Fundamentals Of Nursing Practice: 4th Unit Exam (PDF)

FUNDAMENTALS OF NURSING PRACTICE BSN - 1 FSUU - COLLEGE OF NURSING SECOND SEMESTER 4TH UNIT EXAM COVERAGE Lesson 4: Concepts and Principles of Professional Nursing Professional Communication and Team Collaboration Concepts on Leadership and Management: Professional Practice Environment (PPE) Concept...

FUNDAMENTALS OF NURSING PRACTICE BSN - 1 FSUU - COLLEGE OF NURSING SECOND SEMESTER 4TH UNIT EXAM COVERAGE Lesson 4: Concepts and Principles of Professional Nursing Professional Communication and Team Collaboration Concepts on Leadership and Management: Professional Practice Environment (PPE) Concepts on Continuing Professional Development (CPD) Leadership and Management Lesson 6: Nursing as an Art Filipino Cultures, Values and Practices in Relation to Health Care The Science and Art of Nursing: Care and Caring Practice Communicating: Helping Relationship Teaching: An Integral Component in Nursing Lesson 5: Ethico-Moral and Legal Considerations in the Practice of Nursing Legal Aspects of Nursing Ethico-Moral Aspects in Nursing Philippine Nursing Profession Roadmap 2030 LESSON 4: Concepts and Principles of Professional Nursing PROFESSIONAL COMMUNICATION AND TEAM COLLABORATION WHY STUDY PCT? Nursing profession is faced with a lot of complex health issues. REASONS: ○ Technological and medical achievements. ○ Increased Elderly Population ○ Increased Patients with chronic illness Collaboration is a substantive idea repeatedly discussed in healthcare circles. Though the benefits are well validated, collaboration is seldom practiced. The complexity of collaboration and the skills required to facilitate the process are formidable. Much of the literature on collaboration describes what it should look like as an outcome, but little is written describing how to approach the developmental process of collaboration. They learn the group process through participation, involvement, & guided exercises. 1. DYAD Two person’s groups. 3. Group Two or more people who have shared needs & goals, who take each other into account in their actions and set themselves apart from others by virtue of their interactions. Group dynamics Communication that takes place between members of any group. Functions of group dynamics: 1. Develop and modify its structure for effectiveness. 2. Maintain a degree of unity and cohesion. 3. Accomplish the goals. TYPES OF HEALTH CARE GROUPS: 1. Self- awareness Relationship between one’s perception of oneself and others perception of oneself. Purpose is to develop or use interpersonal strengths. 4. Team Delivery of coordinated care to individual clients by a group of health providers. PARTNERSHIP IN HEALTHCARE What is partnership working in health and social care? BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 ❖ Brings together separate organizations so that they can benefit from pooled expertise, resources and power sharing. ❖ The goal of a partnership is to enhance the efficiency and quality of service provision. ❖ According to the Knowledge Biz, most partnerships share the following traits: All parties involved have some sort of personal stake in the partnership. All partners are working towards a common goal. The partners have a similar ethos or system of beliefs. The partners work together over a reasonable period of time. There is a mutual understanding of the value of each partner’s contribution. There is respect and trust between the partners. “A working relationship becomes a true partnership when all parties contribute a reasonable measure of series resources.” “The successful and effective partnerships should always have effective vision and leadership and there should be strong willingness to learn and listen among the partnership.” Multi-professional Many professionals like nurses, doctors, and pharmacists etc. work together to achieve some common goals in health. Multispectral Sectoral partnership, many organizations from different sectors of the society work together but independently. COLLABORATION IN HEALTH CARE “Collaborative care is a partnership relationship between doctors, nurses and other health care providers with patients and their families.” - Virginia Henderson “Collaboration is nurses and physicians cooperatively working together sharing responsibility for solving problems and making decisions to formulate and carry out plans for patient care.” -Baggs and schmitt, 1988 THE KEY ELEMENTS FOR A SUCCESSFUL HEALTH CARE PARTNERSHIP IN HEALTH PROMOTION, PREVENTION, CURE, SUPPORT AND REHABILITATION: COMMUNICATION Each involved entity should be well informed about the action. COORDINATION The partner can work separate but each other’s action should always be coordinated. COLLABORATION The partner should cohesively work together. OBJECTIVES OF COLLABORATION INTEGRATION Though they are the partners, they still should work together as one agency. TYPES OF PARTNERSHIPS Multidisciplinary Involves various entities from the same sector working independently to achieve a common purpose. Provide client-directed and client-centered care using a multidisciplinary, integrated, participative framework. Enhance continuity across continuum of care Improve client and family satisfaction with care Improve client and family satisfaction with care Improve client and family satisfaction with care Provide quality, cost effective, research based care Promote mutual respect, communication Develop interdependence TYPES OF RELATIONSHIP AMONG HEALTH PROFESSIONALS Complementary relationship One person is dominant and the other is submissive. Control is not divided equally between two participants. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  Relationships are stable and predictable and also inhibit creativity and independent thinking. Symmetrical relationships Control is more evenly distributed between the two participants Free to express their opinions Power struggles occurs when participants compete to acquire or give up control Parallel relationships Control moves back and forth between the two participants Participants take turns holding and giving control depending on the circumstances, rather than competing for control Effective and flexible communication TEAMWORK IN HEALTH CARE Is defined as two or more people who interact interdependently with a common purpose, working toward a measurable goal that benefits from leadership that maintains stability while encouraging honest discussion and problem solving. Researchers have found that integrating services among many health providers is a key component to better treat underserved populations and communities with limited access to health care. Employs the practices of collaboration and enhanced communication to expand the traditional roles of health workers and to make decisions as a unit that works toward a common goal. A multidisciplinary profession in which doctors, nurses, health professionals from different specialties must work together, communicate often, and share resources. Health teams are often made up of a variety of professionals - called cadres in health care - each with specialized knowledge and responsible for different tasks. These multidisciplinary teams are made up to solve health problems. Successful health teams strive to understand the patient’s situation, ask probing questions about the problem, make an initial assessment and, after discussion, provide a recommendation. Teams can also work together to develop health promotion for diverse communities and instill disease prevention behaviors amongst patients. BENEFITS OF TEAMWORK For the Patient: ○ Reduces the number of medical errors and increases patient safety. ○ Improved patient satisfaction and outcome For the Nurses: ○ Quickly learn new methods ○ Higher Job Satisfaction ○ Increased Professional Satisfaction and Outcome ○ Lower Rates of Job Turnover ○ Improved Engagement in the Workplace MEASURES THAT PROMOTES PARTNERSHIPS, COLLABORATION AND TEAMWORK ROLES OF THE NURSE IN PCT ❖ With Nurse Colleagues Share personal expertise with other nurses and elicit the expertise of others to ensure quality client care. Develops a sense of trust and mutual respect with peers that recognizes their unique contributions. ❖ With other health care professionals Recognizes the contribution that each member of the interprofessional team can make by virtue of his or her expertise and view of the situation. Listens to each individual’s views. Shares health care responsibilities in exploring options, setting goals, and making decisions with clients and families. Participants in collaborative interprofessional research to increase knowledge of a clinical problem or situation. ❖ With Professional Nursing Organizations Seeks opportunities to collaborate with and within professional organizations Serves in communities in state and national nursing organizations or specialty groups. Supports professional organizations in political action to create solutions for professional and healthcare concerns. ❖ With Legislators Offers expert opinions on legislative initiatives related to health care. Collaborates with other health care providers & consumers on healthcare legislation to best serve the needs of the public. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 CONCEPTS ON LEADERSHIP AND MANAGEMENT: PROFESSIONAL PRACTICE ENVIRONMENT (PPE) ❖ Healthcare is challenged to reinvent itself to be quality driven, fiscally sound and evidence based. To accomplish this shift, healthcare needs to be agile and innovative. ❖ Since healthcare (and nursing care in particular) is emotionally, mentally, spiritually and physically demanding, a positive PPEN is essential to recruit and retain the best and brightest caregivers. ❖ One of the important responsibilities of a nurse leader and manager is to provide a Positive Professional Practice Environment (PPE). ❖ A positive professional practice (PPE) is vital to : Assure safety of patients and staff Improve professional staff recruitment and retention Sustain an organization’s financial viability. WHY IS THERE A NEED TO STUDY LEADERSHIP & MANAGEMENT Severe shortage of healthcare professionals, causing crisis. Growing demand for an increased population. Not ideal ratio between nurse and patient. Lack of budget, supplies, and facilities Increase morbidity and mortality rates. LEADERSHIP VS. MANAGEMENT LEADERSHIP A means of persuasion and example by which an individual induces a group to take action in accord with a purpose common to everyone. A process by which one inspires others to work together for the achievement of a common mission and goal. A vital ingredient which transforms a mere crowd into a functional and useful ingredient. MANAGEMENT Is a generic function that includes similar basic tasks in every discipline and in every society. The art of getting things done through people. Uses delegated authority within a formal organization to organize, direct and control subordinates so services are coordinated. Is a process of getting things done through people. It supervises people and uses resources in doing the tasks. Management is responsible for initiating steps by which organizational goals and objectives are accomplished. Nurse can hold a management position but fail to realize that this position does not define her leadership qualities. Good nurse leader but not a good manager, when a leader is: ○ Able to inspire her followers (ability to initiate and innovative) ○ Able to lift the staff’s morale ○ Able to motivate her followers to think of a solution to an existing problem. Leaders get other people to do something, while managers get other people to do what they do not want to do. Management works within the paradigm. Leadership creates new paradigms. Management works within the system. Leadership works on the system. You manage “things” but you lead “people” However, leadership and management do not have to work against one another. As these descriptions imply, leadership can be effective managers and managers can be effective leaders. Managers ○ Have a formal authority to direct the work of a given set of employees ○ Are formally responsible for the quality of that work and what it costs to do it. ○ Neither of these conditions is necessary to be a leader Leadership ○ An essential part of effective management, but the reverse is not true. You do not have to be a manager to be a leader but you do need to be a good leader to be an effective manager. ○ You can be the youngest, the newest, or even the least experienced nurse yet you still have opportunities to be a leader. These opportunities will increase as your experience increases and so will your readiness to assume managerial responsibility. