PPN101 Week 11 2023 Professionalism part 1 .pptx

Professionalism Part one Week 11 PPN101 Week 11 1 • • • Examine your own personal, professional, and socio-cultural values and belief systems. How would these values Influence patient care? Discuss professional accountability and CNO Code of Conduct. Discuss the major roles and responsibilitie...

Professionalism Part one Week 11 PPN101 Week 11 1 • • • Examine your own personal, professional, and socio-cultural values and belief systems. How would these values Influence patient care? Discuss professional accountability and CNO Code of Conduct. Discuss the major roles and responsibilities of nursing organizations legal requirement versus voluntary membership College of Nurses of Ontario (CNO) Ontario Nurses Association (ONA) Canadian Nurses Association (CNA) Canadian Association of Schools of Nursing (CASN) International Council of Nurses (ICN) Registered Objectives Nurses Association of Ontario (RNAO) Sigma Theta Tau International (STTI) • Discuss entry to practice competencies for Registered Nurses and NCLEX exam for professional licensing. • Discuss Personal Health Information Protection Act (PHIPA) and Personal Information Protection and Electronic Documents Act (PIPEDA). Discuss how these acts affect nursing practice. • Explore the concepts of negligence and duty of care. • Briefly discuss key components of Canada’s legal system and their effects on nursing practice. Discuss Statute Law (RHPSLAA) and Tort Law (intentional/unintentional). • Discuss the importance of informed consent in the patient care settings and identify the nurses’ role PPN101 Week 11 2 Values and beliefs • Need to be aware of our personal values and beliefs if and when they conflict with the values of a client/institution. • Can you think of some examples of this kind of a conflict of values? • Have you ever experienced this yourself, for example, as a student? • What happened? • How did you approach and/or resolve the problem? (P&P, 2024.p.110) PPN101 Week 11 3 PPN101 Week 11 Accountabil ity • grounded in the moral principles of fidelity (faithfulness) and respect for the dignity, worth, and self-determination of patients and others with whom nurses work. • As accountable professionals, “nurses are honest and practise with integrity in all of their professional interactions” (CNA, 2017). • Accountability means being able to accept responsibility or to account for one's actions and refers to being answerable to someone for something one has done. (CNA 2017; P&P ,2024,p.111) 4 PPN101 Week 11 Professiona l Accountabil ity Nurses who are enacting professional accountability are: • Keeping up with professional standards, laws, and regulations • Ensuring that they have the competence to provide these practice • Maintaining their fitness to practise, ensuring that they have the necessary physical, mental, and emotional capacity to practise safely and competently • Sharing their knowledge with other nurses, nursing students, and other health-care providers through mentorship and giving feedback • Advocating for comprehensive and equitable mental health care services. (CNA 2017; P&P, 2024,p.111) 5 Accountability • When might one’s professional role come into conflict? • What role does it play in ethical and legal practice? PPN101 Week 11 6 Organizations PPN101 Week 11 7 Roles and responsibilities of professional nursing organizations College of Nurses of Ontario (CNO) Ontario Nurses Association (ONA) Registered Nurses Association of Ontario (RNAO) Canadian Nurses Association (CNA) Canadian Association of Schools of Nursing (CASN) International Council of Nurses ( ICN) Sigma Theta Tau International (STTI) PPN101 PPN101 Week 11 8 College of Nurses (CNO) • The nursing profession has been self-regulating in Ontario since 1963. • Self-regulation is a privilege granted to professions that have shown they can put the interests of the public ahead of their own professional interests. • It recognizes that Ontario’s nurses have the knowledge and expertise to regulate themselves as individual practitioners and to regulate their profession through the College. https://www.cno.org/en/what-is-cno/#:~:text=establishing%20requirements%20for%20entry%20to,standards%20of%20practice%20and%20conduct PPN101 Week 11 9 College of Nurses of Ontario Governing/regulating body Protects the public Regulates nursing to protect public interest • How? • Entry-to-practice requirements • Enforcing standards of practice • Complaints and disciplinary processes • Quality Assurance programs • http://www.cno.org/ Under the RHPA and the Nursing Act, 1991, the College of Nurses of Ontario (CNO) is responsible for governing the profession of nursing in Ontario in the public interest. PPN101 www.cno.org/globalassets/docs/prac/49040_code-ofconduct.pdf 10 College of Nurses The College fulfils its role by: • establishing requirements for entry to practice • articulating and promoting practice standards • administering its Quality Assurance