Professional Standards in Nursing Practice

Prince June Cruz Kitane, R.N., C.P.S.Administration in Nursing Practice

Master of Arts in Nursing

Definition of EthicsSome definitions would include:

• Deciding what is right or wrong, good or bad, just or unjust• Making decisions which are consistent with one’s value system and the value system of the organization.• When encountering the many grey areas in which it is difficult to distinguish right from wrong, there is always an answer that is more right than the others. This is an ethical answer.

Ethics: Deciding what is right (or what is more right) in a particular situation: determining what ought to be; deciding what is consistent with one’s personal or organizational value system.Management is doing things right .Leadership is doing the right thing. Ethical leadership is doing things right WHILE doing the right thing.

What is a value?Values are the principles & priorities which help us make decisions on a daily basis. If you truly value honesty, you will choose to be honest in interactions. If you value family strongly, you will make time in your life for family. If growth is a top value for you, you will make decisions which encourage personal development. These are just a few examples of the multitude of values which one might hold. Values are constantly changing & developing throughout our lives. In childhood, our values are usually the ones held by parents and other adults around us. As we continue to mature, other influences such as peers & the media affect our values.

THINGS WE NURSES SHOULD DO TO AVOID LEGAL ISSUES-provides nurses with a reference framework to make moral judgments in both simple and complex nursing situations.

ETHICAL PRINCIPLES IN NURSING PRACTICESuccessful ethical discussion depends on people who

have a clear sense of personal values. When people share the same values, it may be possible to identify a philosophy of utilitarianism, which proposes that the value of something is determined by its usefulness to society.

In most ethical dilemmas, the solution requires negotiation among members of the health care team. The nurse’s point develops a relationship with the client that is unique among all professional health care providers.

Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined a difference of opinion, the best plan of action would be to gather all relevant information regarding the clinical, social and spiritual aspects of the dilemma.

COMMUNICATION

Simply, we can define communication as “sharing of ideas or feelings with others.” Communication takes places when one person transmits information and understanding to another person. There is a communication when you respond or listen to someone. Movements of lips, the wave of hands or the wink of an eye may convey more meaning than even written or spoken words.

BASIC MODEL OF COMMUNICATION

Over the years a basic model of communications has evolved that represents the various elements of the communication process. The elements of the model include:

A. Source/Encoding—the sender or source of a communication is the person or organization who has information to share with another person or group. It should be noted that the source can be an individual (e.g., salesperson or hired spokesperson) or a non personal entity such as the corporation or organization itself. The receivers’ perception of the source influences the manner in which the communication is received, interpreted and responded to. 

Encoding is the process of putting together thoughts, ideas and information into a symbolic form to communicate a message. The sender’s goal is to encode the message in such a manner so as to ensure that it will be understood by the receiver.

B. Message—the encoding process leads to the development of a message that contains the information or meaning the source or sender hopes to convey. Messages can take a variety of forms and may include symbolic forms or signs.

The message must be put into a transmittable form that is appropriate for the channel of communication being used.

 

C. Channel—the channel is the method or medium by which the communication travels from source or sender to receiver. At the broadest level, channels of communication exist as two types:

• Personal Channels which involve direct interpersonal contact with target individuals or groups. For example a salesperson serves as a personal channel of communication when delivering a sales presentation.

• Non personal channels are those which carry a message without involving interpersonal contact between sender and receiver. These channels are often referred to as the mass media as messages transmitted through them are sent to many individuals at one time. The two major categories of non personal channels are print and broadcast media.

D. Receiver/Decoding—the receiver is the person(s) with whom the sender shares thoughts or information. Decoding is the process of transforming and interpreting the sender’s message back into thought and is heavily influenced by the receiver’s frame of reference or field of experience. Effective communication is more likely when common ground or shared meaning or understanding exists or has been established between the sender and receiver. 

E. Noise—throughout the communication process the message is subject to noise which refers to factors that can distort or interfere with adequate reception or comprehension. Noise can occur during the encoding, transmission, or decoding of a message. Noise can also occur because of a lack of common ground or understanding between the sender and receiver.

F. Response/Feedback—response refers to the reaction the receiver has after seeing, hearing and/or reading the message. These responses can range from non-observable actions such as storing information in memory to taking immediate actions such as ordering a product seen in a direct response ad. Feedback is the part of the receiver’s response that is communicated back to the sender and takes a variety of forms. Feedback provides the sender with a way of monitoring how the message is being decoded and received by the target audience. 

Patient Teaching in Nursing

Nurses often forget that they are patient educators. In fact, patient teaching and education are essential components of the nursing process (Jones, 2002). Data indicates that when patients are provided with a solid knowledge base about their disease process and treatment, the outcome is more favorable (Boswell, 2007). 

