UNIT – 5

NURSNING AS A PROFESSION

5 HOURS

Nursing as a Profession
∑ Characteristics of a professional nurse
∑ Regulatory bodies,
∑ I.N.C, S.N.C ,constitution, functions
∑ Current trends and issues in Nursing
∑ Professional ethics
∑ Code of ethics : INC, ICN
∑ Consumer protection act
∑ Legal terms related to nursing practice, registration & licensing procedures
∑ Ethical and legal responsibilities of a professional nurse , malpractice
,negligence, practice standards for nursing
QUESTIONS

ESSAY

1.DEFINE MALPRACTICE AND NEGLIGENCE.DISCUSS BRIEFLY ON ETHICAL

AND LEGAL RESPONSIBILITIES OF A PROFESSIONAL NURSE, (2+2+8=12)

SHORT NOTES (5 MARKS)

1.CHARACTERISTICS OF A PROFESSIONAL NURSE

2. INDIAN NURSING COUNCIL

3.STATE NURSING COUNCIL

4.CURRENT TRENDS IN NURSING

5. ISSUES IN NURSING PRACTICE

6.CODE OF ETHICS BY ICN

7 CODE OF ETHICS BY INC

8.CONSUMER PROTECTION ACT

9.NURSING CARE STANDARDS

LIST THE FOLLOWING(4 MARKS)

1 .FUNCTIONS OF INC

2CHARACTERISTICS OF A PROFESSIONAL NURSE

3. LEGAL RESPONSIBILITIES OF A NURSE

ANSWER BRIEFLY(4 MARKS)

1.LEGAL TERMS RELATED TO PRACTICE, REGISTRATION AND LICENSING

DIFFERENTIATE BETWEEN(4 MARKS)

1.MALPRACTICE AND NEGLIGENCE

UNIT – 5

NURSNING AS A PROFESSION

5 Hours

ESSAY

1.Define malpractice and negligence,Discuss briefly on ethical and legal responsibilities

of aprofessional nurse(2+2+8=12)

ANSWER

Define malpractice and negligence,

Malpractice

∑ Malpractice is one type of negligence and includes professional misconduct, breach of a

duty or standard of care, illegal or immoral conduct or failure to excise reasonable skill,
all of which lead to harm.

Negligence

• Negligence is described as lack of proper care and attention, and carelessness

ETHICAL RESPONSIBILITY

• Caring demands the provision of helping services that are appropriate to the needs
of the client and significant others
• Caring recognizes the client's membership in a family and community,
• Caring acknowledges the reality of death in the life of every person,
• Caring acknowledges that the human person has the capacity to face up to health
needs and problems in his/her own unique way,
• Caring involves a relationship, which is, in itself, therapeutic, demands mutual
respect and trust.
• Caring seeks to establish and maintain a climate of respect for the honest dialogue
needed for effective collaboration.

LEGAL RESPONSIBILITIES

∑ Responsibility of appointing and assigning:

∑ Responsibility in quality control:
∑ Responsibility for equipment:
∑ Responsibility for observation and reporting:
∑ Responsibility to protect public:
∑ . Responsibility for record keeping and reporting:
∑ Responsibility for death and dying:
 SHORT NOTES (5 MARKS)

1.CHARACTERISTICS OF A PROFESSIONAL NURSE

• Honesty:
• Loyally:
• Discipline and Obedience:
• Courtesy:
• Dignify:
• Personal appearance
• Tact, sympathy,
• sense of humour and patience:
• Optimism:
• Observation and adaptability
• Gentleness and quietness:
• EconomySense of responsibility:.
• Adaptability:

SHORT NOTES (5 MARKS)

2. INDIAN NURSING COUNCIL

The Indian Nursing Council (INC) was authorized by the Indian Nursing Council Act of
1947. It was established in 1949 to provide uniform standards in nursing education and
reciprocity in nursing registration throughout the country

