NUR1 222 Week #8 Fall 2023 Strengths-Based Nursing & Professionalism (5).pdf

NUR1 222 Strengths-Based Nursing and Professionalism Prof. Maria Di Feo Oct 19, 2023 1 Outline Nursing Practice and Legal Issues/Considerations Guest Lecturer: Irene Sarasua (Nurse/Professor): Nurse Practitioner’s Scope of Practice Ethical Issues/Considerations Image of Nursing Objectives • I...

NUR1 222 Strengths-Based Nursing and Professionalism Prof. Maria Di Feo Oct 19, 2023 1 Outline Nursing Practice and Legal Issues/Considerations Guest Lecturer: Irene Sarasua (Nurse/Professor): Nurse Practitioner’s Scope of Practice Ethical Issues/Considerations Image of Nursing Objectives • Iden&fy and describe the different elements that guide nursing prac&ce. • Iden&fy ethical and legal considera&ons in Quebec that influence nursing prac&ce. • Explain how ethical and legal considera&ons in Quebec affect nursing prac&ce. • Describe a nurse’s scope of prac&ce in "Ensuring protection Quebec. through and with nurses, while also ensuring the • Iden&fy and explain factors that can improvement of the health of Quebecers." influence the image of nursing. 4 Luc Mathieu, inf., D.B.A. Président de l’OIIQ 5 OIIQ Notre mission • Assurer la protection du public par et avec les infirmières et infirmiers, tout en veillant à l’amélioration de la santé des Québécois. (Protection of Public- main purpose). • Largest professional order in Québec. 83 418 members • https://www.oiiq.org/en/l-ordre/qui-sommes-nous- Ordre des infirmières et infirmiers du Québec (OIIQ) La Maison des infirmières et infirmiers du Québec 4200, rue Molson Montréal (Québec) H1Y 4V4 Professional Practice, Legal and Ethical Issues BScN U3 Fall • NUR1 424: Legal, Ethical & Professional Practice Issues DE MSc (A) DE Year 2 Winter • NUR2 626: Professional Issues in Nursing • NUR2 642: Ethics in Advanced Practice Legislation (laws) that influence, guide and inform Nursing Practice The Professional System in Québec The Nursing Profession belongs to this The Nursing Profession belongs to thissystem system 10 Quebec’s Professional Code (A law) It governs all the profesisons in Quebec Governs all Professions in Québec 11 Quebec’s Professional Code C. 26 (excerpts) A Québec law that governs the Professional System in Quebec (46 Professional Orders in Quebec) Why is she presenting this? How is it relatable to my profession Article 45. The board of directors of an Ordre may refuse to issue a permit or to enter an applicant on the roll, or refuse any other application preceding admission to the profession, if the applicant related to criminal offences… If any applicant enters the professions with criminal offenses = not able to go in nursing Article 57. No professional may refuse to provide services to a person because of the race, colour, sex, age, religion, national extraction or social origin of such person ( Intergrity) Article 52.1. The board of directors may, when it considers that the physical or mental condition of a professional requires immediate action to protect the public, provisionally strike the professional off the roll or restrict or suspend his right to engage in professional activities until a decision is rendered following the medical examination ordered under section 48. 12 Quebec’s Professional Code C. 26 (excerpts) Article 59.3. A professional must, within 10 days from the day on which he is himself informed, notify the secretary of the order of which he is a member that he is or has been the subject of a judicial or disciplinary decision referred to in section 55.1 or 55.2 or a proceeding for an offence punishable by a term of imprisonment of five years or more. Article 60.4. Every professional must preserve the secrecy of all confidential information that becomes known to him in the practice of his profession. Article 109. A professional inspection committee is established within each order. http://legisquebec.gouv.qc.ca/en/showDoc/c s/C-26?&digest= 13 Quebec’s Professional Code & the OIIQ The powers invested in the OIIQ under the Professional Code include the authority to establish conditions for access to the profession and other mechanisms for regulating its practice. In order to regulate practice, the OIIQ is required to : • Establish a professional inspection committee • Set up a disciplinary process • Draw up a code of ethics stipulating professional duties 14 Quebec’s Professional Code Informs OIIQ (Nursing standards, Obligations, Code of Ethics) Quebec’s Professional Code C. 26 § Helps define the practice of nursing within the professional system § Identifies Obligations for OIIQ & Nurses 16 Nursing Profession Quebec Nurse’s Act DIVISION VIII PRACTICE OF THE PROFESSION Section 36. The practice of nursing consists in assessing health, determining and carrying out the nursing care and treatment plan, providing nursing and medical care and treatment in order to maintain and restore the health of a person in interaction with his environment and prevent illness, and providing