Program • enforcing standards of practice and conduct The College also supports the regulation of nursing in the public interest by: • participating in the legislative process • sharing statistical information about Ontario’s nurses https://www.cno.org/en/what-is-cno/#:~:text=establishing%20requirements%20for%20entry%20to,standards%20of%20practice%20and%20conduct PPN101 Week 11 11 What is the Code of Conduct? https://www.youtube.com/watch?v=hnZMJEoY 3IQ&t=78s The College of Nurses of Ontario (CNO) protects the public by promoting safe nursing practice. One way is by developing standards of practice for all nurses in Ontario. The Code of Conduct (Code) is a practice standard describing the accountabilities all nurses registered in Ontario have to clients, employers, colleagues and the public. It explains what people can expect Week 11 12 fromPPN101 nurses. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf The Code of Conduct • The Code also describes what nurses must do to maintain professionalism, competence and ethical behaviour to deliver safe client care. • All nurses (Registered Nurses, Registered Practical Nurses, and Nurse Practitioners) are expected to uphold this practice standard, regardless of their role, title or responsibility. • To maintain public trust and confidence in the nursing profession’s integrity and care, the Code outlines safe and ethical practice requirements based on current evidence. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf PPN101 Week 11 13 Code of Conduct • The Code is also informed by legislation, such as the Ontario Human Rights Code and recommendations in the Truth and Reconciliation Commission of Canada: Calls to Action (2015). • The Code puts clients at the centre of nursing care and includes principles of diversity, equity and inclusion to ensure client care is safe, compassionate, equitable and discrimination free. • Throughout the Code, we use the word “client” broadly, to include individuals, substitute decisionmakers, families, caregivers, groups, communities and populations who receive nursing care. • Nurses are expected to use the Code along with other CNO practice standards. • The Code applies to any method a nurse uses to deliver health care services, such as in-person, virtually or by telephone. • CNO considers the Code in regulatory processes and in reviewing the practice of nurses such as in Quality Assurance and Professional Conduct processes. Nursing practice is considered in its working context and circumstances https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf PPN101 Week 11 14 Principles of the Code • 1. Nurses respect clients’ dignity. • 2. Nurses provide inclusive and culturally safe care by practicing cultural humility. • 3. Nurses provide safe and competent care. • 4. Nurses work respectfully with the health care team to best meet clients’ needs. • 5. Nurses act with integrity in clients’ best interest. 6. Nurses maintain public confidence in the nursing profession. Each principle is supported by a set of statements of core behaviours all nurses are accountable for. All principles have equal importance and work together to describe the conduct, behaviour, and professionalism necessary for safe and ethical nursing practice in Ontario. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf PPN101 Week 11 15 Ontario Nurses Association (ONA) •Trade union since 1973 •“Respected. Strong. United. Committed to members who care for people.” •Vision: “Membership driven, proactive union sensitive and responsive to ever changing needs in an evolving health care system” •Collective agreements •Advocate for: • Safe environments and practices • Patient care concerns • Equality (www.ona.org) PPN101 PPN101 Week 11 16 ONA Vision Mission • “Membership driven, proactive union sensitive and responsive to ever changing needs in an evolving health care system” • Environment: Learning & personal growth, diversity & creativity • Foundations: mutual trust, respect, support & understanding • Goal: high quality efficient HCS, in partnership with communities, consumers and HC professionals “The Ontario Nurses’ Association (ONA) is a proactive union committed to improving the economic welfare and quality of worklife for our members, to enable them to provide high-quality health care.” • https://www.youtube.com/watch?time_continue=167&v =2-ajN8-o9xE (www.ona.org) PPN101 Week 11 17 18 Registered Nurses Association of Ontario (RNAO) • Professional association representing registered nurses in Ontario. • Any registered nurse or nursing student can join for a fee. • Not mandatory to join – optional, your choice. • The ‘voice’ of the nursing profession(http://rnao.ca/about/missio n) PPN101 Week 11 PPN101 RNAO • Foster knowledge-based nursing practice • Promote quality work environments and professional development • Advance healthy public policy to improve health • “Speaking out for nursing. Speaking out for health” • Best Practice Guidelines (http://rnao.ca/about/mission) PPN101 Week 11 19 Canadian Nurses Association (CNA) • National professional voice of RNs • Vision: Registered nurses: Leaders and partners working to advance nursing and health • Mission • Unifying the voices of registered nurses • Strengthening nursing leadership • Promoting nursing excellence & a vibrant profession • Advocating for healthy public policy and a quality health system • Serving the public interest (https://www.cna-aiic.ca/en/home) PPN101 Week 11 20 Canadian Nurses Association (CNA) • Professional federation of nursing associations across the provinces and territories. • Vision: “Nurses contributing to the health of Canadians and the advancement of nursing” • Mission: “advance quality of nursing in the interests of the public” https://www.cna-aiic.ca/en/home PPN101 Week 11 21 Voice for nursing education & scholarship Canadian Association of Schools of Nursing (CASN) Establishes & promotes national standards for nursing education Represents all universities & colleges which offer part or all of an undergraduate or graduate degree in nursing Official accrediting agency for university nursing programs in Canada https://www.casn.ca/about-casn/casnacesi-mi ssion / PPN101 Week 11 22 23 Speaks for Canadian nursing education and scholarship Establishes and promotes national standards of excellence for nursing education Promotes the advancement of nursing knowledge Facilitates the integration of theory, research and practice Contributes to public policy Provides a national forum for issues in nursing education and research https://www.casn.ca/ PPN101 Week 11 International Council of Nurses (ICN) Federation of more than 130 national nursing organizations Canadian Nurses’ Association (CNA) is a member of the ICN To represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies Mission https://www.icn.ch/ PPN101 Week 11 24 Sigma Theta Tau International (STTI) • Founded in 1922 by six nursing students, Sigma Theta Tau International Honor Society of Nursing (Sigma) has more than 100,000 active members and 600 chapters at institutions of higher education and healthcare partners from Armenia, Australia, and Botswana to Thailand, the United States, and Wales. • Sigma members include clinical nurses and administrators, academic nurse educators and researchers, policymakers, entrepreneurs, and others working to fulfill the organization’s vision of connected, empowered nurse leaders transforming global healthcare. Sigma is an international community of nurses, dedicated to the advancement of knowledge, teaching, learning, and service through the cultivation of communities of practice, education, and research. PPN101 Week 11 https://www.sigmanursing.org/why-sigma/about-sigma 25 PPN101 Week 11 Entry-to-Practice Competencies • “A competency is defined as the knowledge, skill, and judgment necessary for safe and ethical practice for all RNs in Ontario.” (CNO, 2014) • ETP competencies means that an employer knows what to expect from a new graduate nurse. • Consistency across the country – so a new grad from PEI should have the same competencies as a new grad from Ontario or BC. • Ensured through review of educational programs and accreditation. https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf 26 Entry-to-practice competencies are the foundation for nursing practice •These competencies are established for: • Protection of the public • Practice reference • Approval of nursing education programs • Registration and membership requirements • Legal reference • Public information • Continuing competence •https://www.cno.org/globalassets/docs/reg/41037-entry-to-practic e-competencies-2020.pdf PPN101 Week 11 27 1. Entry-level RNs are beginning practitioners. It is unrealistic to expect an entry-level RN to function at the level of practice of an experienced RN Over arching Principles 2. Entry-level RNs work within the registered nursing scope of practice, and appropriately seek guidance when they encounter situations outside of their ability 3. Entry-level RNs must have the requisite skills and abilities to attain the entry-level competencies 4. Entry-level RNs are prepared as generalists to practice safely, competently, compassionately, and ethically: • in situations of health and illness • with all people across the lifespan • with all recipients of care: individuals, families, groups, communities and populations (CNO, 2019 • across diverse practice settings • using evidence-informed practice ) 5. Entry-level RNs have a strong foundation in nursing theory, concepts and knowledge, health and sciences, humanities, research and ethics from education at the baccalaureate level 28 PPN101 Week 11 6. Entry-level RNs practice autonomously within legislation, practice standards, ethics and scope of practice in their jurisdiction 7. Entry-level RNs apply the critical thinking process throughout all aspects of practice. 