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SEMINARS ON ADVANCED NURSING PRACTICE

self determination and self regulation. A profession is only as good as its individual members. . As professionals. Every member of the profession must practice as a professional and contribute to nursing as a profession.  It increases innovations in nursing. accountability and legal liabilities. The autonomous practioner is also obligated to collaborate with others for benefit of the patient.  The nurse respects the client and the choices that the client may take. Autonomy involves independence. a willing ness to take risks.AUTONOMY. It is a freedom to decide and act (Hicks. Example A nurse has the autonomy to develop and implement a discharge teaching plan based on specific client needs who has been hospitalized. Example An autonomous nurse might make adjustment about a client’s possible health problems but would work with the client to identify the client’s perceptions and priorities. ACCOUNTABILITY. Beginning nursing students should understand the significance of ascribing to professional attitudes and values and how their behavior can influence the public’s view of the nursing profession. Autonomy means the freedom and authority to act independently and control one’s own life and the lives of others. 2003) Autonomy means the practioners have control over their own functions in the work setting. ADVANTAGES OF AUTONOMOUS NURSING PRACTICE  Autonomy consistent with the scope of nursing practice will maximize the effectiveness of nurse. but occurs in degrees. higher nurse retention and greater client satisfaction. nurses are accountable for providing quality care AUTONOMY It is an ethical principle upholding the exercise of personal choice.  Autonomy is not an absolute. As nursing continues to evolve many questions are also arising regarding its autonomy.  With autonomy a professional nurse can make an independent decision about client care. ASSERTIVENESS AND LEGAL CONSIDERATIONS IN NURSING INTRODUCTION A profession is a group that requires specialized education and intellectual knowledge. increased productivity. The principle of autonomy stems from the action of respect for persons.

It refers to being answerable to someone for something one has done. . to the client. Legislative accountability Legislation defines the legal rights granted to the profession by the public. 1995) Professional regulation is the responsibility of professional organizations.ACCOUNTABILITY Nurses were legally liable for their actions or the omissions of necessary actions but often are unaware of it. Professional regulation is the process by which nursing ensures that its members act in the public interest by providing a unique service that the society has entrusted to them. to the employing agency and to the nursing profession. It means providing an explanation to self. (A N A. The public trusts that a registered nurse will have appropriate knowledge and skills to render the services offered. ( A N A. 1985) It is the state of being responsible and answerable for those behaviours and their outcomes that are included in one’s professional role. accountability has assumed importance and visibility it never before possessed. Organizational accountability Organization is the means by which members of a profession join together to promote and protect the profession. That include. A registered nurse is accountable for acquiring the knowledge and skill to render the nursing care.1991) So each nurse is accountable for their professional activities to the respective organizations.  Professional accountability  Legal accountability  Ethical accountability  Individual accountability  Organizational accountability Professional accountability The nurse has the responsibility to the client to be competent. Professional standards are authoritative statements developed by the profession by which the quality of practice service and education can be judged. to render nursing services in accordance with standards of nursing practice and to adhere to profession’s ethical code. (A N A. DOMAINS OF ACCOUNTABILITY A professional nurse is accountable in several domains. At the turn of 21 st centuary.

An assertive person effectively influences. (A N A.  Deal betterly with criticism and manipulation by others.  Able to deal change. authorize state boards of nursing to interpret the legal boundaries of safe nursing practice.  Don’t be self-deprecating. • Continued competency • Professional development ASSERTIVENESS Assertiveness is the ability to express yourself and your rights without violating the rights of others.  It produces feelings of security. skills and needs. . Assertiveness comprises respect for others. optimism and professionalism. Advantages of assertiveness  Express feelings and motions confidently.  Make decisions and control the life more effectively than others.  Own your message You can acknowledge ownership with personalized statements. Self –deprecating is belittling or undervaluing oneself excessively modest. clear and consistent communication.The Nurse Practice Act defines the legal scope of practice within a state or territory.  Ask for feedback Asking for feedback can encourage others to correct any misinterpretations you may have as well as others realize that you are pressing an opinion. (Darley. negative conditions in both personal and professional life.  Stand up for your own rights and experience self respect. competency. self awareness and effective. Deliver your message directly to the person for whom it is intended. This can be by.  More independence.  Get treated as an individual with special values.1995) Individual accountability Professional nurse must understand the rules and regulations and standards of practice adopted and should be active participant. spontaneously and honestly. power. respect for yourself.  Act confident.  It encourages a sense of self assurance. conflict and stress.2002) It means that we have respect both ourselves and for others. Techniques of Assertiveness  Be direct. even if you are not confident.  Stop apologizing all the time. listens and negotiates so that others choose to cooperate willingly.

