Nursing: Skills, Values, and Ethics

• Nursing is a profession focusing on individuals, families, and communities to help them attain, maintain, and recover from illnesses.
• Nursing involves caring for the patient's physical, mental, and spiritual well-being.
• Nurses need knowledge, skills, and attitudes to enhance caring abilities.

Skills of Nursing

• Nurses assess, implement, plan, and evaluate patient needs to provide quality, holistic care.
• Nurses work with healthcare teams to meet patient needs.
• Nurses promote physical, mental, and spiritual health through teaching and example.
• Nurses are specialized professionals with a developed value system.

Values, Morals and Ethics

• This chapter gives the meaning of nursing.
• This chapter discusses the values, morals, and ethics of the nursing profession.
• This chapter is about nursing as a profession, accountability and responsibility.

Meaning of Nursing Disciplines

• Nursing is a unique discipline that combines science and the arts/humanities.
• The South African Nursing Council defines nursing as a caring profession, helping patients achieve or maintain health. In instances where achieving this is not possible, the goal is to provide care.
• Nursing is challenging because it involves dealing with sick patients and stressed families.
• Nurses need to find meaning in their daily work to avoid burnout.
• Creating relationships with patients, families, and colleagues assists nurses in finding meaning.

The Role of Compassion

• Compassionate caring gives meaning to nursing.
• Socialization during training and mentorship provides strength and support.
• Nurses can create hope for the hopeless by intervening with caring and empathy, especially when patients are first admitted and families are distressed.

Value of Nurses words

• Meaning is given to nurses in realizing they make a difference in someone's life, boosting self-esteem.
• Relationships are developed with families and patients.
• Morale is boosted by collegiality with the healthcare team and their trust.

Mentoring the Nursing Role in a Team

• Senior colleagues provide essential mentorship.
• Nursing evolved from people caring for each other.
• Florence Nightingale made nursing a separate discipline in 1859.
• Nightingale's Crimean War work improved nursing's image.
• Nightingale was known as the 'Lady of the Lamp'.

Nightingale's Accomplishments

• Nightingale started formal nurse education using a theoretical base.
• The nursing profession spread due to missionaries.
• Mrs. Bedford Fenwick, a Scottish nurse, started a list of trained nurses in England and campaigned for statutory recognition.

Nursing Regulation Act

• The Nurses Regulation Act passed in 1919.
• Nursing is now a separate discipline with its own controlling bodies and regulations.
• Today, nursing is taught at the post-school level and also available via online courses.

Nursing as Science and Art

• Nursing is a science due to its grounded knowledge base.
• Nursing is an art when used to serve the individual, family, and community.

Nursing Profession Parameters

• The nursing profession sets limits, boundaries, and parameters for practice due to constant research.
• Nursing has moved from a calling to a profession.
• Nursing connects intellectual and manual labor.
• Nursing incorporates evidence-based practices to improve standards, causing changes to the ethical issues.

Nursing Theory

• Nursing science has discipline-specific theories developed by nurse theorists.
• Nurse theorists are viewed as pioneers.
• Their theories guide nursing practice, education, leadership, and research.

Prominent Nursing Theorists

• Virginia Henderson, Dorothea Orem, and Hildegard Peplau emphasized patients needing to help themselves.
• Nursing intervenes where deficits exist.

Henderson's Theory

• Nursing assists sick or well individuals to perform activities that contribute to health recovery or peaceful death.
• The nurse helps people look after themselves with rehabilitation.

Boundaries of nursing

• The role of the nurse extends beyond the hospital (schools, factories, prisons, homes, hospices, old-age homes).

Orem's Self Care Theory

• Nursing provides specialized actions when an adult cannot keep themselves healthy, including sustaining life/health, recovering from disease/injury, and coping with side effects.
• For children or dependent adults, it's a service necessitated by the caretaker's inability to maintain therapeutic care.
• Nursing is a deliberate action to benefit others, goal-directed, and involves planning.
• Actions relate to practical procedures, interpersonal and social dimensions, and social level/practice regulations.

Peplau's Interpersonal Relations Theory

• Nursing is a caring, healing, and enriching process through the relationship of the patient and the nurse.
• Nursing is an educative force.
• The nurse encourages patients to articulate conceptions and misconceptions, plan, and achieve health.
• Peplau emphasizes the human relationship value.
• Parties in the relationship bring their own experiences, perceptions, thoughts, feelings, desires, assumptions, expectations, and activities.
• The relationship enables patients to verbalize needs, complaints, and fears.
• Nurses use knowledge, skills, and human nature in their relationships.
• Her emphasis is on the link between nursing practice, theory, and applicable research.

Focus Definition

• Both definitions (Orems and Hipplau) focus on caring for those who can't care for themselves.
• Nursing has striven to identify as a profession over the past century.
• Today, nursing is recognised worldwide.

Professionalization

• The process of professionalization starts with a need identified by society.
• Society, nurses, and learners share providing care to people who need it.
• Getting rid of illness and preserving health brings a collegial feeling between a nurse and a patient in a common goal, binding them and implying the need for trust and confidence.

