Lecture-6 Nursing values ethics and advocacy.pdf

Nursing values, ethics and advocacy  Concepts of Continuing Professional Development Life-long learning Career path/ development map Filipino Culture, Values, and Practices in relation to health care...

Nursing values, ethics and advocacy  Concepts of Continuing Professional Development Life-long learning Career path/ development map Filipino Culture, Values, and Practices in relation to health care Ethico-moral and legal considerations in the practice of nursing Topics 1.The Philippine Nursing Law Of 2002: RA 9173, Art. VI, Sec. 28: Scope Of Nursing Practice 2.National Nursing Core Competency Standards 3.Patients Bill Of Rights 4.Informed Consent 5.Data Privacy Law 6.Code Of Ethics For Nurses 7.Philippine Professional Nursing Roadmap  Value- enduring beliefs or attitudes about the worth of a person, object idea, or action -Influences decisions, actions ethical decion-making Beliefs- or opinions, are interpretations or conclusions that people accept as true Attitudes- mental positions or feelings towards a person, object, or idea Essential nursing values Filipino Nurses  Family solidarity- intergenerational solidarity refers to the degree of closeness and support between different generation Dimensions: oStructural solidarity- geography oAssociational solidarity-frequency of social contact oAffectual solidarity- emotional closeness, affirmation, intimacy oConsensual solidarity-actual and perceived agreements oFunctional solidarity- practical and financial assistance and support oNormative solidarity- strength of obligation  Communication- communicating Helping others and dimplomatically. Use of gratitude- Pakikisama polite forms of speech. and utang na loob “hiya”. Physical distance. Filipino family values Respect Independence Service- Trust  Social belief and customs- primarily influenced by religion and demographics Ex: thread on forehead during hiccups; usog; sleeping immediately after bathing; Culture and washing of hands/feet when tired; Nursing Religion and festivals- miracles (healing and fertility) Music and dance- Obando fertility dance Cuisine-rice, pancit(brings about long life)  Filipino health practices Self-medication- use of oils or ointments Use of herbs and roots, faith healers Hilot- based on the concept of balance Suob or steam inhalation Tawas Ethics originated from the Greeks with a word “ethos”. Ethos means moral duty in modern language. it refers to a standard to examine and understand moral life. It simply focuses on how people regard what is right or wrong. Nurses have to encounter ethical issues almost every day in their line of work. Ethics has something to do with making choices that are best for the person, or community at right times and taking responsibility of the results of such choices.  Ethical Codes  systematic guides for developing ethical behavior.  they answer normative questions of what beliefs and value should be morally accepted.  1. Service to others 2. Integrity and Objectivity General 3. Professional Competence Principles 4. Solidarity and Teamwork 5. Social andCivic Responsibility 6. Global Competitiveness 7.Equality of all Professions assumes various versions depending on the organization. For instance, the International Council for Nurses has embraced a code of ethics since 1953. It was in 2006 that it was revised as people and the demands of nursing has changed. This serves as a guide for right actions towards social values and needs. The Code Code of Ethics has been the basis of worldwide practice for ethical practice in nursing. for RN’s 4 elements:  Nurses and the people  Nurses and the practice  Nurses and the profession  Nurses and co-workers  Respect for the client Information confidentiality Ensuring of quality of practice Some ethical Nurses as patient’s advocate considerations: Maintaining of collegial and collaborative working relationship Loyalty and preservation of the profession Some Ethical issues AIDS patient care, faced by nurse: Abortion Organ and tissue transplant End of life issues (euthanasia and assisted suicide) Termination of life-sustaining treatment, withdrawing or withholding food and fluids  Active- actions that bring about client’s death directly, with or without consent Euthanasia- Assisted suicide Greek word Passive-withdrawing or meaning good withholding life- sustaining therapy death  Autonomy - refers to the right to make one’s own decision Non-maleficence - the duty to “do no harm” Beneficence - doing good. Justice - fairness Fidelity - means fatithfulness Moral to agreements and promises principles Veracity - telling the truth Accountability - “answerable to oneself and others for one’s own actions Responsibility - specific accountability or liability associated with the performance of duties of a particular role Legal aspects Of Nursing  Law the sum total of rules and regulations by which a society is governed. As such, law is created by people and exists to regulate all persons (guido)   Framework - establishes which Functions of nursing actions in the care are legal Law in  Differentiates responsibilities from other professionals Nursing  Helps in establishing boundaries  Standard and accountability  Constitutional law - from constitution (Ph. Constitution) Sources Legislation (statutory laws) - enacted by legislative body (R.A) Administrative law - administrative agency is given authority to create rules and regulations to enforce the statutory law (A.O)  Types  Public - body of law that deals with relationship between individuals and the government and governmental agencies Segment: criminal law: actions against safety and welfare of public (homicides, manslaughter, theft) Classification: o felonies o misdemeanor  Private or civil law - deals with relationships among private individuals Categories: Contract law - enforcement of agreement or payment of compensation for failure to fulfil agreements Tort law- defines