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  Decreased absenteeism Reduced turnover Reduced distress/emotional exhaustion Less incivility Positive PPEs have lower staff turnover, lower absenteeism, fewer preventable errors, higher nurse satisfaction and greater nure management. These outcomes reduce the costs of care and improve patient outcomes. Nurse managers are reported as the single greatest influence on a positive professional practice environment (PPE). PROFESSIONAL PRACTICE ENVIRONMENT Negative PPE leads to ineffective collaboration due to intimidating behavior between interdisciplinary team members (ISMP, 2013) and dangerous communication patterns (AHRQ, 2012). Negative PPEs struggle with low staff and patient satisfaction, safety issues, greater preventable errors, increased incivility (or lateral violence) with coworkers and practices inflexible based on “ we have always done it that way”. KEYS TO POSITIVE PPE Communication Collaboration Decision making Leadership KSAs TO FACILITATE POSITIVE PPE OUTCOMES OF POSITIVE PPE Increased job satisfaction Increased trust in management Increased group cohesion Increased job enjoyment Increased flexible/adaptable culture Increased psychologically safe climate KNOWLEDGE: Global thinking, national healthcare arena, QI, change from volume to value, finance/budgeting, supporting evidence based practice, change management models. SKILL: Coaching, team building, giving feedback, handling problems behavior, BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  relationship building, leading practice based on evidence. ATTITUDE: Self-reflection, recognize own behaviors and others, reward and recognition. NEEDS FOR CONTINUING PROFESSIONAL DEVELOPMENT CONTINUING PROFESSIONAL DEVELOPMENT WHAT IS CONTINUING PROFESSIONAL DEVELOPMENT (CPD)? ❖ CPD is the means by which members of the profession maintain, improve and broaden their knowledge, expertise and competence, and develop the personal and professional qualities required throughout their professional lives. ❖ It is an ongoing, planned, learning and development process that: Enables all staff members to expand and fulfill their potential. Contributes to their work based and personal development. Can be applied or assessed against competencies for the staff members role and organizational performance. DO YOU THINK CPD IS IMPORTANT AND WHY? OBJECTIVES OF CPD Keep up to date with new concepts and development in the health field. To increase their knowledge and skills and develop positive attitudes. Develop an ability to analyze problems and to work with others. Meet the challenge of change in technology. Maintain the standards of health at an acceptable level. Help in setting standards of performance. Motivate staff for better patient care. Meet new needs of the community. To assist the nursing educator in increasing the teaching effectiveness. To develop leadership potential in nurses. NOTE: CPD needs careful planning in order to achieve the goal of a person because through planning you can already forecast your activities, the target dates and even budgeting so that there will be no failure. To ensure safe & effective nursing care To meet the needs of populations and should cater to the needs of service Development of nurses by updating their knowledge For career advancement - Example: pursuing higher education To acquire specialized skills. Examples: Stoma care nurse, CAPD nurse It provides opportunities for professional growth. Nurses with research aptitude and preparation are needed. Nurses in administrative positions need to increase their understanding of the administrative process. The demand for specialized nursing services is increasing more rapidly. Planned programmes are needed to increase their competence as practitioners. It gives knowledge that may help you to deal with new or complex situations It will give confidence in your role It will demonstrate your commitment to developing your knowledge and skills in a subject area. The ultimate outcome of well planned continuing professional development is that it safeguards the public, the employer, the profession and professional’s career. CPD ensures that your capabilities keep pace with the current standards of others in the same field. CPD helps advance the body of knowledge and technology within your profession. CPD helps you continue to make a meaningful contribution to your team. You become more effective in the workplace. This assists you to advance in your career and move into new positions where you can lead, manage, influence, coach and mentor others. Depending on the profession - CPD contributes to improved protection and quality of life , the environment, sustainability, property and the economy. CPD ○ Sometimes it is mandated by professional organizations or required BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 ○ by codes of conduct or codes of ethics. But at its core it is a personal responsibility of professionals to keep their knowledge and skills current so that they can deliver the high quality of service that safeguards the public and meets the expectations of customers and the requirements of their profession. FORMAL EDUCATIONAL Courses Further education Research Attending conferences Writing articles or papers Going to seminars Distance learning Courses accredited by professional body Planning or running a course WORK BASED LEARNING SELF- DIRECTED LEARNING Learning by doing Case studies Reflective practice Clinical audit Coaching from others Discussions with colleagues Peer review Gaining, and learning from, experience Involvement in wider work of employer (for example, being a representative on a committee) Work shadowing Secondments Job rotation Journal club In-service training Supervising staff of students Visiting other departments and reporting back Expanding your role Analyzing significant events Filling in self -assessment questionnaires Project work or project management Evidence of learning activities undertaken as part of your progression on the Knowledge and Skills Framework Reading journals/articles Reviewing books or articles Updating knowledge through the internet or TV Keeping a file of your progress OTHERS Public service Voluntary work Courses PROFESSIONAL ACTIVITY Involvement in professional body Membership of a specialist interest group Lecturing or teaching Mentoring Being an examiner Being a tutor Branch meetings Organizing journal clubs or other specialist groups Maintaining or developing specialist skills (for example, musical skills) Being an expert witness Membership of other professional bodies or groups Giving presentations at conferences. STRATEGIC PLANNING Strategic Planning of Professional Self is another method of planning your professional BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 life in the future for your career path. Through this method, this will help you identify your needs for COPD. ○ STRATEGIC PLANNING IN HEALTH CARE Enables an organization to look into the future in an orderly and systematic way, ensures that a hospital remains relevant and responsive to patient and community needs and provides a clear and consistent organizational focus. It also provides a basis for monitoring progress, results and impact. Is a longer type of planning because the planning is done through forecasting the future 3-5 years from now Usually done in an organization and rarely done by an individual. WHAT IS LIFELONG LEARNING? “The continuous building of skills and knowledge throughout the life of an individual. It occurs through experiences encountered in the course of a lifetime.” Learning that doesn’t happen in school or a classroom; an ongoing journey of learning through experiences. LIFELONG LEARNING IS ABOUT Acquiring and updating all kinds of abilities, interests, knowledge, and qualifications. Valuing all forms of learning Taking more control of our futures. Knowledge is like a muscle: the more it is used, the bigger and stronger it gets. Our brains all have a feature called neuroplasticity. That means we develop new neural pathways from our experiences. You're never too old to learn! It also means you get to take responsibility for identifying what you need to learn and how you will learn it. Studies have shown that professionals learn more effectively when they take the initiative to direct their own learning. Critical thinking and critical reflection both pay an important role in lifelong learning. When you ask yourself questions about knowledge and how you know what you know, you are looking for evidence that supports your knowledge. What does this all mean for nurses? Lifelong learning helps nurses build and maintain their clinical competency. There is an expectation that learning and development is an essential component of professional practice. Nurses need to integrate new knowledge with existing knowledge to create new understanding. ○ They need to be self-directed in their acquisition of knowledge. Lifelong learning is an integral part of your journey towards becoming an experienced practitioner. ○ But experience alone is not enough! You need to use it in combination with evidence based practice to ensure quality patient care. ○ That means the advancement of nursing (and patient care) depends on the creation of a culture where educational growth is encouraged. ○ In an environment that is rapidly changing and becoming increasingly complex because of Increased morbidity Higher acuity Emerging technologies Aging population Reduced funding Consider using SWOT analysis to identify learning needs. Strengths Weaknesses (room for improvement) Opportunities Threats CHARACTERISTICS OF LIFELONG LEARNERS Innovative Flexible Adaptable Change agent Creative Self reliant Accountable Curios BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 LESSON 5: Ethico-Moral and Legal Considerations in the Practice of Nursing LEGAL ASPECTS OF NURSING INTRODUCTION Nursing practice is governed by many legal concepts. It is important for nurses to know the basics of legal concepts, because nurses of legal accountable for their professional judgements and actions. Accountability is an essential concept of professional nursing practice and the law. Knowledge of laws that regulate and affect nursing practice is needed for two reasons: 1. To ensure that the nurse’s decisions and actions are consistent with current legal principles. 