ETHOS OF NURSING PRACTICE

By OLAFUSI O.O

(2020)

Table of content

Unit 1: INTRODUCTION TO ETHOS OF NURSING PRACTICE: VALUES AND MEANING OF

NURSING…………………………………………………………………………………………...3

UNIT 2: ETHICS OF NURSING……………………………………………………………………10

UNIT 3: ETHICAL THEORIES AND PRINCIPLES IN NURSING…………………………………16

UNIT 4: PROFESSIONAL REGULATION…………………………………………………………25

UNIT 5: PATIENT’S AND NURSE’S RIGHTS………………………………………………….......33

UNIT 6: LEGAL ISSUES IN NURSING………………………………………………………….....42

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REFERENCES / BIBLIOGRAPHY………………………………………………………………….47

Unit 1: INTRODUCTION TO ETHOS OF NURSING PRACTICE: VALUES AND MEANING OF

NURSING

Learning outcomes

By the end of this unit, students should be able to

 Describe nursing profession

 Define nursing
 Describe nursing theories
 Describe professionalism in nursing
 Explain nursing morals and values
 Describe the criteria for a profession

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  List the professional image in nursing (appearance)

Introduction

Nursing is a noble profession that evolved from the works and abilities of people who
are trained to care for other people. Nursing is a calling as it requires a person to be
compassionate, caring, friendly etc.

Definitions

Ethos is a Greek word which means character. Ethics is derived from ethos. Ethos
deals with people’s character, beliefs, and values that gives identity to people,
community, institution etc.

Ethics deals with what people belief is good and bad. It guides the society on how
to exercise their power in such a way that it will bring benefits to human. “It also
relates to the everyday interactions of people by making ground rules or guidelines
on what is an acceptable way to behave, for example swearing and fighting”
(Cranmer et al, 2013). There are various rules and regulations that bind nurses, this is
to ensure that things are done accordingly.

NURSING PROFESSION

In 1859, during the Crimean war, Florence Nightingale practiced nursing as separate
discipline. She was taking care of the soldiers during the war. She was regarded as
the LADY OF THE LAMP and lamp remains a symbol of nursing till date and would not
change any time soon. Florence Nightingale started a formal education training for
nurses using both theoretical and practical based skills.

According to WHO (2020), Nursing is defined as a profession which “encompasses

autonomous and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings. It includes the promotion of health, the
prevention of illness, and the care of ill, disabled and dying people.”

To be able to become a nurse, it is essential to acquire skills and knowledge through

training that will enhance caring skills.

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It is very important to mention that nursing is a challenging profession due to the fact
that nurses deals with various kinds of people with different diagnosis. Sometimes
patients and their families can be rude because of the stressful situation that they
are going through which is why communication skills is essential for nurses.
Communication skills enables nurses to interact with patients effectively as well as
help nurses to keep their stress in check.

Nursing is a science and art because its “knowledge base is grounded in science
and the art is using the knowledge to serve people.” (Mulaudzi et al, 2019). Constant
research is being conducted to improve nursing profession and enhance quality of
care.

Theories of Nursing

There are various theories developed to guide nursing practice, leadership,

education and research. These are theories are explained below:

1. Henderson’s theory of nursing (Virginia Henderson)

 Define nursing as helping people(well/sick) to perform activities that
contribute to health recovery or peaceful death
 It is the responsibility of the nurse to help patient to help themselves
through rehabilitation
 Nurses need to extend caring hands to schools, prisons, old age
homes, orphanage homes (Primary healthcare) (Orem, 1995).
2. Orem’s self-care theory (Dorothea Orem)
 Defines nursing as specialized actions that need to be performed
when helping an adult to recover from illness such as sustaining life and
death; recovering from diseases and injury; coping with any side
effect.
 In case of a child or dependent, it is the duty of the parent or family
member
 Nursing is goal-directed actions that are result seeking
 Nursing is a deliberate action of someone who has the required
knowledge that will benefit others in a specific way
 Nursing actions that must be carried out include

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  The practical procedures performed, considering the
interpersonal and social dimension of the interaction
 The social level which refers to the regulations and standards set
for the practice
 Interpersonal level which identifies the relationships between the
patient, nurse and family. (Orem, 1995)
3. Peplau’s interpersonal relations theory (Hildegard Peplau)
 Define nursing as a caring, healing and enriching process that takes
place through the interrelationship of the patient and the nurse/
community and nurse
 Lay emphasis on human relationship
 Nursing is primarily an educative force that helps to put patients at
ease
 Good relationship enables patients/ clients to talk about their
condition, feelings, fears and needs which in turn makes it easier for the
nurse to give quality care to the patient.
 It is essential for nurses to use their human nature to build their
relationship with their patients. (Mulaudzi,2019).
4. Nightingale’s nursing theory
This is the first nursing theory that was published in 1860 and it highlights the following:
 Persons are in a relation with the environment
 The physical environment (fresh air, light, warmth, cleanliness) has
healing properties
 Nursing puts client/ patients in the best condition for nature to act
upon them
 Health is positive of which pathology is negative
 Nature alone cures
 When aspects of environment are out of balance, the clients must use
energy to counter these environmental stresses
 Stress drains the client of the energy needed for healing
 The health of the home or community is a critical component in an
individual’s health
 External influences and conditions may prevent, suppress or contribute
to disease or death
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  Nurses help clients retain their own vitality by meeting their basic needs
through control of the environment
 Nursing focuses on the control of the environment for individuals,
families and the community. (Karien Jooste, 2010).
PROFESSIONALISM
Professionalism is “integral to delivering quality care, ensuring effective resource
allocation, team efficiency and workplace ethics” (nursco,2020).
According to the Webster’s dictionary, professionalism is “the conduct, aims, or
qualities that characterize or mark a profession or a professional person”

“Professionalism consists of a set of values that are critical to elevating the quality of
patient care while improving the methods, standards, and judgments that guide
nursing practices every day. Working in professional environments can help nurses
develop skills that are valuable at any stage of their career, from novice clinical roles
to senior leadership positions. Accumulating work experience and pursuing higher
education can create further opportunities to strengthen core professional values.”

Positive attitude, nurse-patient interaction, team work, professional responsibility and

integrity are very essential in nursing profession. “Professionalism in nursing requires
a nurse to adopt a holistic and optimistic (yet still pragmatic) view on any
situation, and always aim to help others above all else. It’s good practice to be
able to anticipate when negative thoughts are approaching so that you can
address the situation before it begins to have a negative impact on the rest of
the nursing team” (nursco,2020).

Nurses are the primary point of contact for every patient that visits the
healthcare facilities therefore, they need to communicate with patients with
compassion. Nurses’ responsibilities need to be carried out diligently. There are
lots of activities/ duties that must be carried out by the nurse such as caring for
the patients, monitor their vital signs using delicate equipments and handling of
medications etc, however, nurses need to understand that they are responsible
and accountable for their actions.

