Professional Foundation of

Nursing
 Part I

• Profession Of Nursing
 1-Historical Perspective
• Nursing Heritages from the past : they look at her
as:
• The folk image of nurse ; which is , her/his
primary responsibility focused on nourishing ,
caring for elderly , skills learned through trial and
error
• The religious image ; their primary concern
focused on care of the sick , the poor, orphans
slaves and prisoners and finally the Servant
image
 The Beginning of Change
• During 17th century social reform began in
Europe
• Nursing groups were organized , these groups
gave money , time and service to the sick and
poor , example of this groups founded in
Farris 1633 with sisters of Charity
• These sisters they gave educational
programs , and hospital experience
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• In 1524 the first hospital on the American
continent the Hospital of Immaculate
Conception was built in Mexico city
• The first medical school in American was
founded in 1578 at the university of Mexico
the second hospital in Lima before 1600
• Then to Canada mainly Quebec and England
 continue
• In England , Elizabeth Fry in 1780-1845
organized the institute of Nursing Sisters and
the sisters often called Fry Sisters . Then
became the practical appearance of :
• Florence Nightingale , in the latter half of the
18th century , dramatically changed the form
and direction of nursing
 Florence Nightingale
• Born May 12 , 1820 , she became from
wealthy family , she was cultured , well
traveled and well educated , by the age of 17 ,
she had mastered several language and
mathematics and she read very well , this was
unusually to the women in her time
• Her only idea to her is to become a nurse
• In 1853 she began working with a committee
that supervised people during illness
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• As her knowledge of hospitals and nursing reform
grew , she was consulted by reformers and
physician who were beginning to the need for
trained nurses
• After Crimean War began in March 1854 , with
her trained nurses they decrease the risk of
infection 60% she was 31 years old , then from
Turkey war she returned to England , where she
established a training school for nurses and
wrote book
 Contributions of Florence
• Identifying the personal needs of the patient
and the role of the nurse in meeting these
needs
• Establishing standards for hospital
management
• Establishing a respected occupation for
women
• Establishing nursing education
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• Recognizing two aspects of health and illness
• Believing that nursing is separate and distinct
from medicine
• Recognizing that nutrition is important to
health
• Instituting occupational and recreational
therapy for sick people
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• Stressing the need continuing education for
nurses
• Maintaining accurate record , recognized as
the beginnings of nursing research
• Florence Nightingale is considered the First
Nursing Theorist
• Then establishment of Nightingale in England ,
nursing programs spread to other countries in
USA occurred shortly after Civil War
2-Conceptual & Theoretical Models of
Nursing Practice
• Since the time of Florence , nursing and health
care technology have continued to change to
meet the needs of the patient , emphasis on
the skills and little emphasis on the knowledge
• Through research nursing theorist have
developed several models to assist today’s
nurse with problem solving and organization
of care
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• Many school nursing loosely base their
curriculum or philosophy on a specific nursing
model to assist the students with their
education and understanding of the nursing
process
• As early as the 1970s nursing leaders
identified four major concepts that were the
basis for all nursing models of care :
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• 1-Nursing : encompasses the roles and actions
of the nurse
• 2-Patient : the individual receiving the care
• 3-Health : the area in which the patient fits on
the wellness/illness continuum
• 4-Environment : the setting for the nurse-
patient interaction
• Note: Theorist developed NSG models will be
presented by the groups
 Applying Conceptual & Theoretical
Framework in Practice
• Kenney in 1996 described how professional
nurses use theories from nursing and from the
behavioral science through the following :
• Collect , organize and classify patient data
• Understand , analyze and interpret patients’
health situation
• Guide the formulation of nursing diagnosis
• Plan , implement and evaluate nursing care
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• Explain nursing actions and interactions with
patients
• Describe , explain and sometimes predict
patients’ responses
• Demonstrate responsibility and accountability
for nursing action
• Achieve desired outcomes for patients
• (the major concepts of a chosen model or
theory guide each step of nursing process)
 Continue
• Theoretical framework of nursing provide a focus
for nursing care activities
• The way each theorist defines that person , the
environment , health and nursing gives a unique
focus specific to a particular theory
• However the overall goal of each framework is
holistic patient care , individualized to meet the
needs , promote health and prevent or treat
illness . In other word to achieve the aims of
nursing
 3-Definitions of Nursing : Nursing
Practice
• Through nursing theorist they gave us several
definitions of nursing , but the main definitions
are :
• The word nurse originated from Latin word
meaning to Nourish , , most definitions of nurses
and nursing describe the nurse as a person who
nourishes
• To Foster , which means to encourage and
• To Protect s which is to take care of the sick and
injury people
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• International Council of Nurses : defined
nursing written by Virginia Henderson and the
Council adopted in 1973 which she said : “ The
unique function of the nurse is to assist the
individual , sick or well in the performance of
the activities that contribute to health or
recovery , unaided the client if he/she has a
necessary strength based on knowledge as to
help client to gain independence .”
