Notes~Theory, Ethics and Professionalism in Nursing-1.pdf

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Page 1 of 19 THEORY, ETHICS AND PROFESSIONALISM IN NURSING Prepared by Shah Ikmal INTRODUCTION TO NURSING THEORIES LOs 1. Define model, theory, and nursing theories 2. Describe the concept of nursing, health, and environment 3. Explain the role of theories in nursing practice Nursing Model Nursing Theory Definition A conceptual framework that outlines the structure & A systematic explanation/framework that describes, predicts, and organization of nursing practice. It provides a systematic prescribes phenomena related to nursing practice, education, and approach to understanding and delivering nursing care research. It consists of definitions and propositions that guide nursing knowledge. Component 1. Conceptual Structure: A model portrays the 1. Provide Guidance: systematic explanation/framework of conceptual structure and organisation of nursing related concepts that propose action to guide practice as it practice. describes, predicts, and prescribes phenomenon related to 2. Visualization Tool: helps in visualizing and nursing. representing complex relationships and interactions 2. Evidence Based Practice: serve as foundation for research & among and between nursing key concepts. evidence-based practice as it provides vital linkages between 3. Application in Nursing: Guide nurses in assessing concepts in nursing. patient needs, planning interventions, 3. Impact on patient care: Theories guide nursing interventions implementing care and evaluating outcomes. and improve nursing care and patient outcomes. Concept Description Example Nursing The profession & practice of providing holistic care to Gathering data about the patient’s health status, needs, and individuals, families, groups, and communities. It encompasses preferences. Developing care plan tailored to the patient’s assessment, diagnosis, planning, implementation, and needs and goals. Assessing the effectiveness of nursing evaluation of care to promote health and well-being. care and making adjustments as needed. Health Represents the overall well-being of the person, including Optimal functioning of bodily systems, Emotional physical, mental, emotional, and social dimensions. It is stability, Ability to cope with stress, Engagement In dynamic and influenced by various factors. meaningful activities, fulfilling relationships. Environment External factors surrounding the person that affect the person’s The hospital unit where the patient receiving care, support health, including physical, social, cultural, economic, and systems such as family and friends, access to healthcare political influences. services, healthcare policies & regulation. Roles of Nursing Theories Clinical Practice Nursing Education Nursing Research Provide a framework for nurses to Foundation of nursing Theoretical Framework: Nursing theories offers understand the relationship between programme: Serves as the researchers a systematic approach to understanding & the patient, environment, health & foundation for curriculum explaining nursing phenomenon, guiding research nursing care-nurses know why they development, teaching questions & hypotheses. Help researchers to select are doing what they are doing. methodologies and others. appropriate methodologies, data collection techniques Guide the nursing care to improve the Facilitate Educators: & analytical approaches for their research. patient outcome. preparing the students for Informing Practice Implications: demonstrating the Indicate in which direction nursing clinical practice and effectiveness of nursing interventions and highlighting should develop in the future. professional roles. areas for improvement, contributes to the enhancement Differentiate the focus of nursing Nurture Critical Thinking of patient care and the promotion of health outcomes from other professions. & Decision-Making Skills: Advancing Knowledge Development: Synthesising Facilitate the generation of further Important skills among existing research findings, generating new knowledge. knowledge. students to enable them to Foster interdisciplinary collaboration & dialogue. apply theoretical. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 2 of 19 INTERDISCIPLINARY THEORIES LOs: 1. Define interdisciplinary theory 2. State different types of interdisciplinary theory such as basic human needs theory, system theory and psychosocial theories Interdisciplinary Theory: a systematic view of phenomenon specific to the discipline of inquiry Basic Human Needs (Maslow’s Hierarchy of Needs): 5 basic human needs that every human being must have met in order to survive. He illustrated with a pyramid to show bottom layers are more important than the top. Physiological Needs Safety Needs Love Needs Esteem Needs Self-Actualization Food, air, water, Protection, stability, pain Affection, acceptance, Self-respect, self-esteem, Achieve full potential, sleep, clothing, sex avoidance inclusion respected by others fulfilment Systems Theory (Neuman Systems Model): Defines a total-person model of holism and open systems approach. Open system is process such as nursing process interact with the environment. Exchanging information between the system & the environment. Application of System Theory in Nursing Process: Input data/information obtained from assessment. Patient’s interaction with environment & physiological functions. Output end product of the system. Health status of the patient (improved, declines/maintained) Feedback inform a system about how it functions. E.g., patient response to nursing interventions/from family/other HCP Content Product & information obtained from the system. E.g., patients with impaired bed mobility have common skin care needs & interventions (e.g., hygiene & scheduled positioning changes) that are very successful in reducing pressure sores. PSYCHOSOCIAL THEORIES (MAJOR THEORY IN NURSING): to help establish therapeutic relationships through psychological, social, and spiritual care. 1. Leininger’s Culture Leininger’s Sunrise Model demonstrates the inclusiveness of culture in everyday life & helps to Care Theory & Sunrise explain why cultural assessment need to be comprehensive. Model The model assumes that the cultural care values, beliefs & practices are fixed in the cultural & social structural dimensions of society which include environmental, context, language & ethnohistory (significant historical experiences of particular group). In Nursing this model differentiates caring according to age groups, defined by people, healthcare systems based on scientific biomedical system. 