and enforces duties and rights that are not based on contractual agreements Ex: Negligence Invasion of privacy Assault and battery  Selected categories of laws that may affect nurses  Terms in judicial process: Plaintiff- Defendants- Complaint - filed by complainant who Answer- made individuals who a complainant claims that his rights by defendants violated the rights have been infringed Trial- relevant facts Discovery-pre- Decision/ verdict- are presented to the trial activities result of the case judge  License - legal permit that a government agency (PRC) grants to individuals to engage Legalities in in practice of a profession and to use a particular title practice having the license is a privilege, not a right  Contract -agreement between 2 or more competent persons. May be written or oral. It is expressed Contractual when the parties have discussed arrangements and agreed to terms and conditions. Implied contract- has not been explicitly agreed to by the parties but the law considers it to exist   Provider of service Liability - quality or state of being legally responsible for ones obligations and actions and for making financial restitution for wrongful acts  Employee or contractor for service - a nurse employed by an agency is a representative of the said agency, and contract with clients being served is Legal roles of implied the nurse Contractual relationship - PDN contract is independent. Employee of hospital creates a relationship: respondent superior (let the master answer); the master assumes responsibility for the conduct of the servant and can also be held responsible for professional negligence by the employee.  Citizen  Informed Consent – agreement by a client to accept a course of treatment or a procedure after being provided complete information( risks and benefits, alternatives,prognosis) -Mutual decision making between both the professional and patient over the treatment option Selected legal that the patient wishes to receive or not- Richardson 2013 aspects of -Types: Express - oral or written agreement practice in Implied - individuals nonverbal behaviour indicates agreement nursing General guidelines in getting IC: Diagnosis/ procedure Purpose Expectation(feeling/experience) Intended benefits Possible risks or negative outcomes Advantages and disadvantages of possible alternative treatment modality  ELEMENTS OF INFORMED CONSENT Given voluntarily Given by client or individual with the capacity and Selected legal competence to understand aspects of Client is given enough information to be the ultimate decision maker practice in **autonomy, culture, literacy (low: limited ability; nursing illiteracy: unable to read or write; health literacy **competent- ≥18y.o, conscious and oriented; functionally incompetent- confused, disoriented, sedated **exceptions: 1. Minors -parents or guardian; adult with mental capacity of a child; minors that are married, pregnant, parents, emancipated; 2 unconscious or injured - closest adult relative; 3 mental illness  obtain signed consent form -not explaining the procedure, but witness the Nurse’s client’s signature on the form role -sign as witness. This will confirm: client consented voluntarily; signature is authentic; client appears competent to consent - remind the right to refuse, inform provider, document refusal in the chart  Warning signs of impairment  Impaired nurse- inability to perform essential job function because of chemical dependency on drugs or alcohol or mental illness Sexual harassment - violation of rights and a form of discrimination Abortions Death and related issues Advance health care directives - includes a variety of Legal issues legal and lay documents that allow persons to specify aspects of care they wish to receive should they become unable tomake or communicate their preferences. Type: living will - provides specific instructions about what medical treatment the client chooses to omit or refuse in the event that the client is unable to make decisions Health care proxy/ surrogate/durable power of attorney for health care - a notarized or witnessed statement appointing someone else to manage health care treatment decisions when the client is unable to do so  Autopsy/post-mortem examination- Certification of death- formal determination of death is performed by provider, coroner, nurse Do-not-resuscitate orders-(DNR) - providers may order “no code” for clients who are in a terminal illness,or expected death -written to indicate that the goal of treatment is a comfortable, dignified death -allow natural death- more palatable Euthanasia/ mercy killing- act of painlessly putting to death people suffering from incurable or distressing disease Voluntary euthanasia Physician-assisted suicide  Crime- act committed in violation of public and punishable by fine or imprisonment Classification: felony- crime of serious nature (murder), punishable with term in prison Misdemeanour-offens of less serious nature , punishable by fine, short-term jail Crime and Tort- civil wrong committed against a person or person’s property tort Classification: uninterntional- does not require intent requires element of harm ex: negligence- misconduct or practice that is below the standard; gross negligence- extreme lack of knowledge, skill, decision making that put other at risk; malpractice- professional negligence, negligence that occurred while the person was performing as a professional Elements of negligence:duty; breach of duty; forseeablity’ causation; harm/injury; damages Principles related to negligence: respondent superior; res ipsa loquitor ( the thing speaks for itself) Ex of negligenece: medication error, instrument left in body during surgery, fall, ignoring of complaints of clients  Intentional - executed act on purpose or with intent, no harm need for liability to exist Ex: assault - attempt or threat to touch another Categories of person unjustifiably; negligence battery- willful