 Continue
• American Nurses Association : defined nursing
as independent profession
• Social Policy Statement describes the values
and responsibility of nursing
• All the definitions of nursing focus on the
achievement of the Aims of Nursing which
are:
• To promote health To Prevent illness
• To restore health To facilitate coping
 4-Educational Preparation for
Nursing Practice
• A- Nursing practice involves several different
types of programs :
• 1-Practical Nursing Programs and be licensed
(LPN)
• 2- Baccalaureate Nursing Programs , licensed
as a registered nurse (RN)
• 3-Programs providing and advancement from
PN to RN to BSN
 Educational Preparation for Nursing
Practice
• The Educational Ladder
• Basic education of nursing are available as:
• 1- practical ( Vocational) nursing
• 2- Registered Nursing
• Each educational provides knowledge and
skills
• The following factors influence the choice of a
nursing program:
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• Career goals
• Geographic location of the schools
• Costs involved
• Length of programs
• Reputation and success of graduates
• Flexibility in course schedule
• Opportunity for part-time and full-time
enrollment
• Ease of movement into the next level of
education
 Practical/Vocational Nursing
• During the World War II when the RN enlisted
in the military hospitals , clinics and school
lead to acute shortage of nurses
• So practical teaching were developed
• The goal was : To prepare graduates to care
for the health needs of infants , children , and
adult who were mild or chronic ill
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• After the war the need for practical become
not only temporary but permanent
• Leaders in practical nursing programs
organized to form the National Association for
Practical Nurses Education & Service so they
facilitated the licensure of graduates
• The length of practical nursing program
average from 12 to 18 months , then the
licensing examination
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• The practical nursing program is considered a
stepping stone to associate and baccalaureate
• The licensees for practical nursing program
nursing degrees LPNs
• The skills that the practical nurses could
performed depend on the agency policy and
the geographical location
 Registered Nursing
• RNs work under the direction of a physician
and dentist ranging from preventive to acute
care
• RNs : provide and coordinate client care
• Educate clients and the public about various
health conditions
• Provides advice and emotional support to the
clients and families
 Continue RNs
• Care for clients who are stable but have
complex health needs or unstable with
unpredictable outcomes
• RNs delegate clients care for LPN and UAPs
(Unlicensed assisted personal) as aid nurses
when appropriate
• Delegation requires the following:
 Delegation
• Right Task: matching the client’s needs with
the caregiver’s skills
• Right Circumstances : ensuring the situation is
appropriate
• Right Person: knowing the unique
competencies of the caregiver
• Right Direction & Communication : providing
sufficient information
• Right Supervision & Evaluation
Hospital-Based Diploma Programs
• Today Diploma Programs are decline due to
two reasons:
• 1- nursing educations start to be given in
colleges or universities
• 2- Hospitals can no longer financially subsidize
schools of nursing
• Diploma students characterized as more self-
confident and more easy socialized into the
role requirements of a graduate nurse
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• Hospital – based diploma program generally
last 3 years many hospital collaborate by
nearby colleges to provide basic science and
humanities courses
• With this diploma nurses can transfer these
credits if can choose to pursue associate or
baccalaureate degrees later
 Associate Degree Programs
• Mildred Montag a doctoral student after war
II talk about AND referred to as a technical
nurse and would not be expected to work in a
management position
• AND demonstrate high-level of competencies
in passing the NCLEX-RN examine
• They can continue to obtain BSN
 Baccalaureate Programs
• This preparation is long and most expensive
• Qualified for higher positions
• Management role independent decision-
making
• Can be employed as administrative positions
• BSN pass the NCLEX-RN examine
• In spite of degree for the public Nurse is a
Nurse
 Graduate Nursing Programs
• Are available as a Master & Doctoral Levels
• These advanced practice nurses fill the role as
a clinical specialists , nurse practitioners ,
certified nurse anesthetists , certified
midwives , administrative and collegiate
educators
• Continuing Education: require by Nightingale
learning is a long life process
 Trends In Nursing
• Two major issues dominate nursing today:
• 1- concern with the methods to eliminating
the shortage of nurses
• 2- strategies for responding to a growing aging
population with chronic problems
• Some factors contributing to the nursing
shortage.
 Unlicensed Assistive Personnel
• The role :
• Assist licensed nurses with client care
activities
• Must be trained and demonstrate
competence for the tasks carried out in a
clinical setting
• Must be supervise by delegating nurse who is
ultimately accountable for UAPs actions
 Unique Nursing Skills
• Nursing skills : activities unique to the practice
of nursing
• All nurses have to share the same philosophy
• In keeping with Nightingale traditions , nursing
practice continue to include assessment skills ,
caring skills , counseling skills and comforting
skills
 Assessment Skills
• Before the nurse can determine what care the
person requires or needs , nurse has to do :
assessment skills involve collecting subjective
and objective data , which include
interviewing , observing and examining the
client , sometime nurses refers to collect data
from the family , client and family are primary
sources of data beside the medical personnel
and record
 Caring Skills
• Caring skills are the nurse interventions that
restore or maintain a person’s health involve
the action of simple activities of daily living
ADL , in which the nurse provides physical
caring also caring involve the result outcomes
from the client-nurse relationship
• Caring for make the client reach the
independence
 Counseling Skills
• A counselor is one who listens to a client’s
needs responding with information, facilitates
the outcomes that a client desire
• The nurse implement counseling skills
through :
• Communicating with the client
• Actively listening during exchange of
information
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• Offering heath teaching
• Provides emotional support in relationship
with the client
• The nurse uses therapeutic – relationship
techniques
• Active listening demonstrate full attention of
what being said and heard
• Nurse provides advice with helping the client
to make his/her health decisions
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• Role of the nurse to share information about
potential alternatives
• Caring the nurse can teach the client how to
promote healing process , accurate
information because people today know much
more about health
• Nurse has to be empathy feeling with the
client not sympathy
 Comforting Skills
• Nightingale while used the light from her lamp
looking and communicating comfort to the
frightened British soldiers in 19th century
• From this heritage nurses understand that
illness cause insecurity to the client and family
so the nurse uses comforting skills
interventions that provides security and
stability during health-related crisis
 5-Guideline for Nursing Practice
