ETHICS AND PATIENT

CARE STANDARDS

MRS. PARVATHY GOPI

SNAP SHORT • Ethics - definition , needs, ICN code

• Application of ethics in improving patient care

• Standards of nursing

• ANA nursing standard model

• Patient satisfaction model for nurse managers

• Tips to improve patient satisfaction

DEFINITION

• Ethics refers to the moral code for nursing and is

based on obligation to service and respect for

human life .

CODE OF ETHICS

• A code of ethics is a set of ethical principles that

are accepted by all members of the profession.

POTTER AND PERRY

NEED FOR NURSING ETHICS

1. Patients and service users, and those who care for

them, can use it to provide feedback to nurses

and midwives about the care they receive.

2. Nurses and midwives can use it to promote safe

and effective practice in their place of work.

3. Employer organizations can support their staff in

upholding the standards in their professional

Code as part of providing the quality and safety

expected by service users and regulators.

4.Educators can use the Code to help students

understand what it means to be a registered

professional nurse and how keeping to the Code

helps to achieve that.

INTERNATIONAL COUNCIL OF

NURSES

• Operated by nurses and leading nursing

internationally, ICN works to ensure quality

nursing care for all and sound health policies

globally.

• Introduced in the year of 1953 code has been

revised and reaffirmed at various levels and the

latest been at 2012.

ETHICS

NURSES AND PEOPLE

NURSES AND PRACTICE

NURSES AND PROFESSION

NURSES AND CO WORKERS

WORKING ELEMENT OF ICN CODE

OF ETHICS . • Study the standards under each

element of code.

• Analyze the application of code in

each domain .

• Discuss the code with co workers.

• Work in groups to clarify ethical

decisions .

• Collaborate with national

associations.

–NURSES AND PEOPLE

MANAGERS

• Provide care that respects human rights and is sensitive to values , customs and beliefs of the people

• Provide CNE on ethical issues

• Informed consent and right to choose or deny

• Using recording and MIS to ensure confidentiality

• Environmental safety in work place

EDUCATORS

• Include reference of human rights, equity and justice in curriculum

• Knowledge about informed consent

• Concept of professional values

• Sensitize the importance of social action in current concerns

ASSOCIATION

• Develop guidelines and statements that supports human rights and ethical standards

• Involvement of nurses in ethical committee

• Organize CNE related to ethical issues and informed consent

• Incorporate confidentiality into national code of ethics for nurses.

• Advocate for safe and healthy environment .

NURSES AND

PRACTICE

MANAGERS

• Establish standards of care and a work setting that promotes the quality of care

• Professional appraisal , CNE and renewal of practice

• Monitor and promote personal health of nursing staff

EDUCATORS

• Provide learning experiences that foster life long

• Promote the importance of personal health and illustrates its relation to other values

ASSOCIATION

• Provide access to CNE , journals conferences , distance education etc

• Lobby for healthy work places and services

NURSES AND

PROFESSION

MANAGERS

• Set standards of practice .

• Workplace support for the utilization of research

• Promote participation in national nurses associations

EDUCATORS

• Sensitize the learners the importance of nursing associations

ASSOCIATIONS

• Collaboration to set the standards with other organisations.

NURSES AND CO

WORKERS

MANAGERS

• Create strategies for conflict management.

• Develop workplaces which support ethical system .

• Develop mechanisms to safe guard individual , family and community when care is endangered by health care personnel.

EDUCATORS

• Understanding the role of other health care workers

• Communicate nursing ethics to other professions

ASSOCIATIONS

• Stimulate cooperation with other related disciplines Develop awareness of ethical issues of other professions

APPLICATION OF ETHICS IN

IMPROVING PATIENT CARE

4 P’s

PRIORITISE PEOPLE

PRACTISE EFFECTIVELY

PRESERVE SAFETY

PROMOTE PROFESSIONALISM AND TRUST

PRIORTISE PEOPLE –

1.TREAT PEOPLE AS INDIVIDUALS AND

UPHOLD THEIR DIGNITY.

• Treat people with kindness , respect and compassion .

• Make sure to deliver fundamentals of care effectively .

• Avoid making assumptions and recognize diversity and individual choice .

• Respect and uphold patients rights.

• Deliver care / treatment for which you are responsible and has to be delivered with out any delay.

2. LISTEN TO PEOPLE AND RESPOND TO

THEIR PREFERENCE AND CONCERNS

• Recognize and respect the contribution the people can make to their own health .

• Encourage and empower people to share decisions about their treatment .

• Respect , support and document a persons right to accept or refuse care and treatment. .

• Recognize when people are anxious or distress and respond compassionately and politely .

3. ASSESS THE PATIENTS PHYSICAL ,SOCIAL

AND PSYCOLOGICAL NEEDS .