2. Family Health System A holistic model that guides the assessment & care for families. This includes 5 processes of family (FSH) life (Interactive, Development, Coping, Integrity, Health). To determine areas of concern, strengths which helps nurses to develop a plan of care with family nursing interventions and outcomes. The goal is to improve family health, assist in family management of illness conditions or transitions & achieve health outcomes. 3. Developmental Theories Families and individuals grow over time. They have own challenges, needs, resources (tasks) to be completed before the family is able to move to the next stage. Impact by societal changes & aging population NURSING THEORIES LOs: 1. Understand Nursing profession & its foundation. 3. State the difference between theory & model. 5. List different types of theory 2. Define theory according to nursing philosophy 4. State the components of a theory. 6. Explain different types of Theory in nursing CONCEPTS COMMON TO NURSING MODELS Person/Patient (Client): small group or a large collective of individuals Health: Continuum (moving depending on circumstances and health (community) status) Environment: ‘simple’ physical environment to ‘larger picture’ Nursing: provide basic care, psychological support and relief of (public sanitation, air, water quality) discomfort. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 3 of 19 Nursing theory is an organized framework of concepts and purposes designed to guide the practice of nursing. It is also a conceptualization of some aspects of nursing that describes, explains, predicts or prescribed nursing care. THEORY MODEL Definition A speculative statement involving some element of reality Hypothetical representation of something that exists in reality that has not been proven Purpose Describe & explain a particular nursing action in order to Attempt to explain a complex reality in systematic and organized make a hypothesis/predict its outcome manner. Concept Theory explains more With pictures or words Example Systems Theory by Betty Neuman (2011) Health Belief Model Component of a Theory are; Concepts, Definitions, Assumptions or Propositions. TYPES OF THEORY Grand Theories Systematic & broad scope, complex & therefore require further specification through research (e.g., Neuman Model) Middle Range Limited in scope and more abstract that address specific phenomena & reflect practice in administration, Theories clinical/teaching. Descriptive Theories Not direct specific nursing activities but help to explain nursing assessment. Prescriptive Theories Addresses nursing interventions for a phenomenon, describe the conditions under which the prescription occurs & predict the consequences. METAPARADIGMS: Four Concepts of Nursing Theory Theory Person/Patient Health Environment Nursing The elements external Being well & using every Perform tasks for patient & Person who receiving to & effect the health of Nightingale power that person has the controlled the patient’s care the sick and healthy (Environment) fullest extend environment to enhance recovery person. Patient who requires Temporarily assisting an individual Virginia All external conditions assistance to achieve Individual’s ability to who lacks the necessary strength. Henderson which influence life and health and function independently as 14 Need to have knowledge of (Activity of development of a independence/peaceful components biological, social sciences, & Daily Livings) person death skills. Ability living life to the Medium through which Individuals perform Help client conduct self-care fullest with the capacity to clients move as they Orem on their own behalf to activities in order to reach maintain life through self- conduct their daily (Self-care) maintain life, health. optimum level of functioning. care activities. A valued person to be A science of human relationships A general adaptive- Includes immediate and cared for, respected, & caring can be demonstrated and Watson maintenance level of daily extended family, nurtured, understood, practiced by the nurses. Creates a (Caring) function community, and culture assisted. care plan Circumstances and Viewed as adaptive A process where he or she is influences that surround Nursing acts to enhance interaction Roy system, their health, & striving to achieve their & affect the of the person with the environment (Adaptation) their environment maximum potential development & to promote adaptation. behaviour of the person Symbol that implies forward movement of personality & Organism that “strives other ongoing human Existing forces outside Human relationship between an Peplau in its own way to processes in the “direction of the organism & in the individual who is sick/need of (Interpersonal reduce tension creative constructive, context of culture. health services. Relation) generated by need”. productive, personal & community living Illness & wellness are shaped by various factors including perceptions & coping skills. Religious & cultural knowledge is an important ingredient in health care. Health concepts held by many cultural groups may result in people choosing not to seek modern medical treatment procedures Leininger Nurse must develop understanding, respect, and appreciation for the individuality & diversity of patient’s beliefs, (Transcultural) values, spirituality. Nurse must encourage in developing & maintenance of physical, emotional, & spiritual self- care. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 4 of 19 CRITICAL THINKING IN NURSING PRACTICE LOs: 1. Describe soft skills and hard skills in nursing practice 6. Describe the aspects of critical thinking 2. Describe critical thinking 7. Explain method to develop critical thinking 3. Explain the importance & purpose of developing critical thinking skills 8. Explain techniques in critical thinking 4. Explain the critical thinking model 9. Describe the critical thinking competencies 5. Explain the components of critical thinking SOFT SKILLS HARD SKILLS A group of skills acquired by a person that facilitate the The discrete, measurable skills that a student/nurse possess optimization of their own performance. It complements e.g: patient assessment, obtain vital signs, medication management, intravenous the clinical skills and lead to improved patient outcome. line management, cardiopulmonary, resuscitation/basic life support. CRITICAL THINKING Definition The ability to think in a systematic & logical manner with openness to question & reflect on the reasoning process. Nursing Practice The process of intentional higher-level thinking to define client’s problem, examine the evidence-based practice in caring for the client, and make choices in the delivery of care to. Important to improve the client’s outcomes. Need to seek knowledge & use it to make clinical decisions & problem solving Importance Need to plan care for each unique client & client problem Need to solve problem & find solutions Integrate theory into clinical Evidence-based practice Purpose Generate many ideas Be independent & self-confident, even when under pressure CRITICAL THINKING FOR DECISION MAKING MODEL Basic Critical Learner is still trusting that the experts have the answer to every problem and situation Thinking Lots of following the step-by-step (doing skills procedure) Very limited ability to think critically, resources include instructors, books, nurses Complex Critical Grow & become more independent thinkers, level of critical thinking will grow. Rely less on their resource Thinking Realization can be more than one alternative & perhaps solution Start developing the ability to be creative, to think out of the box Commitment Nurse makes the decision based on alternatives and then stands by the decision Nurse assumes accountability and responsibility for the decision & evaluates that decision COMPONENTS OF CRITICAL THINKING Competencies Ability to perform nursing skills proficiently until this skills become like second nature. Enable individuals to analyze information, evaluate arguments, and make reasoned judgments effectively. Specific Varies according to basic nursing education, continuing education courses, habits of reading literature. The knowledge Knowledge prepares a nurse to better anticipate and identify patient problems. Based Experience Allows the nurses to learn from observing, sensing, talking & reflecting actively about patient care. We begin to understand clinical situations, anticipate & recognize cues of patients’ health patterns. These attitudes are based on the assumptions that a rational person is motivated to develop, learn, grow & be concerned Attitudes with what to do or believed; Confidence, Fairness, thinking independently, Risk taking, Creativity, Curiosity, Integrity, Humility Standards A. Intellectual Standards: Clear, Precise, Specific, Accurate, Relevant, Consistent, Logical, Complete, Significant. B. Professional Standards: Ethical criteria for nursing judgment, criteria for evaluation, professional responsibility. ASPECT OF CRITICAL THINKING Reflection Purposely thinking back situation to discover its meaning. It allows the nurse to look at a situation honestly and do some evaluation of the situation. Language Must communicate clearly with those around us, peers nurses, patients and families. If language is not well developed and spoken word is not clear it is a sign of sloppy thinking. Intuition It is the understanding of things without the conscious use of reasoning. It is also known as 6 th sense, hunch, instinct, feeling or suspicion. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 5 of 19 METHOD TO DEVELOP CRITICAL THINKING Reflective Keeping a written record of the clinical experiences in own words. Improves observational skills and descriptive Journaling skills. Can be on things that went wrong or went well. Keep the writing confidential. Meeting With To discuss and examine work experiences and validate decisions. Allows for questions, differing viewpoints and Colleagues sharing of experiences. Concept Mapping To visualize patient problems and provide holistic view of a patient and better understand patient’s clinical situation. TECHNIQUES IN CRITICAL THINKING Critical Analysis Nurses critically analyse patient data, including medical history, physical assessment findings, diagnostic test results, to identify health problem Questioning Nurses consider input from various healthcare team members, including physicians, pharmacists, therapists, social workers, to gain diverse insight & viewpoints on patient care issues. Inductive & Inductive: Involves making generalizations or predictions based on specific observations or patterns. Deductive Reasoning Deductive: Involves drawing specific conclusions from general principles or premises Making Valid e.g., After administering the pain medication, the nurse observes a decrease in the patient’s pain intensity and Inferences respiratory rate, inferring that the medication is providing effective pain relief without adverse effects. Clarifying Concepts Clarify complex concepts by defining terms, identifying key ideas, and understanding underlying principle. They and Recognizing also recognize and evaluate assumptions. Assumptions CRITICAL THINKING COMPETENCIES Scientific Method Identify a problem & seek answer with a formal approach (collecting data, formulating a hypothesis, testing the hypothesis, evaluating the results. Problem-Solving Seek information about the problem and the information plus knowledge that we already have to find solutions. Decision Making Endpoint of critical thinking. The pros/cons /risks/benefit of each option is weighted to make a final decision. REFLECTIVE PRACTICE IN NURSING LOs: 1. Describe reflection & reflective practice 3. Explain the models of reflection 2. Explain its role in professional practice Reflection: a cycle which enables the individual to consciously think about an activity or incident, and consider what was positive or challenging and, if appropriate, plan how a similar activity might be enhanced, improved or done differently in the future. Reflective Practice: The ability to reflect on one’s actions and experiences so as to engage in a process of continuous learning while enhancing clinical knowledge and expertise. Role in Professional Practice: 1. Soft Skills 4. Expanding personal knowledge 2. Self-Awareness 5. Personal & Professional Growth 3. Ability to influence others towards positive change 6. Improve patient outcome MODELS OF REFLECTION KOLB’S LEARNING CYCLE REFLECTIVE FRAMEWORK GIBBS 1. Concrete Experience (CE): Learning with experience 1. Description – what happened? 