9 Roles within the ETP Competenc ies Total of 101 competencies organized thematically under 9 roles 1. Clinician 2. Professional 3. Communicator 4. Collaborator 5. Coordinator 6. Leader 7. Advocate 8. Educator 9. Scholar https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf PPN101 Week 11 29 Entry-topractice competenci es •(CNO, 2019, p. 5) https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf PPN101 WEEK 11 30 Some form of licensing or registration necessary for professions. Why? Registrati on and Licensure CNO, 2020 “Control” of profession is left to the profession. Improve standards of practice and education PPN101 Week 11 Register members and monitor professional conduct Judge the practice of professionals when disputes arise Authority to remove from practice those who are found to be incompetent or unethical 31 Registratio n and licensure • Different! • But the terms are often used interchangeably • Licensure: Granted by the provincial or territorial body (CNO), it is the exclusive legal right (like a ‘license’ to drive) to practice a profession (not just anyone can call themselves “a nurse”) • Registration: list of members in good standing of an organization CNO, 2020 PPN101 Week 11 32 Registration Ensures minimum level of safe practice Those registered: • Must meet practice requirements • Must show no evidence of unsafe practice • Must show evidence of expanding knowledge and competence to meet evolving requirements as the profession changes CNO 2020 PPN101 Week 11 33 NCLEX Why do we have a registration exam? Registration exams such as the NCLEX-RN contribute to patient safety. The NCLEX-RN tests whether the writer has the knowledge, skill and judgment to provide safe care during their first year of practice. As the provincial regulator of the nursing profession, we are accountable for ensuring that only those who demonstrate the ability to apply nursing knowledge and provide safe care are able to practise in Ontario. https://www.cno.org/en/become-a-nurse/entry-to-practice-examinations/nclex-rn/ PPN101 Week 11 34 NCLEX “The NCLEX-RN does not test everything that is taught during a four-year baccalaureate nursing program. Rather, the NCLEX-RN focuses on testing entry-level knowledge – what nurses need to know to provide safe care at the beginning of their careers. For example, it asks questions about pain management; medication administration; basic care and comfort; infection control; health promotion and maintenance; and concepts such as maintaining confidentiality of patient information”. In addition, all drug names are generic and refer to medications that entry-level nurses are expected to know. Measurements in metric are provided, as well. https://www.cno.org/en/become-a-nurse/entry-to-practice-examinations/nclex-rn/ PPN101 Week 11 35 Confidentiality & Privacy PPN101 Week 11 • Nurses have ethical & legal responsibility to maintain confidentiality & privacy of client health information (CNO, 2022) • Provincial legislation • Personal Health Information Protection Act (PHIPA), 2004 • Personal Information Protection and Electronic Documents Act ( PIPEDA) (revised 2019) https://www.ontario.ca/laws/statute/04p03 https://www.priv.gc.ca/en/privacy-topics/privacy-lawsin-canada/the-personal-information-protection-andelectronic-documents-act-pipeda https://www.cno.org/globalassets/docs/prac/ 41069_privacy.pdf 36 37 Personal Health Information Protection Act (PHIPA), 2004 • Governs health care information privacy in Ontario • Defines information privacy as the client’s right to control how personal health information is collected, used & disclosed • PHIPA permits sharing of personal health information among health care team members, regardless of whether they are employed by the same organization (CNO, 2017; PHIPA, 2004) https://www.ontario.ca/laws/statute/04p03 PPN101 Week 11 Personal Information Protection and Electronic Documents Act ( PIPEDA) • Organizations covered by PIPEDA must generally obtain an individual's consent when they collect, use or disclose that individual's personal information. • People have the right to access their personal information held by an organization. • They also have the right to challenge its accuracy. • Personal information can only be used for the purposes for which it was collected. • If an organization is going to use it for another purpose, they must obtain consent again. • Personal information must be protected by appropriate safeguards. (Government of Ontario) https://www.ontario.ca/laws/statute/04p03 PPN101 Week 11 38 Privacy belongs to the patient Privacy and Confidentiali ty 39 PPN101 Week 11 Confidentiality is duty of the health care provider How do nurses maintain privacy and confidentiality? CNO Professional Conduct, Professional Misconduct (2019) Professio nal conduct Definitions of professional misconduct continued • Failure to maintain the standards of practice • Working while impaired • Abusive conduct • Theft • Failure to obtain informed consent and breach of confidentiality • Inadequate documentation and record keeping • Misrepresentation