2. To protect the nurse from liability. PHILIPPINE NURSING ACT OF 2002 RA 1973 Republic Act No. 9173 October 21, 2002 On October 21, 2002, it was signed into law by Pres. Gloria Macapagal Arroyo as Republic Act No 9173 AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO.7164, OTHERWISE KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER PURPOSES Parts of RA 9173 RA 9173 is divided into 9 articles and 41 sections and these are as follows: Article I – Title ⮚ Section 1 – Title Article II – Declaration of Policy ⮚ Section 2 – Declaration of Policy Article III – Organization of the Board of Nursing ⮚ Section 3 – Creation and Composition of the Board ⮚ Section 4 - Qualifications of the Chairperson and Members of the Board ⮚ Section 5 – Requirements upon Qualification as Member of the Board of Nursing ⮚ Section 6 – Term of Office BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  ⮚ Section 7 – Compensation of Board Members ⮚ Section 8 – Administrative Supervision of the Board, Custodian of its Records, ⮚ Secretariat and Support Services ⮚ Section 9 – Powers and Duties of the Board ⮚ Section 10 – Annual Report ⮚ Section 11 – Removal and Suspension of Board Members Article IV – Examination and Registration ⮚ Section 12 – Licensure Examination ⮚ Section 13 – Qualifications for Admission to the Licensure Examination ⮚ Section 14 – Scope of Examination ⮚ Section 15 – Ratings ⮚ Section 16 – Oath ⮚ Section 17 – Issuance of Certificate of Registration or Professional License and Professional Identification Card ⮚ Section 18 – Fees for Examination and Registration ⮚ Section 19 – Automatic Registration of Nurses ⮚ Section 20 – Registration by Reciprocity ⮚ Section 21 – Practice through Special/ Temporary Permit ⮚ Section 22 – Non-Registration and Non-Issuance of COR or Professional License or Special/Temporary Permit ⮚ Section 23 – Revocation and Suspension of COR or Professional License or Special/ Temporary Permit ⮚ Section 24 – Re Issuance of Revoked Certificates and Replacement of Lost Certificates Article V – Nursing Education ⮚ Section 25 – Nursing Education Program ⮚ Section 26 – Requirement for Inactive Nurses Returning to Practice ⮚ Section 27 – Qualifications of the Faculty Article VI – Nursing Practice ⮚ Section 28 – Scope of Nursing ⮚ Section 29 – Qualifications of Nursing Service Administrators Article VII – Health Human Resource Production, Utilization and Development ⮚ Section 30 – Studies for Nursing Manpower Needs, Production, Utilization and Development ⮚ Section 31 – Comprehensive Nursing Specialty Program ⮚ Section 32 – Salary ⮚ Section 33 – Funding for the Comprehensive Nursing Specialty Program ⮚ Section 34 – Incentives and Benefits Article VIII – Penal and Miscellaneous Provisions ⮚ Section 35 – Prohibitions in the Practice of Nursing Article IX – Final Provisions ⮚ Section 36 – Enforcement of this Act ⮚ Section 37 – Appropriations ⮚ Section 38 – Rules and Regulations ⮚ Section 39 – Separability Clause ⮚ Section 40 – Repealing Clause ⮚ Section 41 – Effectivity SCOPE OF NURSING PRACTICE ARTICLE VI Section 28 A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. The members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to: a) Provide nursing care through the utilization of the nursing process. ✔ Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. ✔ In case of suturing of perineal laceration, special training shall be provided according to protocol established; b) establish linkages with community resources and coordination with the health team; c) Provide health education to individuals, families and communities; d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and Undertake nursing and health human resource development training and research which shall include, but not limited to, the development of advance nursing practice; Provided, that this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, that in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, that the program and activity for the continuing professional education shall be submitted to and approved by the Board. P Provides nursing care: different stages of life (from conception to old age) Promotion of health & Prevention of illnesses – independent practitioner I Initiates & performs nursing services in any health care setting - IFC Collaborate with other health care providers for the preventive, curative & rehabilitative aspects of care C Practicum PROHIBITIONS in the practice of Nursing Without certificate of registration/ professional license Use of other’s identification card (misdemeanor) Use of invalid/revoked/suspended certificate of registration Use of false evidence to the BON to obtain certificate of registration/ professional license Falsely poses/advertises as a registered licensed nurse Falsely Appending BSN/RN to his/her name Assisting in illegal practice Penalties: a fine of not less than P50000. Nor more than P100,000. Or imprisonment of not less than 1 year nor more than six years, or both, upon the discretion of the court. It shall be the duty of the nurse to: (section 28) Do utilize NURSING PROCESS in providing nursing care Undertake nursing & health human resource development training & research Teach, guide, supervise nursing students Interrelationship/ linkages with community resources & health care team Educate individual, families, community on health Strict/ duty-bound observance of the CODE OF ETHICS INACTIVE NURSES Nurses who have not actively practiced the profession for FIVE (5) consecutive years can return to practice: ⮚ ONE MONTH Didactic training ⮚ THREE MONTHS BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 2012 NATIONAL NURSING CORE COMPETENCY STANDARDS WHEREAS: ✔ Professional Regulatory Board of Nursing ⮚ Amend Res. No. 112 Series of 2005 ⮚ “Revisiting” of the same standards in 2007 ⮚ In accordance with Sec. 9 (c), Art. III of R.A. 9173. THEREFORE: ✔ Amend Board Res. No. 112, Series of 2005. ❖ Three roles of the entry level nurse -Beginning nurses Role on client care and management and leadership. ⮚ Beginning Nurse’s Role on Client Care. ⮚ Beginning Nurse’s Role on leadership and Management ⮚ Beginning Nurse’s Role on Research ❖ Responsibilities and competencies needed to performed each role with corresponding performance indicators. ❖ Key Areas of Responsibility ❖ Types of clients served by the nurse. SIGNIFICANCE: ❖ Basic Nursing Education Program in the Philippines through CHED ❖ Competency-based test framework development of course syllabi and test questions for “entry level” nursing practice in the board licensure examination for nurses ❖ Standards of professional nursing practice in various setting in the Philippines ❖ All related evaluation tools in various practice settings in the Philippines 10 KEY PHASES: ❖ Phase 1 – Work Setting scenario ❖ Phase 2 – Validation studies of roles and responsibilities/Benchmarking ❖ Phase 3 – Integrative review of outputs from the validation strategies ❖ Phase 4 – Core competency consensual validation ❖ Phase 5 – Conduct of public hearing ❖ Phase 6 – Promulgation of the revised and modified core competency standards. ❖ Phase 7 – Printing of the revised and modified core competency standards. ❖ Phase 8 – Training in the implementation of the revised core competency standards. ❖ Phase 9 – Implementation of the revised core competency standards. ❖ Phase 10 – Evaluation of effectiveness of the revised core competency standards. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 1. BEGINNING NURSE’S ROLE ON CLIENT CARE ✔ Responsibility 1: Practices in accordance with legal principles and the code of ethics in making personal and professional judgment. ✔ Responsibility 2: Utilizes the nursing Process in the interdisciplinary care of clients that empowers the clients and promotes safe quality care. ✔ Responsibility 3: Maintains complete and up to date recording and reporting system. ✔ Responsibility 4: Establishes collaborative relationship with colleagues and other members of the team to enhance nursing and other health care services. ✔ Responsibility 5: Promotes professional and personal growth and development. 1. Adheres to ethico-legal considerations when providing safe, quality and professional nursing care. 2. Applies ethical reasoning and decision-making process to address situation of ethical distress and moral dilemma 3. Adheres to established norms of conduct based on the Philippine Nursing Law and other legal, regulatory and institutional requirements relevant to safe nursing practice. 4. Protects clients rights based on “Patient’s Bill of Rights and Obligations”. 5. Implements strategies/policies related to informed consent as it applies in multiple contexts. 2. BEGINNING NURSE’S ROLE ON MANAGEMENT AND LEADERSHIP ✔ Responsibility 1: Demonstrates management and leadership skills to provide safe and quality care. ✔ Responsibility 2: Demonstrates accountability for safe nursing practice. ✔ Responsibility 3: Demonstrates management and leadership skills to deliver health programs and services effectively to specific client groups in the community setting. ✔ Responsibility 4: Manages a community/village-based health facility/component of health program or nursing service ✔ Responsibility 5: Demonstrates ability to lead and supervise nursing support staff. ✔ Responsibility 6: Utilizes appropriate mechanisms for networking, linkage, building and referrals. 3. BEGINNING NURSE’S ROLE ON RESEARCH ✔ Responsibility 1: Engage in nursing or health related research with or under the supervision of an experienced researcher. ✔ Responsibility 2: Evaluates research study/report utilizing guidelines in the conduct of a written research critique. ✔ Responsibility 3: Applies the research process in improving client care in partnership with a quality improvement/quality assurance/nursing audit team. BEGINNING NURSES ROLE ON CLIENT CARE RESPONSIBILITY 1- PRACTICES IN ACCORDANCE WITH LEGAL PRINCIPLES AND THE CODE OF ETHICS IN MAKING PERSONAL AND PROFESSIONAL JUDGMENT RESPONSIBILITY 2- UTILIZES NURSING PROCESS IN THE INTERDISCIPLINARY CARE OF CLIENTS THAT EMPOWERS THE CLIENTS AND PROMOTES SAFE QUALITY CARE. 1. Ensures a working relationship with the client and/or support system based on trust, respect and shared decision making. 1. Establishes rapport with client and/or support system ensuring adequate information about each other as partners in a working relationship. 2. Formulates with the client-partner the objectives and expectations of the nurse- client working relationship. 3. Maintains shared decision making and client’s participatory capability throughout the nurse-client working relationship. 4. Enhances client-partner’s readiness for taking over/begin in-charge when objectives and expectations of the working relationship have been achieved 2. Assesses with client (individual, family, population group, and/or community) ones health status/competence. 1. Develops the data gathering plan with the client. Specifying methods and tools. 2. Obtains assessment data utilizing appropriate data gathering methods and tools guided by type of client and work setting requisites. 3. Analyzes data gathered 4. Synthesizes data gathered 5. Specifies client’s status/conditions problems to be addressed identifying reasons (etiology) for the existing of the condition or problem 3. Formulates with the client a plan of care to address the health conditions, needs, problems and issues based on priorities. 4. Implements safe and quality interventions with the client to address the health needs, problems and issues. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 2.4.1 Implements appropriate psychosocial/ therapeutic interventions to render holistic nursing care in any setting. 12. Implements appropriate nursing interventions to help clients and support system address spiritual needs. 2. Provides appropriate evidence-based nursing care using a participatory approach based on; a) Variety of theories and standards relevant to health and healing. b) Research c) Clinical practice d) Client preference e) Client and staff safety f) Customer care standards. 