• The standards of Nursing Practice ;
• Definition of Standards : Standards allow
nurses to carry out professional roles , serving
as protection for nurses , the patients and
institution where healthcare is given , each
nurse is accountable for the use of quality of
practice and is responsible for the use of
standards to ensure knowledge , safe and
comprehensive nursing care
 6-Nursing as Profession
• How nursing meets the traditional criteria for
a Profession , depend on these criteria:
• Profession of a body of specialized knowledge
• Use of a scientific method to enlarge the body
of knowledge
• Education within institutions of higher
education
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• Control of professional Policy , professional
activity and autonomy
• A code of ethics
• Nursing as lifetime commitment
• Service to the public
• (Note : when they refer to “ Professional”
nursing as requiring a baccalaureate degree in
nursing or higher )
 Continue
• The difference between Professional hood &
Professionalism is :
• Professional hood : as a concept reflects the
attitudes and all related behaviors of nurses
activities , directed toward enhancing support
solidarity and unity among nurses themselves
as a group , while
 Continue
• Professionalism : means the attitudes and
activities related to moving the profession
toward self regulation and autonomy
• Note :( Discussion about the Roles & Functions
of the nurse on the photocopy paper & the
discussion related the moving process from
professional hood toward professionalism
should be presented by the student : topic
development NSG in Palestine
 7-Trends in Nursing Today
• Healthcare is increasingly provided in
community-based settings , such as clinics ,
outpatient setting and homes , this change will
help in implementing a system of managed
care to control and monitor healthcare services
to minimize costs
• Patients who require in-hospital care are more
acutely ill or injured , the length of stay in
hospital decrease
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• The older adult population is increasing in size
more rapidly than any other age group , this
population trend means that patients in all
healthcare settings increasingly are older and
require teaching and skilled nursing
intervention based on knowledge in order to
meet the needs
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• Advanced practice nurses , such as
practitioners and nurse midwives are
increasingly establishing independent
practices in which they diagnose and treat
illnesses , promote health and prevent illness ,
depend on certification requirements they
practice in collaboration with a physician
These trends how its influence on
the society ?
• The importance of culturally competent care
and the use of alternate therapies to treat
illnesses are recognized as crucial to providing
holistic , individualized care , nurses must
become more culturally diverse as society
becomes increasingly global .
 Part II

• Dimensions of Professional Nursing

 A-Values
• Values are the personal aspects and
foundations of social and ethical living
• Values in nursing should help to choose
between alternatives , make decisions and
resolve conflict
• Values can be divided into three expression :
• Beliefs , Attitudes and Values themselves
 1-Beliefs
• Beliefs is the most basic value and the one
that changes least , is a type of faith
• In nursing the main beliefs is that patient will
get better with good care
• 2-Attitudes : usually made up of different
beliefs , some attitude particular to nursing
are expressed in the way care is given
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• Functions of the nurse , without the attitudes
based on the beliefs that they are valuable no
nurse could simply perform the nursing
functions or procedures
• So attitude which the nurse performed are
unique to nursing
• 3-Values : less fixed , and more dynamic than
attitudes and beliefs because there is usually an
element of motivation involved
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• Frankl said a person search for meaning in life
and the person can finds meanings through
values , Frankl speaks of three types of values :
• Creative , Experiential , and Attitudinal
• 1-Craetive : creative values are those which are
discovered through what we do , particularly
through helping others , nursing profession is a
creative , cooking is a creative
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• 2-Experiential Values : this value not created
but discover , so here values are those which
are discovered through appreciation of people
• Example a dying child , can lead nurses to
discover values by being around him/her , that
is experiencing these people for what they are
and who they are
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• 3-Attitudinal Values : are those which are
discovered through the way in which one
reacts to unfortunate circumstances over
which there is no control such as one’s won
and other peoples suffering
• Example , in case the person discovers that
he/she has cancer , the reaction Why , Why
me? Why now?
 Values of Caring
• Receptivity : the other is received as she , he or
it is
• Relatedness : means to be in relation to her ,
him or it
• Responsively : receiving alone is not enough ,
receiving comes alive through responding ,
respond to a call create relationship
• These values , lead Roach to put five CS as value of
caring
 Cs as Value of Caring
• Compassion
• Competence
• Confidence
• Conscience
• Commitment
• (Telling a story ) and through this story Rogers
pointed some principles of helping , when
applied to caring , become value):
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• Being : before we can do we need to be , be
ourselves , one human person with another
human person , this is kind of honesty
• Clarity : a willingness to be express itself in a
clarity towards the other
• Respect : in a caring we respect a person ,
and this may lead to a mutual liking
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• Separateness ; Even though we are caring ,
and deeply caring we are not engulfed by the
other , we need to remain a separate person
• Freedom : the other person needs to be free
to express himself or herself
• Empathy : is the ability to perceive the feeling
of the other person
• Communication : (discuss in management)
 Continue
• Evaluation : we help a person to evaluate
where she is in relation to where she has
come from and where she wants to go , then
we care for and about her
• Becoming : all caring is so that the other can
grow and become
 Value of Health & Health care
• We can understand the importance of health
through the definition of health according to
the WHO
• As we so the value that apply to caring begins
with C but those to which apply to health care
begins with E
• Economy
• Efficiency & Effectiveness
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• Money should be used in less cost (Efficiency)
but created a treatment in an effective way
• The customer should be free to choose which
treatment to have where and when , but we
have to informed the customers about the
choices available
 Values of Nursing
• In spite of lack of nurses due to less money ,
lack of linen , dressing sets… nurses needs to
search a meaning for their values as a nurse
• Values of nurses can be through :
• Standing up for a profession conviction
• Defending a patient’s wishes
• Pointing out inefficiencies
• Not taking No for an answer
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• Saying no when one means no
• Getting involved when this is the right thing to
do
• Defending a colleague in a difficult situation