Aims and Objectives

• To establish and monitor uniform standards of nursing education for nurse-

midwives, auxiliary nurse-midwives (ANM) and health visitors by doing in-
spection of the institutions.
• To recognize the qualifications for the purpose of registration and employment in
India and abroad.
• To give approval for registration of Indian and foreign nurses possessing foreign
qualification under section
• To prescribe the syllabus and regulations for nursing programs.
• Power to withdraw the recognition of qualification , the institution fails to
maintain its standards

Member Representatives

• The council is composed of:

 • State registration councils.
• Central and state health departments.
• Military nursing service.
• Indian Red Cross society.
• University schools of nursing.
• Health schools.
• Postcertificate schools.
• TNAI members.
• Medical Council of India.
• Indian Medical Association.
• Members of parliament.

Activities

• Making the code of nurses.

• The worldwide accepted definition of a nurse.
• Policy statement on health and social issues.
• Arrange exchange program for study and employment.
• Maintain a register on professional qualification of people.
• Conducting seminars around the world to maintain relationship.

Functions

• It provides uniform standards in nursing education and reciprocity in nursing

registration.
• It has authority to prescribe curriculum for nursing education in all states.
• It has authority to recognize program of nursing education or to refuse recognition
of a program if it did not meet the standards required by the council.
• It is registering the foreign nurses.
• It also maintains Indian Nurses Register.
• The INC authorizes state nurses registration council and examining boards to is-
sue qualifying certificates.

SHORT NOTES (5 MARKS)

3.STATE NURSING COUNCIL

State nurses registration council is independent and recognized as a body that can make
statues and prescribe by laws for trained nurses and prospective nurses who are undergoing
various nursing programs

Functions

• To accredit and inspect schools of nursing in their state.

 • To conduct examinations for general nursing and auxiliary nursing courses.
• To prescribe rules of conduct, take disciplinary actions.
• Registration of nurses and midwives in their state.
• Maintenance of register of nurses, mid-wives and others.
• To renew registration and upgrade registration

Activities

• To look after the various nursing educational programs run under its territory.
• To conduct exams of GNM and ANM in its areas.
• To issue certificates of registered nurse and registered midwife to the qualified
nurses.
• Maintenance of various records such as the names and addresses of all registered
nurses, registered health visitors, registered midwives, registered nurse dais,
registered trained dais in each state.

Renewal of Registration

• The registration once done has to be renewed after a specific period of time or after
attainment of higher education in nursing.
• The renewal process includes sending a duly filled form certified by the training
institution with the copies of all the academic certificates and the required process
fees.

SHORT NOTES (5 MARKS)

4.CURRENT TRENDS IN NURSING

Trends:-It denote changes taken place n Nursing trends:-refers to direction towards which the
different nursing events have moved or are moving.

TRENDS IN NURSING PRACTICE

In Hospital setting

• Comprehensive nursing care in hospital setting

• Progressive patient care
• Team nursing
• Specialized care
• Quality care
• Accreditation
• Trauma care
• Medical technology
• Staff development
• Nursing Audit
• PRO ( Personal Relation Officer) Concept
 • Biomedical waste management n Disaster management
• Paper less hospital and Records and reports
• Patients Bill of Rights
• Multidisciplinary approach
• Emergency care
In community setting
• Primary health care
• Palliative nursing care
• Self care concept
• Domiciliary care
• Public Awareness
• Clean India” concept
• Implementation of new National Health Program and the services
Job opportunities in Nursing service
• Staff nurse

• Ward sister

• Supervisor

• Assistant Nursing Superintendent

• Nursing superintendent

• Director nursing

• In service Education Director

• Clinical Nurse Specialist (Pediatric, Oncologist etc. )

• Nurse Anesthetist

• Nurse Researcher

TECHNOLOGY - TRENDS

• Robotics in OTs
• Robotics in cath-labs / Research.
• Laser Technology in surgery , Instrumentation in medical and surgical practices.
• Biotechnology, Genomics, Molecular Biology and Stem cell research.