palliative care. https://www.legisquebec.gouv.qc.ca/en/document/cs/I-8 19 NP scope of practice. Section 36.1 Specialized nurse practitioners may, if so authorized by a regulation made under subparagraph f of the first paragraph of section 14, engage in the following activities, according to their class of specialization and on the terms and conditions prescribed in that regulation: (1) diagnosing illnesses; (2) prescribing diagnostic examinations; (3) using diagnostic techniques that are invasive or entail risks of injury; (4) determining medical treatments; (5) prescribing medications and other substances; (6) prescribing medical treatments; Québec Nurses Act (7) using techniques or applying medical treatments that are invasive or entail risks of injury; and (8) providing pregnancy care. can diognose illnesses , but nurses can't 20 Collective Prescriptions https://www.oiiq.org/pratique-professionnelle/encadrement-de-lapratique/outils-cliniques/ordonnances-collectives • Une ordonnance collective (OC) est « une prescription donnée par un médecin ou un groupe de médecins à une personne habilitée, ayant notamment pour objet les médicaments, les traitements, les examens ou les soins à donner à un groupe de personnes ou pour les situations cliniques déterminées dans cette ordonnance, les circonstances dans lesquelles ils peuvent l'être de même que les contre-indications possibles ». • Written by a physician or a group of physicians for a person who canlegally exercise these acts (example nurse) • Regarding medications, treatments, exams • Groups of people, criteria/circumstances identified, Right to Prescribe https://www.oiiq.org/pratique-professionnelle/exerciceinfirmier/prescription-infirmiere • Need to meet certain criteria established by OIIQ including training provided by OIIQ. • Domains: • Wound care • Contraception • Smoking Cessation • Certain medications Legal Framework 23 Legislation • The Professional Code • The Nurses Act • Other LAWS also govern, the day-to-day practice of Nursing 24 Nursing in Québec – The Legal Framework The Legal Framework imposes obligations on nurses and influences/informs Nursing Practice Clients have legal rights that all professionals must respect (as defined in): Ø Québec Charter of Rights & Freedoms Ø Civil Code of Québec Ø Act Respecting Health Services and Social Services - Québec Ø Organization and Management of Institutions Regulation - Québec Ø Youth Protection Act - Quebec Ø …… 25 2. Every human being whose life is in peril has a right to assistance. Charter of Rights & Freedoms Quebec C.12 (excerpts) • Every person must come to the aid of anyone whose life is in peril, either personally or calling for aid, by giving him the necessary and immediate physical assistance, unless it involves danger to himself or a third person, or he has another valid reason 9. Every person has a right to non-disclosure of confidential information. • No person bound to professional secrecy by law and no priest or other minister of religion may, even in judicial proceedings, disclose confidential information revealed to him by reason of his position or profession, unless he is authorized to do so by the person who confided such information to him or by an express provision of law. https://www.legisquebec.gouv.qc.ca/en/document/cs/c12#:~:text=Every%20person%20must%20come%20to,6%2C%20s. 26 These laws are necessary to protect the patients rights Civil Code of Québec (excerpts) 11. No person may be made to undergo care of any nature, whether for examination, specimen taking, removal of tissue, treatment or any other act, except with his consent. • If the person concerned is incapable of giving or refusing his consent to care, a person authorized by law or by mandate given in anticipation of his incapacity may do so in his place. 14. Consent to care required by the state of health of a minor is given by the person having parental authority or by his tutor. • A minor 14 years of age or over, however, may give his consent alone to such care. If his state requires that he remain in a health or social services establishment for over 12 hours, the person having parental authority or tutor shall be informed of that fact. 26. No person may be confined in a health or social services institution for a psychiatric assessment or following a psychiatric assessment concluding that confinement is necessary without his consent or without authorization by law or the court. http://legisquebec.gouv.qc.ca/en/showdoc/cs/ccq-1991 27 The Act Respecting Health Services and Social Services (Québec) 9. No person may be made to undergo care of any nature, whether for examination, specimen taking, treatment or any other intervention, except with his consent. (excerpts) 19. The record of a user is confidential and no person may have access to it except with the consent of the user or the person qualified to give consent on his behalf. Information contained in a user’s record may, however, be communicated without the user’s