• Values that lead nurses to care deeply plus
the above mentioned are :
 Continue
• Be attentive
• Be intelligent
• Be reasonable
• Be responsible
• Be committed
 B-Ethical Dimension
• Ethics Concerns in Nursing Practice :
• Ethics is a branch of philosophy referred to as
moral philosophy , it seeks to provide answers
to some of the questions of human conduct
that arise in our life and attempts to
determine what is right or good
 Ethics & Morality Defined
• Ethics defined as a systems of valued
behaviors/beliefs to govern conduct to protect
individual rights ,what is right or wrong , what
should be done . Usually no system of
enforcement for ethics or ethical statements
• Nursing Ethics-Philosophical analysis of moral
phenomena in the practice of nursing
• What develops first : Laws , Values ,Ethics
 Morality
• Morals : Standards of right or wrong , how
things get done
• Morality : Set of culturally defined goals and
rules governing how we attain goal
• Moral Agency : Capacity of an individual to act
morally (ethically) on own moral authority
• Moral Development : a series of stages in
which one develops moral reasoning skills
 laws
• Rules of social conduct devised to protect
society , enforceable through some kind of
police force
• The definition of Tort Law : is a civil wrong
committed against a person or the person’s
property
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• Tort Law is based on fault , the accountable
person either failed to meet his/her
responsibility or performed an action below
the standard of care
• In nursing there are two concepts related to
tort law or Unintentional TORT , which are :
 Negligence VS, Malpractice
• Negligence : or carelessness , negligence may
also include doing something that the
reasonable and prudent person would not do
non medical persons can be liable for
negligence , example a fall of elderly person
who is being cared by a lady but a nurse can
follow the standard of care to prevent fall
 Continue
• Malpractice : is a more specific term that
address a professional standard of care as well
as the professional status of the caregiver ,
how commit malpractice usually the
professional such as physician , nurse..
• Courts defined malpractice as any
professional misconduct or lack of skills which
lead to injury , suffering or death
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• Malpractice , is the failure of a professional
person to act in accordance with the
professional standards , the education and
skills is weak
• So when the action is performed by
nonprofessional person the result is negligence
• When the same action is performed by a
professional person → malpractice
 Ethical Theories
• 1-Deontology (Kant) : rightness or wrongness
of action depends on the moral significance of
the action , an act moral if it originates from
good will , ethical action is doing one’s duty
• There are two types :
• Act deontology ; based on gathering facts
• Rule deontology ; all the situations the rules
are followed
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• 2-Utilitarianism (Hume ) assume that it is
possible to balance to good and evil
• 3-Virtue Ethics (Plato) : individual's actions
come from a degree of inborn moral virtue ,
the formation of character , a way of being ,
obvious behavior .
 Ethical Principles : Importance to
nursing practice
• Justice : Equals should be treated the same
• Anatomy : Individuals have the right to
determine own actions , make own decisions
• Beneficence : The doing of good , inflict no
harm
• Nonbeneficence : Avoid causing harm
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• Veracity : Telling the truth , no deception
• Fidelity : Faithfulness , faith to address ethical
issues , practicing within scope of nursing ,
Code of Ethics , keeping commitment, basis on
nurse-patient relationship
• (More Explanation concerning Ethical
Principles )
 Ethical Principles (Continuation)
• There are four fundamental principles are best
used as tools for moral reflection and aids to
decision-making :
• 1-Nonmaleficience : is a fundamental
consideration in every conception moral and
ethical life , this principle asserts an obligation
to not inflict harm on others and is the basis for
the injunction in many medical ethics codes to
do no harm
 Continue
• 2-Beneficience : most people who work in the
healing professions cite the opportunity to
help others as a primary reason for entering
the field , beneficence , the principle that
requires that we seek to do or produce good
for others is integral to the practice of nursing
to do good we must first know what the good
is , because much harm has been done in the
name of doing good
 Continue
• The derivate principle of beneficence are :
• A-Compassion : the principle of compassion or
caring is directly derived from beneficence , the
nurse who acts in a compassionate manner is
likely to do far more good for the spirit of the
patient than is one who does not act
compassionately , being compassionate opens
one’s eyes to further psychological or spiritual
suffering of the patient
 Continue
• B-Veracity : sometimes referred to as honesty
or truth-telling , the rationale for this that
patients cannot act in their own interest
unless they are fully informed of their medical
condition , even bad news which one might be
tempted to withhold out of considerations of
nonmaleficience , informs patients about their
life choices and help them to pursue the best
path available
 Continue
• Duties of veracity although based on
beneficence are also partly derived from
respect of autonomy
• C-Fidelity : the principle of fidelity requires
one to be faithful in relationships and matters
of trust , the principle of fidelity may also be
referred to as principle of trust or obligation
of covenant
 Continue
• D-Paternalism : is a principle of not consulting
a patient at all in his/her health care decision
in an effort to achieve the best outcome for
the patient , today there is a great debate
whether paternalism can ever be justified
toward a competent adult
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• 3-Autonomy : in medicine respect for
autonomy requires us to accept the free and
informed choices of competent patients or
their designated decision-makers , the
derivate principles of autonomy are :
• A-Privacy & Confidentiality , such as knocking
before entering the room
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• Confidentiality confers an obligation on health
care providers to protect the personal
information , the record of the patient
• B-Advocacy , because patients often have a
hard time making their voice heard in medical
setting advocacy on the part of providers is
required to ensure that patients needs and
values are heard an respected
 Continue
• Because the nurse is usually the health care
provider most intimately connected to the
patient , they bear a special obligation to act
as advocates for their patients this obligation
is based in respect for patient autonomy
 Continue
• C-Informed consent , informed consent
requires that patients receive all pertinent
about their health condition and options for
treatment and that they explicitly choose their
own treatment whereas being informed is a
prerequisite to being able to exercise one’s
autonomy , the principle of informed consent
stands on its own as an essential
consideration in the ethical practice medicine
 Continue
• 4-Justice : is the most difficult of the four to be
applying , to be just , or fair or equal , the role
of justice is to ensure that all people have the
same rights and the rights are respected so
respect is the derivate principle of justice .