TRENDS IN NURSING EDUCATION

• Auxiliary Nurse Midwife (ANM)

• , General Nursing and Midwifery (GNM) ,
• Post Basic B.Sc Nursing
• M.Sc.
• M. Phill
 • PhD in Nursing
• Specialty care
• Nurse practioner ,
• Expanded and extended education

TRENDS IN NURSING EDUCATION SPECIALIZATION

• Pediatric Nursing,
• Oncology Nursing
• ,Thoracic Nursing
• ,Operation Theater Nurse
• ,Certified Registered Nurse Anesthetists (CRNA) ,
• Technology in education

TRENDS IN NURSING ADMINISTRATION

• Participative administration
• ,Delegation of responsibilities ,
• Departmentalized administration ,
• Separate nursing directorate
• ,Right to information Act ,
• Consumer protection act

SHORT NOTES (5 MARKS)

5. ISSUES IN NURSING PRACTICE

• Status of nursing profession in society ,Nurse patient ratio ,

• Diploma Vs degree in Nursing care standards
• Values reflected in our nursing performances. ,
• Attitude, human approach
• Quality in nursing v/s education and practice.
• Legal implication n Media Separate Directorate
• Higher education for senior positions in nursing
• Different levels of nurses that we need in our country.
• Non involvement of nurses in nursing matters
• .No political involvement ,Poor pay structures.

ISSUES IN NURSING EDUCATION

• Nursing Training schools multiplied.

• ,Lack of independent building for schools and colleges
• Lack of independent principal for schools and colleges
• ,Inadequate hostel facilities for students
• Shortage of qualified teachers in nursing
• Inadequate library facilities
• No UGC pay scales for college teachers in nursing
ISSUES IN NURSING ADMINISTRATION

• Non involvement of nursing administrators in planning and decision making in

hospital administration
• Lack of knowledge in management among nursing administrators
• Interference of non nursing personnel in nursing administration
• No written nursing policies or manuals
• No separate budget
• No proper job description for various nursing cadres.
• No organized staff development programs for nurses like orientation
• in-service education, continuing education etc.
• No special incentives

• Inefficiency of nursing councils of state and union to maintain standards in nursing

OTHER ISSUES IN NURSING

• Nursing Shortage
• Patient Satisfaction
• National Patient Safety Initiatives
• Evidence-Based Practice
• Information Age
• Genetics n Globalization of Health
• Aging Population
• Global burden of infectious diseases
• Global burden of non infectious diseases
• Political will
• Unenqual distribution of the health services

SHORT NOTES (5 MARKS)

6.CODE OF ETHICS BY ICN

International Code of Nursing Ethics

Elements of ICN code of ethics

Nurses and people

• The most important duty of a nurse is to provide care for those who require
nursing care
• Nurse should always respect patient's rights. values, customs and spiritual beliefs
while providing care.
• Nurse should provide adequate information about patient's treatment to the patient
throughout the care.
• Nurse should be very much confidential about patients details and documents.
Nurse and Practice

• The nurse carries personal responsibility

• The nurse should maintain her own standardized personal health

• The nurse should use her own intelligence

• The nurse should follow standardized principles of nursing care,

• The nurse plays on important role in planning and implementing critical nursing care,
and maintaining acceptable standards of care in management, education and research.

Nurses and the profession:

• The nurseacting through the professional organization, participates in establishing

andmaintaining equitable social and economic working conditions in nursing.

Nurses and Co-workers

• . Nurse always maintains a healthy and smooth relationship with co-workers.

• Nurse also ensures and safeguards the patient from any danger created by the co-
workers

SHORT NOTES (5 MARKS)

7 CODE OF ETHICS BY INC

1.The nurse respects the uniqueness of individual in provision of care – Nurse

1.1 Provides care of individuals without consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political status, personal attributes, or any other
grounds

1.2 Individualizes the care considering the beliefs, values and cultural sensitivities

1.3 Appreciates the place of individual in the family and community and facilitates
participation of significant others in the care.