https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf PPN101 Week 11 40 CNO Professional Conduct, Professional Misconduct (2019)con’t • Failure to meet legal/professional obligations • Conflict of interest • Inappropriate business practices • disgraceful, dishonourable and unprofessional conduct Other grounds for professional misconduct: • Guilty of an offence • Finding of professional misconduct in another jurisdiction • Sexual abuse https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf PPN101 Week 11 41 Who must report? (The roles with a * are defined in the Glossary) What must be reported? Anyone who works with Employers Facility op Nurses erators* a nurse A nurse who poses a serious risk of harm to patients X X X X A nurse who is suspected of sexually abusing a patient. Sexual abuse has a broader definition in health care than other settings. Read more to ensure you are aware of what constitutes sexual abuse in health care A nurse who is incompetent in their care of a patient, who displays a significant and repeated lack of knowledge, skill or judgment, who demonstrates they are unfit to continue to practice, or that their practice should be restricted to ensure patient safety A nurse who is incapacitated by a physical or mental condition that negatively impacts their nursing care, and is a safety concern to patients A nurse who is terminated, and there are concerns about the nurse’s competence, conduct or capacity, or who resigns in lieu of being terminated, or resigns when there is an investigation into their conduct A nurse whose privileges have been revoked, suspended or restricted due to concerns about the nurse’s competence, conduct and capacity X X X X X X X X X X X X When a partnership, health professional corporation or association with a nurse is dissolved due to the nurse’s professional misconduct, incompetence or incapacity X X X https://www.cno.org/en/protect-public/employers-nurses/reporting-guide/what-to-report/ PPN101 Week 11 42 Sexual Abuse Sexual abuse of a patient occurs when a nurse: • has physical sexual relations with a patient • touches a patient in a sexual manner (for example, touching a patient’s genitals when it is not required in caring for the patient) • behaves in a sexual manner toward a patient (for example, touching a patient’s shoulder or hand unnecessarily and in a manner that implies a sexual interest in the patient) • makes remarks of a sexual nature to a patient (for example, commenting on the size of a patient’s breasts or genitals) https://www.cno.org/en/protect-public/employers-nurses/reporting-guide/legalobligations/#sexualabuse PPN101 Week 11 43 CNO: Confidentiality and Privacy Practice Standard (2022) Legal responsibiliti es of nurses To maintain the confidentiality and privacy of client health information • Standard Statements • Personal health information practices • Knowledge consent and substitute decision-makers (SDMs) • The client’s right to access and amend his/her personal health information • Potential for harm • Disclosure without consent 44 https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf PPN101 Week 11 Regulatory law • Established to protect the public/patients’ rights (advocate for patients) • Sets legal boundaries of job • Protects self from liability • Governs standards of care and nursing practice acts • Examples: Nursing Act and the Regulated Health Professionals Act CNO, 2020 PPN101 Week 11 45 Regulated Health Professions Statute Law Amendment Act, 2009 (RHPSLAA). Highlights of the legislation include : Expanding the Services of Regulated Health Care Professionals: • allowing nurse practitioners, pharmacists, physiotherapists, dietitians, midwives and medical radiation technologists to deliver more services that they are now educated and competent to provide • changing the rules for administering, prescribing, dispensing, compounding, selling and using drugs in practice for chiropodists and podiatrists, dental hygienists, dentists, midwives, nurse practitioners, pharmacists, physiotherapists and respiratory therapists • removing restrictions on X-rays that can be ordered by nurse practitioners and enabling physiotherapists to order X-rays for specific purposes. (MOLTC) PPN101 Week 11 46 Regulated Health Professions Statute Law Amendment Act, 2009 (RHPSLAA). Improving Patient Safety and Strengthening the Health Care System • requiring health colleges to work together to develop common standards of knowledge, skill and judgement in areas where their professions may provide the same or similar services • making team-based care a key component of health college quality assurance programs which ensure the ongoing competence of registered health professionals • requiring all regulated health professionals to have professional liability insurance • creating a process to ensure new drug prescribing powers are used in the safest possible manner (MOH, MOLTC) PPN101 Week 11 47 Two main categories of Canadian law • Public law • Concerned with relations between individuals and the state • Includes constitutional, tax, administrative, human rights, criminal law • Private law • Concerned with disputes between individuals • Includes contracts, marriage and divorce, civil wrongs (including negligence) Understandi ng Canada’s Legal System (A&B, 2021; P&P,2024, p.124) PPN101 Week 11 48 • A tort is a civil wrong committed against a person or a property • Torts are classified as intentional or unintentional Torts Intentional torts • Assault • Battery • Invasion of privacy What are examples of intentional torts in health care? (Potter & Perry, 2014, p.124) PPN101 Week 11 49 Unintentional tort: Negligence • No intent is needed for negligence to occur • Nurses can be found liable for negligence if the following 4 criteria are established: • The nurse owed a duty of care to the patient • The nurse did not carry out that duty • The patient was injured • The nurse’s failure to carry out the duty caused the injury Torts (Potter & Perry, 2024,p.123) PPN101 Week 11 50 Preventing negligence • Follow standards of practice from the CNO • Insist on appropriate orientation, education, staffing • Communicate with other health care providers • Develop a caring rapport with the patient & family • Document assessments, interventions, evaluations fully • If records are incomplete or missing, the care is presumed to have been negligent and therefore the cause of the patient’s injuries (College of Nurses of Ontario, 2019; Potter & Perry, 2024, p.125) https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf PPN101 Week 11 51 Preventing negligence • Documentation must be accurate, complete, legible, objective • Documentation is a legal record • Document assessments, interventions, evaluations fully • If records are incomplete or missing, the care is presumed to have been negligent and therefore the cause of the patient’s injuries (Potter & Perry, 2024, p.125) https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf PPN101 Week 11 52 Consent • Nurses are accountable for obtaining consent when the intervention or service relates to: • a treatment • admission to a facility • provision of personal assistance service • Legislation • Health Care Consent Act, 1996 (HCCA) • Substitute Decisions Act, 1992 (SDA) ( https://www.cno.org/globalassets/docs/prac/41069_privac y.pdf ) (P&P, 2024,p.126) PPN101 Week 12 53 Health Care Consent Act (HCCA) • Promotes individual authority and autonomy • Deals separately with: • Consent to treatment • Consent to a care facility • Consent to personal assistance service • Health care practitioners have no authority to make treatment decisions on behalf of clients • When can health care practitioners do this? (CNO, Consent, 2017; HCCA, 1996; P&P,2024,p.126) https://www.cno.org/globalassets/docs/policy/41020_consent.pdf PPN101 Week 12 54 Informed consent • Consent for a treatment is informed if: • The person received information that a reasonable person in the same circumstances would need to make a decision • The person received responses to any requests for any additional information • Information about the treatment must include: • Nature of the treatment • Expected benefits • Risks and side effects • Alternative courses • Likely consequences of not having the treatment P&P,2014,p.126 CNO consent videos https://www.youtube.com/watch?v=TCGpCXBFTfE https://www.youtube.com/watch?v=TWdT0_khVrE https://www.cno.org/globalassets/docs/policy/41020_consent.pdf https://www.cno.org/en/protect-public/employer-resources/employers-toolkit-sexual-abuse-prevention/informed-consent/ PPN101 Week 12 55 HCCA: substitute decisionmaker (SDM) • Substitute decision-makers may make a treatment decision for someone who is incapable of making own decision • Typically, the SDM is a spouse, partner or relative (HCCA provides a hierarchy to determine who is eligible to be the SDM) • SDM has the right to access the same information that a capable client would be able to access https://www.cno.org/globalassets/docs/policy/41020_consent.pdf (CNO, 2017; HCCA, 1996) PPN101 Week 12 56 Nursing responsibilit ies: informed consent • Always explain to the client the treatment or procedure they are performing • Do not provide treatment if there is any doubt about whether the client understands & is capable of consenting (this does not apply if SDM has consented) • Advocate for clients’ and SDMs’ access to information about care and treatment • Informed consent does not always need to be written, it can be oral or implied https://www.cno.org/en/protect-public/employer-resources/employers-toolkit-sexual-abuse -prevention /informed-consent/ https://www.cno.org/globalassets/docs/policy/41020_consent.pdf 57 PPN101 Week 12 Who would provide consent for: • An unconscious patient? • An unconscious patient in an emergency situation? • Patients with mental health issues? • Older adults? • Children? • Adolescents? 58 PPN101 Week 12 Week 12: Professionali sm Part 2 PPN101 Week 11 59