Nurses must also learn to work as a team. “Regardless of your personal feelings
towards a colleague, you must put your patients’ well-being first and work
closely and effectively with each team member.”(nursco,2020)
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It is very important for every nurse to maintain complete integrity throughout
their career. This involves various different facets but largely has to do with a
strong sense of purpose and the ability to do what is right in every situation.

Criteria for a profession

For a person to become a nurse, there are certain criteria that must be met and
they are as follows:

 Education: this involves acquiring knowledge over a period of time to

become a professional. Nursing training is scientifically based and in the
institutions of higher learning.

 Organization: a well organized profession that is controlled by a professional

body (nursing council of Namibia). This professional body makes decisions
regarding educational and practice standards.

 Ethics: the behaviours of the nurses is directed by a code of ethics developed

within the group.

 Commitment: Commitment to nursing profession is driven by the love and

passion that a person has towards his/her neighbor. Nursing is a calling.

 Continuing Professional Development (CPD): health professionals including

nurses are obliged to keep themselves updated regarding educational and
technological advancements. Nursing council of Namibia requires an
enrolled nurse to have at least 15 CPD points while a registered nurse is
required to have at least 30 CPD points.

Characteristics of professionalism

 Commitment to learning and work: Punctuality is the sole of business, nurses

must be punctual to work at all times except for unforeseen circumstances
and it must be communicated to other colleagues on time attending;
seeking additional knowledge and skills enables nurses to be current and
updated in their field of work; seek feedback; willing to assist other colleagues
and students; self awareness of areas for improvements.

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 Ensuring confidentiality: Confidentiality should be respected at all time. Nurses
are not allowed to divulge any information about their patients to other
people unless it will be used for treatment purposes.

 Accountability and initiative: nurses are accountable for their actions, they
must be able to take responsibility for their actions/ mistakes. Nurses must be
able to think out of the box. It is very essential for nurses to ask for help when
needed to avoid unnecessary mistakes.

 Integrity and trustworthiness. nurses are obliged to display honesty and

forthrightness, adheres to ethical standards, truthful in all communications as
well as maintain confidentiality. Integrity goes as far as reporting
inappropriate behaviours by colleagues but must be done carefully and
there must be proof.

 Compassion and respect for others: Nurses must be considerate, cooperative,

must display empathy, respectful of different socio-economic background,
must be aware of cultural differences, must be sensitive and must respect
authority.

 Maintaining competence: Nursing practice is based on scientifically sound

knowledge and skills. Nurses need to display competence at all time as there
is no guess work in nursing.

 Teamwork and professional demeanour: Works well with others, maintain

composure in difficult circumstances, inspires trust, avoid inappropriate
remarks and adhere to nurses’ dress codes.

 Concern for welfare of patients: Nurses must treat patients and families with
dignity, respect patient privacy, maintain accurate information in patient
records as well advocate for patients.

 Selfcare: Nurses must maintain personal health and hygiene as cleanliness is

next to godliness.

Professional image in nursing

 Adhere to prescribed dressing code (uniforms).

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  For recognition by the public, level of responsibilities and professional
appearance make good impression on patients, colleagues and
public at large.

 Tattoos should be covered during working hours and body piercing

that is highly visible is highly discouraged

 Clothing and hair should be neat and clean.

 Hair should be well groomed and clean including beard for men. Hair
should not the shoulders and must be neatly packed

 No artificial nails, nails should be short, clean and no nail polish

 Jewellery should be kept to minimal. Large jewelleries are not allowed

during working hours.

 Shoes should be clean and polished and functional in the work setting
(black/navy blue)

 Women should stay away from spiked heels and opened- toed shoes.
Make up for a woman should be kept to minimal and complimentary
to skin colour.

Conclusion

Nursing is about caring for people, it deals with the wellbeing of the mind, body and
soul. Patients need to be treated holistically with love and compassion. However,
anyone that wants to be a nurse, must be trained to become a professional. Nursing
council of Namibia is the body that controls educational and practice standards in
Namibia.

UNIT 2: ETHICS OF NURSING

Learning outcomes

By the end of this session, students should be able to:

 Define ethics

 Explain morals and values in nursing context

 Describe the core principles of morals

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  List and describe the types of values

 Describe accountability and responsibility

WHAT IS ETHICS?

Ethics deals with what people belief is good and bad. Ethics can also be defined as
science, study of morals, human conducts and characteristics, a universal and
practical science dealing with elements that is common to the entire human race.
Ethics is a moral philosophy of behaviour and conduct.

Nurses’ decision to do good or bad, depend on the knowledge and values they
have. It is very important to emphasize that in nursing, there is disciplinary action that
follows any bad act committed/ wrong decision made and many patients are now
aware of their legal rights. For example, patients can sue a nurse or doctor if they
feel their rights is being violated.

Morals

Morals are the domain of personal values and the rules of behaviour used in
regulating social relationship. The right or wrong involved in any action is determined
by rules set externally by the society. Morals are being taught from a young age,
when children are in their development phase by teachers, parents as well as the
society.

Core principles of moral

 The value of life: individuals need to have respect for life

 Goodness or rightness: no one should any harm to another person. Individuals

need to promote goodness over badness

 Justice and fairness: Justice means giving each person what he or she
deserves while fairness is the ability to judge without reference to one's
feelings or interests.

 Honesty: this involves telling the truth at all times.

 Individual freedom or autonomy: individuals must have the freedom to make

their own choices
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Values

“Values are the beliefs that are based on a person’s life experiences that guides
behaviour”(Mulaudzi, 2019).

“Values seem to be ways of behaviour or ideals that the person holds in high esteem
and given a nominal rating” (Cranmer et al 2013). Values are shaped by culture,
tradition, religion, beliefs and gender which in turn, influences perception, behaviour
and how we interact with people.

Nurses are part of the society and they have their own norms and values but they
also need to embody/ accept the values of nursing profession. Nurses need to bear
in mind that patients are also having their values and beliefs which must be
respected.

Types of values

1. Personal values: this determines what a person view as right or wrong.

Personal values are the expression of what a person sees as most important to
him/her. Personal values are formed through personal experiences and are
also influenced through a complex interaction of factors which include
parents, siblings, friends, education, work, religion and the media.

Personal values allow a person to make careful decisions after giving it a

thought. For example, an individual need to think of the choice of career to
pursue before making a decision on what to do. Nurses need to value
patients/ clients’ uniqueness as well as freedom of choice.

2. Societal values: societal values determined our values and worldviews.

Society shapes our beliefs, values and morals and they are affected by the
cultural practice in the society. Societal values determine how people view
health and diseases as well as how nurses are able to incorporate values of
nursing profession. Societal values allowed us to understand that we all need
each other to make things work, nurses need the patients to carry out their
duties and the patients need the nurses for their health issues.