1.4 Develops and promotes trustful relationship with individual(s)

1.5 Recognizes uniqueness of response of individuals to interventions and adapts accordingly

2.The nurse respects the rights of individuals as partner in care and help in making informed
choices – Nurse

2.1 Appreciates individual’s right to make decisions about their care and therefore gives
adequate and accurate information for enabling them to make informed choices

2.2 Respects the decisions made by individual(s) regarding their care

2.3 Protects public from misinformation and misinterpretations

2.4 Advocates special provision to protect vulnerable individuals/groups.

3. The nurse respects individual’s right to privacy, maintains confidentiality, and shares
information judiciously- Nurse

3.1 Respects the individual’s right to privacy of their personal information

3.2 Maintains confidentiality of privileged information except in life threatening situations

and uses discretion in sharing information.

3.3 Takes informed consent and maintains anonymity when information is required for
quality assurance/ academic/legal reasons

3.4 Limits the access to all personal records written and computerized to authorized persons
only.

4. Nurse maintains competence in order to render Quality Nursing Care

4.1 Nursing care must be provided only by registered nurse

4.2 Nurse strives to maintain quality nursing care and upholds the standards of care

4.3 Nurse values continuing education, initiates and utilizes all opportunities for self
development.

4.4 Nurses values research as a means of development of nursing profession and participates
in nursing research adhering to ethical principles.

5.The nurse if obliged to practice within the framework of ethical, professional and legal
boundaries- Nurse

5.1 Adheres to code of ethics and code of professional conduct for nurses in India developed
by Indian Nursing Council

5.2 Familiarizes with relevant laws and practices in accordance with the law of the state

6.Nurse is obliged to work harmoniously with members of the health team - Nurse 6.1
Appreciates the team efforts in rendering care

6.2 Cooperates, coordinates and collaborates with members of the health team to meet the
needs of people

7. Nurse commits to reciprocate the trust invested in nursing profession by society

7.1 Demonstrates personal etiquettes in all dealings

7.2Demonstrates professional attributes in all dealings

SHORT NOTES (5 MARKS)

8.CONSUMER PROTECTION ACT

Consumer protection act was passed by the parliament in the year 1986. This act considers
patients as consumers, i.e. buyers of services and the doctor as provider of these services on
payment.

• Services rendered by a doctor, hospital or any other healthcare organization for

carrying out consultation, diagnosis, investigations and treatment fall within the
purview of this act.

• If the charges are reimbursable or there is third parry payment, e.g. employer, in-
surance company, etc. and then also the act is applicable.

• If the services rendered are totally free, then the act is not applicable.

• The act is applicable to the patients who are treated free in paying hospitals.

• Consumer does not have to pay court fees or process fees.

• Prescribed time limit for settling the dispute is 3 months.

Forums/Commissions

in Consumer Protection Act

: District forum: The forum consists of three persons:

a.District Judge as President.

b .two persons having knowledge of any of the following:

• Law

• Economics

• Commerce

• Accounting

• Administration

• Industry.

• . At least one person should be a woman. Compensation not exceeding 5 lakhs is the
limit of this body.
 • . If the complainant is not satisfied with the decision, he/she can appeal to state com-
mission within 30 days.

State commission: Consists of three members:

• Sitting or former Judge of High Court as President.

• .Two persons as described in the composition of district forum.
• This commission attends to the complaints asking for compensation: Which is more
than 5 lakhs Less than 20 lakhs.
• If the complainant is not satisfied with the judgment, the appeal can be made to the
National Commission within 30 days.

National commission: Consists of five persons:

• Sitting or former Judge of Supreme Court.

• Four persons as described in the previous two committees.

This commission handles complaints demanding more than 20 lakhs as compensation.