 Tort law – is the enforcement of duties and rights among individuals independent of contractual agreements. Tort is a civil wrong committed on a person or property stemming from either a direct invasion of some legal right of the person. Felony Crime of a series nature punishable by imprisonment in a state penitentiary at hard labour or by death. 2) Civil law –which deals with the relationship between individuals. Civil law It can be. punishment more than one year. There are two types of law 1) Public law – which deals with an individual’s relationship to the state.  Criminal law – refers to acts or offenses against the welfare or safety of the public. punished by fine or sentence to a local prison for less than one year.Saxon term meaning ‘That which is laid down or fixed’. Misdemeanor Offense that is less serious. Consider yourself strong and face responsibilities. Unintentional tort a) Negligence b) Malpractice Intentional tort a) Assault b) Battery c) False imprisonment d) Invasion of privacy.  Administrative law – developed by groups who are appointed to administrative agencies. Public law It can be.  Contract law – is the enforcement of agreements among private individuals. e) Defamation . LEGAL CONSIDERATIONS IN NURSING The word law is derived from an Anglo.  Judicial law – all of state’s lower units must adhere to the interpretations and procedures specified by the state’s supreme or highest court. Two types of crimes.  Constitutional law – developed by legislative bodies.

not merely signing of a form. Obtaining the informed consent requires client teaching by the health care provider. A nurse may witness a client’s signing of a consent form or may be responsible for making sure the signed form is in the chart. which result in harm to another person.f) Fraud. LEGAL LIABILITY IN NURSING When the nurse fails to meet the legal expectations of care. the client can initiate action if harm is incurred by the client. . Negligence It is the failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance. before paying bill and using physical restraints. insulting or physically intimidating manner. Restraints are legal only if they are necessary to protect the client or other from harm and it should have the physician’s order. Example Telling a client not to leave from hospital. that the client understands the reason for the proposed interventions and its benefits and risks and agrees to the treatment by signing a consent form. Informed consent It is a legal written document obtained. Informed consent is a process consisting of information and consent. Restraints or seclusion It shows the rights of the client and responsibilities of a health care provider regarding the use of both physical and chemical restraints. improper discharge of professional duties or failure to meet the standards of acceptable care. Malpractice Refers to the behaviors of a person’s wrongful conduct. Battery It is the touching of another person without the person’s consent. Assault It is a stated intent to touch a person in an offensive. False imprisonment It occurs when clients are made to wrongfully believe that they can’t leave from a place.

the procedure and any resulting complications. performing procedures and photographing the client.Privacy and confidentiality Nurses are accountable for respecting the client’s right to privacy. ADVANCE DIRECTIVES Patient Self Determination Act (PSDA. withdrawing or implementing of life sustaining medical care in the event of terminal illness. overcharging for services. Durable power of attorney for health care It is a private legal relationship created in which one person grants another person (proxy) the authority to make decisions regarding the health care for the person if he is mentally unable to make decisions as a result of an accident. Living will It is a series of instructions regarding the withholding.1990) explains the advance directives. LEGISLATION AFFECTING NURSING There are legal as well ethical implications inherent in nursing practice which require nurses to know and comply with the specific existing health care laws and regulations. GOOD SAMARITAN ACT . or speaking negatively about co –workers. illness or mental incapacity. ABORTION Health care agencies and practioners in various states may be required to report abortions performed as well as other information about the client . Defamation It occurs when information is communicated to a third party that causes damage to someone else’s reputation either in writing (libel) or verbally (slander) Example Giving out inaccurate information from the medical record. discussing clients. Nurses must obtain the client’s permission before disclosing any information regarding the client. It is a written document that s recognized under state law and is related to the provision of such care when the individual is incapacitated. going through the client’s personal belongings. Fraud It results from a deliberate deception intended to produce unlawful gain. families or visitors in public areas. Example Ill-legal billing. It include.

A Devis company.Law that provide protection to health care providers by ensuring immunity from civil liability when assistance is provided at the scene of an emergency when the caregiver does not intentionally or recklessly cause client injury. 1st edition. Perry. CONCLUSION A professional nurse must have adequate knowledge about legal responsibilities. F. today’s issue tomorrow’s trends’ . BIBLIOGRAPHY Catalano T. Lippincott publishers. G.  Thorough with institutional policies. 1st edition. pp-389-391.  Document the care the client receives. There are several roles performed by the nurses:  Render care based on their education.325-343.Joseph (2007). experiences and standards. Nursing practice.’Conceptual bases of professional nursing’. Philadelphia. .’Nursing now. Anne (2005).  Do the expert witness role. education and research provide many opportunities for the professional nurse to take legal responsibilities.  Maintain clinical competency.  Supervise and evaluate aspects of care that have been delegated to licensed and non licensed care givers. Leddy Susan. pp. pp-274-278. Pepper Mar (1998). Mosby publishers.  Nurses should know which situations have to be reported because each state has its own policies. Philadelphia. Potter A Patricia. ‘Fundamentals of nursing’. autonomy and accountability. LEGAL RESPONSIBILITIES OF A PROFESSIONAL NURSE Nurse are legally responsible to practice nursing as a set forth in nurse practice acts and professional standards of care. 6 th edition.

