Studied by 18 people
Values
A standard that has significant meaning or importance to an individual, a group or a society.
Values evaluate worth of a given idea.
Morals
Morals guide right from wrong
Common Nursing Values
Strong commitment to service
Belief in the dignity and worth of every person
Commitment to education
Autonomy
Ethics
Systematic exploration of what is morally right or morally wrong A reflection of what matters most to people or professions Nurses in Canada are guided by the Canadian Nurses Association’s Code of Ethics
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Morals vs Ethics
Morals: Principles and rules of right conduct Private, personal Commitments to principles and values is usually defended in daily life
Ethics: The formal responding process is used to determine the right conduct Professionally and publicly stated Inquiry or study of principles and values Process of questioning and perhaps changing, one’s morals
Code of Ethics
A formal statement of the profession’s ideals and values
Are usually higher standards than legal standards but never less
Helps professional groups settle questions about practice or behaviour
Includes responsibility, accountability, and advocacy
The International Council of Nurses- Code of Ethics (Four Principles)
Nurses and people Nurses’ primary professional responsibility is to the people needing their care
Nurses and practice Emphasises the responsibility and accountability of nurses
Nurses and the profession Highlights nurses role in ensuring acceptable evidence-based standards of practice, management, research.
Nurses and co-workers Nurses sustain collaborative and respectful relationships with colleagues in nursing and other fields.
CNA Code of Ethics
Providing safe, compassionate, competent, and ethical care
Promoting health and well-being
Promoting and respecting informed decision making
Preserving dignity
Maintaining privacy and confidentiality
Promoting justice
Being accountable
Utilarnisim
greatest good for greatest number, end justifies the means
Deontology
considers morality in terms of rules that have intrinsic moral value, irrespective of outcomes –right vs. wrong - duty Ex. As the public heath nurse, I profess that it always wrong to cut programs that are needed without having alternative programs in place
Feminist
traditional theories, based on the male perspective, are problematic for women. Social and political oppression of women is a major concern. Social and political oppression of women is a major concern.
Ethics of Care
Evolved from feminine ethics. Values “feelings, emotions, empathy and care”. Starting point is the person’s circumstance or personal story Aims to understand the context and complexity of relationships. Recognizes the unique needs of each person.
Social Justice
The focus is on equity, opportunity and privilege within society. Grounds advocacy that influences the well-being of persons within society
Ethical Principales
Autonomy: respect for an individuals right to make their own decisions
Benefice: the quality of doing good
Fidelity: loyalty and promise to an individual
Justice: fair and equal treatment for all
Non-maleficence: never doing any harm to any individual
Veracity: Honesty when dealing with an individual
Autonomy
respect for an individuals right to make their own decisions
Benefice
the quality of doing good
Fidelity
loyalty and promise to an individual
Justice
fair and equal treatment for all
Non-maleficence
never doing any harm to any individual
Veracity
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Honesty when dealing with an individual
Ethical Descion-Making Process
Describe the issue
Determine who is involved
Assess the situation
Clarify values
Explore the story and note reactions
Identify ethical principles
Clarify legal rules
Explore options and alternatives
Decide the course of action
Develop an action plan
Evaluate the plan
International Council of Nursing ICN
To represent nursing worldwide, advancing the profession and influencing health policy.
Ensure quality of nursing care for all
For nurses by nurses.
Canadian Nurses Association (CNA)
A national professional voice of Registered Nurses
Wrote the code of conduct
Registered Nurses of Ontario (RNAO)
Represent nursing profession in ON
Speaking out for health and speaking out for nurses
College of Nurses of Ontario (CNO)
Protect public
Ontario Nurses Association (ONA)
Largest union of nurses ON
Represents upwards of 51000
CNO Professionial Standards
Accountability
Continuing Competence
Ethics
Knowledge
Knowledge Application
Leadership
Relationships
Professionalism
Providing top quality care to pts well-upholding values
Components of professionalism
Commitment to professional competence
Commitment to strong ethical values
Commitment to improving quality of care
Commitment to the delivery of compassionate care
How to demonstrate professionalism
PT 1st
Communicate
Collaborate
Respect
Standards of practice CNO
The RN demonstrates professional presence and models professional behaviour
Entry Level Competencies
Demonstrate professional presence, confidence, honesty, integrity and respect in all interactions
Code of Ethics
RNs and NPs are honest and practice integrity in all of their professional interactions
Accountability
identifying her/himself and explaining her/his role to clients;
maintaining competence and refraining from performing activities that she/he is not competent in
providing, facilitating, advocating and promoting the best possible care for clients.
Continuing Competence
investing time, effort and other resources to improve knowledge, skills and judgment;
assuming responsibility for her/his own professional development and for sharing knowledge with others;
participating in the College’s QA Program.
Ethics
identifying ethical issues and communicating them to the health care team;
identifying options to resolve ethical issues;
identifying personal values and ensuring they do not conflict with professional practice.
