NURS17013- WEEK 9 - Lecture notes 9 PDF

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NURS17013: Self and the Profession
WEEK 9- Lecture notes 9...

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November 7th, 2018

NURS17013- WEEK 9 MODULE 5 Practice and Professional Standards Guidelines Unit 9 CNO PRACTICE GUIDELINE: CONSENT HEALTH CARE CONSENT ACT (1996) (HCCA)  The principle of informed consent is entrenched in common law and nursing standards. The HCCA sets out explicit rules on when consent is required for treatment or admission to a care facility, and who can give the consent when the client is incapable of doing so.  As well, it sets out rules for when a practitioner wants to obtain consent from a substitute decision-maker for personal assistance services (i.e., activities of daily living). Purpose of the HCCA 1. Rules for consistency; who can give consent 2. Facilitates treatment, admission, personal assistance for those incapable of decision making 3. Enhances autonomy – incapable and prior expressed capable wishes are adhered to. 4. Promote communication and understanding (provider/clients) 5. Ensures significant role for supportive family when person incapable. 6. Permits intervention by Public Guardian and Trustee as a last resort (superseded other decision makers if applied) AGE OF CONSENT  There is no minimum age for giving consent.  Health care practitioners and evaluators should use professional judgment, taking into account the circumstances and the client’s condition, to determine whether the young client has the capacity to understand and appreciate the information relevant to making the decision. INFORMED CONSENT Consent is informed if, before giving it:  The person received the information about the treatment that a reasonable person in the same circumstances would require to make a decision; and  The person received responses to his/her request for additional information about the treatment.  The information must include the: o nature of the treatment; o expected benefits of the treatment; o material risks and side effects of the treatment; o alternative courses of action; and o likely consequences of not having the treatment. ASSESSING CLIENT CAPACITY  A person is capable of giving consent to a treatment, admission to a care facility and personal assistance services if he/she:  understands the information that is relevant to making a decision concerning the treatment, admission or personal assistance service; and  appreciates the reasonably possible consequences of a decision or lack of a decision. THE SUBSTITUTE DECISIONS ACT (1993)  A person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision.  The HCCA provides a hierarchy to determine who is eligible to be a substitute decision maker.  The substitute decision-maker is usually a spouse, partner or relative. A power of attorney for personal care is not necessarily required to act as a substitute decision-maker.  “Substitute” must be over age 16 and “willing”

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NURSING ETHICS WHAT ARE ETHICS?  Study of philosophical ideals of right and wrong behaviour  Values and standards to which individuals and professionals strive  A reflection of what matters most to people or professions TERMINOLOGY • Ethics • Study of morality, systematic exploration of questions about what is morally right and morally wrong. • Nursing Ethics • Focuses on the moral questions within the sphere of nursing practice and the nurse/client relationship. • Ethical Dilemmas • When the best course of action is unclear, when strong moral reasons support each position; when two compelling possibilities exist; equally compelling for/against a decision that must be made (CNA, 2003). • Moral Distress • When we are not able to face the issues and deal effectively with them CODE OF ETHICS  A set of ethical principles that are accepted by all members of a profession  Collective statement about the group’s expectations and standards of behaviour  Guidelines to assist professionals when questions arise about correct practice or behaviour REFERENCES FOR NURSES • CNA Code of Ethics (2008) • CNO Practice Standard – Ethics (2009) • CNO Professional Standards (2002) CNO CODE OF ETHICS (FROM ONLINE MODULE) Ethical Values • Client well being • Client choice • Privacy and confidentiality • Respect for life • Maintaining commitments • Truthfulness • Fairness ETHICAL PRINCIPLES BIOETHICS  Addresses issues specific to health care  Ethical Principles  Moral decision making guided by principles  Autonomy  Beneficence  Non-maleficence  Justice  Fidelity  Veracity  Paternalism Autonomy  Nurse must respect a person’s right to determine care

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Include client in ALL decision making Client has right to be respected and supported by nurse regarding health care decisions

Beneficence • Do good • Take positive actions to help others • Best interest of client remain more important than self-interest Non- maleficence • Do no harm • Balance the risks and benefits of treatment and plan of care • Always consider the potential of harm Justice • • • •

Fairness Equal distribution of resources With limited resources who should receive care? Should acute care receive more funding than chronic care?