ACCOUNTABILITY.SUBJECT : ADVANCED NURSING PRACTICE UNIT : 1 AUTONOMY. ASSERTIVENESS AND LEGAL CONSIDERATIONS IN NURSING (SEMINAR) .

. the profession and the community. International council of Nurses (ICN) . CODE OF ETHICS Code of ethics is a set of ethical principles that are accepted by all members of a profession. Germany in 1965 and then became known as the ICN Code of Ethics. was adopted by the Grand council of the International Council of Nurses at Sao Paulo. This code is adopted and published by the ICN. Ethics have always been an integral part of nursing. A profession’s ethical code is a collective statement about the group’s expectations and standards of behaviour . It was later revised in Frankfurt. Nursing ethics provide the standards for professional behaviour and is the study of principles of right and wrong conduct for nurses. EVOLUTION OF ICN CODE OF ETHICS Nursing profession uses codes for Nurses: Ethical concepts Applied to Nursing as its guide for professional conduct. other health professionals. The first such Code of Ethics.CODE OF ETHICS AND PROFESSIONAL CONDUCT INTRODUCTION Ethics is the science relating to moral actions and one’s value system. Brazil in 1953.Codes serve as guidelines to assist nurses and other professional groups when questions arise about correct practice and behaviour. American Nurses Association (ANA) and Canadian Nurses Association(CAN) have established widely accepted codes that professional nurses attempt to follow. Nursing ethics provide the standards for professional behaviour and is the study of principles of right and wrong conduct for nurses. called the International Code of Nursing Ethics. Ethics is concerned with motives and attitudes and the relationship of these attitudes to the good of the individual. NURSING CODE OF ETHICS Nursing ethics state the duties and obligation of nurses to their clients.

. the family and the community and co-ordinate their services with those of related groups.  It can be used to protect the nurse who is falsely accused of doing something wrong.  It can also be used as a guide for direction when a legal action must be taken in a law suit. politics. including cultural rights.The most recent revision in 1973 took place in Mexico and resulted in the present “Code for Nurses”. The need for nursing is universal.  It helps teachers to know what must be taught in the education of the nurse. PREAMBLE • Nurses have four fundamental responsibilities: to promote health. nationality. PURPOSES  Code of Ethics serve as a means of self-regulation and a source of guidelines for individual behaviour and responsibility. disability or illness. creed. race or social status. gender. most recently with this review and revision completed in 2005. It has been revised and reaffirmed at various times since. • Inherent in nursing is respect for human rights. sexual orientation. • 2 THE ICN CODE The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. colour. the right to life and choice. to prevent illness. most recently with this review and revision completed in 2005. • Nursing care is respectful of and unrestricted by considerations of age. culture. THE ICN CODE OF ETHICS FOR NURSES An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since. to restore health and to alleviate suffering. to dignity and to be treated with respect. • Nurses render health services to the individual.  It can be used to prevent a nurse from practicing if her/his conduct is poor and clearly below the standards set by the Code.

.  The nurse uses judgment regarding individual competence when accepting and delegating responsibility. customs and spiritual beliefs of the individual. ensures that use of technology and scientific advances are compatible with the safety. NURSES AND PEOPLE  The nurse’s primary professional responsibility is to people requiring nursing care.ELEMENTS OF THE CODE 1. research and education.  In providing care. family and community are respected.  The nurse. NURSES AND THE PROFESSION  The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice.  The nurse also shares responsibility to sustain and protect the natural environment from depletion. participates in creating and maintaining safe. in particular those of vulnerable populations. equitable social and economic working conditions in nursing. values.  The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. and for maintaining competence by continual learning. dignity and rights of people. pollution.  The nurse holds in confidence personal information and uses judgment in sharing this information. the nurse promotes an environment in which the human rights. management.  The nurse. NURSES AND PRACTICE  The nurse carries personal responsibility and accountability for nursing practice. in providing care.  The nurse is active in developing a core of research-based professional knowledge. acting through the professional organisation.  The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. 3. degradation and destruction.  The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public. 2.  The nurse maintains a standard of personal health such that the ability to provide care is not compromised.