The principle of UBUNTU is central to the values in Africa. ‘ Umuntu ngumuntu

nga bantu’ which means A person is a person through other people. ‘I am
because you are’. These principles make people to value each other.
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 The values of UBUNTU are as follows:

 Caring

 Respect

 Compassion

 Kindness

 Warmth

 Understanding

 Sharing

 Humanness

 Reaching out and neighbourness

3. Professional values: these are based on human values. Nursing values were
determined by Florence Nightingale’s work, nursing was dominated by values
such as self sacrifice, benevolence, compassion, faithfulness, patriotism and
love for humanity. Nurses are also bound by the code of ethics controlled by
the Nursing Council of Namibia.

Nursing values

 Human dignity: respect for the inherent worth and uniqueness of

individuals and population. This include empathy, consideration,
respect, kindness, privacy, trust as well as safeguarding the individual’s
right to privacy.

For example, creating privacy for patient and treating others with
respect.

 Equality: acknowledgement that all people possess the same rights

and privileges. This includes fairness, tolerance and regard for self
esteem of others.

For example, nurses’ view of their patient’s as equal to themselves

regardless of their state of health. Treating every patient equally
regardless of their colour, race or tribes.

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  Altruism: deals with a concern for the welfare and wellbeing of others.
This include compassion, caring and generosity.

For example, expressing concerns about social trends and issues that
can have implication on health such as smoking, alcohol abuse,
gender-based violence etc.

 Justice: upholding moral, humanistic and legal principles. This include

integrity, courage and objectivity.

For example, advocating for patient’s right. Nurses are the eyes and
ears of the patients.

 Aesthetics: events and personal characteristics which generate a

sense of deep satisfaction. for example, providing an environment that
is pleasing and conducive for the patients

 Truth: adherence to the facts and reality. This include honesty,

authenticity etc.

For example, documenting nursing care in patient’s file accurately

and honestly. Avoid lying to patients about their conditions.

 Freedom: the power or right to act, speak, or think as one wants

provided it does not interfere with the freedom of others. Freedom
brings confidence, hope, openness and independence.

For example, nurses need to honour and respect patient’s right to

refuse treatment.

Accountability and responsibility

“Accountability means being answerable for the decisions made in the course of
one’s professional practice” (Nursing and Midwifery Board of Ireland, 2020).

“Accountability is understood as being able to give an account of one’s nursing

and midwifery judgements, actions and omissions. Accountability is about
maintaining competency and safeguarding quality patient care outcomes and

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standards of the profession, while being answerable to those who are affected by
one’s nursing or midwifery practice.” (Nursing and Midwifery Board of Ireland, 2020).

In healthcare system, accountability is viewed as an individual’s professional

accountability for the quality of their work, accountability of health professionals
within the organisation in which they work as well as accountability with others for
the organisation’s performance and for provision of services.

“Responsibility is explained as the obligation to perform duties, tasks or roles using

sound professional judgement and being answerable for the decisions made in
doing this. A nurse or midwife who is considering expanding their scope of practice
should realise that this will involve greater responsibility.” (Nursing and Midwifery
Board of Ireland, 2020).

Types of accountability

1. Professional accountability: “this is integral to professional practice, and is

fundamentally concerned with weighing up the interests of patients and
clients in often complex situations, whilst using professional knowledge,
judgement and skills, based on evidence, to make a decision” (NHS:
Education for Scotland, 2014).

The ethical and professional behavior of nurses is controlled by nursing

profession itself through Nursing Council of Namibia. Nurses are expected to
have high degree of accountability for all actions to patients, the employing
body and other colleagues. Healthcare workers are accountable and
responsible for their actions.

2. Legal accountability: this is regulated by policy manuals/policy guidelines,

laws and regulations. Nurses are accountable and responsible for their
actions and it is their duty to ensure that patients are well cared for, but in the
event where something goes wrong, they will be accountable for their deeds
which is answerable to the council. “Legal accountability has to do with the
law of the state, if one does not deliver upon his responsibilities, he can be
held accountable and punished for the same or penalised. When
accountability is contractual, failure to fulfil one's responsibility will lead to
termination of the contract or some other action based on the
contract.”(Quora,2020)
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 3. Moral accountability: individual’s morals, values and knowledge gained, will
determine how a person will carry out moral accountability. This could mean
reporting someone to the higher authority. For example, reporting a
negligence case to the sister in charge. Nurses are trained to think creatively,
screening of patients, making decisions as well as diagnosing which in turn,
makes them to be responsible and accountable for their actions.

4. Management accountability: deals with being accountable to one’s

employer. When a person is employed, he/she need to accept the
responsibilities of adhering to policies laid down by the employer as well as
perform his/her duties diligently.

Conclusion

“Nursing ethics fundamentally entails doing good and avoiding harm in relation to
the patient. Nursing morals involves rules that are being set out by the profession
such as respect for patient’s worth and dignity, respect for human right etc”(
Mulaudzi,2019).

UNIT 3: ETHICAL THEORIES AND PRINCIPLES IN NURSING

Learning outcomes

By the end of this unit, students should be able to

 Describe ethical theories: consequentialism, deontology, utilitarianism, virtue

 Describe the ethical principles of nursing

 Mention the characteristics of autonomy

 Describe ethical decision making

 Describe ethical decision-making model

 Enumerate the features of ethical decision-making model

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  Describe the steps in nursing process according to ‘Thompson, Melia and
Boyd’s model’.

 Mention the functions of ethical code

Introduction

As discussed in the previous unit, ethics is a moral philosophy of behaviour/ or

conduct, knowing what is good or bad. This unit deals the theories and principles
that are integrated into nursing care and nurses need to adhere/ abide by the
principles.

Theories provides guidance in moral thinking and reasoning as well as justification for
moral actions

There are 4 types ethical theories. These theories are also known as ethical
approaches and they are as follows:

1. Consequentialism: action is judged by its results. Actions should be judged by

their rights or wrongs based on their consequences.

2. Utilitarianism: promoting good that is possible in a situation. “It states that

people should produce the greatest balance of value over disvalue i.e
everyone involved should benefit as much people as possible from a decision
made”(Mulaudzi, 2019). Utilitarianism is a sub-category of consequentialism. It
is morally right to promote what is good and minimizing harm. For example, in
an emergency situation, Triage is usually applied, this means that people will
be treated according to the severity of their conditions as it has nothing to do
with ‘first come first serve principle’. This is why it is important to understand
that utilitarianism is not about doing good but it is rather about the needs of
the patients.

Utilitarianism is not about who will benefit but it is about how many people will
benefit from it which is why truth telling is not a priority for the utilitarian, it is just
an option if it will benefit more people. “It does not consider individual’s right
and autonomy because it keeps a set of rules that promotes the greatest
good for the greatest number of people”( Mulaudzi’ 2019). Utilitarianism’s
weakness is that it diminished the importance of personal integrity.