touching of a person (even things that result in currently used) that may or may not cause harm; professional false imprisonment-unjustifiable detention; invasion negligence of privacy-violation of right to withhold themselves and their lives from public scrutiny; lawsuits defamation (libel(printed)/slander(verbal/spoken))- communicating false or made with a careless disregard for the truth and results in injury to the reputation of a person  Good Samaritan act- not yet a law (2017) Legal protections -protect health care provides who provide assistance at the scene of an in the emergency against claims of practice professional negligence unless it can be shown that there was a gross departure from the normal standard of care or wilful wrongdoing on their part  Republic Act No. 9173  Known as the Philippine Nursing Act of 2002, repealing R.A. No. 7164  The prevailing law regulating the nursing practice in the Philippines  This was signed into law on Oct. 2002 and took effect on Nov. 2002 Legal Scope of Nursing Practice (Section 28 of R.A. No. 9173) protections in a. Nursing services, whether singly or collaboratively, to individuals, families and communities in any health-care setting; the practice b. Nursing care, whether singly or collaboratively, during conception, labor, delivery, infancy, childhood, pre-school, school age, adolescence, adulthood and old-age; c. Nursing action as independent practitioners for the promotion of health and prevention of illness; and d. Collaborative work with other health-care professionals for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and, when recovery is not possible, toward a peaceful death.  Duties of a Nurse a. To provide nursing care using the nursing care process; b. To establish linkages with community resources and coordination with the health team; c. To provide health education to individuals, families and communities; d. To teach, guide and supervise students in nursing education programs including the administration of Legal protections in nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse the practice e. To undertake nursing and health human resource development training and research, which shall include the development of advanced nursing practice. ***The widened scope of nursing care in R.A. No. 9173 allows a nurse to advance to areas such as internal examination during labor and delivery; suturing of perineal lacerations, and parenteral medications.  Doctor’s order 1. Question any order a client questions 2. Question any order if the client’s condition has changed 3. Question and record verbal orders to avoid miscommunication 4. Question any order that is illegible, unclear or Legal incomplete protections in  Providing competent nursingcare the practice  Documentation - chart is a legal document. “not written, not done”  Incident report - or unusual occurrence report; agency record of an accident or unusual occurrence  Magna Carta of Patient’s Rights and Obligations Right to Appropriate Medical Care and Humane Treatment. Right to Informed Consent RightTo Privacy and Confidentiality Obligations Right to Information. Know Rights Right To Choose Health Care Provider and Facility Right to Self-Determination Provide Accurate and Complete Right to Religious Belief Information Right to Medical Record Report Unexpected HealthChanges Right to Leave Understand Purpose and Cost of Right to Refuse Participation in Medical Research Treatment Right to Correspondence and to Receive Visitors Right to Express Grievances Accept Consequences of Own Informed Right to be Informed of His Rights and Obligations as a Patient Consent Magna Carta of Patient’s Rights and Obligations- Societal Rights of patients Settle Financial Obligations Right to Health. Relation to Others Right to Access to Quality Public Health Care Exhaust Grievance Mechanism Right to Healthy and Safe Workplace Right to Prevention and Education Programs Right to Participate in Policy Decisions  Continuing professional development RA 10912(2016) -Nurses should expand their knowledge and improve technical competencies to meet healthcare needs and demands for better dekivery of safe nursing care -45 units -> 15units  The following tasks or activities can be counted as CPD Units for renewal of PRC Card. Seminars, training, workshops; Attainment of higher academic qualifications such as master’s or doctorate Degrees Professional chair appointment, Residency Ext ernship Additional specialty/sub-specialty programs, Fellowship grants, Post-graduate diploma; Self-Directed Training offered by non-accredited CPD providers evaluated by CPD Councils; or other such activities recommended by CPD Councils and approved by the Board and the Commission. Professional Track and Self Directed Training may be in the form of face to face interaction or done online. Accredited CPD Providers may be Local or Foreign.  Guide for the development of National the following: Nursing Core Basic nursing education program Competency through CHED Competency-based test framework Standards Standards of professional nursing (2012) practice National career progression program any or related evaluation tool in practice  “To protect the fundamental human right to privacy of communication while ensuring free flow of information to Data privacy promote innovation and growth [and] the [State’s] inherent act of obligation to ensure that personal 2012 (RA information in information and 10173) communications systems in government and in the private sector are secured and protected” Philippines Professional Nursing roadmap -Pathway from compliant to proficient status  Dynamic leadership Strategic Service excellence Objectives/ themes(way Operational excellence s on how to achieve) Strategic partnerships Social responsibility  Balanced perspectives (specific on how to attain the goals): Learning and Internal Customer Financial growth process perspectives perspectives Thank You!!!