consent…… • Consent to care or the authorization to provide care shall be given or refused by the user or, as the case may be, his representative or the court, in the circumstances and manner provided for in articles 10 and following of the Civil Code. The Act Respecting Health Services and Social Services (Québec) (excerpts) 118.1. Force, isolation, mechanical means or chemicals may not be used to place a person under control in an installation maintained by an institution except to prevent the person from inflicting harm upon himself or others. The use of such means must be minimal and resorted to only exceptionally, and must be appropriate having regard to the person's physical and mental state. Si la personne refuse de prendre une médication quelquonque et refuse et présente un état d'esprit tout a fait conscient.... Il faut respecter son choix. • Any measure referred to in the first paragraph applied in respect of a person must be noted in detail in the person's record. In particular, a description of the means used, the time during which they were used and a description of the behaviour which gave rise to the application or continued application of the measure must be recorded. • Every institution must adopt a procedure for the application of such measures that is consistent with ministerial orientations, make the procedure known to the users of the institution and evaluate the application of such measures annually. http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/S-4.2 Organization and Management of Institutions Regulation (Québec) (excerpts) 50. Every institution shall keep an individual record for each beneficiary who obtains services from it, except in cases covered by sections 45 and 51… 52.1 The consent of a beneficiary or his legal representative to anesthesia or surgery shall be supported by a written document signed by the beneficiary or his legal representative specifying that the beneficiary has obtained appropriate information particularly about possible risks or effects. The document must be countersigned by the attending physician or dentist and be preserved in the beneficiary’s record http://legisquebec.gouv.qc.ca/en/ShowDoc/cr/S-5,%20r.%205 Youth Protection Act Québec http://legisquebec.go uv.qc.ca/en/ShowDoc/ cs/P-34.1 31 Department of Youth Protection is responsible for protecting children and youth when their safety or development may be endangered. Director of Youth Protection (DYP) Direction de la protection de la jeunesse (DPJ) Direction de la protection de la jeunesse (DPJ) 32 Youth Protection Act Quebec 34.1 (excerpt) 39. Every professional who, by the very nature of his profession, provides care or any other form of assistance to children and who, in the practice of his profession, has reasonable grounds to believe that the security or development of a child is or may be considered to be in danger within the meaning of section 38 or 38.1, must bring the situation to the attention of the director without delay. The same obligation is incumbent upon any employee of an institution, any teacher, any person working in a childcare establishment or any policeman who, in the performance of his duties, has reasonable grounds to believe that the security or development of a child is or may be considered to be in danger within the meaning of the said provisions. ….. 33 Ethical Issues/Considerations in Nursing 34 https://cna-aiic.ca/-/media/cna/page-content/pdfen/code-of-ethics-2017-edition-secureinteractive.pdf?la=en&hash=09C348308C44912AF2166 56BFA31E33519756387 Ethics and Professionalism 35 Code of Ethics for Registered Nurses (Canadian Nursing Association) Part 1.Nursing Values and Ethical Responsibilities 1-Providing Safe Compassionate and Competent and Ethical Care 2-Promoting Health and Well- being 3-Promoting and Respecting Informed Decision-Making 4-Honouring Dignity 5-Maintaining Privacy and Confidentiality 6-Promoting Justice 7-Being Accountable Part 2. Ethical Endeavours Related to Broad Societal Issues — describes activities nurses can undertake to address social inequities. 36 Nursing & Ethics- Four Main Principles/Concepts Autonomy (self determination): Patients have the the right to make their own decisions based on their own beliefs and values Beneficence: Healthcare workers have an obligation to refrain from maltreatment, minimize and prevent harm. Intent of doing good. Non – maleficence: Patients have a right to no harm. “First do no harm”. Justice: All patients have a right to be treated fair and equally. 