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 Case study

Joshua has been diagnosed with HIV/AIDS. He resigned from his job and
relocated to stay with his parent. Joshua has an ulcerative wound on his leg
and has refused to take ART. His parents decided to hire a private
nurse(Rejoice) that will take care of the Joshua’s wound. Joshua opened up
to the nurse about his HIV status but made the nurse to promise him not to
disclose his HIV status to his parents as he doesn’t want them to know.
Joshua’s parent invited his girlfriend to their house because they felt that
Joshua is depressed and needed someone to cheer him up.

Question: what would do if you are in nurse Rejoice’s situation?

3. Deontology : it is the ethical approach/ theory that is based on rights and

principles and asserts that deeds have direct worth morally. Deontology is
patient’s centered unlike utilitarianism that is more socially centered and its
ethical action means that a nurse must perform his/her duty. Autonomy is not
always important in deontology. The principles of beneficence does not play
a role in deontology theory. There is conflict in deontology theory because
they believe that is suitable one person in a situation is also suitable for
another person in any other another situation.

Deontology is divided into 2

 Act deontology: for right thing to be done, relevant data must be

gathered first, then a decision is made about what to do. Whatever
decision is made will be applied in any situation.

 Rule deontology: deals with principles that guides our actions. These
principles are followed even if the circumstances changes. Some
principles in nursing profession are based Rule deontology such as
respect for human life, compassion, respect for privacy and
confidentiality, respect for human dignity etc.

Case study 1

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Nurse Tito have 2 patients that are suffering from cancer namely Mr. Shipo and Mr.
Lewis. Nurse Tito feels that the two patients need to be told in details about their
present conditions as she does not want to lie or hide any information from her
patients. So she explained in details to her patients. Mr. Shipo accepted his condition
without much difficulty but Mr. Lewis finds it difficult to believe nurse Tito which in
turn makes his condition to deteriorate.

Questions: 1.what type of deontology is applicable to this scenario?

2. what would you have done better if you were in nurse Tito’s position?

Case study 2

A patient is diagnosed with HIV/AIDS and has refused to tell his wife about his HIV
status. Nurse Anna advised him to protect his wife by using condom during sexual
intercourse but he refused. He argued that he felt nothing(sensation) the last time he
used condom and has promised himself never to use condom again.

Questions: 1. Should confidentiality be upheld by the nurse in this scenario?

2. Everyone have the right to life. Is the man’s right not infringing his wife’s
right?

3. is nurse Anna obliged to reveal the man’s status to the wife?

4. what would you have done in this situation?

4. Virtue ethics: this is a moral theory that lay emphasis on virtues of a person’s
character to determine whether an action is right or wrong. It focuses on the
attitude and character of the person who perform the deeds/ action.

Virtues are traits of character that are valued. This include generosity,
honesty, courage, trustworthiness as well as kindness. This helps a nurse to
make ethical decisions that might be difficult to make under normal
circumstance.

Virtue ethics: allows a nurse to use wisdom when making crucial decision.
Good virtues reflect in people’s characters, attitudes and behavior especially
in tricky and difficult situations.

Ethical principles

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 These are guidelines that helps with moral decision making as well
professional moral judgements. This include autonomy, non-maleficence,
beneficence and justice.

Autonomy

This simply means that individual should be free to do what they want to do as long
as it does not infringe on other people’s autonomy. Autonomy applies to both
decisions and actions because individuals must be ready to take responsibility for
their actions. Nurses need to learn to respect patient’s autonomy at all times.
Healthcare workers are obliged to respect the medical decisions of patients even if
they don’t agree to medical advice.

Characteristics of autonomy

 Autonomy is based on reason and much careful consideration

 Based on individual’s values

 Based on sufficient knowledge

 Nobody else has forced the decision in anyway

Non- maleficence

This means refraining from actions that can harm or cause injuries to others. This
include avoiding being negligent, avoid withholding patient’s treatments as well as
avoiding emotional, spiritual and psychological harm to the patient.

Beneficence

“This principle states that health care providers must do all they can to benefit the
patient in each situation. All procedures and treatments recommended must be
with the intention to do the most good for the patient. To ensure beneficence,
medical practitioners must develop and maintain a high level of skill and
knowledge, make sure that they are trained in the most current and best medical
practices, and must consider their patients’ individual circumstances; what is good
for one patient will not necessary benefit another”(Saint Joseph University, 2020).

Case study

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Mr. Joan was admitted to the hospital for spinal cord injury and he needed to be
operated. During the operation, he had cardiac arrest and on recovery, he had
brain severe damage. Mr. Joan has been in ICU on life support for about 2 months.
The Dr. in charge of his case told the family member to decide if they want to take
Mr. Joan off life support for him to die naturally as he might not recover from the
severe condition. Nurse Tito noticed that Mr. Joan responds to stimulation sometimes
but the Dr. felt Mr. Joan will not recover even with the response. The family members
approached nurse Tito for advice on what to be done because before the surgery,
Mr. Joan had told his family members to let him die should things get worse. This is a
tough decision for the family to make.

Questions: 1. As a nurse, what advice would you give?

2. what principle fit into this scenario and what is the nurse’s function
regarding these principles?

Principles: beneficence

Justice

In healthcare setting, justice is related to fairness and resource allocation which

called distributive justice. There must be fairness in decisions that burden and
benefit, as well as equal distribution of scarce resources and new treatments, and
for medical practitioners to uphold applicable laws and legislation when making
choices.

Justice simply means that each person should be given equal share, according to
their needs (Mulaudzi, 2019). Individuals needs to be treated the same way unless
their situations differs from each other.

Other ethical principles

Principle of veracity

Veracity means acting in truthfulness and honesty to ensure that information given
to patients and on behalf of the patient is always in their best interest ( SANC, 2013).
Nurses need to be honest with the patients to gain their trust but must be done
diligently so as not to cause more than good to the patient.

Confidentiality
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This simply means keeping patient’s information secret which must not be divulged
unless for treatment purposes. Confidentiality helps to build nurse- patient
relationship because the patient develop trust in the nurse.

Fidelity

“Fidelity simply means keeping promise. Nurses must be faithful and loyal to
professional promise made by providing quality care as well as advocating for the
patients.

Privacy

This is a fundamental right of every individual. Privacy goes hand in hand with
confidentiality. Keeping patient’s information is part of privacy, respecting patient’s
decision to carry out certain tasks on their own without any disturbance is also part
of privacy.

ETHICAL DECISION MAKING

This is when a deliberate and purposeful decision is made by the nurse in order to
perform certain tasks according to his/her job description and obligation.

Ethical decision making is based on ethical- legal framework, ethical and

professional codes of conduct, practitioner’s personal philosophy as well as
fundamental human rights.

Ethical decision- making model

 Identify the dilemma

 Gather relevant data

 Examine ethical principles

 Examine all the possible solutions

 Choose the most appropriate solution

 Evaluate the chosen solution.