Consumer Protection Act also provides for:

a.State level consumer protection council.

b.Central consumer protection council for the purpose of:

• Protecting rights of the consumers

• Promoting rights of the consumers

• Educating consumers.

Advantages

1.Doctors are accountable for their actions of:

• Omission.
• .Commission.

2.Speedy justice to consumers.

3.Decisions are made on die basis of law, faith and fairness.

4. It encourages:

• .Proper communication with patients.

• .Proper documentation.
• .Better performance.
• .Reasonable charges
Disadvantages

• Medical services are personalized and cannot be standardized. Hence there may be
unnecessary complaints.
• Doctors tend to practice defensive medicine by ordering more tests, ordering
opinions, from other specialists and treating doubtful conditions vigorously.
• Blackmailing by patients, colleagues, lawyers and so-called social workers.
• Likely damage to the reputation.
• Doctors may refuse to take up complicated cases.

SHORT NOTES (5 MARKS)

9.NURSING CARE STANDARDS

Nursing care standard is a discriptive statement of desired quality against which to evaluate
nursing care.

CHARACTERISTICS OF STANDARDS

1. Statement must be broad enough to apply to a wide verity of settings.

2. Must be realistic, acceptable and attainable.

3. Standards of nursing care must be developed by members of nursing profession.

4. Should be phrased in positive terms.

5. It must be express what is describable.

6. Must be understandable.

7. Must be based on current knowledge and scientific practice.

8. It must be reviewed and revised periodically.

SOURSES OF NURSING STANDARDS

• Professional organization
• Licensing bodies
• Institutions/Healthcare agencies
• Department of institutions
• Patient care unit
• Government unit
• Individuals

Classification Of Standards

• Normative
• Empirical
• End standard
 • Mean standardStructure standard
• Process standard
• Outcome standard

ANA STANDARDS OF CLINICAL NURSING PRACTICE

STANDARDS OF CARE

I. ASSESSMEMT

II. DIAGNOSIS

III. OUTCOME IDENTIFICATION

IV. PLANNING

V. IMPLEMENTATION

VI. EVALUATION

STANDARDS OF PROFESSIONAL PERFORMANCE

I. QUALITY OF CARE

II. PERFORMANCE APPRAISAL

III. EDUCATION

IV. COLLEGIALITY

V. ETHICS

VI. COLLABORATION

VII. RESEARCH

VIII. RESOURSE USE

LIST THE FOLLOWING

1 .FUNCTIONS OF INC

2CHARACTERISTICS OF A PROFESSIONAL NURSE

3. LEGAL RESPONSIBILITIES OF A NURSE

ANSWER BRIEFLY

1.Legal Terms Related to Practice. Registration and Licensing

DIFFERENTIATE BETWEEN

1.MALPRACTICE AND NEGLIGENCE

MALPRACTICE IN NURSING NEGLIGENCE IN NURSING

• Malpractice is one type of negligence • Negligence is described as lack of
and includes professional misconduct, proper care and attention, and
breach of a duty or standard of care, carelessness. Negligence is the
illegal or immoral conduct or failure failure to meet an ordinary standard
to excise reasonable skill, all of which of care, resulting in injury to the
lead to harm. patient
• Malpractice is also a professional • Negligence does not involve intent
misconduct performed in and applies when a care provider
professional practice, any makes a “mistake” in treating patient
unreasonable lack of skill in and that mistake results in harm to the
professional duties or illegal or patient. While the act or omission is
immoral conduct that results in injury definitely negligence
or death to the client or consumer. • In the case of negligence the medical
• In the case of malpractice, the care provider makes a mistake and/or
provider takes action or fails to take doesn’t know that his or her actions
action with the knowledge that the will be harmful.
patient may suffer harm. • Only an experienced medical
• Malpractice is considered more negligence attorney is qualified to
serious than negligence. evaluate the case based on the facts to
determine whether a medical
negligence lawsuit is required