Knowledge
providing a theoretical and/or evidence-based rationale for all decisions;
understanding the knowledge required to meet the needs of complex clients;
understanding the legislation and standards relevant to nursing and the practice area
Knowledge Application
assessing/describing the client situation using a theory, framework or evidence-based tool;
identifying/recognizing abnormal or unexpected client responses and taking action appropriately;
recognizing limits of practice and consulting appropriately.
Leadership
role-modelling professional values, beliefs and attributes;
collaborating with clients and the health care team to provide professional practice that respects the rights of clients;
advocating for clients, the workplace and the profession.
Relationships
demonstrating respect and empathy for, and interest in clients;
using a wide range of communication and interpersonal skills to effectively establish and maintain collegial relationships.
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CNO Competencies for Entry to Practice
Protection of the Public
Practice reference
Approval of Nursing education programs
Registration and membership requirements
Legal reference
Public information
Continuing Competence
Why study the legal system?
Understand and comply with the governing rules and regulations
Nurses must understand their rights
The laws influence on nursing
Regulates the education and licensing of nurses.
Clarifies the nurses’ duty toward patients.
Provides a forum for resolving disputes and conflicts.
Establishes legislation.
Outlines the civil and criminal consequences
Primary sources of common law
Statute law and Case law
Statute law
passed by parliament and legislative assembly
Case law
precedents from centuries of judicial decisions
Secondary sources of common law
Doctrine
journal articles etc
Tertiary Custom
principles/rules of trade
Canadian Charter of Rights and Freedoms
Fundamental Rights
Democratic Rights
Mobility Rights
Legal Rights
Equality Rights
Language Rights
Civil Law
between indivuals or organizations, compensation involved, private party files
Criminal Law
crime and legal punishment of crime, goverment files
Examples of Professional misconduct
Failure to maintain the standards of practice
Working while impaired
Abusive conduct
Theft
Failure to obtain consent and breach of confidentiality
Inadequate documentation and record keeping
Misrepresentation
Failure to meet legal/professional obligations
Conflict of interest
Inappropriate business practices
Disgraceful, dishonourable and unprofessional conduct
Other: guilty of an offence, finding of professional misconduct in another jurisdiction, sexual abuse
Malpractice
The failure to observe and adhere to the appropriate standards of care for a given act or procedure – professional wrongdoing.
Incapacitated
Means that one is suffering from a physical or mental condition or disorder that makes it desirable and in the best interests of the public that the member no longer be permitted to practice or that the member’s practice be restricted.
Incompetence
it must relate to the nurse’s professional care of a client
the nurse must display a lack of knowledge, skill or judgment
any deficiencies must demonstrate that the nurse is unfit to continue to practise, or that her or his practice should be restricted.
Negligence
Negligence occurs when the nurse fails to follow established policies, procedures
Battery
intentional bringing about of a harmful or offensive and non-consensual contact upon another. Can be direct example slapping or indirect pulling a chair to cause a fall.
Assault:
intentional creation of the apprehension of imminent harmful or offensive contact. A threat where a reasonable conclusion is that the defendant could carry it out.
Importance of consent
Key element of intential torts no consent treatment can be considered assault or battery
Nursing act 1991
mandate of the College of Nurses of Ontario and defines a scope of practice
Regulated Health Professions Act, 1991 (RHPA)
contains a procedural code
Standard of Practice
is an authoritative statement that sets out the legal and professional basis of nursing practice
Professional Standards
provide an overall framework for the practice of nursing and link with other standards, guidelines and competencies developed by the CNO.
Confidentiality-Duty to report
Harm to self
Harm to others
Children and vulnerable
Good Documentation is…
contemporaneous
in chronological order
clear and concise
accurate
Legible
Nursing Regulation
Nurse is a legally defined term
Self-regulared profession government gives permission to profession to regulate itself (CNO)
RN vs RPN
RN: uni, acute, more specialization
RPN: college, stable, less specialization
Registration
Need to register to use title CNO
Nurse is a protected title
Can’t practice if suspended (professional misconduct)
Complaints with CNO
A breach of, or failure to meet, the practice standards expected by the College, the nursing profession and the public.
Not criminal
Examples: Failure to provide adequate care, Unsafe medication administration, Handling a client in a rough manner
Delegation “D”
Process by which a regulated health professional who has legal authority to perform a controlled act transfers that authority to an unauthorized person.
The nurse transfers responsibility and authority for the completion of delegated tasks but retains accountability for the delegation process.
For example a respiratory therapist may delegate administration of oxygen to a physiotherapist permitting the physiotherapist to administer oxygen on condition of an order from a physician).
Delegation “d”
“the process for a nurse to direct another person to perform nursing tasks and activities”
The nurse transfers responsibility and authority for the completion of delegated tasks but retains accountability for the delegation process.
process by which a regulated health professional who has legal authority and competence to perform a procedure under one of the controlled acts delegates the performance of that procedure to another individual (delegatee).
