of medical assessment for comprehensive care.

Best Approach and Aligned Standard of Practice

The best approach would involve finding a middle ground where the client’s immediate needs for support are met, while also ensuring their long-term well-being through appropriate medical assessment and intervention. The standard of practice aligned with legal and ethical principles is patient-centered care, which emphasizes involving the patient in decision-making, respecting their autonomy, and providing the necessary information for informed choices. Balancing the client’s immediate needs and long-term health ensures a holistic and patient-centered approach to care.