Ethics, Legal, and Regulations of the Nursing Profession PDF

Ethics, Legal and Regulations of the Nursing Profession RAPINYANA OBJECTIVES 1 2 3 profession Ethical issues Legal issues  Definition of a profession is based on an understanding of the theoretical underpinnin...

Ethics, Legal and Regulations of the Nursing Profession RAPINYANA OBJECTIVES 1 2 3 profession Ethical issues Legal issues  Definition of a profession is based on an understanding of the theoretical underpinnings of some specific knowledge areas and its accompanying abilities, which are applied to man’s welfare A profession has an ethical obligation to provide altruistic service to its clients PROFESSIONALISM education reflects a long and intensive period of study standardisation of education and control over practice Critically analyse how ethical, professional and legal issues underpin nursing practice.  Ethics Standards of moral judgement Prof conduct As nurses you are accountable for pts,public,employees and entire profession There are 3 primary duties for nurses: Duty of autonomy,Confidentiality, Care of all pts. The 3 primary duties for nurses are supplemented by: 1. Principles of beneficence (doing good)or Acting in pts best interest. 2. Non Malificence –Avoid harm. These are prof duties which become legal duties if any legislation or policies are breached during practice. CHARACTERISTICS OF A PROFESSION Abraham Flexner’s (1915 ) characteristics of a profession Activities must be intellectual (as opposed to physical) Activities are based on knowledge, and therefore can be learned Profession must have teachable techniques Must have a strong internal organization of members Practitioners must be motivated by altruism (a desire to help others)  Ethics regards standards of moral judgement and professional conduct. Nurses are highly accountable to patients, the public, employers, and the entire ETHICS profession It is imperative they have a sound understanding of various ethical, legal and professional issues they will face during their careers. There are three primary duties for nurses, among many others, which are the duty of autonomy, confidentiality, and duty of care to all patients. i These duties are supplemented by the principles of beneficence, meaning promoting or doing good and acting in patients’ best interests, and non- maleficence, meaning to avoid harm. ii These are professional duties which become legal duties if any legislation or policies are breached during practice. OCCUPATION VS PROFESSION Decision making is based Training may occur on the largely on science or job. Education takes place Work involves mental Education is prolonged. theoretical constructs in a college or university. creativity. (evidence-based PROFESSION practice). Values, beliefs, and ethics are an integral part of OCCUPATION Length of training varies. Work is largely manual. preparation. Decision making is guided Values, beliefs, and ethics largely by experience or are not prominent by trial and error. features of preparation. EIGHT CHARACTERISTICS OF A PROFESSION (Kelly, 1981) EIGHT CHARACTERISTICS OF A PROFESSION (Kelly, 1981) ❑The services provided are vital to humanity and the welfare of society Caring is the core of professional nursing through which nurses intervene for their patients ❑There is a special body of knowledge that is continually enlarged through research. Research nursing degrees Nursing relies on theory and research as a basis for practice. Example: Evidence-based practice Characteristics cont ❑The services involve intellectual activities and individual responsibility (accountability) is a strong feature. Critical and creative thinking serves as basis for providing nursing care e.g., use of the nursing process Accountability is firmly rooted in the ethical principles of “fidelity (faithfulness), loyalty, veracity, beneficence, and respect for the dignity, worth, and self-determination of patients.” ❑ Nurses are educated in institutions of higher learning. Example- University of Botswana Entry level into practice still a debatable issue Normally at least a Bachelor’s degree Characteristics of a profession ❑ Practitioners are relatively independent and control their own policies and activities (autonomy). Autonomy – control over one’s practice. Licensure and autonomous practice “Doctor’s orders” connotation ??? Practitioners are motivated by service (altruism) and consider their work an important component of their lives Altruism – ideal of service to others Nurses’ altruism is sometimes questioned when they demand higher compensation and better working conditions. Collective bargaining CONT ❑ There is a code of ethics to guide the decisions and conduct of practitioners. 