4. Critical Analysis – what sense 2. Reflective Observation (RO): You step back and reflect on did you make of the experience? what happened. You think about what went well. 2. What your feelings & how you 5. Conclusion – What have you 3. Abstract Conceptualization (AC): Concluding from did react? learnt from reflecting on this? experience 3. Initial evaluation of 6. Final evaluation & action plan 4. Active Experimentation (AE): Apply what you've learned experience – what was good & – what would you do differently? by trying out new approaches or behaviours. bad? THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 6 of 19 EVIDENCE-BASED PRACTICE IN NURSING LOs: 1. EBP Concept 2. Steps of EBP EBP CONCEPT STEPS OF EBP A method that allows the practitioner to assess the 1. ASK: Convert information need into an answerable clinical question research, clinical guidelines, and other 2. ACQUIRE: Track down best evidence for answering the question. information resources based on high quality 3. APPRAISE: Critically appraise the evidence for validity, impact, & findings and apply the results to practice. applicability. EBP is the thorough use of current best evidence 4. APPLY: Integrate the evidence into your clinical decision making. in making decisions about patient care. 5. AUDIT: Evaluate steps 1-4 and seek ways to improve next time Elements In EBP Clinical Expertise: knowledge gained from Patient Preferences: unique preferences, Research Evidence: Randomised controlled practice over time. Inductive reasoning concerns, expectations, financial resources, trials, laboratory experiments, social supports. epidemiological research, outcomes research, qualitative research. EVOLUTION OF THE NURSING PROFESSION 1. Evolution of the nursing profession from Florence 3. Historical and social events affecting nursing development in Malaysia and Nightingale and Rufaidah Sa’ad. internationally including the Islamic nursing history and medical development 2. The evolution of nursing practice from the era primitive 4. Contribution of Islam in Medicine society, and early civilization till the present era of advanced nursing. Florence Nightingale Rufaidah Sa’ad Established cleanliness & sanitation rules Shared clinical skills with the other nurses whom she trained Special diets and worked with Improved water supply went out to the community to solve the social problems that Upgraded the practice of nursing and made nursing an honourable lead to disease. profession for women Mobilize other to produce a good work Revolutionized the public’s perception of nursing (not the image of doctor’s assistant) and the method for educating nurses. Evolution of Nursing Practice Illness seen as magic, sin, punishment. Caused by the invasion of the victim’s body of evil spirit. Believed that medicine man, Primitive Shaman or witch doctor had the power to heal. Societies Trephining: drilling a hole in the skull with a rock or stone without anesthesia was a last resort to drive evil spirits from the body of the afflicted. Nursing was untaught and no organized nursing care. Babylonians: Code of Hammurabi Egyptians: Ebers Payrus and mummification 1st record on the medical practice, established the medical Ebers Papyrus (1550 BC) – believed to be the oldest medical text in fees, specific doctor for each disease having an assistant the world. Describes diseases and symptomatology. List more than (nurse-like figure), no organized nursing care only to 700 substances that were used as drugs and describe their preparation support and comfort. and medicinal use. Mummification: development of effective solution to preserve the body from decay. Indian: China: Ayurveda-1500BC (Explains, hygiene, disease Rule of physical exam (Look, Listen, Ask, Feel), baths to reduce prevention, major/minor surgery, children’s disease, fever, Sen Lung (Father of Medicine) used vegetable, animal drugs, inoculation, materia medica), Sushruta -1400BC (Father vaccination, physiotherapy, treated syphilis and gonorrhea. Ancient of Surgery in India. Charaka wrote Internal medicine), Civilizations King Ashoka (Public hospitals with male nurses and some older women, Nurses should have 3 qualities; high standards, skills, trustworthy) Romans: Greek: Medical advances borrowed from Greece after they Apollo (son of God)-God of health, Asculapus (son of Apollo)-God conquered it, had good hygiene and sanitation, made of healing, Epigone (Asculapus’ wife)-The soother, Hygeia- drainage systems, drinking water aqueduct, public baths, THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 7 of 19 hospitals (for soldiers and slaves), men & women of good (daughter of Asculapus)-Goddess of health, Temples-became social, character did nursing, Two classes; intellectual and medical centers. Patricians: Academicians Aristotle: Plebicians: common people Philosophy & sciences Differentiated arteries from vein. APPRENTICE AGES – MIDDLES AGES Middle Ages (a.d 500-1500) Apprentice Period: The Bubonic Plague/Black Death Care was done by crusaders, prisoners, religious orders. Ended the middle ages Nursing care: without any formal education by people who were Germs carried by rats directed by more experienced nurses killed ¼ of the entire world population Developed by religious orders of the Christian Church. “Ring-a-ring of roses/A pocketful of posies At-choo at-choo! /We Nursing went down to the lowest level all fall down!” Shortage of Nurses The plague caused death and destruction wherever it went. Hundreds of hospitals closed there was no provisions for the sick, But in 1633, no one to care for the sick. sister of charity founded by St. Vincent de Paul in France=caring for sick. Theodor Fliedner reopened small hospital & nursing training school in Kaiserswerth Germany. DEVELOPMENT OF MODERN NURSING Interest increased in science Industrial revolution happen and discovery – Newton, New illness transmitted through sailors & stowaway rodents > jumped Renaissance Galileo to national boundaries (1400-1600) Medicine increased-van Long hours working with unhealthy conditions “Rebirth of Nursing Leeuwenhoek (Father of Lack of prenatal care, inadequate nutrition Microbiology) Economic revolution Period of reformation until the American Civil War Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves) Nurses were uneducated, filthy, harsh, ill-fed, overworked