Value of Knowledge

• Although equality is needed, unequal amounts of knowledge can exist in a professional setting.
• Nursing ensures each one participating contributes to the relationship in given ways.

The Obligations

• Nursing is relational and nurses maintain relationships with health care system members to provide quality care.
• Nurses facilitate and coordinate care in all areas and recognized as the backbone of the healthcare systems.
• Nurses improve practice by gaining knowledge, which also strengthens the collegial relationship.

Accountability

• The stages of professionalization: Society recognizes a need, trained staff identify skills/knowledge needed, learners come for training.

The Steps to Professionalization

• Develop formal programs, do constant research.
• Standards of practice are laid down by professional organizations.

South African Nursing Council

• The South African Nursing Council (SANC) is a statutory body.

Criteria of a Nursing Profession

• The criteria for a profession apply not only to nursing but to all professions.

Key points of the profession

• Accepted in most professions are: Education, organization, ethics, commitment and continuous education and development.
• It entails knowledge and intellectual responsibility. The education for a profession gains an identity over a long period of time and can be applied to a specific group.

Aspects of Education

• Education is scientifically based, and learned in higher learning institutions. A profession is organized, functions independently, and is controlled by a professional body.
• The professional body determines standards.
• Members' behavior is directed by a code of ethics, and they are motivated by altruism.

Commitment and Continuous Education

• Commitment is motivated by altruism (love for one's neighbor) and a desire to do good.
• Members stay updated on advancements.
• Nursing has met professions criteria and can be called a profession.

Nursing Expectations

• A person wanting to be a professional needs to live up to standards.
• Nurses develop professionally and provide the best care to patients, their families, and the community.
• Silvers (2003) distinguishes a profession by delineating the three components comprising the community: knowledge, standards, and controls.

Elements of Knowledge

• The curriculum criteria make up what constitutes the knowledge.
• Assessment criteria makeup the standards, which enable the evaluation of competency.
• The enforcement mechanisms makeup the controls, that ensure reinforcement of the controls.

Henderson's Perspective

• Virginia Henderson saw education as important and stressed clinical skills for success

The Components

• are set out in her publication.
• Nursing involves helping a patient or providing conditions enabling the patient to do specific key activities.

A nurses goals in promoting health

• Help a patient to breathe, eat, eliminate waste, move, rest, dress, regulate body temperature, maintain cleanliness, avoid dangers, communicate, worship, work, play, and grow.

Orem's three Self Care Levels

• Level One: The wholly compensatory nursing system, where the nurse provides all self-care.
• Level Two: Partly compensatory nursing system, where the nurse performs activities the patient cannot.
• Level Three: Supportive-deductive nursing system, where the nurse educates the patient towards self-care.

A nurses plan and patient responsibilities

• Utilise all available resources in the patient's best interests.
• Provide a positive environment, utilise personnel, and give all services available.
• Encourage the family and patient.
• All parties have the right to: prevent and treat disease, want to become/stay healthy and participate in rehabilitation.

A Nurses accountability

• The nurse is accountable and responsible for care.

Ethics and Nursing

• Ethics are rules of good behaviour.
• Medical ethics dictate that doctors cannot discuss a patient's history without permission.
• Morals are related to what is right internally.
• Standards guide behaviors and values.
• Ethics guides the exercise of power to bring human benefit and conditions of happiness.

Ethics Role in Avoidance of Harm

• As a nurse you must do good and avoid harm.
• Assess decisions to see which are better than the other.
• Ethics is what guides people, also a guide for decision making. There are some ethical components.
• To be aware of what affects those decisions and what is good to do.
• Ethics in health care depends on cultural awareness, good decision and criticalness.
• Ethical decisions should include human rights education. If done ethically decisions become lawsuits.

Ethical codes to remember

• Nurses' need to understand people's difference.
• They promise ethical behaviours when becoming a nurse with other ethical codes.

Moral Understanding

• Morality can be viewed as what is good, or bad. There are actions that entail discerning the good and bad of others. Actions are influenced by peers. It's important to think about what will do more good than harm. External principles determine the difference between these two. The steps are learned mostly by the environment.
• In the 18th century five principles guide behaviour.

Guiding behaviours

• Taking a life, or suicide is bad. Keeping is good, not keeping promise is bad, also being untruthful is bad.
• The teaching is important as action affects repercussions. Society as a whole has guidelines, regulations from the norms they adhere to. As we advance, our community affects how we grow right and wrong.

Values in nursing

• Our values determine how we see the world as it may or may not be the reality. What we believe, we value determines our actions and interactions to patients based on individual values. There are personal views as well. It's important to respect the beliefs and value patients, personal value and patterns.
• We learn our moral values during periods of socialisation. They dictate our sense of being good and honest. Nurses who demonstrate these morals, tend to do well. Ubuntu is also a good principle to follow.

Positive attributes

• It entails respect, warmth, openness and caring. There are nurses who come without needing to please, instead they help.