3. Applies safety principles, evidence-based practice, infection control measures and appropriate protective devices consistently, when providing nursing care and preventing injury to clients, self, other health care workers and the public. 13. Manages client load to ensure health program service coverage. 5. Provides health education using selected planning models to targeted clientele (individuals, family population group or community). 1.Determines the health education planning models appropriate to target clientele/experienced objective and outcomes. 2. Utilizes health education process to accomplish the plan to meet identified client’s learning needs. 4. Implements strategies related to the safe preparation and administration of medications based on institutional policies and protocol. 6. Evaluate with the client the health status/competence and/or process/expected outcomes of nurse-client working relationship. 5. Applies evidence-based practices on pain prevention and management of clients using pharmacologic and nonpharmacologic measures 7. Documents client’s responses /nursing care services rendered and process outcomes of the nurse client working relationship. 6. Implements safe, adequate, evidence-based care on clients during the pre-intra and post diagnostic and treatment procedures 7. Implements safe and quality nursing interventions addressing health needs, problems and issues affecting pregnant woman during the peripartal to neonatal stage. 2.4.8 Apples appropriate and evidence based nursing interventions for physiologic and related psychosocial needs of patient/clients to preserve physiologic integrity and prevent complications of problems of oxygenation (ventilation, transport, perfusion); fluid and electrolyte imbalance and acid-base imbalances; nutrition and metabolism; gastrointestinal (indigestion, digestion, absorption, coordination, and altered sensation; inflammation, infection, and immune responses; cellular aberration, altered genetic conditions; and reproductive problems. 9. Implements participatory and empowerment strategies related to promotion of health, healthy lifestyle/adaptation, wellness, disease management environmental sanitation, environment protection and health resource generation, use of access within the context of primary health care. RESPONSIBILITY 3- MAINTAINS COMPLETE, ACCURATE AND UP-TO-DATE RECORDING AND REPORTING SYSTEM. 1. Ensures completeness, integrity, safety, accessibility and security of information. 2. Adheres to protocol and principles of confidentiality in safe keeping and releasing of records and other information 3. Implements system of informatics to support the delivery of health care. RESPONSIBILITY 4- ESTABLISHES COLLABORATIVE RELATIONSHIP WITH COLLEAGUES AND OTHER MEMBERS OF THE TEAM TO ENHANCE NURSING AND HEALTH CARE SERVICES 1. Ensures intra-agency, inter-agency multidisciplinary and sectoral collaboration in the delivery of health care. 2. Implements strategies/approaches to enhance/support the capability of the client and care providers to participate in decision making by the inter professional team. 10. Implements interventions guided by prescribed context of specific health programs services. 11. Implements appropriate care to individuals, families, vulnerable groups, and communities during the three phases of disaster situations, such as 1) pre incident phase 2) incident phase 3) post incident phase. RESPONSIBILITY 5- PROMOTES PROFESSIONAL AND PERSONAL GROWTH AND DEVELOPEMENT 1. Assumes responsibility for lifelong learning, own personal development and maintenance of competence. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 2. Demonstrates continued competence and professional growth. 3. Engage in advocacy activities to influence health and social care service policies and access to services. FACILITY/COMPONENTS OF HEALTH PROGRAMS OR A NURSING SERVICE 1. Coordinates the tasks/functions of other nursing personnel (midwife, BHW and utility worker) 2. Collaborates with other members of the health team in the implementation of programs and services 4. Models professional behavior BEGINNING NURSES ROLE ON LEADERSHIP AND MANAGEMENT RESPONSIBILITY 1 – DEMONSTRATES MANAGEMENT AND LEADERSHIP SKILLS TO PROVIDE SAFE AND QUALITY CARE 1. Utilizes appropriate and efficient methods/strategies/tools to manage multiple nursing interventions for clients with co-morbidities, complex and rapidly changing health status with consultation as needed. 2. Coordinates care by organizing use of human, material financial and other resources to achieve expected health outcomes. 3. Maintains a harmonious and collegial relationship among members of the health team for effective, efficient and safe client care. 4. Creates a safe environment of care through the use of quality assurance, continuous quality improvement and risk management strategies. RESPONSIBILITY 2 – DEMONSTRATES ACCOUNTIBILITY FOR SAFE NURSING PRACTICE 3. Ensures adequate resources (e.g. human, material) to effectively implement programs/services based on requirements, ratio, and standards 4. Mobilizes resources for effective program implementation/services delivery. 5. Supervises the implementation of nursing component of the health services/programs 6. Ensures that all nursing personnel adhere to standards of safety bioethical principles and evidence-based nursing practice. 7. Evaluates specific components of health programs and nursing services based on parameters/criteria 8. Applies management and leadership principles to ensure a complete accurate, and up-to-date documentation of activities and outcomes of managing community village-based facility component of a health program and/or nursing service RESPONSIBILITY 5- DEMONSTRATES TO LEAD AND SUPERVISE NURSING SUPPORT STAFF. 1. Applies principles of supervision for effective and efficient delivery of health programs and services. 1. Participates in the development of policies and standards regarding safe nursing practice 2. Assesses supervisory needs of the nursing support staff. 2. Organizes own workload demonstrating time management skills for meeting responsibilities and achieving outcomes. 3. Participates in the planning and implementation of staff development activities to enhance performance of nursing support staff. 3. Institutes appropriate corrective actions to prevent or minimize harm arising from adverse effects 4. Monitors the performance of the nursing support staff. RESPONSIBILITY 3 – DEMONSTRATES MANAGEMENT AND LEADERSHIP SKILLS TO DELIVER HEALTH PROGRAMS AND SERVICES EFFECTIVELY TO SPECIFIC CLIENT GROUPS IN THE COMMUNITY SETTING 1. Applies management and leadership principles in providing direction to manage a community/village-based: Health facility Component of health program or Nursing service 2. Uses appropriate strategies/approaches to plan community health programs and nursing services. RESPONSIBILITY 4 - MANAGES A COMMUNITY/VILLAGE BASED HEALTH 5. Evaluates performance of nursing support staff using a standard evaluation tool 6. Participates in improving policies and standards of nursing practice. 7. Disseminates policies, regulations, circulars and programs among nurses and nursing support staff 8. Participates in developing policies and procedures relevant to human resources management. RESPONSIBILITY 6- UTILIZES APPROPRIATE MECHANISMS FOR NETWORKING, LINKAGE BUILDING AND REFERRALS 1. Applies principles of partnership and collaboration to improve delivery of health services. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 2. Determines resources available for networking, linkage building, and referral necessary for improving delivery of health services 3. Collaborates with GOs, NGOs and other socio-civic agencies to improve health care services, support environment, protection policies and strategies, and safety and security mechanisms in the community 4. Engages in advocacy activities to deal with health-related concerns and adopts policies that foster the growth and development of the nursing profession. BEGINNING NURSES ROLE ON RESEARCH 1. Prepares a data collection and analysis plan as a member of the quality improvement/quality assurance/nursing audit team. 2. Conducts collection and analysis of the date with the team member based on the agreed plan. 3. Implements with the team the developed action plan for the identified variance to improve the system or process. 3.1.4 Communicates, both in oral and written form, the results of the quality improvement project in partnership with the quality improvement team/quality assurance//nursing audit team. RESPONSIBILITY 1 - Engage in nursing or health related research with or under the supervision of an experienced researcher. 1. Participates in preparing a research proposal complying with the ethical principles in nursing research 2. Conducts a research study as a member of a research team 3. Presents the research study conducted in partnership with a research team. Prepares a written research report Conducts an oral and or poster presentation RESPONSIBILITY 2- EVALUATES RESEARCH STUDY/REPORT UTILIZING GUIDELIENS IN THE CONDUCT OF A WRITTEN RESEARCH CRITIQUE 1. Determines if the research problems/questions, objective and/or hypotheses are clearly logically linked to the research purpose, concepts and relationship, and propositions generated from the study framework 2. Analyzes if the conceptual framework the summary of review of related literature, research design, and data analysis procedure are logically linked with the research purpose, problems/question and hypotheses. 4. Establishes if the interpretation, implications, and recommendations are consistent with the result considering the limitation of the study 4. Analyzes the research study/report for adherence to standards of writing mechanics, ethical principles and guidelines in all phases of the research study RESPONSIBILITY 3- APPLIES THE RESEARCH PROCESS IN IMPROVING CLIENT CARE IN PARTNERSHIHP WITH A QUALITY IMPROVEMENT/UALITY ASSURANCE/NURSING AUDIT TEAM 1. Participates as a member of a quality team in implementing the appropriate quality improvement process on identified improvement opportunities. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 PATIENT BILL OF RIGHTS 1. The patient has the right to considerate and respectful care 2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment and prognosis. Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the crisis involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits. 3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommend treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution. 4. The patient has the right to have an advance directive (such as living will, health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement a fully a legally valid advance directive. 5. The patient has the right to every consideration of his privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy. 6. The patient has the right to expect that all communications and records pertaining to his/her care should be treated as confidential by the hospital, except in cases such as suspected public health hazards where reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records. 7. The patient has the right to review the records pertaining to his/her medical care and to have information explained or interpreted as necessary except when restricted by law. 8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for risks, benefits, and alternatives to such a transfer. 9. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or players that may influence the patient’s treatment and care. 10. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting his care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide. 11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers available and realistic patient care options when hospital care is no longer appropriate. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 benefits of the surgery or treatment, what the consequences are for not having the surgery or procedure performed, treatment options, and the name of the health care provider performing the surgery or procedure. INFORMED CONSENT ETHICAL AND LEGAL ISSUES Comprehensive Review for Nurses INFORMED CONSENT Is the client’s approval (or that of the client’s legal representative) to have his or her body touched by a specific individual CONSENTS Or releases, are legal documents that indicate the client’s permission to perform surgery, perform a treatment or procedure, or give information to a third party. A client’s questions about the surgery or procedure must be answered before signing the consent. A consent must be signed freely by the client without threat or pressure and must be witnessed (witness must be an adult) A client who has been medicated with sedating medications or any other medications that can affect the client’s cognitive abilities should not be asked to sign a consent. Legally, the client must be mentally and emotionally competent to give consent. If the client is declared mentally or emotionally incompetent, the next of kin, appointed guardian (appointed by the court), or durable power of attorney has legal authority to give consent. TYPES OF CONSENTS ⮚ Admission Agreement- are obtained at the time of admission and identify the health care agency’s responsibility to the client ⮚ Immunization Consent- may be required before the administration of certain immunizations; the consent indicates that the client was informed of the benefits and risks of the immunization. ⮚ Blood Transfusion Consent- indicates that the client was informed of the benefits and risks of the transfusion. Some clients hold religious beliefs that would prohibit them from receiving a blood transfusion, even in a life-threatening situation. ⮚ Surgical Consent- is obtained for all surgical or invasive procedures or diagnostic tests that are invasive. The physician, surgeon, or anesthesiologist who performs the operative or other procedure is responsible for explaining the procedure, its risks and benefits, and possible alternative options. ⮚ Research Consent- obtains permission from the client regarding participation in a research study. The consent informs the client about the possible risks, consequences, and benefits of the research. ⮚ Special Consents- are required for the use of restraints, photographing the client, disposal of body parts during surgery, donating organs after death, or performing an autopsy. INFORMED CONSENT Indicated the client’s participation in the decision regarding health care. The client must be informed, in understandable terms, of the risks and MENTALLY OR EMOTIONALLY IMCOMPETENT CLIENTS Declared incompetent Unconscious Under the influence of chemical agents such as alcohol or drugs Chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions INFORMED CONSENT (continuation) A competent client older than 18 years of age must sign the consent. In most cases, when a nurse is involved in the informed consent process, the nurse is witnessing only the signature of the client on the informed consent form. An informed consent can be waived for urgent medical or surgical; intervention as long as institutional policy so indicates. A client has the right to refuse information and waive the informed consent and undergo treatment, but this decision must be documented in the medical record. A client may withdraw consent at any time. REMINDER! An informed consent is a legal document, and the client must be informed, in BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 understandable terms, of the risks and benefits of surgery, treatments, procedures, and plan of care. The client needs to be a participant in decisions regarding health care. MINORS A minor is a client under legal age as defined by state (usually younger than 18 years) A minor may not give legal consent, and consent must be obtained from a parent or the legal guardian. Parental or guardian consent should be obtained before treatment is initiated for a minor except in the following cases: in an emergency; in situations in which the consent of the minor is sufficient, including treatment related to substance abuse, treatment of a sexually transmitted infection, human immunodeficiency virus (HIV) testing and acquired immunodeficiency syndrome (AIDS) treatment, birth control services, pregnancy, or psychiatric services; the minor is an emancipated minor; or a court order or other legal authorization has been obtained EMANCIPATED MINOR An emancipated minor has established independence from his or her parents through marriage, pregnancy, service in the armed forces, or by a court order. An emancipated minor is considered legally capable of signing an informed consent. Data is one of the most used in this century. It does not only transcend to less important but also to the most sensitive data as well. Without the proper knowledge of how can it will be used in other terms, more so, it will be used against the individual’s advantage. DATA PRIVACY LAW Republic Act- RA 10173 Data Privacy Act of 2012 Penalties: Unauthorized Processing 1y to 3y - 3y to 6y 500k to 4m Access due to negligence 1y to 3y - 3y to 6y 500k to 4m Improper disposal 6m to 2y - 1y to 3y 100k to 1m Unauthorized Purposes 18m to 5y - 2y to 7y 500k to 2m Intentional Breach 1y to 3y 500k to 2m Concealing Breach 18m to 5y 500k to 1m Malicious Disclosure 18m to 5y 500k to 1m Unauthorized Disclosure 1y to 3y - 3y to 5y 500k to 2m Combination of Acts 3y to 6y 1m to 5m Know your RIGHTS! if one of your rights are violated, you can report it to [email protected] if you have other concerns, you can email it to [email protected] Privacy and data protection PRIVACY AND DATA PROTECTION More info’s from YOUTUBEKnow Your Data Privacy Rights! Personal data are passed on for profiling/Direct Marketing. - - Right to be informed Right to object Right to access Right to rectification Right to erasure or blocking Right to damages Right to data portability Right to file a complaint NATIONAL PRIVACY COMMISSION National Privacy Commission or NPC, is an independent body created under Republic Act No. 10173 or the Data Privacy Act of 2012, mandated to administer and implement the provisions of the Act, and to monitor and ensure compliance of the country with international standards set for data protection. - Privacy - Article 12 of the Universal Declaration of Human Rights treats privacy as a distinct Human RIght. it says that: ❖ “No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence ❖ Everyone has the right to the protection of the law against such interference or attacks.” depending on the context, privacy can mean the right to freedom of thought in conscience, ❖ the right to be left alone ❖ the right to control one’s own body ❖ the right to protect your reputation BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 - ❖ the right to a family life ❖ the right to a sexuality of your own definition there are ambiguities In legal terms, privacy isn’t an absolute right It can be restricted, ❖ to protect National security or Public safety (example). ❖ if it conflicts with other rights, like the right to free expression. ❖ Example: A public figure invoking privacy to avoid disclosing their financial records. ➔ Contrary to popular belief, privacy is not the same thing as data protection. ➔ Privacy is a broad concept, referring to the conditions which enable a basic foundation of human dignity and autonomy. ➔ while Data protection is more specific, ➔ Privacy is the big picture ➔ and Data protection is one corner of it. Data Protection - this is concerned with the ways third parties handle the information they hold about us - how it is collected, processed, shared, stored, and used - it is also subject to limits ❖ Example: A warrant is obtained allowing law enforcement to access the phone records of a suspect. - how it is applied legally can still vary depending on which country you’re in. The digital age has created new ways to collect,access, analyze and use data, often across multiple borders and jurisdictions. - it poses challenges for human rights ❖ One challenge relates to the way companies use our data ❖ Another challenge relates to the collection of personal data by governments The internet’s business model depends on people sharing their personal data in exchange for access to content, services and social media platforms. Technological developments now enable governments to monitor our conversations, transactions, and the locations we visit. In some countries - including Russia, Brazil, Australia and South Korea - companies are legally required to store this data for long periods of time, making it easier for governments to get information on their citizens. ❖ These measures are often introduced in the name of fighting cybercrime and terrorism ❖ Without adequate protections, this data can easily be abused to target dissidents and activists - undermining freedom of expression and the rights to association and assembly There are many bodies and forums where privacy and data protection issues are discussed and defined: National and regional courts have a crucial role here The European Court of Human Rights, for example, has imposed limits on ‘Stop and search’ practices by the police, and on the amount of time data can be legally retained. At the national level, it’s common to find a specific public body responsible for privacy and data protection. ❖ This can be a specialist post or an ombudsman But the extent to which privacy is defined and protected varies greatly between different jurisdictions. ❖ Example: there is no clear right to privacy in the African Charter on Human and Peoples Rights (ACHPR) Following a UN resolution on the right to privacy in the Digital Age, the Human Rights Council has established a new Special Rapporteur for Privacy and various internet policy forums like the: ❖ Internet Governance Forum (IGF) ❖ Council of Europe ❖ Organisation for Economic Cooperation and Development and conferences like: ❖ HOPE ❖ CyFy contributing to shaping the scope of privacy in the digital age. The decisions of the companies can also have a huge impact on data protection and privacy rights. ❖ Example: By building end-to-end encryption into their software, as WhatsApp did in early 2016 Two Examples of Privacy and Data Protection in the Real World 1. Apple vs. FBI case - After the 2016 terrorist attacks in the US city of Bernardino, the FBI asked apple for the information on the iPhone of one of the suspects. - However, Apple’s operating system is encrypted and only accessible through a pin code - The FBI asked Apple to modify the system to let them in. - Apple refused - opening a lively debate on the right to privacy versus security needs - The case was almost taken to court but in the end the FBI found a vulnerability to crack the phone. - In privacy terms, this was a legal setback. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 - If the case had gone to court, it could have helped popularise the risks of weakening encryption for society and establish what constitutes a legitimate limitation on privacy by the state 2. Surveillance in Kenya - In Kenya, a combination of invasive surveillance measures and a lack of adequate data protection facilitated a crackdown on civil society in 2013, which was documented by Peace Brigades International. - Many Human Rights defenders had their offices raided, computers hacked and phones tapped by the government - One of the ways human rights defenders have been fighting back us by pushing for the ratification of Kenya’s first data protection law, long stalled in Parliament. - If implemented properly, this could limit the worst excesses of state surveillance So what can human rights defenders do to protect and strengthen privacy and data protection? 1. An easy first step is taking digital self security measures yourself. ❖ using of encryption and anonymity tools ❖ encouraging your friends to do the same 2. Human right defenders also advocate for alternative digital business models, which aren’t based on the extraction and sale of data ❖ Economic pressure on the existing model is already growing ❖ Example: over the last few years, the number of users using adblock software globally has exploded ❖ There is evidence that this is already pushing companies to less invasive advertising practices 3. Engagement in debates at the national and regional level is, of course, crucial. ❖ When privacy protections are weak, human rights defenders need to actively advocate for stronger ones. 4. Make sure legislation is keeping up with new technological developments. ❖ Internet of things 5. If we want things to change, human rights defenders need to make these issues accessible and relatable by being more creative about the way we talk to them ETHICO-MORAL ASPECTS IN NURSING In their daily work, nurses deal with intimate and fundamental human events such as birth, death, and suffering. They must decide the morality of their own actions when they face the many ethical issues that surround such sensitive areas. Because of the special nurse-client relationship, nurses are the ones who are there to support and advocate for clients and families who are facing difficult choices, and for those who are living the results of choices that others make for and about them. The present environment of cost containment and the nursing shortage tends to emphasize business values. This creates new moral problems and intensifies old ones, making it more critical than ever for nurses to make sound moral decisions. Therefore, nurses need to: a. develop sensitivity to the ethical dimensions of nursing practice b. examine their own and clients' values c. understand how values influence their decisions d. think ahead about the kinds of moral problems they are likely to face. ETHICS Ethics - study of the norm of human acts as guided by human reason. CODE OF ETHICS FOR REGISTERED NURSES BR 220 S 2004 CODE OF ETHICS Code of Ethics - A guide of principles designed to help professionals conduct/perform work honestly and with integrity. - A code of ethics document may outline the mission and values of a certain organization, how professionals are supposed to approach problems, the ethical principles based on the organization's core values and the standards to which the professional will be held. Preamble 1. Fundamental responsibility of the nurse is four fold (Prevention, promotion, alleviation, rehabilitation) 2. Nurse renders service regardless of race, creed, nationality or political belief. 3. Nurses protect life and respect the dignity of man. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 4. Nurse works in collaboration with members of the health team ELEMENTS OF THE CODE OF ETHICS 4. REGISTERED NURSES, SOCIETY AND ENVIRONMENT ETHICAL PRINCIPLES 1. Healthy environment and preservation of life, respect for human rights 2. Establishment of linkages 1. REGISTERED NURSES AND PEOPLE ETHICAL PRINCIPLES Respect 1. Values and spiritual beliefs 2. Individual decisions 3. Personal information Guidelines to be observed: a. Culture and values considered - in the event of conflict, welfare and safety take precedence b. Uphold the rights of individuals c. Respect spiritual beliefs and practices- diet and treatment d. Ensure individuality and totality Guidelines to be observed: P - articipate in programs L - ives to uphold right Principles A - ctive role in primary health care Y - earns to uplift image of profession S - erves the community 5. REGISTERED NURSES AND THE PROFESSION ETHICAL PRINCIPLES 1. Loyalty maintained 2. Uphold by laws of PNA 3. Commitment to CPE 4. Know appropriate legislation 2. REGISTERED NURSES AND PRACTICE P - rofessional awareness R - ecords confidential A - ccurate documentation– hallmark of nursing accountability C - ognizant that NSCC accredits professional programs Guidelines to be observed: a. M - embers of PNA b. O - bserves nursing standards c. N - ursing profession dev’t d. E - quitable working conditions through legislation e. Y - es to implementation of labor and work standards T - o be advocates I - nviolability of human life C - ompetence E - xcellent and quality care Guidelines to be observed: 1. Not allow to be used in advertisements that demean image of the profession 2. Not accept any gift, favor or hospitality from patient 3. Not demand and receive fee for recommendations made 4. Not abuse relationship 3. REGISTERED NURSES AND CO-WORKERS Trans.: ETHICAL PRINCIPLES 1. Solidarity 2. Healthy working relationships Patriotism Preservation & Enrichment of the Environment & Cultural Heritage LOVE OF COUNTRY Guidelines to be observed: P - rofessional identity maintained R - espect rights of co-workers A - ctively participate in organizations Y- ields to group activities S - hares in professional growth Respect For The Dignity Of Each Person Regardless Of Race, Creed, Color, Gender, Political Affiliation LOVE OF PEOPLE Compassion, Conscience, Competence, Confidence, Commitment, Professionalism CARING THE CORE OF NURSING LOVE OF GOD BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 Remember the three P’s that are emphasized youtube link Examples of Autonomy, Beneficence, Nonmale… ETHICAL PRINCIPLES Autonomy - Freedom to make your own decision without external influence - independence and freedom patients have when making their own decisions without any external pressure or influence ❖ while the physician has to honor patient’s autonomy, the physicians have their autonomy of their own ❖ there are certain situations which the physician can refuse providing the treatment such as refusing to perform cesarean section for a patient who lacks any medical reason ❖ there are certain situations in which the patient doesn’t have autonomy: for example, if the patient has an active TB, they have to take the treatment to protect the community in which the patient lives. Beneficence - doing what’s in the patient’s best interest … which is the duty of the physician to act in the patient’s best interest, basically choosing the best treatment available and following procedural guidelines Nonmaleficence - also known as “do no harm” or “Do good” - the doctor as to weight the benefits and risks of any treatment or procedure such as treating the patient with medication or surgery Justice - treating patients equitably and fairly, not equally ❖ Example: in the emergency department, a patient with urgent life-threatening illness can be treated first before patients who come with simple trauma Trans.: Professionalism Patriotism Personal Governance - commitment to personal governance - have a holistic and a balance perspective Additional: Basis - Code of Good Governance for professions in the Philippines Violation of code- Ground for suspension or revocation of Certificate of Registration Date of Effectivity - July 14, 2004 ETHICAL AND LEGAL RESPONSIBILITIES BIOETHICAL PRINCIPLES 1. BENEFICENCE - means to do good and not to do harm. 2. NONMALEFICENCE - Avoid inflicting harm/ evil 3. JUSTICE - refers to the obligation to be fair to other people/equality 4. AUTONOMY - means self determination (Consent, restraints, false imprisonment, illegal detention) 5. VERACITY - truth telling 6. FIDELITY - be faithful to your patients 7. TOTALITY - body should function as a whole 8. STEWARDSHIP - not harm our body because it is God’s not ours 9. PRIVACY - freedom from unwarranted publicity or exposure 10. PATERNALISM - father-son relationship 11. SHARING OR ALLOCATION OF RESOURCES - applies when resources are scanty or very limited 12. RESPECT - treat all individuals as persons with rights with or without abnormality QUIZ: After a motor vehicle accident, a patient was rushed to the ER where a splenectomy was performed (due to damage from the accident) without the patient’s consent. Autonomy Beneficence Nonmaleficence Justice check the answer in the last part of the yt video. https://bit.ly/39hu082 BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 PHILIPPINE NURSING PROFESSION ROADMAP 2030 FILE - The Filipino nurses responding to the needs of society, are engaged in providing humane and globally competent nursing care. Develop dynamic leaders and provide opportunities for innovative management in education, training and research. The Board of Nursing has mandated itself to pursue the challenge in the Nursing profession. Amidst all controversies, the new set of board has maintained its course toward unifying the profession and paving its way to excellence and competitive Nursing in the year 2030. Nursing-road-map_2030.pdf BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 LESSON 6: Nursing as an Art A. Caring 1. Caring practice models 2. 6’Cs of caring 3. Caring for self and others AMERICAN NURSES ASSOCIATION (ANA 1980) Nursing is the diagnosis and treatment of human response to actual or potential health problems. B. COMMUNICATION 1. 2. 3. 4. Process and models Therapeutic communication Helping relationship Communication and the nursing process C. TEACHING 1. Health promotion 2. Disease prevention 3. Health restoration and maintenance 4. Rehabilitation FILIPINO CULTURES, VALUES AND PRACTICES IN RELATION TO HEALTH CARE Nursing began as a desire to keep people healthy and to provide comfort and assurance to the sick Although the general goals of nursing have remained relatively the same over the centuries, ever-advancing science and the changing of society’s needs have deeply influenced the practice of nursing Nursing has had a significant effect on people's lives. As rapid change continues to transform the profession of nursing and health care system Today. Nurses bring knowledge, leadership, spirit , and vital expertise to expanding roles that afford increased participation , responsibility and rewards. DEFINITION OF NURSING Florence Nightingale - the act of utilizing the environment of the patient to assist him in his recovery”. nightingale considered a clean , well ventilated and quite environment essential for recovery Virginia Henderson - the unique function of the nurse is to assist the individual , sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) CANADIAN NURSES ASSOCIATION Describe nursing practice as dynamic caring. Helping relationships in which the nurse assist the client the client to achieve and obtain optimal health CERTAIN THEMES ARE COMMON TO MANY OF THESE DEFINITION Nursing is caring Nursing is an art Nursing is a science Nursing client centered Nursing is holistic Nursing is adaptive Nursing is concerned with health promotion, health maintenance and health restoration. Nursing is a helping profession NURSING AS A SCIENCE It is the “body of abstract knowledge” arrived through scientific research and logical analysis Is the scientific knowledge and skills in assisting individuals to achieve optimal health. It is the diagnosis and treatment of human responses to actual or potential problems. WHAT IS AN ART? The expression or application of human creative skill and imagination, typically