Professional Issues and Code of Ethics MARCH 21, 2013 Ch 8

Profession Is Nursing a profession, what are the criteria to define a profession and who decides? Profession is defined by Gruending (1985) as a complex organized occupation preceded by long training program.

Professional Status Profession exist for the purpose of meeting the needs of society. Professionals contract with society by promising to meet a set of identified needs better than any other group of people. Society grants the profession a monopoly (exists when a specific person is the only supplier of a particular commodity )over these particular service.

Professional Status of Nursing -Nurses and others have Debate the Professional status of nursing. -Flexner (1915) evaluated nursing according to the following criteria: Involving intellectual operations Based on science and learning Self-organization Altruistic (practice of concern for the welfare of others) in motivation -He concluded that nursing was not a profession Optimistically he proposed that occupation could alter status by developing these traits

Is Nursing a Profession? Seven main characteristics: 1)A body of specialized knowledge 2)Use of the scientific method to enlarge the body of knowledge 3)Education within institute of higher education

Cont 4)A profession applies its body of knowledge in practical services. 5)Control profession policy, professional activity and autonomy (practical service) 6)Nursing attracts individual of personal quality who recognize nursing as a lifetime commitment 7) Provide freedom of action, opportunity for continuous professional growth and economic security.

Professional Status for Nursing Expertise Autonomy Accountability Authority Unity Ethical codes Competence testing licensure, credential Description of the scope of Nursing Establishment of standards

Expertise -Relate to the characteristics of having a high level of specialized skills and knowledge (gained through long years of study in academic setting) -Is the primary distinguishing difference between professionals and non-professionals

We gain expertise through 1)Extensive educational requirements 2)Intense guided practice 3)Examination of licensure Certification 4)Mandatory continuing education

Is Expertise enough? -We have knowledge base that is continually expanded through research -Purely claim expertise is not enough -We need mechanism of accountability (must prove to society that we are faithful to the promise the profession makes)

Profession grants us authority to practice with a certain measure of autonomy

Autonomy Self governing Two levels 1)Autonomy of the profession self-regulation 2)Autonomy of the individual practitioner, self- determination, responsibility, accountability, independence and willingness to take risks.

Autonomy of the Profession -Having the power and authority to control various aspects of their work, goals, and choices. -Explicitly and implicitly stated and reflected in different codes of ethics for nurses -No other group has the ability to do the work of nurses---legal restriction

Are you autonomous, even though you are required to follow physicians orders You can’t get to know the patients (too much work)

Lyon defines autonomous nursing practice as diagnoses, and treatment of phenomena that nurse have self directed authority to treat

Two Different Scopes of Practice 1.medical scope requires physician authority to initiate treatment 2.autonomus nursing scope require no authority (feverish pt)

Nurses might refuse to carry out physician’s order (incorrect) Protect patient from physician’s negligence and prevent court action against nurse, physician, or institution

Accountability -Refers to being answerable to someone for something one has done -Grounded in various moral principles, fidelity, respect for dignity, worth, and self determination of client

-Nurse Accountability ; safe and autonomous practice -Related to responsibility and answerability -Trust from society gained through expertise -(Autonomy) right given the profession to regulate practice -Nurse is responsible for all individual actions done/ judgment made and omission

Mechanisms of Accountability -Code of nursing ethics -Standards of nursing practice -Nurse practice act -Nursing theory and practice derived from nursing research -Education requirements for practice -Advance certification -Mechanisms for evaluation the effectiveness of performance for nurses

Codes of Nursing Ethics Is an explicit declaration of the primary goals and values of the profession that indicate the profession’s acceptance of the responsibility and trust with which it has been invested by society (ANA 1985)

Nurses make an implicit moral commitment to uphold the values and moral obligations expressed in their code Nurse should base their judgment upon consideration of consequences and universal moral principles of respect for person

Examples of professional code of ethics ANA code of ethics ICN international council of nurse code Canadian nurses association code of ethics Jordanian Nurses Code of Ethics

What does a code of ethics do? Gives guidance for decision making about ethical matters by providing a set of values that are basic to nursing practice

What does code of ethics not do Provide rules of ethical or moral behaviors for every circumstances Offer guidance about which values should take priority or how they can be balanced in practice

Standards of Nursing Practice Are written documents outlining minimum expectation for safe nursing care Should reflect reasonable expectation for safe nursing care rather than optimal or ideal care

-Standards may describe in detail specific acts performed by nurses or may outline the expected process of nursing care -We use standards to guide and evaluate nursing care -Courts look to standards of nursing practice for guidance when malpractice cases are deliberated

Basic types of standards of nursing practice Internal standards of nursing practice External standards of nursing practice

Internal standards of nursing practice -Are those developed within the profession of nursing for the purpose of establishing the minimum level of nursing care -can be used as yardstick to measure the practice of individual nurse -determine whether the actions of nurse accused of malpractice are consistent with reasonable minimum expectations

-Nursing process is an example on internal standards of nursing practice -They make nurses accountable for ensuring that each step of the process is followed in the delivery of nursing process -ANA publishes standards of care for nurses in advanced or specialty roles such as nurse practitioners, maternal child nurse

External standards of nursing practice -Consist of guides for nursing care that are developed by non-nurses, the government, or institution -These standards describe the specific expectation of agencies or groups that utilize the services of nurses -They serve the same function as internal guidance and evaluation e.g., nurse practice act E.g., formal policies and procedures for individual agencies

Nurse Practice Acts Protect the public Define nursing practice Describes the boundaries of practice Establish boundaries for nurses Protect the domain of nursing

-Nurse practice acts are considered a form of nursing standards -Utilized by courts in determining the appropriateness of nursing action -Violation can result in either civil or criminal action

Nursing theory and practice derived from research -Using the scientific method -Past debate: is nursing body of knowledge or borrowed from other science -nursing research increase the uniqueness by respond to the needs of society more knowledgeably and skillfully -Validating nursing as a true profession

Authority Relates to the state of having legitimate power (legal) The authority to practice nursing is granted by government It acknowledges the professional's rights and responsibilities E.g., nurse practice act, specified entry to requirements into practice, scope and standards granted through : examination and licensure

Unity Sense of unity among members Ability of the nurse to organize for the purpose of fulfilling the profession’s promises and the relationships that nurses have with one another

Through unity, nurses can standardized the professional characteristics of competence, autonomy, authority, and accountability Professional associations

Main four elements of the ICN in nursing The international council of nurse code declared 4 important elements in nursing 1-nurses and people 2-nurses and practice 3-nurses and co-workers 4-nurses and profession

Nurses and People -Primary responsibility is to people requiring nursing care -In providing care , nurse promote an environment in which human rights, values, customs and spiritual beliefs of family, individual and community are respected Sufficient information\ -sharing responsibility

Nurse and Practice -Nurse carries personal responsibility and accountability for nursing practice -Maintain competence by continual learning -Maintain the standards of personal health -Ensure the using of technology and scientific advance

Nurse and Co-workers -Sustain cooperative relationships with co-workers in nursing and others -Take appropriate action to maintain individual when care is endangered by co-workers

Nurse and the Profession -Nurse play major role in determining and implementing desirable standards of nursing practice management and education -Developing core of research based professional knowledge -Participate in creating and maintain equitable social and economic working condition in nursing

THE END