 Document everything that was done

Features of ethical decision-making model

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The acronym of this features is called RESPECT

Recognize moral dimensions of the task or problem

Enumerate the guiding and evaluative principles

Specify the stakeholders and their guiding principles

Plot various action alternatives

Evaluate alternatives in the light of principles and stakeholders

Consult and involve stakeholders as appropriate

Tell the stakeholders the reasons for the decision

Thompson, Melia and Boyd’s model

According to Thompson et al. (2006), nurses need to access the patient’s situation
and make decision s to how provide appropriate care to the patient. The following
steps are suggested with regard to how to carry out appropriate nursing process

Steps in nursing process

Assessment: this is the initial stage of nursing process. Patient’s condition and
problems are assessed. At this stage, nurses need to build nurse-patient relationship.
These involve relevant moral values.

Planning: this involves designing plan of action as to how to tackle the problem at
hand. At this stage, nurses can share their concerns about patient’s condition to
ensure that quality care is rendered to the patient. Decisions are made on what to
do.

Implementation: putting the decision made onto action. The needs and wellbeing of
the patients must be taken into account at this stage. Autonomy must be
maintained

Evaluation: determining the effectiveness of the actions that was implemented. This
is to check if the implemented action is successful or not.

Ethical codes

Ethical codes emphasize that dignity, human right, right to life and respect for
patients are inherent in nursing. International Codes for Nurses (ICN) was launched in
22
1953 and was revised in 2012. Ethical codes guides nurses on social values and
needs and it also laid down the rules that guides nurses’ actions.

According to ICN, nurses have 4 basic responsibility ( Mullaudzi, 2019) which are as
follows:

 Promote health

 Prevent illness

 Restore health

 Alleviate suffering

Functions of ethical codes (Mullaudzi, 2019)

 Ethical codes serve to guide professional growth and maintain competences

 Give advice on establishing good nurse- patient relationship

 Give advice on establishing good cooperative relationships with colleagues

 Give clarity on what the nurses’ legal and ethical obligations are, to patients
and the society at large

 Emphasize that privacy and accountability are essential in nurse- patient

relationship

 Aids the development of maturity and competence.

Conclusion

Nursing practice involves doing what is right and beneficial for the patient. Nurses
are responsible and accountable for their actions. Codes of ethics is there to guide
nurses.

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UNIT 4: PROFESSIONAL REGULATION

Learning outcomes

By the end of this session, students should be able to

 Define profession regulation

 Identify the legislation and guidelines prescribing rules and conditions of

practice (Nursing Act No. 8 of 2004), scope of practice and continuous
professional development

 Mention the responsibilities of the nursing board (Nursing Council)

 Interpret the rules and conditions of nursing practice in Government Notice 10

of 1999

 Define scope of practice

 Interpret the scope of practice for nurses considering Government Notice 206
of 2014;

24
  Explain continuous professional development (CPD) and its requirements for
registration as a nurse/midwife in Namibia.

Introduction

Nursing is a noble profession that provides all the necessary healthcare services
needed by the community, however each nurse is accountable and responsible for
their actions. In Namibia, nursing is regulated by the Nursing Council of Namibia. The
council is a member of the International Council of Nurses (ICN), ICN is a body that
regulate nursing profession globally. There are key elements of professional
regulation as well as purposes which guides nurses.

“The broad scope of nursing practice reflects all of the roles and activities
undertaken by registered nurses to address the full range of human experiences and
responses to health and illness. This includes: health promotion, health protection,
health maintenance, health restoration, rehabilitation, and palliation”.

Professional regulation can be defined as the way in which order, consistency and
control are brought to a professional practice (Mulaudzi, 2019).

Scope of nursing practice: “is defined as the range of roles, functions, responsibilities,
and activities which registered nurses are educated and authorized to perform”
(Association of Registered Nurses of Newfoundland and Labrador, 2006). “Nursing
practice is directed towards the goal of assisting clients to achieve and maintain
optimal health in order to maximize quality of life across the lifespan” (ARNNL, 2006).

The purpose of professional regulation

There are three main purposes of professional regulation and they are as follows:

 To confer identity, accountability and professional status upon the

practitioner

 To set professional ethical standards to ensure quality service

 To protect the public from unsafe practices.

Nursing Act

25
Nursing Act is a law that is made by the state legislature to regulate nursing practice,
protect the public and also make nurses accountable for their actions.

Purpose of Nursing Act

 To regulate the registration and enrolment of the members of nursing

profession

 To provide for the establishment and constitution of a professional Council for

the nursing and midwifery or accoucheur profession

 To determine the powers, duties and functions of such Council (Nursing

Council)

 To prohibit the practicing of any such profession without being registered

 To specify the education, training and qualifications of persons practicing

such profession.

There is a statutory board/ council that regulate the profession by drawing up rules
and regulations which eventually becomes administrative law. This statutory board
acts on behalf of the parliament.

Brief history of the statutory board

The statutory control of nursing profession in Namibia was regulated by directives to

control the practice of midwives in the settler communities from 1908- 1920. In 1921,
South African laws took over the control of nursing/midwifery professions in Namibia.

After independence in 1990, the nurses in Namibia started working towards

Namibia’s own Nursing Practice Act. In 1993, the nurses in Namibia attained the right
to regulate their profession by the promulgation of the first Nursing Act namely the
Nursing Professions Act No 30 of 1993 which led to the establishment of the first
Nursing Board in Namibia.

In 2004, the Nursing Profession Act was revoked and a new Principle Act was
promulgated and was named Nursing Act no 8 of 2004 and it has been in use till
date.

Responsibilities of the Nursing Board (Nursing Council)

 To determine the eligibility of applicants for licensure (registration)

26
  To issue licenses to qualified applicants

 Setting procedure for the renewal of license (CPD points)

 To set standards for educational programs in nursing

 Carry out investigation of complaint against licensed professional

 Enforcement of the provision of the statute promulgated in the Nursing Act

Nursing Act no 8 of 2004

Most Acts are divided into different parts, sections, subsections, paragraphs and
subparagraphs for easy compilation and amendments Nursing Act no 8 of 2004 is
divided into 6 parts

Parts are divided as follow:

 Part I: Interpretation

 Part II: Establishment, objects, functions, and powers of Nursing Council of

Namibia

 Part III: Education, tuition, trainings, qualifications and registration

 Part IV: Offences by unregistered persons or persons not enrolled

 Part V: Disciplinary powers of Council

 Part VI: General and supplementary provisions.

Activity: see if you can find the parts of the Act

The sections

Sections in the Act are arranged within the different parts

On pages 2-3 of the Principle Act, sections are arranged in the different parts as
follows:

Principle Act has 66 sections

Sections 1 – 2: Part I

Sections 3 – 15: Part II

Sections 16 – 34: Part III

27
Sections 35 – 36: Part IV

Sections 37- 48: Part V

Sections 49 – 66: Part VI

NB: Definitions in part I of the Act are the interpretation of the concepts in the Act.

Sections are written in numbers in the Act and they are printed in BOLD throughout
the Act.

