1http://ginconforti.com/images/sheep_in_the_meadow_q8fc.jpg

SkitSkit

CNA Code of Ethics for RN’sCNA Code of Ethics for RN’s

Value 7Value 7

“Being Accountable”“Being Accountable”

Brought to you by:

ἀρετήἀρετήNURS3400 – C

Shannon MacFarlaneMallory MacGregor

Robert McMurdyTawnya Werb

2

Our Group Name:

ἀρετήἀρετή

Aretēgoodness, excellence, virtue

3

HandoutHandout

4

WebsiteWebsite

5

Accountability

… “an obligation or willingness to accept responsibility or account for one’s actions.”

Accountability represents multiple facets ,including: Integrity Responsibility Answerability Advocacy Moral community

As nurses, we are accountable for maintaining privacy and confidentiality, safeguarding justice and preserving dignity.

6

Individual Accountability

Virtue and Integrity

Moral agencyActing on one’s moral beliefs.

Fidelity to promiseThe ability to commit to one’s promises.

SteadfastnessLoyalty in the face of trouble

7

Individual Accountability

Relational AccountabilityRelational ethics allows nurses to know what is in the best interest of our

patients and what matter to them through a personal connection. Consequently, this responsibility lies in the foundation of accountability.

…continued

8http://www.covenanteyes.com/blog/wp-content/uploads/2008/11/conversation.jpg

Erosion of Moral Integrity

Moral disengagement…“distancing oneself from the relational aspect of

care and focusing instead only on mechanistic skilled tasks.”

This may ultimately lead to moral distress, decreased job satisfaction and a lower standard of care.

9

http://1.bp.blogspot.com/_g8bqCHwZjig/SIxsMCWe1LI/AAAAAAAACVY/019adqYOScU/s400/damsel-in-distress1.jpg

Strengthening Moral Community

The quality of a nurses working environment affects: Job satisfaction Productivity Quality of care Positive patient outcomes

Thus a positive management style is vital to promote a quality environment.

An environment with strong moral community is essential to accountability and the ability to perform compassionate, competent and safe ethical care.

10

““Being accountable is a call to relationship, Being accountable is a call to relationship, to responsiveness and sensitivity to others, to responsiveness and sensitivity to others,

to excellence in practice and to upholding the to excellence in practice and to upholding the profession’s highest standards”profession’s highest standards”

11

Accountability & Accountability & Legal RepercussionsLegal Repercussions

Nurses will be brought before the court when one’s actions or lack of actions result in patient harm.

Battery and assault Issues pertaining to consent Negligence Breach in the standard of care

12

Accountability &Accountability &Legal RepercussionsLegal Repercussions

Ethical violations “actions or failures to act that breech fundamental duties to the persons

receiving care or to colleagues and other health care providers.”

Moral unpreparedness Occurs when a nurse, in caring for a patient, lacks preparation which

jeopardizes the ethical care provided.

…continued

13

AccountabilityAccountability

Canadian Nurses AssociationCanadian Nurses AssociationCode of Ethics for Registered Nurses Code of Ethics for Registered Nurses [2008 version][2008 version]

Value 7Value 7

“Being Accountable”“Being Accountable”

Nurses are accountable for their actions and answerable for their practice

14

Ethical Responsibilities

1. Nurses, as members of a self regulating profession, practice according to the values and responsibilities in the Code of Ethics for Registered Nurses and in keeping with the professional standards, laws and regulations supporting ethical practice.

15

1.

Ethical Responsibilities

2. Nurses are honest and practice with integrity in all of their professional interactions

3. Nurses practice within the limits of their competence. When aspects of care are beyond their level of competence, they seek additional information or knowledge, seek help from their supervisor or a competent practitioner and/or request a different work assignment. In the meantime, nurses remain with the person receiving the care until another nurse is available.

16

2.3.

Ethical Responsibilities

4. Nurses maintain their fitness to practice. If they are aware that they do not have the necessary physical, mental or emotional capacity to practice safely and competently, they withdraw from the provision of care after consulting with their employer or, if they are self employed, arranging that someone else attend to their clients’ health care needs. Nurses then take the necessary steps to regain their fitness to practice.

17

4.

Ethical Responsibilities

5. Nurses are attentive to signs that a colleague is unable, for whatever reason, to perform his or her duties. In such cases, nurses will take the necessary steps to protect the safety of persons receiving care.

6. Nurses clearly and accurately represent themselves with respect to their name, title and role.

18

5.6.

Ethical Responsibilities

7. If nursing care is requested that is in conflict with the nurse’s moral beliefs and values but in keeping with professional practice, the nurses provides safe, compassionate, competent and ethical care until alternative arrangements are in place to meet the person’s needs or desires. If nurses can anticipate a conflict with their conscience, they have an obligation to notify their employers or, if the nurse is self employed, persons receiving care in advance so that alternative arrangements can be made.

19

7.

Ethical Responsibilities

8. Nurses identify and address conflicts of interest. They disclose actual or potential conflicts of interest that arise in the professional roles and relationships and resolve them in the interest of the persons receiving care.

9. Nurses share their knowledge and provide feedback, mentorship and guidance for the professional development of nursing students, novice nurses and other health care team members.

20

8.9.

