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Professional Practice Nursing Notes Week 1 Lecture The History of Nursing Nightingale  nursing pioneer and most influential as results of her writing Improved sanitation and good nursing practice like hand washing and single-patient only cleaning cloths During Crimean war she went to Scutari in Turkey  reduced patient mortality from 42% to 2% in 6 months during 1854 Founded Nightingale training School for Nurses at St Thomas’ Hospital in London (1860) Profound effect on nursing on both Australia & NZ  methods of education and care filtered throughout the world The History of Nursing: Australia First hospital in Australia was a series of temporary structures  the Rocks area Beginnings in 1788 upon arrival of First Fleet into Sydney Cove Sydney hospital opened at its current site in 1811 Convict women and men preformed care duties First trained nurses to arrive in Sydney  1838 and were religious sisters form the order of the sister charity Henry Parkes, the then future premier of NSW sent request to UK for professional nurses Lucy Osburn and 4 nightingale nurses came in 1868 to improve nursing in Australia Osburn appointed  Lady Superintended at Sydney Hospital and  introduced ‘Nightingale’ system of nurse education & care Foundations for nurse training: formal lectures & teaching session in daily hospital routine First nursing school in Australia was opened shortly after  this began the revolution around nurse education Once Lady Superintendent at Sydney Hospital Osburn: o Improved standards of care o Positively influenced the way nursing was perceived o Introduced uniforms o Improved hygiene standards for nurses The History of Nursing: Improved Image Following First World War, nursing became considered a respectful and admiral profession Increasingly popular for all classes of women Demand for trained staff to implement new medical treatments Women saw nursing  domestic, factories and home duties The History of Nursing: Global Nursing Developments USA expands nursing education into universities  1950s Nursing process Orlando  1960s o Push to ‘scientise’ nursing o Positivism Care plans Henderson  1968 Primary Nursing  1973 o Individualise nursing care ICU specialisation The Evolution of Nursing: A Vocation Rigid hierarchical structure o Obedience o Service o Hard work Nurses seen as different women Personal attributes of what was considered to be the ideal nurse Devotion to patients Affected the politicisation/industrialisation of nursing workforce The Evolution of Nursing: Social Inequality Mostly women – gender specific inequality Role of nurse  role of mother/housewife Skilled role of nursing  unrecognisable Men –> unacceptable for training until 1970s (they were mental health) The Evolution of Nursing: Early Socialisations Women were o Subservient to men o Experienced in sanitary and domestic matters o Self-sacrifice and devotion to duty Nurse training reinforced these socialisations The evolution of nursing: Lack of a sense of control Hierarchical o Governed by matron o All nurses subordinated to doctors Obedience

o Did not question instructions or directions o Absolute adherence to hospital etiquette The hierarchical structures of nursing and its power (less) relationships were reinforced by living (1900-1960) Good manners, moral and behaviour Strict rules of regulations designed to control behaviour of the nurse Poor pay RN wages=untrained ship assistant The evolution of nursing: Education of the times “No woman should take up the profession of nursing unless she if prepared for hard work, continual self-denial and constant subordination of her own will” The evolution of nursing: Professionalisation Nurse registration  NSW 1924 Remained difficult  reliance on the orders of doctors The Evolution of nursing: Politicisation Dissatisfaction with wages & conditions  industrial issues Nurses union  stronger, louder, more vocal for improved as they lobbied wages + conditions The evolution of nursing: feminism Feminist theory + ideology  1960s with growth of women’s liberation movement New awareness for women women  able to enter male dominated professions (medicine, law, science) rather than marriage/child rearing The evolution of nursing: Social changes social norm challenged  1960s-1970s o divorce rates increased o marriage rates fell o birth control rules and regulations became relaxed The evolution of nursing: Technology boom increase in technological development  1970s-1980s Strongly influenced nursing Greater responsibilities for procedures that were technologically difficult Nursing roles & responsibilities  more complex The evolution of nursing: Professionalism Improve self-image Develop professional status Nursing journals Nursing researched Nursing theory The evolution of nursing: Australia Nurses seen as workers Educational reform  1983 Nursing education: transfer from transitional apprenticeship model to colleges of advanced education 1980s (1985 NSW) Education has had to keep pace with o Specialised body of knowledge o Increasing technology Nursing influences While modern nursing was heavily influenced by nightingale, nursing continues to evolve and had often been influenced or associated with conflict, including both world wars Modern definitions of nursing Holistic caregiver Holistic means to treat and heal whole person Includes body, mind, psychosocial, emotional and spiritual needs Consider patient family member and personal relationships Nursing Skills Good communicator Organised Knowledgeable and researched Critical thinker Reflective practitioner Professional and dedicated Qualities and Virtues of a good nurse Wisdom

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Empathy Compassion Patience Sense of justice Honesty and integrity Courage