Activity: see if you can find the sections in the Act

Subsections

• Subsections are numbered and these numbers are in brackets. E.g (4)

• Subsections are Not printed in bold

Activity: - see if you can find the subsections in the sections

- Look for subsection 4 of section 4

Paragraphs

• There are paragraphs within the subsections of the Act. Alphabets are used to
identify paragraphs and they are in brackets. E.g (a)

Activities: See if you can find the following in the Act

 Section 6, subsection 1, paragraph (a)

 Section 28 (1)(b)

 Section 12(4)(a)

Subparagraphs

 Subparagraphs are under paragraphs in the Act and they are Roman
numerals in brackets E.g (ii)

 Certain subparagraphs can contain further paragraphs, which are identified

by double letters of the alphabets in brackets example (aa) and (bb)

Activity: Look at section 7 (1) (iii), you will see that subparagraph (iii) contains further
paragraphs (aa) and (bb)

28
(Go through the Nursing Act with the students)

Scope of practice

“Scope of practice is a statement that states the responsibilities of nursing. It relates

to each nurse practitioner and states the responsibilities in all nurse- patient situations
and nurse to nurse as well nurse to other health professionals, anywhere nursing is
practiced”(Mulaudzi, 2019).

Namibian scope of nursing practice is regulated by Government Notice 206 of 2014.

Government Notice No 10 of 1999

These deals with the rules and conditions of nursing practice. It is divided into
chapters, parts, sections, subsections, paragraphs subparagraphs and annexures.

Chapters contains the following information:

Chapter 1- preliminary provisions

Chapter 2 - acts or omissions by registered nurses constituting improper conduct or

misconduct

Chapter 3 - application of certain rules to registered midwives

Chapter 4 - application of certain rules to enrolled nurses

Chapter 5 - application of certain rules to enrolled midwives

Chapter 6 - Acts or omissions of an enrolled nursing auxiliary constituting improper

conduct or misconduct

Chapter 7 - general provisions: Acts or omissions not constituting complete list of

offences

Government notice No 10 of 1999 has 29 sections and are divided as follows:

Section1 - part I

Section 2-7 - part II

Section 8-12 – part III

Section 13-18 – part IV

29
Section 19-23- part V

Section 24-28 - part VI

Section 29 – part VIII

NB

 Sections are written in numbers in the government notice and they are
printed in BOLD throughout the notice.

 Subsections are numbered and these numbers are in brackets. E.g (4)

 Alphabets are used to identify paragraphs and they are in brackets. E.g
(a)

 Subparagraphs are under paragraphs in the Act and they are Roman
numerals in brackets E.g (ii)

 Certain subparagraphs can contain further paragraphs, which are

identified by double letters of the alphabets in brackets example (aa) and
(bb)

( Go through rules and conditions in the scope of practice pg 1- 15, with students)

Government Notice No 206 of 2014

These are the regulations relating to the scope of practice of persons registered or
enrolled under the nursing act, 2004. These regulations replaced the government
notice No 13 of 1999 which was withdrawn by the former minister of Health and
Social Services, Dr. R. N. Kamwi

The government notice is divided into parts, regulations, sub-regulation, paragraphs

and subparagraphs.

It consists of 2 parts and 9 regulations and they are divided as follows:

Part I – regulation 1-6

Part II – regulation 7-9

NB

30
• Regulations are written in numbers in the government notice and they are
printed in BOLD throughout the notice.

• Sub-regulations are written in numbers and these numbers are in brackets. E.g
(4)

• Alphabets are used to identify paragraphs and they are in brackets. E.g (a)

• Subparagraphs are under paragraphs in the Act and they are Roman
numerals in brackets E.g (ii)

• Certain subparagraphs can contain further paragraphs, which are identified

by double letters of the alphabets in brackets example (aa) and (bb)

(Go through Government Notice No 206 of 2014 with students)

Continuing professional development (CPD)

CPD can be defined as “the means by which health and social care professionals
maintain and improve their knowledge, skills and competence, and develop
professional qualities required throughout their professional life” (CORU, 2013). It
contributes to a professional’s learning and development.

CPD includes the activities that develop the knowledge, skills and competencies for
Social Care practice in relation to work with individuals, families, groups,
organizations and communities, and it also includes knowledge, and skills required
for areas such as policy development, management, research, education,
attending workshops and the promotion of the social care profession (CORU, 2013) .

In Namibia, it is required for a registered nurse/ midwife to have at least 30 points

annually and an enrolled nurse/ midwife must have at least 15 points annually.

See section 34 of the Nursing Act No 8 of 2004 for more details

Benefits of CPD

 CPD helps to boost the confidence of healthcare workers in practice as well

as providing opportunities for career development.

 It increases quality provision of a high standard of care that will lead to

improved health outcomes.

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  It enhances the effective delivery of services that are responsive to meet
changing needs of patients/ clients

Conclusion

“Professional regulation defines the legal framework within which professionals

practice and nurses are given the responsibilities to protect the public from unsafe
practices”(Mulaudzi, 2019).

“Scope of practice is the range of responsibilities that each nurse has in their
practice which helps nurses to clarify their roles in relation to the patients, patient’s
family and other health care worker at work” (Mulaudzi, 2019).

Continuing professional development allows the health professionals to remain

updated with the current information in healthcare system and community at large
which in turn, improve the healthcare service delivery.

UNIT 5: PATIENT’S AND NURSE’S RIGHTS

Learning outcomes

by the end of this session, students should be able to

 Define human right.

 Describe the fundamental human rights

 Differentiate between rights and privilege

 Describe the patients’ rights and responsibilities

 Describe the nurses’ rights

 Identify nurses’ obligation towards their patients and employers

 Identify the employer’s obligations towards their staff

 Identify the Patient rights (human rights in health context)

 Describe patient charter of Namibia

32
Introduction

In 1948, the United Nations launched the universal declaration of Human Right. Every
individual has certain human right should not be violated. “The Namibian
Constitution protects the gains achieved in the victorious struggle against apartheid,
racism and colonialism. It protects the dignity and the fundamental rights of all
persons – including the rights to life, liberty and the pursuit of happiness. All
Namibians now have equal rights, without discrimination. The Constitution’s
protection of everyone’s rights is necessary for freedom, justice and peace in
Namibia. The fundamental rights and freedoms protected by the Constitution must
be respected by all government bodies and officials, and by all people in Namibia”
(Legal assistance trust, 2018).

Nurses must respect patients’ rights and must treat them with dignity. However,
nurses also have their rights as they are also human being.

Definitions

Human rights: Is defined as the basic rights and freedom to which all humans are
entitled and are the most important rights in a democratic society (Mulaudzi, 2019;
Legal assistance trust, 2018). This is also known as the fundamental human rights.

Rights: simply means power that a person may claim legally / morally or legal power
that is a person’s due.

Privilege: Is a special right or advantage granted or available only to a particular

person or group.