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Nursing Act-Controlled Acts
Performing a prescribed procedure below the dermis or a mucous membrane.
Administering a substance by injection or inhalation.
Putting an instrument, hand or finger i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, iii. beyond the larynx, iv. beyond the opening of the urethra, v. beyond the labia majora, vi. beyond the anal verge, or vii. into an artificial opening in the body.
Dispensing a drug.
Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.
Five rights of delegation
The "right" person
The "right" task
The "right" circumstances
The "right" directions and communication
The "right" supervision and evaluation
Priortization
Deciding which needs or problems require immediate action and which ones could tolerate a delay in action until a later time because they are not urgent
ABCsVL (airway–breathing–circulation)
Maslow’s Hierarchy of Needs theory
Steps of the nursing process (assessment is first)
Maslow’s Hierarchy
Basic Physiological Needs
Safety and Security Injury Prevention
Love and Belonging
Self-esteem
Self actualization needs
Documentation
Monitors on a continuing basis the course of treatment and the effect of interventions.
Defined as “both the act of creating records of care and the actual records themselves”.
If its not documented its not done
Purpose:
Communication
Accountability
Legislative Requirements
Quality Improvement
Research
Funding and Resource Management
Caregiver Rights
Under the Charter of Rights and Freedoms nurses, as with all citizens, have rights HOWEVER professional rules and regulations may limit their individual freedom.
Conscientious Objection
When possible, employers are obliged to respect the conscientious objections of employees who decline to participate in certain actions on moral or religious grounds (does not apply in emergencies)
Right to a healthy work enviroment
the high degree of staff satisfaction
low rates of absenteeism
strong commitment to the organization
high staff morale
able to attract and retain employees
RNAO guidelines…
Developing and Sustaining Nursing Leadership
Collaborative Practice in Nursing Teams
Embracing Cultural Diversity in Health Care
Professionalism in Nursing
Workload and Staffing
Workplace Health and Safety of the Nurse
Prevention of Violence in Nursing Practice
Workplace violence
Workplace violence
bullying
harassment
disrespectful behaviour
physical/sexual/verbal abuse
Violence from clients and families, physicians, each other, leaders, and/or other members of the team
Nurses are 3X more likely to experience violence than any other professional group
Unions
provincially certified group of employees, in most cases have a common employer
Protecting worker interests
Bargaining influence
Power
Leverage
Union then becomes the exclusive bargaining employee agent
Closed Shop
all employees must join a union if employed – no choice
Open Shop
union membership is not mandatory but preference in hiring will be given to union members
Informed Consent
A pts choice to have treatment or a procedure. This is based on a full understanding of Benefits,
, Risks & Alternatives to Treatment
Refusing consent
Pt has the right to refuse consent to treatment regardless of whether it is in there best interest
Implicit Consent
Indirect Ex. the doctor says I’m going to draw your blood and then you give them your arm
Explicit Consent
Direct and formal, Verbal or in writing Ex. blood transfusion form
Opt-out consent
Passive and indirect Lack of objection consent Ex. countries where organ donation is automatic unless you opt out
Meaningful Autonomy
Being mentally competent to make own decisions Based on full info on: Risks, Material facts, Alternatives, Consequences of non-treatment
Components of informed consent
Proposed treatment or procedure
Who will perform treatment or procedure
Purpose of treatment or procedure
Expected outcome
Benefits
Possible risks
Alternatives
Benefits and risks associated with alternatives
Clients' right to refuse
Nurses role in consent
Verification and witnessing
Assuring competence of pt or POA
Confirmation that pt or POA has enough knowledge
Obataining Informed Consent MD/NP/PA
Provide info regarding:
Potential risks
Benefits
Who will perform the procedure
Alternatives to treatment
Benefits and risks to alternatives
Role of patient or POA
Provide HCP with complete info
Report any safety issues and concerns
Report lack of understanding relating to care
Actively participate in all their care
Follow organizational policies and procedures
Verification of consent
Written
Required processes
Clients understanding
Confirmation *needs to be charted that informed consent is given
Withdrawl of consent
A pt has the right at any time to withdraw consent
The Healthcare consent act
All persons, including minors are presumed to be capable of making treatment decisions
Requires for informed consent
HCP entitled to presume consent to treatement
Preserves the right and duty of healthcare providers to restrain or confine persons who harm themselves or others
Substitute Decisions Act
Persons 16 years of age are capable of giving or refuse consent for their own care
Sexual activity
The age of consent to sexual activity is 16
14 to 15 less than five years older
12 to 13 less than two years older
Defining Capable
Capable: pt understands the info given
A person is always presumed to be capable unless HCP has reasonable grounds to believe pt is not
Note 
Flashcard (22)