College of Nurses of Ontario (CNO): Professional Standards, Revised 2002

21

Accountability (1 of 7 Professional Standards)Accountability (1 of 7 Professional Standards)

Each nurse is accountable to the public and responsible for ensuring that her/his practice and conduct meets legislative requirements and the standards of the profession.

CNO: Entry to Practice Competencies

As a graduate nurse, you are accountable for: Knowing/meeting the CNO standards Understanding scope of practice as documented in

the Regulated Health Professions Act All client care provided and decisions about

assigning care to other providers Decisions regarding personal competency to

provide care Actively identify and ask questions Apply a consistent framework to practice decision-

making Perform conscience and deliberate application of

theory to practice via critical thinking and problem solving skills

22

23

RNs personal rights vs. RNs personal rights vs. professional responsibility in professional responsibility in

caring for members of caring for members of undeserved and undeserved and

disenfranchised populationsdisenfranchised populations

Claire D Martino Maze (2004)Claire D Martino Maze (2004)Journal of Clinical Nursing 14Journal of Clinical Nursing 14: 546-554: 546-554

Article DiscussionArticle Discussion

Prejudice and discrimination continue to exist in society and have adversely affected the healthcare system and the nursing profession

24

Discrimination based on: Age Gender Religion Race Sexual orientation Ethnicity Ability

Article DiscussionArticle Discussion

25

Vulnerable populations = groups in society that have limited resources and are at high risk for morbidity and mortality

Groups may include: Disenfranchised Victims of crime Impoverished Frail elderly Stigmatized Women, children Homeless People with AIDS Refugees Racial and ethnic minorities

Article DiscussionArticle Discussion

26

Societal trends indicate that the number of disenfranchised people in the population will increase and put greater demand on the healthcare system

Development of nursing curricula which identify prejudicial thinking, racism, bigotry, and intolerance for marginalized populations will help to decrease fears & increase comfort levels and nurse’s willingness to provide culturally competent care to these populations

Article DiscussionArticle Discussion

27

To provide culturally competent nursing care to underserved and disenfranchised populations involves an understanding of one’s value system and biases while valuing diversity and the uniqueness of others

3 categories of healthcare workers: culturally unaware culturally non-tolerant culturally sensitive

Clinical Nursing Issue

28

Do RNs have an ethical responsibility to remove themselves from caring for populations they are unwilling to serve?

Do RNs have the right to refuse to work with certain populations or is it in their professional obligation to care for these groups?

What do you think?!

Nursing Responsibilities

29

If the nurse concluded that she/he lacks the competence or is inadequately prepared to carry out a specific function, the nurse has the obligation to refuse that patient assignment

A refusal of assignment may be warranted when the risk of injury to the patient is greater by accepting the assignment than rejecting it

RNs are accountable for nursing decisions and actions regardless of personal preference

Nurses Moral Obligation

30

Nurses have the right to object to taking part in procedures that violate their personal beliefs; however, nurses need to do so responsibly or risk charges of patient abandonment

A nurse’s objection can be based on moral, ethical, or religious beliefs not on personal preferences

In an emergency situation the nurse must provide treatment regardless of any personal objections

CNA Code of EthicsPart ll: Ethical Endeavours

Nurses should endeavour as much as possible to advocate for and work toward eliminating social inequities by:

“understanding that some groups in society are systematically disadvantaged, which leads to diminished health and well-being.

Nurses work to improve the quality of lives of people who are part of disadvantaged and/or vulnerable groups and communities, and they take action to overcome barriers to health care” (viii)

31

VideoVideo

32

http://nurs3400.wikispaces.com/Video

33

Villagers Front of Class

Villagers Sheep

Discuss the framework from the position of the primary nurse, Tawnya

Discuss the framework from

the position of the secondary

nurse, Rob

Discuss the framework from the position of the primary nurse, Tawnya

Discuss the framework from

the position of the secondary

nurse, Rob

Your Discussion Goal:

From the position of nurse Tawnya or Rob (video)

move through the framework for ethical decision

making to discuss and reflect upon the situation,

how accountability is illustrated, and how the

scene could have played out differently.

**Also think about The Boy Who Cried Wolf

and who is accountable in that situation**

34

Assessing the Ethics of the Situation:Relationships, Goals, Beliefs and Values

Reflecting on and Reviewing Potential Actions: Recognizing Available Choices and How those Choices are Valued

Selecting an Ethical Action: Maximizing Good

Engaging in Ethical Action

Reflecting On and Reviewing the Ethical Action

35

Discussion

1. What happening here?

2. What could I do?

3. What should I do?

4. What will I do?

5. What did I do?

36

37

Summary Being accountable is a fundamental value inherent in every situation and action nurses encounter in their practice

Accountability is a function of personal integrity, which demands moral agency, fidelity to promise, and steadfastness

Understandings of nursing accountability are changing because of the complex nature of the health care environment and the expanding scope of nurses’ responsibilities

As part of moral community, nurses acknowledge their responsibility to contribute to positive, healthy work environments for themselves and others.

A relational ethic allows us to see accountability as a demonstration of mutual respect, rather than simply a duty.

38

Archway Keystone as Archway Keystone as metaphor for metaphor for

Being AccountableBeing Accountable

http://www.sharetheguide.org/images-folder/generic-images/tree-archway.jpg