in a visual form such as painting or sculpture, produces works to be appreciated primarily for their beauty or emotional power. WHAT MAKES NURSING AN ART? The art of nursing may have been in each person even before entering the profession. That innate capacity to respond to the needs of individuals is already the art of nursing. In nursing school, this vivacity is awakened through constant interaction with the patients in various settings. Nurses are called to perform relational work. Therefore, the motivation to keep that art is BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  un should be continuously burning. We have the power to heal the sick. An effective nurse is one who gives nursing care independently and collaboratively with other healthcare teams. The art of nursing comes in as a nurse independently does his or her job. The options s/he considers in taking a certain action and ultimately the action s/he does to respond to patient needs are the art of nursing It is in the nurses' hands to promote positive changes in patients. Everyday we are faced with patients who are in different conditions. In this case, individualized nursing care is noteworthy. Knowledge is not enough. Compassionate care is paramount. The art of nursing is our ability to connect with those around us. It is only when we begin direct patient care that we become aware of the art of nursing. The word art can be used to describe the result of a particular task as well as the knowledge and skill required to perform that task. Like other more fashionable art forms, nursing can be dramatic, inspirational, comedic, relaxing,comforting, joyful, and even sad. Nursing is also creative, existential, and has a particular rhythm. This intangible connection can create an environment of healing that allows patients to fully participate in their own recovery process. Nurses teach, support, communicate, medicate, and coordinate patient-care events. Nurses are patient advocates who provide comfort and hope to our patients and their families. The art of nursing is in play when we just know what to do to meet a patient's emotional needs: when to hold a patient's hand, stroke their brow, crack a joke or even just sit and listen. Most of this is being accomplished simultaneously during each patient interaction "The science of nursing allows us to care for our patient's bodies ; but it's the art of nursing that calls me to the profession and allows each nurse to touch souls.” Nursing...its very essence lies in the creative imagination , the sensitive spirit , and the intelligent understanding that provides the very foundation for effective nursing care. Donahue (1985 ) Is the art of caring for sick and well individuals. It refers to the dynamic skills and methods in assisting sick and well individuals in their recovery and in the promotion and maintenance of health. It involves the creative application of knowledge in the service of people NURSING SKILLS BED BATH: SHOWING NURSING SCIENCE AND AN ART When removing a patient’s clothes, notice how careful they are (keeping the patient covered and protecting their dignity at all times) and maintaining the privacy of the patient so that they don’t feel awkward is an art. - It’s an art because you are trying to maintain a kind helping relationship with the patient. - You are applying the value of respect and privacy to the patient Why do we start and follow the sequence of cleaning the face first then, the arms, chest legs and lastly the perineum? - Because scientifically we wash from the cleanest down to the dirtiest - Even the arms, we start from distal to proximal (from the wrist to the axilla) - And the one stroke from proximal to distal is the art Science and art should go together because that’s the holistic approach of caring Why do we need to put a towel on the cleaned legs before washing the feet? - Because by art we want the patient to be comfortable - And by science we don’t want the cleaned legs to be contaminated by the lenins or sheets BED MAKING: HRM VS. NURSING Nursing differs from HRM because from the start, it should art What’s the reason why you have to work at one side first? - Because of the application of science, for work of organization and to save time and energy. - If you notice in the HRM they spread the lenine, while in nursing they don’t do that to reduce dust and contamination - And because of the application of science we become creative. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  We do this because of scientific reason Which means because of the knowledge of the science that we have we become artistic and creative in our approach in doing tha task or the nursing care. Science + art = caring CARING they have made a difference in their clients' lives. When nurses feel free to concentrate their attention on others they can make a positive difference to clients. The ability to give clients focused attention means leaving the egocentric self behind. 1:24:20 In this age of technological competence and efficiency, the knowledge and skills embedded in caring practices are often overlooked. Technology does not negate caring ; in fact, the isolation that may accompany technology makes the significance of caring all the more important (Diener & Hobbs, 2012). Caring a dimension of human relating , and often referred to as The art of nursing Smith (2013) proposes that nursing cannot exist without caring. Caring is central to all helping professions , and enables people to create meaning in their lives Caring is sharing deep and genuine concern about the welfare of another person. CARING PRACTICE involves connection, mutual recognition , and involvement between nurse and client. Examples of caring, emerging from nursing situations : - A client experiencing postoperative pain is given medication to control her symptoms , and then the nurse talks quietly and holds her hand for a few minutes as the pain resolves. The nurse's presence , in itself, provides comfort for the client. - After the student nurse washes the hair of an older woman who is immobilized and applies her makeup , she helps the woman into a wheelchair to greet her daughter and grandchildren. The woman is extremely grateful and her sense of dignity is enhanced by this personal care. Just as clients benefit from caring practices, the nurses involved in these situations experience caring through knowing that CARING AS “HELPING THE OTHER GROW” Milton Mayeroff (1990), a noted philosopher, has proposed that to care for another person is to help him grow and actualize himself Caring is a process that develops over time, resulting in a deepening and transformation of the relationship. Recognizing the other as having potential and the need to grow, the caregiver does not impose direction, but allows the direction of the other person’s growth to help determine how to respond. Mayeroff (1990) defines major ingredients of caring that provide structure and further description of this process: 1. Knowing means understanding the other’s needs and how to respond to these needs; 2. Alternating rhythms signifies moving back and forth between intermediate and long-term meanings of behavior, considering the past; 3. Patience enables the other to grow in his own way and time; 4. Honesty includes awareness and openness to one’s own feelings and a genuineness in caring for the other. 5. Trust involves letting go, to allow the other grow in his own way and own time; 6. Humility means acknowledging that there is always more to learn, and that learning may come from any source; 7. Hope is belief in the possibilities of the other’s growth; 8. Courage is the sense of going into the unknown, informed by insight from past experiences. Mayeroff (1990) proposes that the caring process has benefits for the one giving care thru: ❖ Helping the other person grow, the caregiver moves toward self-actualization. ❖ Caring and being cared for, each person “find his place” in the world. ❖ Serving others through caring, individuals live the meaning of their own lives. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 NURSING THEORIES ON CARING Caring is at the heart of nursing’s identity; indeed, the root of the word nursing means “nurturance” or “care” (Smith, 2013) Nurse scholars have reviewed literature, conducted research, and analyzed nurses’ experiences, resulting in the development of theories and models of caring. These theories and models are grounded in humanism and the idea that caring is the basis for human science. Each theory develops different aspects of caring, describing how caring is unique in nursing. Several nursing theorists focus in caring: ❖ Culture Care Diversity and Universality (Leininger) ❖ Theory of Bureaucratic Caring (Ray) ❖ Caring, the Human Mode of Being (Roach) ❖ Nursing as Caring (Boykin and Schoenhofer) ❖ Theory of Human Care (Watson) ❖ Theory of Caring (Swanson) 5. Care with commitment - The deliberate choice to act in accordance with one’s desires as well as obligations, resulting in investment of self in a task or cause. “Teamwork is the key to great outcomes for our patients.” 6. Care with Comportment - Appropriate bearing, demeanor, dress, and language that are in harmony with a caring presence. - Presenting oneself as someone who respects others and demands respect. ❖ Dress properly ❖ Good Behavior ❖ Follow policies and procedures ❖ If you have nothing good to say, don’t say it. RECLAIMING THE ART AND IMAGE OF NURSING: Participation in Healing Relationships NURSING AS A CALLING SISTER SIMON ROACH’S 6C’S IN A ‘NURSING SITUATION 1. Care with compassion - Awareness of one’s relationship to others, sharing their joys, sorrows, pain, and accomplishments, participation in the experience of another “Caring: Most Authentic Criterion of Humannage” 2. Care with Competence - Having the knowledge, judgment, skills, energy, experience and motivation required to respond adequately to the demands of one’s professional responsibilities.” “False knowledge can be more dangerous than ignorance” 3. Care with Confidence - Comfort with self, client, and others that allows one to build trusting relationships. 