*As I mentioned above sometimes we cannot
apply as nurses , these ethical principles so we
face ETHICAL DILEMMA
 Ethical Dilemma
• Is a situation that requires an individual to
make a choice between two equally
unfavorable alternatives , by its very nature ,
there is no one good solution and decision
made often has to be defended against those
disagree with it
• So here we face ETHICAL DECISION-MAKING
 Ethical Decision-Making
• A variety of models and strategies have been
proposed as guides for facilitating decision-
making , although each model has its special
focus for example Curtin emphasized the
consideration of rights , Shelly in 1980
suggested that the decision-maker take into
consideration biblical principle , Savage in
1990 proposed a facilitation model so all
models include four steps :
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• Identify the ethical problem
• Identify and consider alternatives
• Implement a choice
• Evaluate the decision-making and its
outcomes
• These four steps are so familiar with the steps
of nursing process : Assessment , Diagnosis ,
Goals ,Intervention & Evaluation
 Classifications (Types) of Law
• 1-Common Law : this law derived from
principles rather than rules and regulations ,
it based on justice reason and common sense
• 2-Civil Law : based on rules and regulations ,
used to distinguish the area of the rights and
duties of private person and citizens
• 3-Public law ;is a branch of law concerned
with the state in its political capacity
 Continue
• 4-Criminal Law : refers to the conduct that is
offensive or harmful to society as a whole
• 5- Nursing Law : or other name is
Administrative law , which is boards of nursing
or regulatory boards for nursing or
• (Nursing Legislation)
 State Boards of Nursing
• Is an example of an administrative agency ,
some activities of the state’s board of nursing
include :
• Reviewing and approving nursing education
programs
• Establishing criteria for licensing nurses
• Overseeing procedures for nurse licensing
examination
 Intentional Torts
• Such as :
• Assault : is an act in which bodily harm is
threatened , such harm may be physical ,
remarks or gesture , example of this if the nurse
oblige the client not to use signal light
• Battery : can include touching a person’s body
clothing , chair or bed
• So the unintentional as we mentioned above are
Malpractice & Negligence
 Continue
• Inherent in the study of ethics is an
appreciation of individual values that are
derived from societal norms , religion and
family orientation
• The basic ethical concepts of beneficence ,
nonmaleficience , autonomy, justice , fidelity ,
veracity and standard , underlie ethical
decision-making and may be in conflict in an
individual solution
 Continue
• The ethical theories of utilitarianism ,
deontology , natural law and social equity and
justice may be used to examine the
implication of ethical decision
• A variety of social and cultural factors
including attitudes , science and technology
legislation and funding all influence ethical
decision-making
 Ethical Guidelines of Nursing
Practice
• In his/her work the nurse must show respect
for integrity of the patient , recognizing that
she/he is an autonomous with individual
needs and choices
• The nurse should acknowledge personal and
profession responsibility for his/her own
nursing practice and the assessment made in
the line of duty
 Continue
• The nurse must ensure that his/her
professional practice is up-to-date and she/he
should contribute to the development of
nursing care
• In his/her professional practice the nurse
must ensure that the patient’s right of
confidentiality of information is safeguarded
 Continue
• In his/her professional practice the nurse must
exhibit respect for the work of colleagues and
in his/her professional capacity be supportive
of colleagues , this does not prevent the nurse
from bringing up violations of the basic
principles of professional ethics and loyalty
• In her/his professional practice the nurse
should actively promote cooperation between
the various groups of health professionals
 Continue
• In his/her professional nurses should uses the
ethical principles in solving problem and
decision making , also uses of the professional
nursing skills and knowledge
• It is the duty of the nurse to help ensure that
the people trust and respect his/her profession
• So more about the influence of ethics in
nursing practice…
 Ethical Principles : Importance to
Nursing Practice
• Justice : Equals should be treated the same
• Autonomy : Individuals have the right to
determine own actions and make decisions
• Beneficence : The doing of good
• Nonbeneficience : avoid doing harm
• Veracity : telling the truth
• Fidelity : Faithfulness
 Continue
• Confidentiality : safeguard a person’s health
information from public disclosure , is the
foundation of trust
• Allocation of scarce resources : is the process
of deciding how to distribute limited life-
saving equipment or procedure among several
who could benefit
 Values & Ethical Decision making
• Values are a person’s most meaningful beliefs
and the basis on which he or she makes most
decisions about right or wrong , Values
commonly are
• 1-Acquired from parental models , life
experience and religious life
• 2-Reinforced by a person’s world view
• 3-Models in personal behavior
 Continue
• 4-Consistent over time
• 5-Challeging
• The following serve as guidelines to ethical
decision making :
• Make sure that whatever is done is in the
client’s best interest
• Preserve and support the Patient’s Bill of
Rights
 Continue
• Work cooperatively with the client and other
health practitioners
• Follow written policies , code of ethics and
laws
• Follow your conscience
Responsibility & Accountability in
Nursing Practice
• Ethical accountability related to the moral
requirement to be answerable to their patients
within a practitioner/patient relationship
• To be identified as accountable or responsible
to anyone or for their actions , individuals must
be independent moral agents despite the fact
that they may work within hierarchical
organizational structure
 Continue
• Individuals who have overall accountability
may also delegate responsibility to other
concerning nursing practice
• All we are accountable first in front of God ,
our students , colleagues , and accountability
to ourselves
 Continue
