PPN101 week 12 2025 Professionalism part 2 FINAL

Objectives of the Course: Professionalism in Nursing

  • Regulated Health Professions Act (RHPA) and Nursing Act, 1991:

    • Key Issues:

    • Scope of Practice

    • Controlled Act

    • Health Regulatory Colleges

  • Roles of Nursing Profession: Within the context of the RHPA

  • Patient Safety, Accountability, and Advocacy:

    • Relation to being a regulated health professional

  • Ethical Principles:

    • Autonomy

    • Beneficence

    • Nonmaleficence

    • Justice

  • Relationship between Ethics and Professional Practice:

    • Focus on responsibility, accountability, advocacy, and moral agency

  • Informed Consent:

    • Importance in patient care and the nurse's role

  • Ethical Decision Making:

    • Concepts of “moral distress” and “moral resilience” in nursing

  • Identifying Ethical Dilemmas:

    • Possible strategies for resolution

Regulated Health Professions Act (RHPA)

  • Definition: A regulation/legislation aimed at governing 27 health professional groups including nursing.

  • AIM: To regulate professional procedures, clearly delineating the scope of practice and controlled acts.

  • FOCUS/GOAL: Ensuring consumer choice, quality care, and transparency.

  • Mechanisms of the RHPA:

    • Provides consumers with choices of safe, licensed, and competent professionals.

    • Recent impacts on Nurse Practitioners and midwives.

Regulatory Framework for Health Professions in Ontario

  • Governing Legislation: The RHPA and specific acts like the Medicine Act, 1991.

  • Health Regulatory Colleges:

    • Responsibilities include:

    • Ensuring safe, ethical practice of health professionals.

    • Setting practice standards.

    • Investigating complaints and disciplining professionals when necessary.

    • Example: College of Nurses of Ontario (CNO).

The Nursing Act, 1991

  • Overview: This act and RHPA jointly dictate nursing regulation in Ontario.

  • Key Components:

    • Classes of Registration

    • Entry-to-Practice Requirements (Title Protection)

    • Controlled Acts (Procedures requiring authorization)

    • Quality Assurance and Professional Misconduct

RHPA Goals

  • Objective of the RHPA:

    • To regulate health professions in the public interest.

    • To establish appropriate standards of practice.

    • To ensure access to chosen health services for consumers.

    • To treat individuals with respect and sensitivity.

  • Public Interest Focus:

    • Protecting and serving the public.

    • Open and accountable self-governance for health professionals.

Important Terms in Nursing Practice

  • Controlled Act:

    • Defined as acts that only qualified professionals may perform due to potentially harmful consequences if done by others.

    • Examples include:

    • Communicating diagnoses

    • Setting or casting fractures

    • Administering injections

    • Applying prescribed treatments and interventions.

  • Scope of Practice:

    • Defined by the Nursing Act, 1991.

    • Nursing Scope of Practice Statement:

    • “The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventative, therapeutic, palliative, and rehabilitative means in order to attain or maintain optimal function.”

Authorizing Mechanisms for Controlled Acts

  • Under the Nursing Act, 1991:

    • Nurses may initiate certain controlled acts if they meet defined competencies.

    • Examples of procedures include:

    • Care of wounds below the dermis.

    • Venipuncture for IV access.

    • Assisting clients in specific health management activities.

Delegation of Controlled Acts

  • Definition of Delegation: A formal process where a qualified regulated health professional assigns a controlled act to an individual not authorized to perform it.

  • Nurse's Responsibility: The nurse who delegates is responsible for ensuring that the act is appropriate for delegation.

Development of a Code of Ethics

  • Historical Codes:

    • 1950: ANA established the first North American Code of Ethics.

    • 1953: ICN approved a code used in Canada until 1980.

    • 1980: CNA initiated its own Code of Ethics, revising it approximately every five years.

Importance of Ethics in Nursing

  • Relationship with Therapeutic Nurse-Client:

    • Ethical considerations are central and help navigate conflicts and distress inherent in nursing practice.

    • Modern challenges, such as technological advancements, can contribute to ethical dilemmas.