37 Code of Ethics of Nursing Québec All those laws are affected by Quebec laws that have them obligated to do code of ethics Associated regulation with • Nurse’s Act 1.8 • 3. Subject to this Act, the Order and its members shall be governed by the Professional Code (chapter C-26). • Code of ethics of nurses • Professional Code C. 26 • 87. The board of directors must make, by regulation, a code of ethics governing the general and special duties of the professional towards the public, his clients and his profession, particularly the duty to discharge his professional obligations with integrity. Such code must contain, inter alia: 38 Code of Ethics of Nursing Québec Law in Québec • is a keystone of the Order’s professional legislation. • serves as a guide for nurses and imposes general and specific duties and obligations toward the public, clients and the profession, in order to protect the public and regulate unacceptable conduct within the profession. 39 Professionalism Adhering to the ethics, rules and regulations that govern the profession. Professionalism • The Ingram School of Nursing expect their students to respect and abide by the OIIQ Values from the Code of Ethics regarding Nursing professionalism. The Ingram School of Nursing is critically reflecting on how we define “Nursing Professionalism”. We acknowledge our institutionalized privileging of whiteness that is embedded, sustained, and has perpetuated cultural assimilation, discrimination, and bias in nursing education through “Professionalism” definitions and standards. • As we continue to engage in critical discussions on this topic, the OIIQ Values from the Code of Ethics is the student reference for Nursing professionalism. 41 Values serve as the pillars for the different divisions of the Code of Ethics of Nurses and define the resulting professional duties and obligations. 42 Code of Ethics of Nursing - Values Integrity refers to honesty and truthfulness. It transcends all dimensions of the practice of the profession and is the cornerstone of nurses’ professional ethics. Respect for the client: Establishing and maintaining a relationship of trust, and recognizing the client’s uniqueness, right to privacy and decision-making autonomy, as expressed in his or her right to make choices and to be informed. Professional autonomy: Relates to nurses’ ability to make objective and independent decisions in the client’s interest, and to be accountable and responsible for them. Professional competence: Competence refers to nurses’ responsibility to maintain and update their knowledge and skills and to take account of evidence-based data and best practices. It also means nurses’ ability to recognize and respect their limits in practising the profession. 43 Code of Ethics of Nursing - Values Excellence in care is the raison d’être of the nursing profession, and reflects the importance accorded to human life. It means striving to ensure the well-being and security of clients of every age, at every stage in their lives, and is the ulVmate goal of the nursing profession. Professional collabora:on reflects the importance of acVng in partnership with other professionals and individuals involved, so as to ensure and opVmize the quality and security of care and services for clients. Humanity: DemonstraVng humanity in the provision of care means, in parVcular, showing generosity, tolerance and solidarity in dealings with others. It lets nurses show empathy and recognize others’ uniqueness. 44 Division I: Duties inherent to the practice of the profession Code of Ethics of Nursing Division II: Relationship between the nurse and the client Québec Division V: Relations with the Order Division III: Quality of care and services Division IV: Relations with persons with whom the nurse interacts in the practice of the profession Division VI: Determination and payment of fees Division VII: Conditions and procedures for the exercise of the client’s rights of access and correction of information contained in records established in respect of him or her Division VIII: Conditions, obligations and prohibitions relating to advertising Division IX: Professions, trades, industries, businesses, offices or duties incompatible with the dignity or practice of the profession Division X: Graphic symbol of the Order 45 Code of Ethics of Nursing Québec Division 1 Duties Inherent to the Practice of the Profession §1 General Provisions Excerpts 1. A nurse shall come to the aid of anyone whose life is in peril, either personally or by calling for aid, by giving necessary and immediate assistance to that person, except in the event of danger to the nurse or a third party, or unless the nurse has another valid reason. 2. A nurse may not refuse to provide professional services to a person on the basis of race, colour, sex, pregnancy, sexual orientation, civil status, age, religion, political convictions, language, ethnic or national extraction, social origin or condition, a handicap or the use of any means to palliate a handicap. • However, a nurse may, in the interest of the client, refer the client to another nurse. 46 Code of Ethics of Nursing Québec Division 1 Duties Inherent to the Practice of the Profession § 2 Integrity Excerpts 12. A nurse shall report any incident or accident that results from her or his intervention or omission. • The nurse shall not attempt to conceal such incident or accident. • When such an incident or accident has or could have consequences for the client’s health, the nurse shall promptly take the necessary measures to remedy, minimize or offset the consequences of the incident or accident. 