NSB102 lecture module 2 (2).pdf

Nursing: An overview of your new profession with guiding principles, law & standards Associate Professor Jo Ramsbotham (School of Nursing, QUT)  1. What is nursing Globally & in Australia Overview – 2 parts 2. Info relevant to you as a ne...

Nursing: An overview of your new profession with guiding principles, law & standards Associate Professor Jo Ramsbotham (School of Nursing, QUT)  1. What is nursing Globally & in Australia Overview – 2 parts 2. Info relevant to you as a new member of the profession Ethics in practice Nursing Professional Code of Conduct  https://youtu.be/WzQ2HVrrGQk Nursing Global directions & priorities – WHO (2021-2025) Education: educating enough midwives and nurses with competencies to meet population health needs; Jobs: creating jobs, managing migration, and recruiting and retaining midwives and nurses where they are most needed; Leadership: strengthening nursing and midwifery leadership throughout health and academic systems; Service delivery: ensuring midwives and nurses are supported, respected, protected, motivated and equipped to safely and optimally contribute in their service delivery settings health labour market lens:  3 regulated levels of nurse in Australia with protected titles Enrolled Nurse Registered Nurse Nurse Practitioner What is a (Tafe or other (Bachelor or (Master level after education Master – university RN qualification & provider) level) yrs of experience) Nurse in Australia? Assistant in Nursing – a role described by an employer. Not a formal role in law for regulation. Nursing students often employed after 1st placement completed Regulation of Nursing Profession – national level Australian Health Practitioners Regulation Agency Nursing & Midwifery Board of Australia All other health disciplines Nursing practice standards, guidelines, Paramedics, Pharmacy, Medicine, policies Registered as a student in nursing. You at QUT Accredited course eligible to register as an RN at graduation Where do we practice as Registered Nurses? Primary care – (first contact) e.g. Community child health, GP practice, prison health clinic, outreach mental health service Secondary care- (referral)- e.g. radiology or rehabilitation service, Hospital OPD. Rural clinic /hospital Tertiary care - acute hospital, day surgery centre. Often services have a mix of primary, secondary or tertiary – all with nurses as part of the team. Nurses provide care for individuals or at a population / group level too. Goal of nursing care: helping people manage their health for their best outcome. E.g. curative treatment, chronic disease management, health promotion, short or long term focus.  The Registered nurse standards for Registered nurse (RN) practice is practice consist of the following seven person-centred and evidence- standards: based with preventative, What do RNs 1. Thinks critically and analyses nursing practice. curative, formative, supportive, restorative and palliative do? 2. Engages in therapeutic and elements. RNs work in professional relationships. therapeutic and professional relationships with individuals, as 3. Maintains the capability for well as with families, groups and This is what you practice. communities. These people may will be capable 4. Comprehensively conducts assessments. be healthy and with a range of abilities, or have health issues of at exit / 5. Develops a plan for nursing related to physical or mental illness and/or health challenges. practice. graduation 6. Provides safe, appropriate and These challenges may be posed responsive quality nursing by physical, psychiatric, practice. developmental and/or intellectual disabilities. (NMBA, 7. Evaluates outcomes to inform 2016) nursing practice NMBA, 2016  The decision making framework for nursing (NMBA, 2020) guides consideration of: What guides The health need of the person an individual The scope of practice of the RN (often in terms RN in of training) & if the practice fits within the RN knowing standards The context of practice, governance & what identification of risk practice is Is the appropriate competent person available to acceptable? perform the activity  Safety of the Public – a paramount concern Nursing / Nurses play a crucial role in Why is safety of the public important in ensuring the safety and well-being of Nursing? the public within the healthcare Vulnerable populations / individuals system. Position of significant trust and responsibility Nurses are often the ‘constant’, the person who is there most to see the whole picture. 70% of the health care workforce Role of Nurses in Patient Safety: Nurses are linchpins of patient safety. Their responsibilities include: Administering medications correctly. Monitoring vital signs for deterioration. Identifying and reporting errors and near misses & much more (National Safety and Quality Health Service (NSQHS) Standards)  Why do students (in approved programs e.g. Your student Bachelor of Nursing) need to be registered? registration The National Law states that students with AHPRA undertaking clinical training placements in a health profession must be registered in the interests of protecting the public’s safety in much the same way that health practitioners must be registered. This enables National Boards to act on student impairment matters or when there is a conviction of a serious nature that may impact on public safety. Delegation by Registered Nurses at practice All your student actions / practice is supervised and practice delegated by RNs. Formal delegation & supervision of students is part of RN More info in professional roles NSB132/131. You will work ‘with’ and will be supervised by RNs. They delegate Student skills to you as a student and they retain professional responsibility / /role defined in accountability in terms of patient safety. You are accountable for each unit your clinical performance in unit study assessment terms. ‘Skills at a glance’ Early in course experience you may be buddied with enrolled document nurses to learn foundational skills. This is not supervision / delegation.  For you to think about before accepting delegation from an RN What is my Scope of Practice: Scope of Am I ready to do this? Have I done relevant Practice preparation / training? What do I need to ask? Where is the RN and are they still here supervising me?  