Fundamental human rights and freedoms

Fundamental rights are specified in chapter 3 of The Namibia Constitution, 2018

(Legal assistance trust, 2018).

Fundamental human rights: every Namibian have the rights to the following:

 Protection of Life – (Article 6): All people have the right to life. The death
sentence cannot be used in Namibia anymore, no matter what crime has
been committed.

 Right to liberty - (Article 7): No one can take another person’s liberty

33
away, unless this is done according to the law.

 Respects for Human Dignity – (Article 8): No one can be tortured or punished
in any cruel or degrading way, not even a person who has been convicted
of a crime.

 Equality and Freedom from Discrimination – (Article 10): No person can be

discriminated against on the grounds of sex, race, colour, ethnic origin,
religion, creed or social or economic status.

 Privacy – (Article 13): All people have a right to privacy in their own homes.
Patients have the rights to privacy at the heath care facilities.

CHILDREN’S RIGHTS (Article 15)

 All children have the right to a name and a nationality, from birth.

 They also have the right to know and be cared for by their parents, although
laws enacted to protect the best interests of the child can override this right
if necessary.

 Children must be protected against economic exploitation. Children under

age 16 cannot do work that is dangerous to their health or development, or
work that interferes with their education.

 Children under age 14 cannot work in a factory or mine, unless this work
follows the conditions in a law passed by Parliament to protect them.

Fundamental freedom: All persons shall have freedom of:

Speech and expression

Thought, conscience and beliefs

Practice any religion and to manifest such practice

Freedom of associations which shall include freedom to form and join unions

To assemble peacefully without arms

Leave and return to Namibia

34
 Reside in any part of Namibia

To move freely throughout Namibia

Practice any profession

Differences between Rights and Privileges (WHO, 2017)

Rights are societal norms in the form of freedoms that are available to people by
virtue of being citizens of a country or as members of a society. While

Privileges are special benefits or permission granted to an individual or a group of

people based upon status, class, rank, title, or special talent.

Rights are available to all citizens. while

Privileges are special right that are not available to all members of the society but is
rather restricted to a chosen few in the society.

Rights cannot be taken away from a person while privileges can be withdrawn

Example of privilege: Immunity to diplomats from regular checking at airports in the

country is a case of a privilege that these people enjoy.

Example of Rights: everyone has the right to life. human right creates a legal
obligation on states to ensure access to timely, acceptable, and affordable health
care of appropriate quality as well as to providing for the underlying determinants of
health, such as safe and potable water, sanitation, food, housing, health-related
information and education, and gender equality.

Nurses Rights

Nurses has the rights to:

 The right to accept or refuse responsibility within the clearly stated limits of the
knowledge and competence of the nurse, provided that the employer is
aware at the time of her employment of her range of abilities in accordance
with her qualifications. This does not preclude the practitioner from declining
to undertake a responsibility where she doubts her own competence unless
given guidance.

35
  Right to make judgements about her ability to accept specific responsibilities,
prescription or orders, and to involve herself in actions which are illegal, for
which she lacks the required competence, which are against the policy of
the employer, or which are not in the best interest of the patient or society in
general

 The right to working conditions that will enable her to practice in accordance
with prescribed standards. This includes:

 The provision of material and human resources and reasonable

workload that will ensure good productivity

 Appropriate communication, support and supervisory that is feasible

 Availability of other categories of health personnel to prevent

performing duties that are beyond the scope of practice except in
emergency cases

 The right to maintain her competence and continue her/ his learning.

Obligations

Nurses are held to a higher standard than other professionals because they deal
with patients on a constant basis, and their actions could lead to injury or death to
someone if they are not careful. These obligations that nurses should carry out affect
the health and wellbeing of many different individuals each day.

Nurses’ obligations towards the employer (Steven Edwards, 1996)

 To practice as a competent professional, i.e to practice in accordance with

the standards set out by the nursing council

 To be punctual to assume duty all the time, unless there is an agreement

between both parties which must be communicated early to avoid
interruption of healthcare delivery

 There must be a mutual trust between employer and employee

36
  To ensure the safety of the patients

 To co-operate with other personnel, i.e work hand- in – hand with other
healthcare professionals

 Nurses should strive to be a role model to students and other people around
them

 Must safeguard the properties and supplies, avoid wastage of supplies

Nurses’ obligation towards the patient (Steven Edwards, 1996)

 To promote the well-being and autonomy of patients and their relatives

 To be patients advocate

 Avoid doing any harm to patient

 Treat patients with respect and dignity

The employer’s obligation to the nurse (Steven Edwards, 1996)

 To provide a safe and conducive working environment for the staff

 To provide orientation and a job description for the staff

 The employer must provide a manageable workload to avoid burn out

 The employer must provide regular in- service training to keep staff updated
with current information

 Should try to have occasional stress management training and team building
activities

Patient rights and responsibilities (Karien Jooste, 2010; Legal assistance trust, 2018)

Patient rights (human rights in health context) are as follows:

 The right to treatment

 The right to know (right to information)

 The right to confidentiality and privacy-

 The right to self –determination (autonomy)

 Decide what may be done to their bodies;

37
  Receive information to enable them to make an informed decision;

 Know the effects of the treatment; and

 Accept, refuse or stop treatment

 have your values, culture, religion and dignity respected at all times

 to be listened to, and to be heard

 Informed consent: everyone has the right to given full and accurate
information about the nature of their illness, diagnostic procedure, the
treatment and the cost involved.

 Right to be referred for second opinion

Patient’s responsibilities

1. General responsibilities: each patient has the responsibilities to:

 Respect and safe-guard the government property

 Respect the service providers and other service users

 Maintain own personal hygiene

 Keep facilities and environment clean

 Familiarize him/herself with the content of the patient charter

 Keep his/her passport in a safe and have it at all time

 Ask service providers for assistance and information

 Accept that emergency cases will be given priority

 Pay the required fee at the health facilities

 Give correct information to the service provider for diagnostic,

treatment, rehabilitation and/ or rehabilitation purposes

2. Specific responsibilities: each patient has the responsibilities to:

 Bring along the necessary documents when visiting health facilities

 Get to the health facility and back home.

38
  To take care of their own health

 To comply with prescribed treatment of rehabilitation procedures

3. Responsibilities related to community health: patient have the responsibilities

to

 Protect him/herself against communicable diseases such as HIV/AIDS,

TB

 Report any health threatening condition in the environment to the

nearest service provider

 Assist other community members as far as reasonably possible during

emergencies.

 Attend and participate in community education and promote

activities organized by service providers

 Co-operate with service providers during community treatment and

care

 Visit service facilities when required

Patient Charter

A Charter is a document from the sovereign power of a country, which gives

certain rights and privileges to a person or the people.