• Accountability means being personally
responsible for the outcomes of one’s own
profession actions , nurses must be
accountable to the employer , profession and
even own self , accountability means not only
having to answer for an action when
something went wrong but is a continuous
process of monitoring how the nurse
performs professionally
 Continue
• The responsibility differ in different situations
but there is a need to be aware that one is
constantly responsible and therefore
accountable
• Both accountability and responsibility have a
similar degree of moral accountability which
related to the ethical principles that is respect
goodness , justice , honesty
 Continue
• In order to be legally accountable a nurse
needs certain specific thing :
• 1-Degree of autonomy , autonomy gives
power to a person
• 2-Freedom to act or practice in accordance
with the training and education
• 3-To use her/his judgment and act on it , here
the nurse needs certain degree of assertiveness
 Continue
• While responsibility is never something very
clear-cut and always stretch beyond the
boundary
• So the new nurse starts with the following :
• Being accountable and responsible
• Task-oriented approach gives way to patient
oriented approach
• Concern the values of the community
 Continue
• Being assertive
• Autonomy & Power
• Primary nursing care in community
• More knowledge which increase the
independence
• The use of the nursing process
 Professional Code of Ethics
• Code of ethics : is a written of a profession’s
values and standards of conduct , is a
framework for decision making and oriented
towards day to day decision-making
• Code of ethics are created to the benefit of
the public , so the code is constructed
carefully with understandable
 Continue
• Codes for nurses : through their professional
organizations , nurses have developed some
common guidelines to use in making ethical
decisions , they are contained in the ANA ‘s
code for nurses , the International Council of
Nurses' code for nurses and Standards of
Practice for licensed practical/vocational
nurses
 Continue
• Nurses presented tentative codes in the 1920s
1930s and in 1940s and finally in 1950 a code
of ethics was adopted , then the code of
ethics through ANA was published in 1976 ,
the last codes was published in 2001
• NOTE : Please look for the recent code of
nurses ( Students assignment)
 Code for Nurses

• 1-The nurse provides services with respect for

human dignity and the uniqueness of the
client unrestricted by considerations of social
or economic status , personal attributes ,or
the nature of health problems
• 2-the nurse safeguards the client’s right to
privacy by judiciously protecting information
of a confidential nature
 Continue
• 3-The nurse acts to safeguard the client and
the public when health and safety are affected
by incompetent , or illegal , unethical practice
of any person
• 4-The nurse assumes responsibility and
accountability for individual nursing judgment
and actions
• 5-The nurse maintains competence in nursing
 Continue
• 6-The nurse exercises informed judgment and
uses individual competence and qualifications
as criteria in seeking consultation , accepting
responsibilities and delegating nursing
activities to others
• 7-The nurse participates in activities that
contribute to the ongoing development ,
which improve standards of nursing
 Continue
• 8-The nurse participates in the profession’s effort to
establish and maintain conditions of employment
conductive to the high quality of care
• 9-The nurse participates in the profession’s effort to
protect the public from misinformation and
misrepresentation and to maintain the integrity of
Nursing
• 10-The nurse collaborates with other health
professions for the promotion of the community and
to meet the public needs
 Ethical Conflicts confronted by
nurse
• Types of Ethical Problems in Nursing Practice
• 1-Confidentiality : has been defined in a
variety of ways :
• Keeping the secrets of the patient
• Controlling access to sensitive personal
information
• Keeping something classified restricted
undisclosed secrete or private
 Continue
• The nurse must become knowledgeable about
what information must not be disclosed , which
information can be disclosed and who should
have access to that information
• The American Nurses Association in 2001 states
that Confidentiality is associated with the right
to privacy , the nurse has duty to maintain
confidentiality of all patient information
 Continue
• A person’s right to privacy is supported by
ethical principle of nonmaleficence because
actions taken to maintain privacy are
undertaken to decrease harm to the individual
protecting patient confidentiality is necessary
for establishing and maintaining a trusting
relationship
• Usually any information can be disclosed under
these categories :
 Continue
• With the consent of the patient
• Without the consent of the patient when
disclosure is required by law or order by court
• By accident
• Without the consent of the patient when the
disclosure is considered necessary in the
public interest
 Continue
• 2-Restraints : the practice of restraining a
person is implemented throughout society as
a means for promoting safety or as a means of
punishment in health care situations , the
practice of restraining a patient is only
ethically when based on the principle of
nonmaleficience doing no harm
 Continue
• Physical restrain such as devices used to limit a
patient’s movement like side rails , geriatric
chair attached to the tray , application of tie to
the wrist
• Since 1987 the Federal government &
Accreditation agencies have worked to reduce
or eliminate using restraints they stated that
restraints can cause physical and psychological
harm , loss of dignity may be death
 Physical Hazards associated with
restraints are :
• Danger from suffocation
• Impaired circulation
• Loss of skin integrity
• Pressure ulcer and contractures
• Diminished muscle tone and mess
• Aspiration and breathing difficulties
 Continue
• 3-Trust Issues : for the health care system to
work accurately and efficiently trust must
exist among persons and agencies involved ,
patient should be able to trust that heir health
care providers are competent and will act to
promote the patient will be truthful and fulfill
his or her responsibilities the nurse’s ability to
remove harm and to promote good for the
patient .