1893: Nightingale Pledge ICN and ANA established a Code of Ethics ❑Has an organization (association) that encourages and supports high standards of practice. Botswana Nurses Union – official voice of nursing BONU. Botswana Nurses Union and NMCB Responsible for the Nurses Welfare-Member Social welfare Professional arm The Nursing and Midwifery Council of Botswana [NMCB] Regulatory body to ensure appropriate nursing education and subsequent safe patient care Registration/Licensure: Grant or official authorisation from a regulatory body to grant permission to practice in a proffesion NMCB Establishes the minimum competence required to protect the public health,safety and wellbeing Licensure-A permit from authority to own or use something. Only those who qualify(nurses/midwives) To be reg ,one has to meet reg stds Importance of registration-Gives one legal right to practice, quarantees public safety in health facilities. Registration is the core business of NMCB ACT Cap 61:03 0f 1995 According to Section 10(1) of the Nurses and Midwives Act, No person will practice as registered nurse and midwives unless his name appears in appropriate register referred to in section8 and is in possession of a practicing certificate entitling him to practice as such, in Botswana. Powers of the council-To keep and maintain registers, To remove from the register the names of nurses and midwives and for any reason have their licences revoked. It further determine registration for both local and non-local(initial and renewal of registration) THE CONCEPT OF ETHICS IN NURSING Branch of philosophy that deals with standards of conduct or human behaviour The study of morality – concerned with right or wrong Ethics govern our relationships with others, based on personal beliefs and values Provide base for decision making ETHICAL PRINCIPLES CONT ❑ BENEFICENCE & NONMALEFICENCE Beneficence is the duty to help others by doing what is best for them Nonmaleficence is duty not harm or risk to harm others At times the demands of beneficence and the functions required in a health care setting come into conflict E.g. sometimes treatment decisions are seen as harmful, from patients perspectives Conflict between beneficence & autonomy -When a patient refuses treatment even when the treatment is in their best interest CONT ❑JUSTICE Provision of services patients deserve Services should be distributed equally and fairly, independent of race, gender, religion or socioeconomic status CODE OF ETHICS ❑ Critical standard for professional behaviours ❑ The nurse provides services with respect for human dignity and the uniqueness of the client ❑ The nurse safeguards the clients right to privacy – protecting information of a confidential nature ❑ The nurse acts to safeguard the client and public when health care and safety are affected by incompetent, unethical or illegal practice of any person ❑ The nurse assumes responsibility and accountability for individual nursing judgements and actions ❑ The nurse maintains competence in nursing ❑ The nurse participates in the professions efforts to protect public from misinformation and misinterpretation and to maintain the integrity of nursing. ❑ The nurse’s priority in caring for the sick is to play an advocacy role [American Nurses Association] ICN CODE OF ETHICS FOR NURSES ICN CODE OF ETHICS FOR NURSES Reference: https://www.icn.ch/news/revis ed-icn-code-ethics-nurses- reflects-lessons-learned- covid-19-pandemic LEGAL ISSUES IN NURSING ❑ NURSING LICENSURE Licensure is a type of credential provided for by state statutes that authorises qualified individuals to perform designated skills and services In nursing, these statutes are referred to as Nurse Practice Acts Nurse practice acts establish national regulatory bodies authorised to set and enforce rules and regulations pertaining to nursing practice For Botswana, the regulatory body for nurses is the Nursing and Midwifery Council of Botswana - NMCB PATIENT CARE ISSUES ❑PATIENT RIGHTS Patients should enjoy their basic fundamental rights ascribed to individuals by the constitution even when accessing healthcare services The rights are spelled out in the patient’s bill of rights or the patients rights charter The patients rights charter is often used as a standard to judge the nursing care rendered PATIENT RIGHTS ❑THE RIGHT TO PRIVACY The right to be left alone without being subjected to unwarranted publicity Invasion of privacy is a violation of this right Information shared by the patient is confidential and available to authorised personnel only Patients can sue for invasion of privacy when confidential information is shared with unauthorised personnel Patients can also sue if unauthorised persons directly observe them without permission PATIENT RIGHTS ❑CONFIDENTIALITY This is the right to privacy of records Patients have the right to believe that information disclosed to health professionals is to be used strictly for diagnosis and treatment Patient records must therefore be kept safely, away from unauthorised persons’ access Only under rare special circumstances can the nurse lawfully disclose confidential information about the patient e.g. when the welfare of a person or a group is at stake, or when a personal injury is being filed. PATIENT RIGHTS ❑INFORMED CONSENT Patients have the right to consent to treatment or any intervention by health care professionals Violation of this right except in emergency situations could result in liability for unauthorised touching or battery Capacity to consent is determined by age and competence Generally one should be an adult [>18years old] for them to consent to treatment Adult are deemed competent when they can make choices and understand the consequences of their choices PATIENT RIGHTS ❑ INFORMED CONSENT – Continued Consent should be voluntary, without force, fraud, deceit, duress or any form of coercion Consent should be preceded by information sharing Information shared to be understandable – free of medical terms ❑ The following to be included: o Explanation of the treatment to be performed & expected results o Anticipated risks and discomforts o Potential benefits o Possible alternatives o An offer to answer any questions from the