Each Board’s role is focused on registering students and dealing with notifications: whose health is impaired to such a degree that there may be a substantial risk of harm to the public; or Relevance to you? who have been found guilty of an offence punishable by 12 months imprisonment or more; or who have a conviction of, or are the subject of, a finding of guilt for an offence punishable by imprisonment; or who have contravened an existing condition or undertaking. What is an impairment? Examples: Illicit drug use Intoxication at clinical practice Major mental health illness that may impact professional judgment What is a conviction? Criminal charges bought by police What to do? Consult with Course Coordinator Video break We are back – part 2 Ethics and Code of Conduct  Autonomy: each person has the right to make decisions based on their beliefs and values. Nurses educate and allow people to accept or refuse. Respecting a person’s Ethical choice is a core professional value. E.g. Consent principles Beneficence: ‘to do good, actions resulting in good’. All nursing care / actions of a nurse should benefit the person / patient. Simple to complex. E.g. Empathy, privacy Justice: ‘just treatment’, equality for all. People are respected and are treated fairly with impartiality and no judgement. All receive care. E.g. access to health care is never withheld on the basis of age, gender, ethnicity etc. Non-maleficence: ‘do no harm, prevent harm’. Nurses advocate and protect people / patients. Ethical dilemmas – a principle is in conflict ICN code of Ethics International Council of Nurses (2021). Adopted globally & supported by WHO conduct is framed around seven principles, each with a supporting values statement and practical guidance demonstrating how they can be applied in practice − the principles are categorised into four domains − ‘person’ is used to refer to the those in a professional relationship with a nurse − ‘woman’ is used to refer to those in a professional relationship with a midwife they apply to all nurses and midwives across all areas of practice they are founded on evidence-based practice, and they are designed to be read in conjunction with NMBA standards, codes and guidelines 4 Domains Values ICN, 2021  Derived from concepts of ethics, law & professionalism Domain: Practise legally 1. Legal compliance Domain: Practise safely, effectively and collaboratively 2. Person centred practice Code of 3. Culturally safe practice and respectful relationships conduct – Domain: Act with professional integrity 4. Professional behaviour what is it? 5. Teaching, supervising, assessing 6. Research in health Domain: Promote health and wellbeing 7. Health & wellbeing (NMBA, 2022) QUT student CoC apply too but focus today is the nursing profession Raising your awareness - Code of Conduct breaches as a nursing student 1. CoC breach: student posting clinical practice information or pictures on social media Guidance: infringes person’s privacy, not adhering to professional behaviour, may erode dignity. Person’s consent is not protective. Ask – is this for the patient’s good? Beneficence / non-maleficence ICN, 2021 Raising your awareness - Code of Conduct breaches as a nursing student 2. CoC breach: nursing student knew their neighbour was having cancer treatment. Looked up the neighbour’s health record while at practice in QHealth to see how they were going, if they needed any help Guidance: trust & privacy expectations. Good intentions are not protective Ask: who’s needs were being met by this action? No needs met for neighbour. ICN, 2021 Raising your awareness - Code of Conduct 3. CoC breach: asking another student out on a date & repeatedly asking for phone number. Not taking no for an answer. Contacts the other student on several social media platforms with sexually explicit messages. Guidance: professional relationships are respectful & collaborative within the ‘work / practice’ space. 4 Domains ICN, 2021  Code of Conduct 4. CoC breach: During clinical placement student wasn’t sure what to document when assessing a patient so copied the patient data that had been written by the previous nurse one hour ago into the health assessment page of the person’s health record. Guidance: doesn’t meet professional behaviour expectations of competence & accountability (NMBA, 2016). Risk to patient safety. Beneficence / non-maleficence ICN, 2021  Code of Conduct – raising your awareness CoC breach: student was at mental health placement and through that met a patient & developed rapport. They got on well and the patient contacted the student via social media, and invited student to meet for a drink. Interaction develops into a sexual relationship. Guidance: Professional (the student) has a role in defining and adhering to professional boundaries of professional relationship. Concepts of power, professional judgement & patient’s vulnerability My Advice: You may see poor behaviour and you always have a choice to participate or not. An example FOR YOU TO THINK ABOUT Potential CoC breach: a person was admitted to an acute hospital with a clinical background of acute exacerbation of mental health illness. Patient was refused pain relief by staff for an injury as he was abusive of staff on the previous shift. Patient located in a side room far away from staff as person was homeless and refused to shower. Smelled strongly of urine & faeces. If you were a student providing care in this ward and in this situation what do you think the key issues are here? Summary Code of Ethics Practice Standards of guidelines Practice (e.g. social media) Student & RN professional practice with people Code of Supervision / conduct & delegation of professional ENs / students boundaries Decision making framework References & links Resource Title Link Australian Health Practitioner Regulation Agency www.ahpra.gov.au Nursing and Midwifery Board of Australia www.nursingmidwiferyboard.gov.au Code of Conduct resources page https://www.nursingmidwiferyboard.gov.au/Codes- Guidelines-Statements/Professional-standards.aspx International Council of Nurses https://www.icn.ch/system/files/2021-10/ICN_Code- Code of Ethics – link to PDF version of-Ethics_EN_Web_0.pdf Fact Sheet for students – Student registration with https://www.nursingmidwiferyboard.gov.au/Registrati AHPRA on-and-Endorsement/Student-Registration/Fact- sheet-FAQ-student-registration.aspx Decision making framework https://www.nursingmidwiferyboard.gov.au/Codes- Guidelines-Statements/Frameworks.aspx