4. Care with Conscience - Morals, ethics, and an informed sense of right and wrong. Awareness of personal responsibility “Follow your value, Follow your heart” Pittman (1985) in her article “goodbye Florence,” stated that nurses’ struggle for status has ended the age of Florence Nightingale. Could it be what nurses need to gain status is to embrace the visionary genius of Florence nightingale? NURSING AS A CALLING NURSING AS A SCIENCE A SACRED TRUST It was Florence Nightingale who created the “art and science” model of professional nursing practice and entrusted it to future generations. It is up to the nurses of the 21st Century to ensure that the art of the nursing is not sacrificed at the altar of the gods of science and technology, fiscal restraint and bureaucracy.. THE NURSE - A RARE COMBINATION OF ARTIST, SCIENTIST AND HEALER It is more than technical skills Qualities of the Healer Wisdom and Insight Love of humanity The ability to share another’s pain Courage to Offer Hope Courage to face the unknown Profound compassion BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  Presence and Connectedness Comfort with our own and others’ spirituality Empowers Others A sense of Humor THE ART OF HEALING TOUCH A LOVE OF HUMANITY COURAGE TO OFFER HOPE COURAGE TO FACE THE UNKNOWN A SENSE OF HUMOR CARING FOR THE VULNERABLE EMPOWERING SELF AND OTHERS CONNECTEDNESS BRINGS MUTUAL HEALING RELATIONAL CARING BRINGS JOY TO THOSE CARED FOR AND THE CARER CARING PRESENCE AND INTERCONNECTEDNESS BRINGS HOPE NURSES HAVE CONFIDENCE, SELF-ESTEEM & ENERGY CARE FOR EACH OTHER AND HAVE A PASSION FOR NURSING NURSING IS A LIFE-GIVING AND LIFE-RECEIVING CAREER NURSING AND MEDICINE What makes Nursing different from Medicine? Nursing complements medicine NURSING Medicine is disease oriented MEDICINE Nursing focuses on the Human response THE HEART OF NURSING The heart of nursing is the CARING presence and connectedness of the nurse, the nurse as healer, the integration of caring and healing and the exploration of the meaning that patients and families attach to sickness and death. Science is in awe of, and places great trust in its accomplishments. The heart of the nurse is in awe of the raw courage of the human spirit and stays to offer healing when science has failed. THE ART OF BEING The courage to stay when the limits of Science and technology have been reached. THE MUTUALITY OF CARING Jean Watson stated that when we include caring and love into our work, we discover that nursing is not just a job but a life-giving and life receiving career for a lifetime of growth and learning, Watson (2001) According to Hall "It is the experience of caring and the merhories of these experiences which lead to confidence, self-esteem and energy.....engagement with patients enriches, protects and empowers the healer," Hall (1997) ENGAGEMENT WITH PATIENTS ENRICHES, EMPOWERS AND PROTECTS THE HEALER CARING IS AN HONOR AND A PRIVILEGE NURSING Attention to full range of human responses to health & Illness Provision of Caring relationship that facilitates health & Healing “The nursing profession began with a genuine desire to serve and care for others, combined with a sense of compassion and commitment.” “Nurses stay by the side of those they serve through the worst times and celebrate with patients and families in the best times.” “There is an intimacy nurses and patients share which is understood.” “The essence of nursing is an unconditional love for mankind.” “To be called a nurse is an honor, a profession of the highest realm.” MAINTAINING CARE AND PRACTICE Caring for Self The concept of caring for self seems almost foreign to many nurses and students of nursing because of the professional emphasis on meeting others’ needs. Don’t forget your own needs Nurses take on multiple commitments to family, work, school, and community, they risk exhaustion, burnout, and stress Obstacles to self-care may be professional, related to the demands of a particular work setting or may be personal, such as a poor health habits or unrealistic expectations of self. Despite these challenges, it is imperative that nurses attend to their own needs, because caring for self is central to caring for others. BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13  According to Mayeroff (1990) describes Caring for self as helping oneself grow and actualize one’s possibilities Self-care, when defined as responding to one’s own needs to grow, is the opposite of the self-complacency that often accompanies egocentricity. Caring for self means taking the time to nurture oneself This involves initiating and maintaining behaviors that promote healthy living and well-being. Self-care focuses on care of the self in the deepest sense Self-awareness and self-esteem are intimately connected to self-care Each person is unique and possesses individual strengths and weaknesses. Self-care practices are intentionally created by the self and vigilantly maintained. This is a lifelong unfolding process, leading to wholeness that comes from and contributes to self-esteem. In its code of ethics, the American Holistic Nurses Association (2002), states that “the nurse has a responsibility to model health care behaviors. Holistic nurses strive to achieve harmony in their own lives and assist others striving to do the same.” Individuals with high self-esteem can critically problem solve and tackle obstacles more effectively, Self-care practices build self-esteem, leading to feelings of comfort and accomplishment TYPES OF SELF CARE Physical Social Mental Spiritual Emotional CARE FOR SELF: HEALTHY LIFESTYLE Nutrition Activity & Exercise Recreation BESEREL, CELESTIAL, CENIZA, E., POLIDO & VALLEDOR | N-13 NURSING THEORIES ON CARING CARING CARING indeed, the root of the word nursing means Caring is a dimension of human relating, and often referred to as the art of nursing. “nurturance” or “care” (Smith, 2013). These theories and models are grounded in Smith (2013) proposes that nursing cannot exist humanism and the idea that caring is the basis without caring. for human science. Caring is central to all helping professions, and enables people to create meaning in their lives. Caring is at the heart of nursing’s identity; Culture Care Diversity and Universality (Leininger) Caring is sharing deep and genuine concern Her theory of culture care diversity and universality is based on the assumption that about the welfare of another person nurses must understand different cultures in order to function effectively. CARING PRACTICE Theory of Bureaucratic Caring (Ray) Involves connection, mutual recognition, and involvement between nurse and client. Ray’s theory of bureaucratic caring focuses on caring in organizations (e.g., hospitals) as cultures. CARING AS “HELPING OTHER GROW” contextual Milton Mayeroff (1990) Proposed that, to care for another person is to help him grow and actualize himself. the relationship. Recognizing the other as having potential and of trust involves letting go, to allow the other to grow in his own way and own time; humility means acknowledging that there is always more to learn, and that learning may come from any source; hope is belief in the possibilities of the other’s growth; and courage is the sense of going into the unknown, informed by insight from past experiences. DESIATA, LYRIZZA A. N12 emphasize the From the perspective of the theory of nursing as caring person, whole and complete in the moment. The idea of wholeness includes the understanding that: ○ People are not perfect, but constantly growing and changing. honesty includes awareness and openness caring for the other; Schoenhofer caring, the nurse approaches each client as a patience enables the other to grow in his to one’s own feelings and a genuineness in and caring person. own way and time; Boykin importance of the nurse knowing self as a behavior, considering the past; and Schoenhofer suggest that the 2010). and forth between the immediate and meanings Boykin individuals living and growing in caring (Purnell, knowing means understanding the other’s long-term Furthermore, the meaning of caring was further nursing is to know people and nurture them as alternating rhythms signifies moving back the purpose of the discipline and profession of respond. by Nursing as Caring (Boykin and Schoenhofer) other person’s growth to help determine how to needs and how to respond to these needs; influenced held. impose direction, but allows the direction of the is influenced by the role and position a person the need to grow, the caregiver does not MAJOR INGREDIENTS OF CARING and organizational structure. Caring is a process that develops over time, resulting in a deepening and transformation of The theory suggests that caring in nursing is By living nursing as caring, the nurse establishes a mutual relationship of trust and respect with the client Caring, the Human Mode of Being (Roach) Roach (2013) philosophical focuses concept on and TYPES OF KNOWLEDGE IN NURSING caring as proposes a that caring is the human mode of being. All individuals are caring, and develop their Empirical Knowing: The Science of Nursing knowing observable caring abilities by being true to self, being real, ranges phenomena from (e.g., factual, anatomy, physiology, chemistry) to theoretical analysis and being who they truly are. Empirical (e.g., Thus, caring is not unique to nursing. developmental theory, adaptation theory). 6 C’s of Caring in Nursing Knowledge about the empirical world is 1. COMPASSION Awareness of one’s relationship systematically organized into laws and theories to others, sharing their joys, sorrows, pain, and for the purpose of describing, explaining, and accomplishments. predicting phenomena of special concern to Participation in the experience of another. 2. COMPETENCE judgment, the discipline of nursing. Having skills, the energy, “knowledge, experience and motivation required to respond adequately to the demands of one’s professional Personal Knowing: The Therapeutic Use of Self integrity in the personal encounter, achieves responsibilities” (Roach, 2013, p. 172). engagement rather than detachment, and 3. CONFIDENCE Comfort with self, client, and others that allows one to build 4. CONSCIENCE Morals, ethics, and an informed sense of right and wrong. denies trusting relationships. 5. COMMITMENT The deliberate choice to act in Appropriate bearing, demeanor, dress, and language that are in harmony with a caring presence. Presenting The nurse is aware of his or her own attitudes or his own life. Ethical Knowing: The Moral Component Ethical knowing focuses on “matters of obligation or what ought to be done” (Carper, 2009, p. 382), and goes beyond simply observing the nursing code of ethics. Goals of nursing include the conservation of life, alleviation of suffering, and promotion of health. Swanson defines caring as “a nurturing way of Aesthetic Knowing: relating to a valued ‘other,’ toward whom one The Art of Nursing feels a personal sense of commitment and Personal knowledge is concerned with the individual who is free to choose and create her demands respect impersonal and behavior and views the client as a unique oneself as someone who respects others and Theory of Caring (Swanson) or concrete, individual self. obligations, resulting in investment of self in a 6. COMPORTMENT manipulative knowing, encountering, and actualizing of the accordance with one’s desires as well as task or cause. the approach Awareness of personal responsibility. Personal knowing promotes wholeness and Aesthetic knowing is the art of nursing and is responsibility” (Wojnar, 2010, p. 743). expressed by the individual nurse through his or The theory focuses on caring processes as her creativity and style in meeting the needs of nursing interventions. clients. Caring Processes from Swanson’s Theory of Caring The nurse uses aesthetic knowing to provide 1. KNOWING care that is both effective and satisfying. 2. BEING WITH Empathy, compassion, holism, and sensitivity are 3. DOING FOR important modes in the aesthetic pattern of 4. ENABLING knowing 5. MAINTAINING BELIEF CARING ENCOUNTERS Because EMPOWERING THE CLIENT (continued..) caring is contextual, a nursing approach used with a client in one situation mutual relationship, the nurse is able to identify may be ineffective in another. and Caring responses are as varied as clients’ empowering needs, environmental resources, and nurses’ respect, trust, and confidence in the other’s imaginations. abilities and motives. According to Swanson When clients perceive the encounter to be (Wojnar, 2010), the caring behavior of enabling caring, their sense of dignity and self-worth is is defined as “facilitating the other’s passage increased, and feelings of connectedness are through life transitions and unfamiliar events” (p. expressed. 743). Common caring patterns include: informing, ○ knowing the client, ○ nursing presence, ○ empowering the client, ○ compassion, Knowing the and family ultimately includes explaining, coaching, supporting, assisting, Like empathy, compassion involves and a willingness to share in their experience. Compassion is given as part of the caring By attending broadly to personal, ethical, sorrows, pain, and accomplishments. Compassion re