1. Member of a profession What is a profession? a vocation requiring knowledge of some department of learning or science a profession includes discipline specific o regulation o specialised body of knowledge and skills o education Demonstrate accountability and that the profession demonstrates accountability and autonomy Role of the registered nurse Provides evidence-based nursing care to people of all ages and cultural groups Role includes o Promotion and maintenance of health o Prevention of illness o Alleviation of pain and suffering at the end stage of life o Assesses, plans, implements and evaluates nursing care: in collaboration with individuals and the multidisciplinary health team Recognition of factors that may impact health Provides care in a range of settings Leadership role in the coordination of nursing and health care within and across different health care contexts to facilitate optimal health Refers and coordinates care when required RN contributes to quality health care through o Lifelong learning o Professional development of self and others o Research data generation o Clinical supervision o Development of policy and clinical guidelines Develop professional practice in accordance with the health need of others and the changing pattern of disease and illness Nurse Responsibility Understand and meet the standards set by the profession Be accountable to self, consumers and the community, other health care professionals and employers Accountable for the appropriateness, quality and cost of health care you provide o Manifested through your decisions and actions Commitment to ongoing competence and continuation of leaning Nurse must have their own knowledge and skills to be counted as a profession Take responsibility in the development of their own knowledge base Develop knowledge through being involved in research o Using research o Conduction research Educations Standards Higher education sector is important for professionalism Accreditation standards – RN education must be delivered by a higher education provider 2. Health System Frameworks The Australian public health system Universal health care system o Medicare o Controlled by the government through the commonwealth – state agreement The Australian private health care system Self-funded health care system o Covered for many within the health insurance industry Medicare -

Provides access to medical and diagnostic services Pharmaceutical benefits scheme (PBS) provides access to medicines Public hospital services Based on principle on universality All Australian citizen covered for medical, optical and public hospital services Medicare is funded through the taxation system, most tax payers are levelled a 2% levy based on their income (2.5% in 2019) There may be a co-payment required for services

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A Medicare levy surcharge for those who earn +$90,000 (single) or %180,000 (family) if you are not paying private health insurance Remainder comes from Australian government

Medicare: Safety Nets Assist families who have high medical and medicinal cost PBS safety net o Helps with cost of prescription medications once the safety net s reached Medicare safety net thresholds o Out of the pocket costs is the difference b/w Medicare benefit and what your doctors charges you Medicare: Bulk Billing Federal government pays medical or health practitioner for a service Medicare: Schedule and suggested fees Medicare benefits are based on a list of standard fees for medical services: the so-called ‘schedule fees’ Doctors are free to set their own fees Many doctors follow Australian Medical Association’s list of suggested fees  keeps up with costs and recommends higher fees than the Medicare schedule fees Private Insurance Funding healthcare under the current arrangements cannot depend on Medicare alone For individuals who would like options regarding their health care, they need to take out private insurance o Primarily to access the health care environment in a timely fashion Covers the amount b/w Medicare rebate and the standard fees for the consultation or service o May not be what the practitioner charges o Can create ‘out of pocket expenses’ Medicare rebate freeze in place but it currently being returned to indexation Private insurance As of June 2015 o 47.4% Australians have hospital cover o 55.8% Australians have general treatment cover o Overall, private health insurance coverage is 55.9% Personal Funding Personal contribution to health has grown at a greater rate than government spending in recent years Private sector involvement and increase in private health spending may worsen health inequality and a growing burden of disease Increasing costs Costs in the health sector have grown quicker than in the broader economy over the last 10 years Driver by an increase in volume of health goods and services purchased rather than the price of the services Also related to increase in population rather than in the expenditure per person per year Activity based funding (ABF) Health services are funded based on the activity they undertake Health system produced more than treated patient cases includes maintaining the health of people at home, prevention, teaching and research. Fort this reason, no hospital system in the world is funded solely on the basis of its ‘casemix’ Financial incentive is to minimise the cost of each episode of care, which inevitably rewards the shortest length of stay in a hospital bed and raises concerns that patients will be discharged too soon Case mix Classifies patients according to clinical characteristics o Allows for benchmarking of patient and length of stay Case mix data is used to enhance the management of hospital resources Aids in financial management o The cost of care is calculated on the average cost of treating a patient with similar characteristics A two-tiered health system Public vs, private o 70% of patients wait many months for surgery- if you are privately insured you can have it tomorrow o Some areas of surgery are now predominantly preformed in private hospitals o Patients without private health insurance therefore have to wait o Equity challenge: where access is based on the ability to pay Many patients wait for a greater than 9 months for some elective surgery o Physiotherapy: in the public hospital patients can wait for up to 6 months Public private mix in health funding Access to health services is becoming less equitable Patients out of pocket expenses have grown 50% in the past decade o For some this presents a sizeable barrier to healthcare

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Private health surcharge o Unfair to some, those living in rural areas who do not have access to private facilities