It requires recognition on a sense that all share a . BASIC ETHICAL PRINCIPLES International Council of Nurses proposed some basic ethical principles. Respect for autonomy. Respect for justice. SUGGESTIONS FOR USE OF THE ICN CODE OF ETHICS FOR NURSES The ICN Code of Ethics for Nurses is a guide for action based on social values and needs.             Respect for persons.4. Confidentiality. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. Respect for fidelity. RESPECT FOR PERSONS It directs individuals to treat themselves and other. families and communities when their health is endangered by a coworker or any other person. Respect for rights. NURSES AND CO-WORKERS  The nurse sustains a co-operative relationship with co-workers in nursing and other fields. Responsibility. Accountability. Principles are the moral norms that nursing. They are to be followed by each members of our profession. To achieve its purpose the Code must be understood. Respect for freedom. with a respect inherent to man’s humanness. Ethical principles actually control professionalism nursing practice much more than to ethical theories. internalised and used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives. So the nurse should consider them when making decisions are as follows.  The nurse takes appropriate action to safeguard individuals. Respect for beneficence. Respect for non-maleficence. Respect for veracity. as profession both demands and strives to implement to every day clinical practice.

The respect to person’s need to be simplified as it affects nursing practice. Nurses are also becoming more responsible in answering to patients. and physicians for the quality of nursing care they provide. This principle should be observed by staff nurses when planning patient care.common human destiny. ACCOUNTABILITY Accountability refers to the ability to answer for one’s own actions. When one is answerable.Nurses as a group believe that patient should have greater freedom of choice within the nations health care system. the profession. Commitment to beneficence helps to guide difficult decisions where in the benefits of a treatment may be challenged by risks to the client’s well-being or dignity. BENEFICENCE Beneficence refers to taking positive reactions to help others. It dictates that a person is obliged to help others to advance their legitimate and important interests. head nurses. it places the responsibility for the outcomes of nursing care directly on the practitioner. the employer and society. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. RESPECT FOR FREEDOM This principle of individual freedom suggests that patients be exempt from control by others to select and pursue personal health goals . by nurse manger when leading subordinates. Domains of accountability are  Professional accountability  Organizational accountability  Legal accountability  Individual accountability RESPECT FOR AUTONOMY Autonomy is defined as the freedom to make prudent and binding decisions consistent with the scope of one’s practice. It is also freedom to implement those decisions. NON-MALEFICENCE . Respect for another’s autonomy is fundamental to the practice of health care. The nurse balances accountability to the client. Accountability means being answerable for acts carried out in the performance of one’s professional role. The practice of beneficence encourages the urge to do good for others.

The following problems complicate the application of justice. FIDELITY Fidelity is keeping one’s promises or commitments.Non. The principle of confidentiality provides that care givers should respect a patient need for privacy and use personal information about him or her only to improve care. Truth telling is an ethical concern for nurses. Nurse managers use this principle when they give all the facts of a situation. This principle of justice requires treating others fairly and giving persons their due. There is not always enough for each person to receive an equal share. because truth is the basis for mutual trust between patient and nurse. but also the equal commitment to do no harm. sometimes there are situations in which it seems that one person should receive a greater or lesser share than another. Fidelity is important in a nurse because a patient’s hope for relief and recovery rests on evidence care givers conscientiousness. Nurses and other health care professionals agree to national code of ethics that define practice and offer to the public a definition of professional practice standards. It requires professional care-givers to provide with accurate. a) Not everyone is equal in everyway. b) Resources are limited. CONCLUSION In professional practice such as nursing. truthfully and assist their employees to make decisions. CONFEDENTIALITY Confidentiality is the duty to respect privileged information. JUSTICE Justice concerns the issue that persons should be treated equally and fairly. a code of ethics provides guidelines for safe and compassionate care. reality based information about their health status and care or treatment prospection.The standards of nonmaleficence promotes a continuing effort to consider the potential for harm even when it may be necessary to promote health. In health care ethics it is important to remember that ethical practice involves not only the will to do good. and trust is the basis for patient’s hope of benefit from nursing services.maleficence is the avoidance of harm or hurt. Nurses should practice confidentiality to decrease patient vulnerability and share from wide spread knowledge of personal information divulged during care. A professional nurse is . VERACITY Veracity concerns truth telling and incorporates the concept that individuals should always tell the truth. The principle of fidelity holds that a person should faithfully fulfill his duties and obligations.

Todays issue. T.391.274.expected to follow Code of Ethics. pp – 95. Philadelphia. pp.A Devis company. 1st edition.6 th edition. F. I Publishers. A.116. 1st edition.” Professional adjustment and ethics for nurses in India”. B. Anne (2005). BIBLIOGRAPHY Catalano.pp -389. Zwemmer J Ann (1980).278 Potter. . which represents the whole nursing profession to the public. “Fundamentals of Nusing”. Joseph (2007). Patricia. Perry G. Tomorrow’s trends”. “Nursing now. Mosby publishers.