patient PATIENT RIGHTS RIGHT TO REFUSE TREATMENT Competent adults have the right to refuse treatment Interlinked with the right to self-determination ----- the right to make decisions about what should or should not be done to their bodies The right is also embodied in the informed consent ethical principle. PATIENT RIGHTS –Advance Directives Competent adults can also give advance directives – where people make choices prior to the need for medical treatment The two most common advance directives are the living will & the power of attorney for health care Living will – the competent adult signs a form indicating what healthcare the person wants in future Durable power of attorney – permits a competent adult to appoint a surrogate or a proxy to make decisions for that person in the event that he/she becomes incompetent. RESPONSIBILITIES OF NURSING STUDENTS REGARDING PROFESSIONALISM KNOWLEDGE ACQUISITION ❑Students to acquire adequate knowledge to meet minimum level of competence required for professional nursing practice ❑To maintain & update knowledge base throughout their training & career Constantly changing drug market Changing disease profiles Emergence of novel diseases Advances in technology etc COMPETENCE Expected of ALL students from enrollment throughout training to practice Accepting responsibility to acquire knowledge and skills, and to develop a positive attitude towards the profession Five levels of progression Novice Advanced beginner Competent Proficient Expert [Novice to Expert Theory – Patricia Benner] INTEGRITY ADHERENCE TO STRICT UPHOLD NURSES CODE OF NEVER FUNCTION OUTSIDE ALWAYS VERIFY WITH MORAL, ETHICAL CODE ETHICS SCOPE OF PRACTICE REGISTERED NURSES OR INSTRUCTORS IF IN DOUBT  Mental state involving values, beliefs, feBeliefs: sensitivity to cultural and religious variationselings, mood Values: altruism, respect for clients, integrity, etc. POSITIVE ATTITUDE Beliefs: sensitivity to cultural and religious variations Self awareness of own feelings & mood – not to interfere with client care COMPASSION COMPASSION Awareness of, Treat client as concern about unique, special other individuals' individual suffering WORK ETHIC ❑Belief in importance, moral worth of work High value on hard work and diligence Apply self to task at hand Thorough approach to get work done right the first time ATTENDANCE AND PUNCTUALITY Be on time for class and work Responsibility to stay long enough to complete work at hand! THE NIGHTINGALE PLEDGE ❑ I solemnly pledge myself before God and in the presence of this assembly: to pass my life in purity and to practice my profession faithfully; ❑ I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug; ❑ I will do all in my power to maintain and elevate the standard of the profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling; ❑ With loyalty will I endeavour to aid the physician in his work, and devote myself to the welfare of those committed to my care Gretter 1893 NURSES PLEDGE OF SERVICE In full knowledge of my obligations. I am undertaking, I promise to care for the sick all the skill and understanding I possess, without regard to race, creed colour ,politics and social status, sparing no effort to conserve life, alleviate suffering and to promote health. I will always respect the dignity and religious beliefs of the patients under my care, holding in confidence all personal information entrusted to me, and refraining from any actions which might endanger life and health. I will endeavour to keep to keep my professional knowledge and skill at the highest level and to give loyal support and cooperation to all members of the health team. I will do my utmost to honour the international code of nursing ethics and to uphold the integrity of the professional nurse. OI make these promises freely and upon my honour. References Burkhardt,M&Nathaniel(2008):Ethics Issues in contemporary Nursing Hrycyk, Catherine [ ]: Professionalism and Education / Conceptual and Philosophical Basis of Nursing Pearson. Nursing: A Concept-Based Approach to Learning Moloney, M. Professionalization of Nursing; Current Issues and Trends Revised ICN Code of Ethics for Nurses reflects lessons learned from the COVID-19 pandemic Scenario 1 Dineo and Lorato are nurses working in the same ward/unit. They have about 120 clints in female medical ward. They are supposed to check clients' vital signs for the clients under their care. That is , checking temperatures and blood pressure itc. Nurse Lesego instructs nurse Lorato that there are many patients in the unit and they are not very sick so they should just estimate their vital signs so that they are to write a report and finish their work on time. At the time of change of shift and giving report, it was found that one of the patient had died and the two nurses who were on duty were on duty we supposed to provide more details about the passing of the patient since her vitals were checked just 45minutes ago. Questions and Answers 1.What are the issues here? 2. Is it wrong to estimate clients vital signs? Why?  3. Is there a problem in what these two nurses did? If there is, what is the problem? 4.How can the problem /transgression be classified? 5.Do you think these nurses should report what they do when providing care? 6.Who should report? 7.Should Nurse Lorato have reported this matter to the manager why or why not? 8.What are your impression about these two nurses? 9.What do you think should be done about what has happened?