13. A nurse shall not appropriate medications or other substances, including drugs, narcotic or anesthetic preparations or any other property belonging to a person with whom she or he interacts in the practice of the profession. 47 Code of Ethics of Nursing Québec Division 1 Duties Inherent to the Practice of the Profession §2 Integrity Excerpts A nurse shall not, in respect of a client’s record or any report, file, research record or document related to the profession: (1) falsify same, in particular by altering any notes already entered therein or by inserting any notes under a false signature; (2) fabricate any records, reports, files or documents; (3) enter therein any false information; (4) fail to enter therein any necessary information. 48 Code of Ethics of Nursing Québec Division I Duties Inherent to the Practice of the Profession §4 Competence Excerpts 17. A nurse shall act competently in fulfilling her or his professional duties. To that end, the nurse shall take into consideration the limits of her or his knowledge and skills. 18. A nurse shall practise her or his profession in accordance with generally accepted standards of practice and scientific principles. To that end, she or he shall update and develop her or his professional knowledge and skills. 49 Code of Ethics of Nursing Québec Division II Relationship Between the Nurse and the Client § 1 Relationship of Trust Excerpts 28. A nurse shall seek to establish and maintain a relationship of trust with her or his client. 29. A nurse shall act respectfully toward the client and the client’s spouse, family and significant others. 30. A nurse shall respect, within the limits of what is generally admissible in the practice of the profession, the client’s values and personal convictions. 50 Code of Ethics of Nursing Québec Division II Relationship Between the Nurse and the Client § 2. Provisions to Preserve the Secrecy of Confidential Information Excerpts 31. A nurse shall abide by the rules set forth in the Professional Code (chapter C-26) in regard to the obligation to preserve the secrecy of confidential information that becomes known to her or him in the practice of her or his profession and the cases where she or he may be released from the obligation of secrecy. 31.2. When a nurse provides professional services for a couple or a family, she or he shall preserve the professional secrecy of each member of the couple or family. 36. A nurse shall not hold or participate in indiscreet conversations, including on social networks, concerning a client and the services rendered to such client. 51 Code of Ethics of Nursing Québec Division II Relationship Between the Nurse and the Client § 3 Prohibited Behaviour Excerpts 37. A nurse shall not use physical, verbal or psychological abuse against the client. 38. For the duration of the professional relationship, a nurse may not establish a personal friendship or an intimate, amorous or sexual relationship with the client. 52 Code of Ethics of Nursing Québec Division III Quality of Care and Services §1. Information and Consent Excerpts 40. A nurse shall provide her or his client with all the explanations necessary for the client’s comprehension of the care, treatment or other professional services being provided to him or her by the nurse. 41. When a nurse is obliged to obtain a free and enlightened consent, she or he shall: (1) provide the client with all the information required for that purpose; (2) ensure that the client’s consent remains free and informed for the duration of the period during which she or he provides care, treatment or other professional services; (3) respect the client’s right to revoke his or her consent at any time. 53 Code of Ethics of Nursing Québec Division III Quality of Care and Services §2. The Therapeutic Process Excerpts 42. In the course of performing her or his duties, a nurse shall take reasonable measures to ensure the safety of clients, in particular by notifying the appropriate authorities. 44. A nurse shall not be negligent in the care and treatment provided to the client or to the research subject. In particular, a nurse shall: (1) perform the assessment required by the client’s state of health; (2) intervene promptly when the client’s state of health so requires; (3) ensure the clinical monitoring and follow-up required by the client’s state of health; (4) take reasonable action to ensure continuity of care and treatment. 54 Code of Ethics of Nursing Québec Division III Quality of Care and Services §2. The Therapeutic Process Excerpts 45. A nurse shall not be negligent when administering or adjusting medication or other substances. In particular, when administering medication or other substances, a nurse shall have sufficient knowledge of the medication and abide by the principles and methods applicable to its administration. 