 Continue
• Trust relationship are also forged between
health care agencies and their employees
• Using trust to build therapeutic relationship
based on honesty , clear communication ,
relationship exist in this statement:
• “A feeling of comfort with growth in self-
awareness and an ability to share this
awareness with others , acceptance of others as
they are without needing to change them”.
 Continue
• 4-Refusing care : according to Bill’s right the
patients has the right to refuse care after
receiving information concerning the
treatment or conditions , in this case patient
should sign the refusal of care
• 5-Hospice Care : or palliative care meaning
taking care of the whole person mind , body ,
spirit , heart and soul , the goal is to give the
patient with life threatening the best quality of care
 Continue
• 5-End-of-life issues : involve decisions about
preferences for how a person should die the various
options differ as to the circumstances and intent and
how is the decision-maker here is a bid dilemmas
concerning this issues also DNR is a big debates
related these issues
• Well exploration for these topics will be discussed
with the Euthanasia presentation
 C-Legal Dimension
• Legal Concepts are :
• Definitions of Law
• Types of Law
• Intentional Torts ;Assault , Battery , Informed
Consent , Fraud
• Unintentional ; Negligence , malpractice
• (All we explained before )
Professional & Legal Regulation of
Nursing Practice
• 1-Standards of Care : is a quality assurance
concerned with performance , standards of
care should be valid , and acceptable in the
quality of care , can solve problems and can
be achieved within an agreed time so the
standards of care should be acceptable ,
achievable , observable , measurable , in order
to set such standards nurses need :
 Continue
• To be clear about the extent of their authority
responsibility and accountability which must
be matched with the necessary authority to
carry out their job effectively
• 2-Accrediation , Legislation , licensure and
Certificate all ensure our competency in
perform and ensuring the standards and the
quality of care
 Legal Issues Common in Nursing
• Duty to report or seek medical care for a
patient
• Nursing responsibility for medical orders
• Confidentiality and right to privacy
• Informed consent (Explain)
• Advance directive- Living Will
 Legal Safeguards for Nurses
• Contracts *Bargaining
• Adequate staffing
• Competent Practice
• Patient Education
• Carry out physician orders
• Documentation *Good Samaritan laws
• Risk management programs
• Incident , Variance & Occurrence report
 Legal Aspect between nurse-client-physician-
employees relationship

• Ethical Issues Between Nurse & Physician :

• Disagreements about the proposed medical
regimen here the nurse play the role of
ADVOCACY , which based upon common
humanity our common needs and our human
rights , When Advocacy should be practiced ? :
 Continue
• An advocate is one who pleads the cause of
another so we needs to know a greater things
about the person and the reason why we
pleading for
• Understanding of common humanity which is
knowing the patient’s need which comes from
listening and hearing
• Needs to know the human rights (Bill’s Right)
 Continue
• So advocacy is the fundamental aspect of an
ethic of caring , according to Brown there are
four reasons why nurses should advocate on
behalf of patients which are :
• 1-Advocacy is a quality of care which the
patient receives corresponding to the
principles of values of life and goodness or
rightness
 Continue
• 2-Acess to care by the patient which is the
principle of justice or fairness
• 3-The patient should be fully informed about
care which receives , which is principle of
telling the truth
• 4-The patient should understand an
alternative to care which is principle of
freedom
 Continue
• There are reasons why advocacy should not
be practiced :
• May be the employer are concern about their
own job or profession
• Lack of awareness about ethical problems and
if nurses are unaware about ethical problems
how can be advocate , how they can fight to
maintain good system
 Continue
• Lack of experience of how and when to be an
advocate or not
• The issue between the nurse and physician is
very important , most the relationship consists
upon the inequity due to the question of
power
• Here there are three issues :
 Continue

• 1-Nursing Autonomy : Autonomy has to do

with discretion , control and self-government ,
struggle for autonomy is generally struggle for
power and authority , the most that has
autonomy are midwives , mental health
nurses , researcher , nurse practitioners .
 Continue

• 2-Making independent decision when nurses

become more conscious of their role and
ability , responsibility and right so the nurse
can make independent decision concerning
for example patient treatment or ethical
critical situation
 Continue
• 3-Challenging medical opinion or treatment :
because studies shows that nurses are more
in touch with patients than doctors and in
order for nurses to share her/his medical
opinion or treatment the nurse should have
an attention intelligent , responsible ,
commitment to their own profession
 Ethical Issues Between Nurses &
Patient
• This issues is mainly consider the
CONFIDENTIALITY , the legal sides of
confidentiality concern particularly the
patient’s case notes , in the Court of Law all
information must be given but to the policy
only (The topic concerning confidentially was
discussed before )
• Second issue is ADVOCACY , also discussed
before
 Ethical Issues Between Nurses &
their Employers
• The employer is the one who hires and fires ,
the relationship between an employer is the
one of contract and obligation not one of
consensus , it is formal not friendly ,difficulties
in relationship between nurses and their
employers focus largely on the needs of the
individual versus the need of the organization
the ethical issues which arise between nurses
and employer arise out of the conflict
 Continue
• Conflict of what the employer demands and
does and how the nurses responds to this
demand .
• The ethical issues between nurses & employer
• Standards of Care (Explained before)
• Accountability (Explain before )
• Responsibility (Explained before)
 Continue
• Conflict with manager : mostly conflict here
arise due to MONEY
• Objection to treatment & policies : when
nurses object to certain treatments they don’t
only come into conflict with prescribing doctor
but also with their employer , a nurse can
legally object to take part in Abortion , ECT
treatment , ..here is a dilemmas and ethical
decision-making
 Ethical Issues Between Nurses &
Nurses
• Most of the ethical issue which arise between
nurses are to do with : Incidence report ,
Assault and Abuse which are kinds of
malpractice never excusable
• But here the conflict arise e Does the nurse
can tell other nurse or nurse responsible ?