Era of social reform for prisons, public health & care of the poor 19th Century Pastor Theodur Fliedner & his wife established the Kaiserwerth Institute for the training of Deaconesses (the 1st formal training school for nurses) in Germany, first real nursing school The most famous student: Florence Nightingale (1820-1910) 3 month course of study Dark Period of Nursing Civil War shaped nursing by dramatizing Licensure of nurses started (1700-1900) the need for nursing care. Training of nurses in diploma program Clara Barton established hospitals for all Nursing involvement in community Contemporary colors of people health Period Bellavue Hospital 1873 opened the New Expanded roles of nurses was developed York Training School modelled after Computers were utilized-data collection, Nightingale School teaching, diagnosis, inventory, payrolls, record keeping, billing Factors that influenced development of nursing education: Educative Period Social forces Emancipation (freedom) of women Trends resulting from war Increased educational opportunities Women’s roles & status: wife, mother, daughter Societal Attitudes Religious Values Before Mid-1800: without organization, Historical Factors Islam: this life is a life of worship education, social status. Effecting Nursing th century: doctor’s handmaiden Christian: love their neighbor as theirself Early 19 Development War Nursing Leaders Crimean War: Florence Nightingale Rufaidah Binti Sa’ad American Civil War: Harriet Tubman & Sojourner Florence Nightingale, Clara Barton, Linda WWI: Monument “The Spirit of Nursing” Richard, Mary Mahoney (18th century) WWII: Heroin THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 8 of 19 1900: Nursing profession had begun after WWII & 21st century: Certification has been upgraded to a Communist attack. The initial nursing school were minimum diploma with a minimum of 3 years training. Nursing Development in started in Penang, Johor Bahru & Kuala Lumpur trained Clinical nurse specialist training via post-basic, Malaysia by British matrons, sisters and medical doctors. Degree/Bachelor, Master, Doctor of Philosophy (Ph.D) Awarded with the certificate level of qualification. 1800 began with the arrival of the East India Company where hospitals for the sick were established in Penang and Singapore. Nursing practice in the pre-war era in Malaya then was carried out by nurses who received, on the job training, with lectures given by expatriates by European sisters, matrons and doctors at the hospital level. 1923 Introduction of legislation for the control of the Practice of Midwifery and the training of midwifes 1950 The Nurses Act and Nurses Registration Ordinance were enacted to control the practice of nursing 1956 The development of the Nurses Registration Regulation 1969 Extension of the Nurses Act to Sarawak 1978 Extension of the Nurses Act to Sabah 1985 Revision of the Nurses Registration Regulation 1985 and the Implementation of the Annual Practicing Certificate. 1966 The Midwives Act 1966 was enacted and a Midwives Board to provide for the registration of nurse – midwives and to regulate the practice of midwifery in the country. 1971 The Midwives (Registration) Regulation, whereby all midwives were required to apply for registration. The Traditional Birth Attendants (TBA) were registered up till 1st August 1972) 1990 The Midwives Act, 1966 was revised. The regulation reopened its doors to allow TBA to register for the next 10 years. CONTRIBUTION OF ISLAM IN MEDICINE Health to be one of the greatest blessings to have been given to human beings by God. Islam and Health There are two blessings which many people do not appreciate: health and leisure. No blessing other than faith is better than well-being The Solah: Recitation of Quran: Physical movement and mental concentration Has healing effect on the body, mind and heart. The circulation of blood, breathing and general suppleness joints Diet & Nutrition: The movement are mild, uniform, involve all muscles and joints. Allah states in the Quran to maintain the balance in nutritious diet Fasting: Over indulgence & wasting of food are further dissuaded Many processed foods we eat contain chemicals which over-time Forbidden to eat dead meat, blood and flesh of swine, and can be stored by our bodies as toxins within cells intoxicants Fasting assist to purge this toxins & digestive system can rest Fruits are low in calorie, high in vitamins and minerals, sugar is Stabilizes the secretion of hormones which control our behaviour. fructose and not sucrose. Cleanliness: Exercise in maintaining health: Miswak (brushing teeth) and flossing (khilal) He advised all Muslims to teach their children swimming, archery This was stressed as part of our daily routine by Prophet & horse riding. Muhammad He used to walk at a fast pace He used to work with his hands whether at home, in the kitchen, or collecting wood for fire, fighting during wars. PROFESSIONALISM IN NURSING 1. Introduction to professionalism in nursing 2. Function and role of a professional nurse 3. Principles that guide nursing practices Definition Profession occupation that requires advance training, specialised knowledge and skill, and formal qualification. Professional a person who belongs to and practices a profession. Professionalism demonstration of high level of personal, ethical and high level of skill characteristics for a member of a profession. Professionalism in demonstrating an unwavering commitment to the vocation and the willingness to continuously deliver the highest- Nursing quality care to patients. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 9 of 19 Criteria of a Professional Nurse High Intellectual Level of Modern nurses use assessment skill and knowledge, have the ability to reason and make routine judgement Functioning depending on patient’s condition. Professional nurses’ function at high intellectual level. High Level of Individual Has a legal, ethical and professional implications that include accepting responsibility for action taken to Responsibility and Accountability provide client care as well as accepting responsibility for the consequences of action that are not performed. obtain advanced degrees, conduct research and develop philosophies and theories about nursing, this body Specialized Body of Knowledge of knowledge will increase in scope. Evidence Based Practice (EBP) practice of nursing in which interventions are based on data obtained from research Well Organised and Strong control the quality of professional practice. Representation document may outline the mission and values of the business or organization, how professionals are Code of Ethics supposed to approach problems Competencies and Professional must pass a national license examination to demonstrate that they are qualified to practice nursing License Autonomy and Independence of need to be recognized by other disciplines as having practitioners who practice nursing independently Practice Professional Identity and Nurses are fully committed to the profession of nursing Development Dedicated to its future development Discipline and obedience Confidence Patience Ongoing research Alertness and Intelligent Resourcefulness Good physical and mental Honesty and loyalty Observation Dignity health Professional Preparation Provide patient-centered care Apply quality improvement principles Work in interdisciplinary teams Utilise informatics Employ EBP Code for Professional Nurse 1. Provides service with respect for dignity of man, unrestricted by considerations of nationality, race creed, color, or status. 2. Safeguards individual’s right to privacy by judiciously protecting information of confidential nature, sharing only that information relevant to his care 3. Maintains individual competence in nursing practice, recognizing and accepting responsibility for individual action and judgment. 4. Acts to safeguard the patient when his care and safety are affected by incompetent, unethical, or illegal conduct of any person. 5. Uses individual competence as criterion in accepting delegated responsibility and assigning nursing activities to others. 6. Participates in research activities when assured that the rights of individual subjects are protected. 7. Participates in the efforts of the profession to define and upgrade standards of nursing practice and education. 8. Participates in establishing and maintaining conditions of employment conductive to high quality nursing care. 9. Works with members of health professions and other citizens in promoting efforts to meet health needs of the public. 10. Refuses to give or imply endorsement to advertising, promoting, or sale for commercial products, services, or enterprises. How to Demonstrate Professionalism in Nursing? Advocate for patients Communicate effectively Work as a team Keep a positive attitude Deliver top-quality care Maintain your integrity Caring is Nursing, Nursing is Caring: nursing practice will become more technical without a caring substance. Caring requires nurses who focus on the relationship with the human being by seeing, understanding and taking responsibility In Watson’s Human Caring Theory, there is ten caritas processes, Caritas comes from the Greek word meaning “to cherish” 10 Caritas Processes 1. practicing loving-kindness to self and others 6. using problem-solving for decision making 2. being authentically present to enable faith, hope, and the 7. engaging in genuine teaching-learning experiences inner-subjective life world of oneself and others 8. creating a caring-healing environment for all involved 3. fostering one's own spiritual practices 9. valuing humanity 4. developing trusting interpersonal caring relationships 10. embracing the unknowns and miracles in life THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 10 of 19 5. Forgiving and showing empathy to self and others Function of a Professional Nurse Dependent Function Independent Function Implementing the doctor’s order Must know why the medication/treatment is prescribed, what to Supervise patients as a whole management care-bio psychosocial observe, how to prevent unwanted reaction, and when intelligently and spiritual. intervene if reaction should occur. Observe the symptoms and reactions (physical and mental) Questioning the physician order to seek clarification for safety of Do accurate recording and reporting (facts and evaluation) patient. Direction and education to secure physical and mental care for Nurse/student nurse are obliged to bring knowledge, skill patient competence to all aspects of patient care. Role of a Professional Nurse Caregiver: assist the client physically and psychologically, Communicator: identify client problems and communicate these developmental, cultural, and spiritual levels. verbally to other members of the health team. Client Advocate: acts to protect the client, represent the client’s needs Teacher: educate client about their health and the health care procedures and wishes to other health professionals. they need to maintain their health Change agent: make modifications in client’s behaviour, make changes Counsellor: helping a client to recognize and cope with stressful in a system such as clinical care if it is not helping a client return to psychological or social problems, to promote personal growth. Involves health providing emotional, intellectual and psychological support. Manager: delegate nursing activities, supervises and evaluates their Leader: influences other to work together to accomplish a specific goal performance Case Manager: to measure the effectiveness of the case management Research consumer: use research to improve client care, have some plan and to monitor outcomes. awareness of the process and language of research. Quality of a Nurse as a care provider Caring Communication Skill Empathy Attention to details Problem-solving skill Stamina Patient advocacy Willing to learn Critical thinking Time management Leadership INTRODUCTION TO HEALTHCARE DELIVERY SYSTEM 1. Identify the functional components of a healthcare delivery 3. Discuss nurse’s role in today and future healthcare system system at global level. 4. Describe inter-organizational structures and functions. 