Cost Shifting From state to federal government by privatising outpatient saves the state government o But costs the tax payer more because the fee for service payment is considerably more than the sessional payments for doctors Should we be concerned for the future? Yes  area of health funding Health and disease burden is changing o Increase in chronic disease o Children  type 2 diabetes mellitus associated with obesity o Children are not as health today as earlier generation Rapid expansion of urban Australia  created challenges in planning for health and sustainable communities Increasing urbanisation o Obesity, asthma and depression Week 2 Lecture Nurse Regulation Nursing is regulated as a profession Regulation may be either o Statutory regulation or o Self regulation Statutory regulation Created under legislation enacted by parliament and deals with regulation of the profession, including protection to the public Legally binding (required) Protect the public by establishing a national scheme for the regulation of health practitioners and students Health Practitioner Nation Law 2009 No 89a Establish a national registration and accreditation scheme o Regulation of health professionals o Registration of students undertaking a qualification for registration in a health profession/clinical training Nurses subject to the laws (e.g. the Poisons and Therapeutics Act) which govern our practice Nurses are subject to system of regulation imposed by the government o Primarily determined by the profession o Profession should be able to implement a self-regulatory system that establishes nursing standards and disciplinary procedures Nurses are expected to know and practice nursing according to the standard of care established by the professional board Self-Regulation The standards set by and the mark of a profession Standards set by the profession determine the minimum acceptable standards required for nursing practice Includes anything beyond commencement or entry to practice The standards and codes also apply to nursing students Legally persuasive Grounded in the ideals of professional behaviour and conduct Self-regulation aims for protection of the public If the governance of nurse by nurses in the public interest o Aimed at providing evidence that we are meeting society’s expectations and maintaining standards of practice Elements: o Setting a professional standard o Development of codes and ethics and professional conduct o The generation of knowledge The strength and unity of the profession is dependent on those who belong to i o Readiness of each individual nurse to be personally accountable for their practice Self-regulation increases professional standards and accountability o This in turn increases the quality of the nursing and care Statutory regulation and self-regulation must work closely together The profession governs itself through its regulatory body (NMBA) and with the involvement of its professionals The nursing profession has an excellent history of self-regulation – protection of the public o We continue to feature as one of the most trusted professions Self-regulation is a privilege that can be taken away to o Promote good practice o Prevent poor practice o Intervene where practice is unacceptable How is practice self-regulated? Formal ways of regulating practice o Registration standards

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o Codes of conduct and ethics o Registered nurse standards for practice (there are also other for enrolled nurses and nurse practitioners) Informal way of regulating practice o Policy o Procedure o Guidelines

Nursing Codes and Standards Codes and Standards Codes designed for multiple audiences o Nurses o Nursing students o People requiring or receiving nursing care o Other health workers o The community generally o Employers of nurses o Nursing regulatory authorities o Consumer protection agencies The cores and standards apply in their entirety Meaning the whole document should be read and understood, from introduction right through to the final paragraph Registered nurse standards and practice Registered nurses are responsible and accountable to the Nursing and Midwifery Board of Australia Registered nurse standards for practice should be evident in current practice, and inform and development of the scopes of practice and aspirations of the registered nurse Registered nurse practice is person-centred, and evidence based with preventative, curative, formative, supportive, restorative and palliative elements Registered nurses work in therapeutic and professional relationships with individuals, as well as with families, groups and communities Practice if not restricted to the provision of direct clinical care. Nursing practice extends to any paid or unpaid role where the nurse uses their nursing skills and knowledge Seven Standards: 1. Thinks critically and analyses nursing practice 2. Engaged in therapeutic and professional relationships 3. Maintain the capability for practice 4. Comprehensively conducts assessments 5. Develops a plan for nursing practice 6. Provides safe, appropriate and responsive quality nursing practice 7. Evaluates outcomes to inform nursing practice The standards are interconnected Standards one, two and three relate to each other, as well as to each dimension of practice in standards four, five, six and seven

ICN Code of Ethics A guide for action based ono social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. Nurses have four fundamental responsibilities: 1. To promote health 2. To prevent illness 3. To restore health 4. Alleviate suffering The need for nursing is universal To achieve its purpose the code must be understood, internalised and used by nurses in all aspects of their work. Must be available to students and nurses throughout their study and work lives. Four Elements: o The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct and give a framework for the standards of conduct.

1. 2. 3. 4.

Nurses and people: Nurses primary professional responsibility is to people requiring nursing care Nurses and practice: Nurses carry personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning Nurses and the Profession: Nurses assume the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education Nurses and co-workers: Nurses sustain a collaborative and respectful relationship with co-workers in nursing and other fields.

Code of Conduct for Nurses Comes into effect 1st March 2018 “Professional conduct refers to the manner in which a person behaves while acting in a professional capacity” “professionals will uphold exemplary standards of conduct. Not generally expected of lay people or the ordinary person in the street” Conduct is framed around seven principles, each with a supporting values statement o The principles are categorised into four domains o ‘person’ is used to refer to those in a professional relationship with a nurse Four Domains: 1. Practise legally 2. Practice safely, effectively and collaboratively 3. Act with professional integrity 4. Promote health and wellbeing The principles o Apply to all nurses and midwives across all areas of practice o Founded on evidence-based practice o Designed to be read in conjunction with NMBA standards, codes and guidelines Principle No 1 o Legal compliance  Nurses respect and adhere to their professional obligations under the national law, and abide by relevant laws. Principle No 2 o Person-centred practice  Nurses provide safe, person-centred and evidence-based practice for health and wellbeing of people and, in partnership wit...