And what are the obligation of the nurse ?
 Ethical Issues Between Nurses &
Profession
• 1-Political action : should nurses be involved
in politics ? Many nurses and other health
care workers feel that to defend their rights
the need to belong to a union or professional
body , these organization exist to speak on
behalf of nurses and defend their interest
such as condition work and salary …
 Continue
• 2-Strikes : one area where nurses do run into
difficulties with their profession is on the
question of strikes , the contract employer
and employee implies that there are two sides
to a bargain , there is a duty and right on both
sides , strike can take place when on side of
the bargain is not kept , most nurses strike is
for money and this is a dilemmas , nurses
want the right and also the moral right to the Pt
 Continue
• So the argument of strike or not striking is
really a question about the status of the nurse
if nurses want to be professionals then they
have to act and look professionals and share
the clients their knowledge and committed to
their care , theses values cannot be easily be
compatible with strike action .
 Continue
• 3-Professionalism : a profession is
distinguished by :
• A-it teaches its students itself in a body of
specific knowledge that must be higher than
necessary for ordinary survival
• B-it regulates its own control over admission
to and dismissal from profession
 Legal Issues arises in Nursing
Practice
• Here is good to define :
• Bioethics :
• “Bioethics applied ethics inquiry in the
biomedical sciences attempting to provide
moral responses to difficult questions in
healthcare , technology use and related public
policy.”
 Legal Issues arise in Nursing
• 1-Paternalism : means that the patient is
happy not to do decision because he or she do
not understand the anatomy and physiology
or chemistry but it does not means that they
do not think or have no feeling , for example,
when the doctor tell the patient how is going
to do goiter surgery that there is no risk and
the patient after the surgery lost the voice the
patient can sue the doctor and the doctor in
 Continue
• This case he respond that he is doing good to
the patient so in this case the doctor is right
• 2-Deception : is form of manipulation giving
rational in order to let other to do what one
wants them to do
• 3-Allocation of Scare Resources : allocation of
resources is commonly viewed in terms of the
use of equipment or other resources within
institution
 Continue
• But nurses also accountable for other forms of
resources allocation .This story for the class
discussion
• “A nurse has just been pulled from your unit ,
leaving under staff , among your patient 33 yrs
old man recovering from heart attack , who is
discharged in the morning tells you that he still
has many questions , an older patient that is
close to death and a woman with cancer
 Continue
• Who is vomiting all the day and who is in a
severe pain , you as a nurse you know that you
cannot meet everyone’s need so how do you
distribute your nursing resources ?
• 4-Professional Misconduct : When a
professional nurse become aware of
professional misconduct related to
incompetent or impaired of another health
care provider
 Continue
• The nurse has an obligation to protect the
public from potential harm and assist the erring
health care professional to receive appropriate
educational or treatment interventions
• 5-Incompetent Practice : a nurse is considered
to be incompetent when he/she possesses
sufficiency of abilities ,but she/he acts
incompetent
 Continue
• Or inability to meet competency expectations
may be related to lack of knowledge or
experience
• 6-Unethical Practice : a nurse’s practice is
deemed unethical when he/she actions failed
to meet the ethical standards established by
profession through codes and societal
standards , such as lying , cheating failure to
respect patient autonomy…
 Continue
• 7-Illegal Practice : a nurse’s practice is illegally
when her/his actions violate local , state or
national laws such as failure to comply with
abortion laws or abuse , assault , false
imprisonment which is interfere with a
person’s freedom to move about will without
legal authority , or defamation which is untrue
information harms a person’s reputation…
 Scholar & Scholarly
• Scholar , means a person who knows a lot
about a particular subject , because they have
studies it in details
• Scholarly , spending a lot of time studying and
having a lot of knowledge about an academic
subject
 Scholarliness in Nursing
• Scholarship is evident in discipline in which
knowledge and its progress are easily
articulated and in which research and
philosophical inquires explores ,examine and
answer significant questions
• Theory is an essential component of scholarly
disciplines
 Continue
• So scholarliness combines theory and research
, philosophies and discipline such as nursing
and nursing practice
• The scholarship of the discipline is drives by
our nurse theorists
 Characteristics of the Stage of
scholarliness
• Relationship among theory , research ,
practice and philosophy become more
apparent
• Boundaries of domain more identified
• Domain guides nursing practice , research ,
and theory
• Knowledge is developed that makes a
difference in health care
 Indicators of Scholarliness in
Nursing
• Continuity , is manifested by the important
and fundamental questions in the field that
addressed within conceptual or theoretical
scheme in order to modified ideas
• Concentration , is demonstrate through
nursing theories that evolve from practice and
are used in education
 Continue
• Concentration also involves joining with the
public media to inform the public of nursing
their mission and to modifies its goals based on
public
• Development of the National Institute of
nursing Research
• Cumulative Nursing Research & Theory , that is
being done on the central concepts of nursing
 Continue
• The center of research in our nursing
advancement
• The 21st centaury movement is toward the
evaluation and respect accorded to clinical
scholar who integrate clinical and academic
goals
 Revisiting Scholarship in the 21st
century
• Clinical scholarship is reflected in careful
analyses of situations and critical assessment
of response it requires a certain intellectual
maturity that comes from experience→
expertise (Benner)
• Scholarship of teaching discovering more
knowledge
 Continue
• Critical thinking
• Collaborative efforts of all resources within
nursing to work together to develop critical
and reflective thinking for the students
• Providing framework in nursing practice