2. Discuss the quality of healthcare system in Malaysia. Objective of 1. It must enable all citizens to obtain healthcare services when needed Healthcare 2. The services must be cost-effective and meet certain establish standards of quality Delivery System Basic Components of Global Healthcare Delivery System Financing For private-employer base. May cover spouse, children & parents. Small employers may not afford in doing so. Insurance The insurance function also determines the package of health services the insured individual entitled to receive. Refers to the provision of healthcare services by various providers (independently bill @tax supported). E.g., Physician, Delivery dentists, optometrist & therapist in private practice, hospitals & diagnostic & imaging clinics & suppliers of medical equipment. Reimbursement to providers for service delivered. Patient may need to pay small amount of money when seeing the Payment physician. The remainder is covered by the managed care organization (MCO) or insurance company. Quality of Malaysia's healthcare system reflects a blend of public and private sectors, providing a comprehensive range of services. Healthcare Public Sector: Governed by the Ministry of Health, emphasizes universal access and affordability through public hospitals System in and clinics. Malaysia Private Sector: Offers higher quality services but often at a higher cost, catering to those who can afford it. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 11 of 19 Challenges in the Malaysian healthcare system include accessibility, especially in rural areas, and disparities in quality and affordability between the public and private sectors. Today's Role: Nurses serve as frontline caregivers, providing direct patient care, monitoring vital signs, administering medications, and educating patients and families. Nurse's Role in Expanded Roles: Nurses increasingly take on leadership, advocacy, and research roles, contributing to policy development, Today and Future quality improvement, and interdisciplinary collaboration. Healthcare Future Roles: With advancing technology and evolving healthcare models, nurses are poised to play even more critical Systems roles, including telehealth and remote patient monitoring, health informatics, and patient education using digital platforms. Key Skills: Adaptability, critical thinking, communication, and technological proficiency are essential for nurses to thrive in the evolving healthcare landscape. Functions: Inter-organizational collaboration is crucial for seamless patient care, resource sharing, and optimizing healthcare delivery. Hospitals: Primary Care Clinics: Health Insurance Companies: Government Agencies: Provide acute Offer preventive care, Facilitate financial coverage for Regulate healthcare standards, Inter- care services routine check-ups, and medical expenses, influencing allocate resources, and oversee organizational and specialized initial treatment for access to healthcare services. public health initiatives. Structures and treatments. common ailments. Functions Challenges: Coordination among diverse organizations, differing priorities, and resource constraints can hinder effective collaboration. Importance of Inter-organizational Collaboration: Enhances efficiency, reduces duplication of services, improves patient outcomes, and promotes innovation in healthcare delivery. HEALTH EDUCATION 1. Define health education 3. Describe the methods and approaches in health education 2. State the objective and principles of health education 4. Discuss the effectiveness and barriers in health education Definition of Health The process by which health professionals and others impart information to patients that will alter their health Education behaviours or improve their health status 1. Maintenance and promotion of Health and illness 4. Ensure the staff and students delivering high- Purposes of prevention quality care Health Education 2. Restoration of health 5. Increases consumer satisfaction 3. Increase confidence in self-care 6. Improves quality of life Methods and approaches in Health Education COGNITIVE AFFECTIVE PSYCHOMOTOR Learners’ ability to process information Learners’ ability to use motor skills to Learners’ attitudes and feelings that are a in a meaningful way learn result of the learning process Categories: Knowledge, comprehension, Categories: Perception, set, guided Categories: Receiving, responding, application, analysis, synthesis, response, mechanism, complex overt valuing, organizing, characterizing. evaluation. response, adaptation, origination. Strategy: role model, role play, Strategy: lecture, discussion, self- Strategy: demonstration, return simulation, gaming, questioning, case instructed activities, verbal tools, written demonstration, simulation, self- studies, group discussion sessions. tools instruction. BARRIERS IN HEALTH EDUCATION Teaching Learning Lack of time, low-priority status given to teaching, lack of confidence Lack of time, stress of illness, readiness to learn, complexity, and competence, questionable effectiveness of client education, inconvenience of health care system, denial of learning need, lack of documentation difficulties, absence of third party reimbursement, support from health professional, extent of needed behaviour changes, negative influence of environment, lack of motivation and skills. negative influence of environment, literacy problem. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 12 of 19 INTRODUCTION TO ETHICS AND VALUES IN NURSING 1. Introduction to ethics 4. Code of conducts – Nursing Board Malaysia (NBM) 2. Introduction to theories of ethics: deontology & teleology 5. Application of the code in nursing practice 3. International Code of Nursing Ethics The ethics and values provide an ordered set of moral standards to be used in assessing what is morally right and what is morally wrong regarding human action in general and in nursing practice Term ethics derived from the Greek, ethos = custom/character while Arabic = Akhlaq Concerned with determination of right and wrong in relation to people’s decisions and actions Morals – refers to judgement about behaviour, based on specific beliefs Value – personal beliefs about the worth a person holds for an idea Introduction To Ethics Health Ethics – moral decision-making situations in the practice of medicine and health (What is Ethics) Bioethics – concerns from diverse field including health, medicine, law, philosophy, biotech, life sciences and others Islamic Ethics – right principles and values based on Islamic sources which include Al-Quran’s teachings and Prophet Muhammad’s Sunnah Nursing Ethics – professional standards of conduct practices by nurses related to moral behaviour in providing health care services. Facilitate nurses to make informed decision making Enhance quality of care and patient safety by minimizing the risk of harm while ensuring safe and Purpose of Ethics in effective delivery of care