Purposes of the patient charter

 To ensure that improved quality healthcare is provided to patient/ client

 To enhance nurse- patient relationship

 To protect the integrity and dignity of patients and clients

 To give patients/ clients the opportunity to participate in decision making,

thereby building a trusting relationship and confidence in the healthcare
service

 To ensure that patients’ rights are upheld by healthcare providers

(Mulaudzi, 2019; MOHSS, 2016)

39
 The Patient Charter will ensure the following:

 Access

 Dignity and respect

 Safe and effective services

 Communication and information

 Participation

 Privacy

 Improving health

 Accountability

 Confidentiality

 Respect

(Go through the patient charter booklet for more information)

Conclusion

The Namibian constitution protects the dignity and the fundamental rights of all
persons, including the rights to life, liberty and the pursuit of happiness. Fundamental
human rights are the basic rights and freedom to which all humans are entitled and
are the most important rights in a democratic society.

Nurses are held to a higher standard than other professionals because they deal
with patients on a constant basis, and their actions could lead to injury or death to
someone if they are not careful.

40
UNIT 6: LEGAL ISSUES IN NURSING

Learning outcomes

By the end of this session, students should be able to

 Distinguish between the concepts of malpractice, misconduct,

incompetence and negligence

 Describe the different legal terms in the justice system that apply to nursing
practice

Introduction

Nursing practice requires application of knowledge and skills as well as exercise of

judgment. Careful nursing care delivery is able to meet the needs of clients/ patients
and it must be consistent with the goals of each patients/ clients level of health.
Nursing practice needs to be dynamic and need to have the capacity to adjust as
appropriate to changing circumstances.

Malpractice

Malpractice is a legal term used to describe any situation where professional service
or results are unsatisfactory (Karien Jooste, 2010).

41
It includes mistreatment of disease or injury through ignorance, criminal intent or
carelessness. It is also regarded as an immoral act and an evil practice towards
clients.

Factors that contribute to the increase in number of malpractice case against nurses

 Nurses delegating their duties to unlicensed auxillary staff or unqualified staff

such as cleaners

 Shortage of staff has contributed greater workloads for nurses which in turn,
increase the likelihood of errors

 Clients are being discharged from the hospital at earlier stages of recovery
and nurses may be sued for not providing adequate care or making
appropriate referrals

 Advances in technology require nurses to have knowledge of the

capabilities, limitations and safety features of a variety of technologies.
(Karien Jooste, 2010)

 Malpractice exists due to nurses make under stressful condition.

Misconduct (Karien Jooste, 2010)

 It is a non-professional conduct

 professional conduct that is of a lower standard than what the public expect
from a nurse

 A finding of guilty of an indictable offence in a court of law

 The failure to act as a nurse when the situation required such action

 Nursing conduct that is influenced in such a way that client’s care may be
compromised

Actions that can be taken against a staff found guilty of misconduct

 He/ she may be reprimanded

 He/ she may be transferred to another post or another facility

 His/ her salary may be reduced and the person can also be demoted

42
  He/ she may be discharged/ dismissed or called upon to resign

NB: go through chapter 2 of Government notice no 10 of 1999 for Acts on

misconduct

Incompetence

Incompetence can be defined as the lack of possession of or the failure to exercise

the skill, care and experience ordinarily possessed and exercised by a competent
person. Unethical care is due to intentional violation of fundamental norms.

Nurses have the responsibility to safeguard clients/ patients from incompetent and
unethical care by another practitioner of the health care team.

Incompetent care may be due mental, physical impairment or ignorance of

standard.

Negligence

Negligence is the failure to adhere to fundamental principle and it is judged

according to training and experiences. It is failure to do what you supposed to do
(Karien Jooste, 2010).

By law, a negligent person is defined as a person that has failed to exert his/ her
abilities to avoid harmful behavior.

Degree of negligence

1. Gross negligence: failure to exercise even the slightest care to protect the
rights of others.

2. Criminal negligence: offence against the states and the state punish the
person. For example, any negligence that results to the death of a patient.

3. Contributory negligence: occurs when a patient contributes to his/ her own

injury either accidentally or deliberately

Test for negligence

 Reasonable man principle

 it is also known as reasonability rule

43
  it is used to determine the extent to which a person should be charged
with committing a crime

 it determine a person’s culpability in a civil suit

 it determine an appropriate sentence

 Liability : means that a person is responsible/ liable for a crime if the damage
or loss is his/ her fault regardless whether the case is taken to court or not.

 Vicarious liability: this is when the employer is liable/ responsible for the act
and omissions committed by the employees

Reasons for negligence

 Lack of knowledge

 Shortage of resources

 Lack of equipment and supply

 Laziness and carelessness

 Disregarding rules and regulations and policies

 When people don’t know what to do

Legal terms used in justice system relating to nursing

Law a rule, usually made by a government, that is used to order the way in which a
society behaves(Cambridge dictionary 2020).

Judgement

 Making judgement is the process of forming an opinion or evaluation about a

person which is based on ethical conduct and moral principles.

 Nurses are accountable decisions regarding clients care which is based on

their assessment of the client

 Judgement allows nurses to make nursing diagnosis, create and implement

care plans as well as identifying and evaluating patient outcomes

Sources of law

44
Common law: “it is also known as law of precedent. It is a law that is being formed
and developed as history and society progress. It is a body of legal principles that
has evolved from court decisions and is intentionally acknowledged” (Karien Jooste,
2010).

Administrative law: consists of rules and regulations established by administrative

agencies that have been appointed to carry out government (Gillies, 1994).

Statutory law: it is the law of the state. It comprises of all the legislation promulgated
by parliament.

Civil law: it regulates and enforce the legal rights of persons

Labour law: laws that deal with the legal rights of working people and the
organizations they work for (Cambridge dictionary 2020).

Conclusion

Incompetence is the lack of possession of or the failure to exercise the skill, care and
experience ordinarily possessed and exercised by a competent person

By law, a negligent person is defined as a person that has failed to exert his/ her
abilities to avoid harmful behavior.

Law a rule, usually made by a government, that is used to order the way in which a
society behaves

45
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Karien Jooste ( 2010). The principles and practice of nursing and health care: Ethos
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World Health Organization (2020). What is Nursing?

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Saint Joseph University(2020) THE FOUR PRINCIPLES OF HEALTH CARE ETHICS

https://online.sju.edu/graduate/masters-health-
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NURSING PRACTICE: DEFINITION, DECISION-MAKING & DELEGATION.
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REGISTERED OR ENROLLED PERSONS CONSTITUTING IMPROPER CONDUCT OR
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GOVERNMENT GAZETTE OF THE REPUBLIC OF NAMIBIA Government Notice No. 206 of

2014. MINISTRY OF HEALTH AND SOCIAL SERVICES:

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ENROLLED UNDER THE NURSING ACT, 2004

CORU (2013). Guide to Continuing Professional Development. Health and Social

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https://www.socialcareireland.ie/wpcontent/uploads/2017/01/Guide_to_CPD.pdf .
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https://www.differencebetween.com/difference-between-right-and-vs-privilege/
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https://dictionary.cambridge.org/dictionary/english/labour-law

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