• Recognise and respond compassionately to

the needs of those who are in the end stage of

their life.

• Act as an advocate for the vulnerable

,challenging poor practice and

discriminatory attitude and behavior relating

to their care.

4. ACT IN THE BEST INTEREST OF PEOPLE

ALL TIMES.

• Make sure of receiving properly taken informed consent and document it before carrying any information .

• Keep to all laws related to mental capacity of the country in which you are practicing.

• Inform colleagues , managers and the patient receiving care that if you have an objection to a particular procedure and arrange for a suitably qualified colleague to take over the responsibility for that persons care.

5. RESPECT PEOPLES RIGHT TO

PRIVACY AND CONFIDENTIALITY

• Respects persons right to privacy in all

aspects of care.

• Make sure that persons are aware of how

and why information is used and shared by

those who are practicing care.

• Respect that the patients right to privacy

will continue after the death of the patient .

• Share the information with other agencies

and professionals when the interest of

patient safety and public protection override

the need of confidentiality.

PRACTICE EFFECTIVELY

6. ALWAYS PRACTICE IN LINE WITH

THE BEST AVAILABLE EVIDENCE

• Make sure that information given is evidence

based .

• Maintain the knowledge and skills you need for

safe and effective practice .

7. COMMUNICATE CLEARLY

• Use terms that people in your care , colleagues and public understands.

• Take reasonable steps to understand people’s language and communication needs , providing where ever possible assistance to those who need to communicate.

• Use a range of verbal or non verbal communication methods and be aware of cultural sensitivities.

8. WORK COOPERATIVELY

• Respect the skills , contributions and expertise of your colleagues , referring matters to them when appropriate.

• Work in cooperation with your colleagues....

• Keep your colleagues informed when you are sharing an information with other health care professionals and staffs.

• Evaluate the quality of care with your colleagues.

Contd…..

• Share information to reduce the risk.

• Be supportive to colleagues if they are suffering

with health or performance problems.

9. SHARE YOUR SKILLS ,

KNOWLEDGE AND EXPERINENCE

FOR THE BENEFIT OF PEOPLE

RECEIVING CARE AND YOUR

COLLEGUES.

10. KEEP CLEAR AND ACCURATE

RECORDS RELEVANT TO YOUR

PRACTICE.

11.BE ACCOUNATBLE FOR YOUR

DECISIONS TO DELEGATE TASKS AND

DUTIES TO OTHER PEOPLE• Only delegate tasks and duties which are

within other persons scope of competence , making sure that they will fully understand your instructions.

• Make sure that everyone you delegate task is adequately supervised and supported

• Confirm that the outcome of task delegated meets the required standards .

PRESERVE SAFETY

12. RECOGNISE AND WORK WITHIN

THE LIMITS OF YOUR COMPETENCE.

13. BE OPEN AND CANDID WITH ALL

SERVICE USERS ABOUT ALL ASPECTS OF

CARE AND TREATMENT, INCLUDING WHEN

ALL MISTAKES OR HARM HAVE TAKEN

PLACE.

14. ALWAYS OFFER HELP IN CASE OF AN

EMERGENCY IN YOUR WORK PLACE OR

ANYWHERE ELSE.

15.ACT WITHOUT DELAY IF YOU

BELIEVE THAT THERE IS A RISK

TO PATIENTS SAFETY OR

PUBLIC PROTECTION.

PROMOTE

PROFESSIONALISM AND

TRUST.

16.UPHOLD THE REPUTATION OF YOUR

PROFESSION AT ALL TIMES

• Keep the standards set by the code in all times.

• Act with honesty and integrity all times

• Treat people in way that will not take an

advantage on their vulnerability.

• Stay objective and have a clear professional

boundary with the patient and their family

members.

• Do not impose your personal or religious belief

on your patient.

Contd….• Act as a role model to nursing students and

newly qualified nurses to aspire to

• Maintain the level of health you need to carry out your professional role .

• Use all forms of spoken , written and digital communication including social media platforms responsibly respecting the privacy of the patients.

17.UPHOLD THE POSITION OF RN

AND RM • Refuse all gifts , hospitality or favors from

the patient .

• Never ask for or accept loans from anyone in your care or anyone close to them.

• Act with honesty and integrity in any financial dealing you have with everyone you have professional relationship with

• Cooperate with media only when it is appropriate .

18. COOPERATE WITH

INVESTIGATIONS AND AUDITS

19. RESPOND TO ANY COMPLAINTE

MADE AGAINST YOU PROFESSIONALLY

• Never allow someone's complaint to affect the

care that is provided to them.

• Use all complaints as a form of feedback and an

opportunity for reflection and learning to

improve practice.