46. A nurse may not refuse to collaborate with health professionals engaged in providing care, treatment or services necessary for the client’s welfare. 55 Reviews complaints OIIQ Le Conseil de discipline Investigated by Syndic Makes decisions/imposes sanctions 56 57 58 59 These considerations come in to play in determining Nurses’ Professional Liability Legal, Professional & Ethical Considerations Underlie Nurses’ Clinical Reasoning & Clinical Decision Making • Professional Liability • The legal responsibility of a professional to pay for damage, harm or loss that they cause (damages incurred by negligent acts) while practicing their profession • Professional Liability – nurses covered against any fault or negligence by the Professional Liability Insurance Program (OIIQ members pay annual fees mandatory) 60 • Nurses obligations with respect to Professional Activities analyzed from the standpoint of an objective reference standard Negligence • i.e., what a reasonably prudent, diligent and competent nurse would have done under the same circumstances 61 Professional Responsibility and Social Media Remember Legal and Ethical Considerations!! 62 Ingram School of Nursing Student and Faculty Handbooks – Social Media • It is unprofessional to post any information about a client, any photos of clients, or derogatory commentary on a clinical institution on social media. • Students are not to become ‘friends’ with their patients/clients. • The following (excerpted with minor modification from Faculty of Medicine) provides considerations when using social media: • Maintain a safe professional distance between patients and superiors online. • Accepting invitations to become ‘friends’ with patients, their families, and instructors is discouraged. • Conduct yourself online as you would in public places. • Your online identity is a projection of your own behavior, and thus it is important to maintain professionalism. • Do not discuss clinical encounters openly. It is critical to maintain the confidentiality of patients. Failure to do so is a breach of professionalism and can result in sanctions. • Do not post photos or any details of clinical encounters to avoid breaching confidentiality. • Never discriminate. It is easy to click ‘Like’ or post a comment, which might be inappropriate. By posting such a comment it might be linked to you for an indefinite period of time! 63 64 65 Ingram School of Nursing Student and Faculty Handbooks Review Section: Social Media, Anonymous Feedback and Professionalism: 66 What Guides Nursing Practice? • Nursing School • Person’s Philosophy of Nursing (Beliefs, Values) • The Professional Code • The Nurses Act • Other LAWS (Canadian & Québec) • Code of Ethics of Nursing Quebec Image of Nursing 68 69 10/19/23 70 10/19/23 https://www.nurseblake.com/ 72 https://www.youtube.com/watch?v=551bkmQHhx U&t=10s&ab_channel=NurseBlake 10/19/23 73 Laughter is the best medicine! Nurse Blake is a nurse, creator, advocate, touring comedian and so much more. And he’s coming to Canada! 10/19/23 74 Canada’s Most Respected Occupations 2022 https://canadasmostre spected.com/occupati ons-2022/ 10/19/23 75 Nursing Profession ØNurses trusted and respected for their honesty and integrity ØNeed to improve public’s understanding of nursing’s expert knowledge base, complexity and contribution to health of population and delivery of healthcare Improving public understanding of nursing. Challenging inaccurate depictions of nursing in the media. • A non – profit organization Mission statement The Truth About Nursing seeks to increase public understanding of the central, front-line role nurses play in modern health care. Our focus is to promote more accurate, balanced and frequent media portrayals of nurses and increase the media's use of nurses as expert sources. The Truth About Nursing's ultimate goal is to foster growth in the size and diversity of the nursing profession at a time of critical shortage, strengthen nursing practice, teaching and research, and improve the health care system. • https://www.truthaboutnursing.org/index.html#gsc.tab=0 OIIQ Image of Nursing Profession https://www.oiiq. org/imageprofessionnelledes-infirmieresune-prise-depositionactualisee https://www.oiiq.org/documents/20147/237836/5513image-professionnelle-infirmieres-prise-position-web.pdf 10/19/23 78 ISoN Student Handbooks Professional Attire Professional attire is regulated by the OIIQ and the clinical site. All students are expected to be read the OIIQ guidelines as well as be informed of the specific expectations for each clinical site. 10/19/23 79 References • OIIQ (2018) Rapport statistique sur l’effectif infirmier 2017-2018 • OIIQ (2010) Preparation Guide for the Professional Examination of the OIIQ – Nursing in Quebec Supplement • OIIQ (2010) Self- Study Guide to the Code of Ethics and Other Legal and Ethical Considerations for Quebec Nurses • OIIQ (2009) Mosaic of Nurses’ Clinical Competencies – Initial Competencies (2nd Edition) 80