In order to provide teaching, the nurse must first have an understanding of the patient education process. The following is an outline of the overall process:

Assessment: The nurse must first identify the patient’s needs. In this initial process, she must identify the needs and the problems of an individual patient and family. 

Planning & Diagnosing:  Based on this assessment of the patients’ needs, the nurse then formulates a diagnosis and Treatment plan.  This treatment plan should be tailored to the patient’s needs and educational level. The end product of this assessment is a nursing diagnosis which will serve as a guide for treatment. And, this nursing diagnosis is a sound judgment based on data and information (Rankin, 2001). 

In the hospital, it is especially important for nurses to begin patient teaching at the time of admission; and it is equally important to document this teaching for evaluation and reimbursement purposes.  nurses often report feeling that they do not have enough time for teaching. 

The following is a list of strategies that promote the incorporation of teaching into daily nursing practice: 

Emphasize What is Necessary:  In the inpatient setting, many patients fear losing their independence (Jones, 2002). Patients will be motivated to learn what is necessary for them to care for themselves; therefore nurses should emphasize these strategies. 

Choose the Right Time:  Remember when teaching, the timing is crucial. For instance, if the patient has just been informed of a diagnosis, he or she will need time to cope with this information. There might be associated feelings of grief, powerlessness, fear, and vulnerability (Jones, 2002). And, these overwhelming feelings will cloud the ability to learn.  

Plan teaching During an Uninterrupted Time: When teaching the patient, timing is crucial. It is not appropriate to crowd all the patient teaching into the day of discharge. Similarly, it would not be appropriate to provide complex teaching during meal time or visiting hours. 

Use Basic Principles:  It is important to consider the educational level of the patient when teaching. Some patients might be illiterate and may not be able to read handouts; or they might not be able to understand complex medical jargon. 

Evaluate the Senses:  Similarly, it is important to evaluate the patients’ ability to see and to hear. For example, if a patient has difficulty seeing, it might not be practical to give her a handout on disease management.  Or, if the patient has difficulty hearing, it might not be appropriate to provide her with verbal instructions.

Clearly Define Goals & Objectives:  Before beginning teaching, it is important to have a list of goals and objectives that are formulated by the patient and the nurse.  The significance of these should be understood by each person, and they should be evaluated on a continuous basis.    

Remember To Document:  Whenever teaching a new skill, documentation is important. This allows the oncoming nurse to see what has been done, and where she should pick up. Likewise, if the patient has difficulty with a certain skill or needs certain assistance, this should be documented so that accommodations or further instruction can be provided. 

Patient teaching requires that the nurse think critically.  No longer is the nurse simply responsible for administering medications and communicating with physicians; she also plays a dynamic role in assuring that the patient is able to be independent in managing his disease.  In essence, she is an educator; after all, education and teaching are vital components of the nursing process.  However, the teaching process is not uniform in nature.  In order to promote learning, it is valuable to keep these proposed strategies in mind, and to remember that the patient population is indeed heterogeneous. 

Documentation Definition Documentation is any written or electronically

generated information about a client that describes the care or service provided to that client. Health records may be paper documents or electronic documents, such as electronic medical records, faxes, e-mails, audio or video tapes and images. Through documentation, nurses communicate their observations, decisions, actions and outcomes of these actions for clients. Documentation is an accurate account of what occurred and when it occurred. Also referred as CHARTINGInvolves entering data in the clients recordRequires the use of clear, concise and complete wordsThe clients chart is owned by the HOSPITAL/ institution.

PURPOSES OF DOCUMENTATIONCommunication - Proper documentation ensures continuity

of care by facilitating evaluation of a client’s condition based on documented

needs.Education - Documentation serves as a tool to enhance

students learning through a review of client’s record.

Research - Documented data from a client may serve as a data source for researchers. It can initially be used to screen possible subjects for research study.

Legal Document - The information contained in the client’s medical record serves to provide

proof of what exactly happened to a client.Auditing Monitoring- The charts are used to determine the

degree to which nursing care standards are met.

KEY POINTSDocumentation is a vital aspect of nursing practiceThe nurse should ensure that the data recorded, reported or

communicated to other health care team members are confidential and must be protected.

CLIENTS HAVE THE RIGHT TO READ THEIR RECORDSKardex is the source of the most concise and accurate information related

to the client.Source oriented charting is a form of documentation that involves separate

sheets for each member of the health team.When a nurse documents only the significant findings in a client, the type

of charting used in charting by exception.A nurse is legally obligated to sign his/her full name and credential on a

nurse’s note. It is best to sign ones name and credential in full. However in instances where the entry contains the word nurse or staff nurse after the nurse’s name. it can be accepted as long as the nurses name is written in full.

The primary purpose of quality assurance is to provide for the highest level of client care.

The chart can be accessed by the client, physical therapist and the pharmacist or other members of the health team. The clients consent is needed before the chart can be seen by other persons like a relative.

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