20. PROVIDE LEADERSHIP TO MAKE SURE

PEOPLES WELLBEING IS PROTECTED.

• Identify the priorities manages time, staff and

resources effectively.

• Support any staffs that you may be responsible to

follow the code .

QUICK

BRAINSTORMING

SECTION

Q no 1 :- A nurse is not trained to do the procedure

of IV cannulation , still she tries to do the

procedure . You are the colleague of this nurse.

What will be your action?

• A – You should tell that nurse to not to do this

again

• B – You should report the incident to someone in

authority

• C – You must threaten the nurse, that you will

report this to the authority

• D – You should ignore her act

Q no. 2 A mentally capable client in a critical

condition is supposed to receive blood transfusion.

But client strongly refuses the blood product to be

transfused. What would be the best response of the

nurse?

• Accept the client’s decision and give information

on the consequences of his actions.

• Let the family decide

• Administer the blood product against the patients

decision

• The doctor will decide

Q No 3. A police officer approached the nurses’

station asking for information on a specific client.

The nurse knows that the she can give the

necessary information if:

• The police shows his identification

• The police officer has the right to such

information

• There is a clear risk of safety and potential harm

to the public

• The hospital manager authorized to give the

information

STANDARDS OF

PROFESSIONAL NURSING

PRACTICE

NURSING STANDARDS• Nursing standards reflect a desired and achievable

level of performance against which actual

performance can be compared. Their main

purpose is to promote, guide and direct

professional nursing practice.

(Registered Nurses Association of BC (2003) & the

College of Nurses of Ontario (2002)

WHY STANDARDS ARE IMPORTANT • Outlines what the profession expects of its

members.

• Promotes guides and directs professional nursing practice – important for self-assessment and evaluation of practice by employers, clients and other stakeholders.

• Provides nurses with a framework for developing competencies

• Aids in developing a better understanding & respect for the various & complimentary roles that nurses have.

STANDARDS OF NURSING

STANDARDS OF PRACTICE

STANDARDS OF PROFESSIONAL PERFORMANCE

HEALTHY WORK ENVIRONMENT FOR

NURSING PRACTICE

SKILLED COMMUNICATION

TRUE COLLABORATION

EFFECTIVE DECISSION MAKING

EFFECTIVE STAFFING

MEANINGFUL RECOGNISATION

AUTHENTIC LEADERSHIP

MODEL OF PROFESSIONAL NURSING

PRACTICE REGULATION- ANA 2006

ANA STANDARDS OF PRACTICE

ANA STANDARDS OF PROFESSION

ETHICS

EDUCATION

EBP

QUALITY OF PRACTICE

COMMUNICATION

LEADERSHIP

COLLABORATION

PRACTICE EVALUATION

RESOURCE ULTILISATION

ENVIRONMENTAL HEALTH

PATIENT SATISFACTION MODEL FOR

NURSE MANAGERS

Patient flow

Customer service and patient satisfaction

Hiring pratices Safety

Financial goals

Medical staff performance

Work environment

Plans to boost performance

1. PATIENT FLOW • Was the patient spoken with respect when calling in for

an appointment?

• Was the patient greeted by the receptionist with courtesy and respect?

• How long did the patient wait to see the doctor?

• Did the nurse and doctor explain the details of the services provided to the patient?

• Did the nurse and doctor answer all the patient's questions?

CONTD…• Did the patient receive excellent customer service?

• Was the exam room clean, comfortable and prepared?

• Was the waiting area safe, clean and spacious?

2. CUSTOMER SERVICE AND PATIENT

SATISFACTION.

• Develop and distribute Patient Satisfaction Surveys.

• Sit in the waiting area and observe what goes on

from that point of view.

• Put yourself through the entire process.

• Talk to your staff and find out what problems they

may be aware of.

3. HIRING PRACTICES

• CRIMINAL BACKGROUND CHECK

• REFERENCE CHECK

• HEALTH CHECK UP

• VERIFICATION OF CREDENTIALS.

4.. SAFETY

• OCCUPATION AND ENVIRONMENT

SAFETY

• PATIENT SAFETY

5. FINANCIAL GOALS

• RISING OPERATING COSTS

• MAXIMISING INSURANCE

REIMBURSEMENTS

6. MEDICAL STAFF

PERFORMANCE

• COMPLIANCE

• COMMUNICATION

• MOTIVATION

• DEVELOPMENT

7.WORK ENVIRONMENT

8. PLANS TO BOOST

PERFORMANCES

TIPS TO IMPROVE PATIENT SATISFACTION

– NURSES PERSPECTIVE

Scripting

Supplies

Uniform

Hourly Rounding

Sitting Down

Patient Education

Bed Side Report

Nurse Led Initiatives

Nurse Empowerment

Demonstrate Caring

THANK YOU !!!!