Nursing Prioritise patient welfare and advocacy Ensure nurses comply with legal and regulatory compliance Develop sense of personal fulfilment, satisfaction and professional integrity ETHICAL THEORIES o Focus on the results of action and it treats intentions as irrelevant o Right actions ought to produce the greatest happiness or pleasure for the greatest number of people o Ought always to produce the maximal balance of positive value over disvalue Utilitarian Theory o Act is considered right if it brings about more please than pain, and wrong if it produces more pain than pleasure o Difficult to prove what counts as good. One’s good may be another’s bad and vice versa o Ignore concerns on the human rights and justice especially to the minority population o Obligations that they are bound to follow, regardless of the consequences o Duties may be derived from: religious beliefs, societal norms, or rational principle. Deontology Theory o Can lead to absolutism and inability to adapt to complex situations o May fail to provide practical solutions or guidance in morally complex, leaving individuals unsure of how to act when faced with moral uncertainty o Emphasises the development of moral character and virtues as the key to ethical behaviour, rather that focusing on rules or consequences o Nurses are encouraged to develop good moral virtues such as compassion, empathy, honesty, integrity, Virtue Ethics Theory and professionalism. o Nurses are encouraged to prioritise the needs and interests of patients, advocate for vulnerable populations, and work towards creating environments that support the development of virtuous characters. THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 13 of 19 INTERNATIONAL CODE OF NURSING ETHICS A statement of ethical values, responsibilities and professional accountabilities of nurses and nursing students that defines and guides ethical nursing practice within different roles nurses assumes Serve as framework for ethical nursing practice and decision making to meet professional standards set by regulatory bodies a. It is a succinct statement of the ethical values, obligations, duties, and professional ideals of nurses individually and collectively. Purposes b. It is the profession’s non-negotiable ethical standard. c. It is an expression of nursing’s own understanding of its commitment to society Four principles Nurses and people or other people requiring care or services Nurses and profession element of ICN Nurses and practice Nurses and global health NURSING BOARD MALAYSIA (NBM) – CODE OF PROFESSIONAL CONDUCTS 1998 **this is simplified version Professional 1.1 Respect for patient: know the patient’s right 1.4 Advocacy: act to protect the interest of the patient 1 Nursing 1.2 Standards of care: must follow the standards when not incapable of communicating his needs Practice 1.3Accountability: remain accountable for the work done 1.5 Teamwork: works collaboratively Neglect or If a nurse doesn't do their job properly, like giving the wrong medicine, it's called negligence. Disregard of Nurses should do what any competent nurse would do to keep patients safe. 2 Professional However, as nurses practice in a variety of settings, it is recognized that there may be factors beyond the nurses’ control, Responsibilities such as management policies and resource constraints, which affect the fulfilment of their moral obligations 3.1 Dangerous drugs Expected to abide by the dangerous drug ordinance and regulations Not use drugs for her own or other people addiction 3.2 Sale of Poisons Not participate directly or indirectly in the sale of poisons Abuse of 3.3 non-therapeutic abortion Not participate directly or indirectly in induces non-therapeutic abortion Professional 3 3.4 Acting as a witness Not involved as a witness for patient or his relation to personal matters Privileges and 3.5 Confidentiality Not disclose information about a patient unless it is to other related professionals Skills 3.6 Undue Influence Not ask patient to lend money, ask for gifts or alter the patient’s will 3.7 Personal relationship between Must not involved emotionally or sexually with a patient urgently under her care the nurse and the patient 4.1 Respect for Must not verbally or physically abuse the patient while caring for him people o Not be involved in the selling and buying of goods while on duty o Must not indulge in the consumption of drugs or alcohol which may adversely affect her 4.2 Conduct professional capability and image Personal Derogatory to o Must not commit dishonest acts such as soliciting funds from the patient, forgery, tempering of Behaviour 4 The Reputation records, fraud, theft or any other offence involving dishonesty of The o Must not commit indecent and violent behaviour Profession 4.3 Commercial o Must not associate herself with commercial activities that may influence her care of the patient Undertaking such as promoting the use of medical supplies and facilities o Expected to report to the appropriate authority, any colleague who exhibit unethical behaviour or 4.4 who is incompetent to practice due to the influence of drug, alcohol, physical or mental capacity Incompetence to o Must have undergone an approved course or education and certified as clinically competent by a practice recognized educational institution before undertaking such functions. Advertising, 5.1. May disseminate information on health care and services provided that it is done in an ethical manner. Canvassing and 5.2. Must not allow her name and professional status to be used in the advertisement of goods and services which ma. 5 Related may cause deception and biases in order to mislead the public Professional 5.3. Must not use calling cards for the purpose of soliciting patients. Offences If there be any written complaint on any nurse, a preliminary investigation will be conducted by the disciplinary 6 Disciplinary committee of the respective organization and there may be referred to the NBM for further action THEORY, ETHICS AND PROFESSIONALISM IN NURSING S.I (2024) (NURA 1311) Page 14 of 19 ETHICAL PRINCIPLES o Self-determination and the right and freedom to make one’s own decision without coercions o Respect for patient autonomy AUTONOMY o Health care team making choices on patient care, the team’s role is to inform patients about risks and benefits of treatm w m m m M m w m w D m w A m m B N C NC M w w m w m