Definition of Ethics

  • Ethics: The study of philosophical ideals concerning right and wrong behavior, intertwined with personal convictions regarding what one ought to do.

  • Characteristics of Ethics:

    • Govern behavior or conduct of activities, involve decision-making, evaluations, and reasoning.

CNA Code of Ethics

  • Definition: The Code represents the ethical values and commitments of nurses towards persons with healthcare needs.

  • Components:

    • Part I: Nursing Values and Ethical Responsibilities

    • Part II: Ethical Endeavours Related to Broad Societal Issues.

Ethical Responsibilities to Nursing Values

  • Seven Primary Values:

    • Providing safe and ethical care

    • Promoting health and well-being

    • Honouring dignity and maintaining privacy

    • Promoting justice and being accountable

Broad Societal Issues in Nursing Ethics

  • Addressing Social Inequities: Ethical nursing practice involves addressing issues of social justice affecting health and well-being.

Ethics and Professional Practice

  • Core Dimensions:

    • Responsibility: Reliability and dependability in care.

    • Accountability: Rooted in respect and moral principles.

    • Advocacy: Actions taken on behalf of patients and their rights.

    • Moral Agency: Important for effective advocacy.

CNO Ethical Values in Nursing Care

  • Priority Values Include:

    • Client well-being

    • Respect for choice and privacy

    • Commitment to truthfulness and fairness in dealings.

Complexity of Ethical and Legal Issues

  • Contributing Factors:

    • Equity in patient advocacy movements

    • Expanding nursing scope and responsibility

    • Public interests and professional obligations

Ethical Dilemma Definition

  • Definition: A conflict between two value systems, both of which possess intrinsic value, where neither can be fully satisfied.

  • Effects: Results in stress and confusion for nurses and patients, necessitating systematic and critical resolution approaches.

Example of an Ethical Dilemma

  • Scenario:

    • A patient desires to die at home, creating family stress, while healthcare staff push for the patient’s home return. The nurse must decide how to balance these competing interests.

Moral Distress in Nursing

  • Definition: Occurs when nurses act contrary to their moral judgments due to organizational pressures.

  • Consequences: Effects include burnout, turnover, and decreased quality of care.

Strategies to Reduce Moral Distress

  • Suggestions:

    • Advocacy and accountability.

    • Building support networks in practice settings.

    • Engaging in interdisciplinary education on moral distress.

Ethical Reasoning in Nursing

  • Definition: Using principled reasoning in healthcare decisions.

  • Core Principles: Include autonomy, beneficence, nonmaleficence, and justice.

Ethical Principles in Nursing Practice

  • Autonomy: The right of individuals to make their own choices regarding healthcare.

  • Beneficence: The duty to act in ways that benefit others, prioritizing patient interests.

  • Justice: Fair and equitable distribution of healthcare resources.

  • Nonmaleficence: Obligation to avoid harm to patients.

Ethical Decision-Making Process

  • Elements Involved:

    • Ethical reasoning and considerations of autonomy, justice, beneficence must guide decisions.

Informed Consent in Nursing

  • Accountability: Nurses are responsible for obtaining informed consent for treatments and services provided.

  • Legislation Governing Consent: Health Care Consent Act (HCCA) and Substitute Decisions Act (SDA).

Components of Informed Consent

  • Definition of Informed Consent: Consent must be informed, meaning the patient has adequate information to make decisions, including:

    • Nature and purpose of treatment

    • Risks and benefits

    • Alternatives to treatment

    • Consequences of refusal.

Capacity and Consent

  • Medical Decision-Making Capacity: The ability of a patient to comprehend the implications of decisions for treatment.

  • Assessment: This can often be observed intuitively but may require formal evaluation under certain circumstances.

Substitute Decision-Makers (SDM)

  • Definition: Individuals authorized to make healthcare decisions for others who cannot make their own decisions.

  • Hierarchy: Typically includes spouses, partners, or relatives as designated in the HCCA.

Nursing Responsibilities Regarding Consent

  • Responsibilities Include:

    • Clear communication of treatment procedures.

    • Advocacy for patient understanding and consent.

    • Recognition that informed consent can be verbal or implied in specific situations.