Fidelity • • • •

Foundation of nurse-patient relationship About loyalty, keeping promises, truth telling (veracity), and being faithful to those in our care Challenge – your ethical principles are compromised when you are loyal to a patient Against abortion but assigned to care for a woman who is about to undergo this procedure

Veracity • Truth telling; honesty • Foundation of trust in nurse-client therapeutic relationship Paternalism • Father/mother knows best • Decisions for others; may strip of autonomy CULTURALLY SENSITIVE CARE TERMINOLOGY Globalization: • Or the increased interconnectedness and interdependence of peoples and countries, is generally understood to include two inter-related elements: the opening of international borders to increasingly fast flows of goods, services, finance, people and ideas; and the changes in institutions and policies at national and international levels that facilitate or promote such flows. • Globalization has the potential for both positive and negative effects on development and health Global Health: • The optimal well-being of all humans from the individual and collective perspective (CNA, 2009). International Health: • Focuses on health issues of countries other than one's own, especially those of low- and middle-income countries Public Health: • An emphasis on the health of the entire population. Its goal is to achieve a healthy environment for everyone. CULTURE • Shared patterns of learned values and behaviours that are transmitted over time and that distinguish the members of one group from another.

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Culture refers to the learned values, beliefs, norms and way of life that influence an individual’s thinking, decisions and actions in certain ways.

WHY IS PROVIDING CULTURALLY SENSITIVE CARE IMPORTANT? - think pair share CULTURALLY SENSITIVE CARE • As nurses strive to provide culturally sensitive care, they must recognize how the clients’ and their perceptions are similar as well as different. • Nurses enhance their ability to provide client-centred care by reflecting on how their values and beliefs impact the nurse-client relationship. • All the attributes of the nurse, including age, gender, past experiences, strengths and weaknesses, have an impact on the interaction with the client. • Through reflection, learning and support, nurses will be better able to strengthen the quality of care they provide to the diverse communities they serve. ASSUMPTIONS • The following assumptions are the core tenets of providing care that is culturally appropriate. o Everyone has a culture. o Culture is individual. Individual assessments are necessary to identify relevant cultural factors within the context of each situation for each client. o An individual’s culture is influenced by many factors, such as race, gender, religion, ethnicity, socio-economic status, sexual orientation and life experience. The extent to which particular factors influence a person will vary. o Culture is dynamic. It changes and evolves over time as individuals change over time.  The following assumptions are the core tenets of providing care that is culturally appropriate.  Reactions to cultural differences are automatic, often subconscious and influence the dynamics of the nurse-client relationship.  A nurse’s culture is influenced by personal beliefs as well as by nursing’s professional values. The values of the nursing profession are upheld by all nurses. (See the College’s Ethics practice standard)  The nurse is responsible for assessing and responding appropriately to the client’s cultural expectations and needs. ACQUIRING CULTURAL KNOWLEDGE  It is unrealistic to expect nurses to have in-depth knowledge of all cultures, but it is possible to obtain a broad understanding of how culture can affect beliefs and behaviours.  Acquiring cultural knowledge begins with the recognition that behaviours and responses that are viewed one way in one cultural context may be viewed in another way, or have a different meaning, in another cultural context. HOW CULTURAL BELIEFS AND VALUES MAY AFFECT CLIENT CARE In health care, areas in which an individual’s culture may affect beliefs and values include:  perception of health, illness and death;  meaning and role of suffering;  view of hospitals, nurses, doctors and other healers;  rituals and customs (religious and other);  boundaries related to privacy, age, gender and relationships;  effectiveness and value of different types of therapies;  individual time-keeping beliefs and practices that may direct activities (e.g., medical testing appointments before sunset, or instructing clients to take medication before or after an event (such as breakfast) instead of at a specific time, such as 0800 hrs) In health care, areas in which an individual’s culture may affect beliefs and values include: • family and social relationships (e.g., roles of family members in decision-making and caregiving, perception of what is best for the individual versus the family and what is best for the family as a whole);

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decision-making on consent to treatment (e.g., sharing information versus clients being shielded by family and having decisions made for them); independence/self-care versus interdependence/ being cared for by others; and communication norms (e.g., eye contact versus avoiding direct eye contact, asking questions versus avoiding direct questioning)....