Topic outline
UNIT 1: LEGAL ISSUES IN NURSING (10 sessions)
Key Unit competence: To explain effectively the good and bad nursing practic.
1.0 Introductory activity
Read carefully the case study below and answer to the related questions.
A 25 years old female has been treated in the health centre after presenting the following signs: abdominal pain, fever and loss of appetite. These problems have evolved since two years and by auto medication, she has taken some drugs for relieving headache and but she is still feeling abdominal pain . On admission, the nurse well received the patient and positioned her on the bed before data collection. She started by taking vital signs and the client was shivering with high temperature of 390 Celsius. The nurse decided to withdraw a blood sample then give medication to reduce body temperature. However, a nurse committed an error of giving drug in the wrong route; while the drug should be given in subcutaneous route, she gave it in intramuscular route.
Consequently, the drug given to client resulted in allergic reactions and the client had difficulty in breathing and cyanosis. The nearest hospital was informed and the ambulance comes soon to conduct the client in the hospital. The client was admitted in emergency for better management of the case, a day after she was discharged but she complains against the nurse for being not well cared.
a) Identify the activities carried out by the nurse which may be qualified as good in nursing practice
1.1. Identification of good and bad nursing practice
Learning activity 1.1
After reading the previous scenario, answer to the related questions: During a procedure of drug administration, a nurse gave medication to reduce body temperature but, committed an error of giving drug in the wrong route; while the drug should be given in subcutaneous route, she gave it in intramuscular route.
a) Which acts must be qualified as nursing malpractice?
Definition of nursing practice: Nursing practice may be work experience that is direct and/or indirect patient care in clinical practice, nursing administration, education, research, or consultation in the specialty represented by the credential. The position must be one that may be filled by associate or Registered Nurse.
A good nursing practice is when the nurse provides care with kindness, empathy, compassion and good communication with the patient. The nurse, while caring inspires fairness and trust (Ezio Di Nucci, 2019). Is also when a nurse acts to benefit clients by relieving suffering, restoring and promoting health or preventing diseases (Bandman, 2004). Example: A good practice should respect the six rights of drug administration: right patient, right drug, right dose, right route, right time and right documentation.
Nurses play a vital role in in health care settings in order to meet the needs of their patients with exceptional care. Beyond getting expertise acquired through a nursing degree program, but they display higher qualities that contribute to their professional success. Those ones include:
Hardworking,Knowledgeable,Curious,Effective,Communicator,Optimistic,Compas sionate,Empathetic,Even-Tempered,Flexible,Detail-Oriented,Critical Thinker
a) Hardworking: good nurses have willingness to put in the hard work it takes to meet their goals. At times, lengthy shifts spent on one’s feet make this career physically demanding.
b) Knowledgeable: nurses must possess extensive knowledge to care effectively for their patients, an in-depth understanding of subjects such as human anatomy, microbiology and pathophysiology, added with the skills to apply healthcare theories in real-life situations.
c) Curious: nursing is a professional career that requires specific medical knowledge. It also requires practitioners to be life-long learners. Continuing education is crucial for all healthcare workers. Nurses can pursue additional degrees by entering an RN to BSN program, Master of Science in Nursing and can attend specialized certification programs to grow their knowledge in specific fields.
d) Effective Communicator: Another quality of a good nurse is strong communication skills. In the workplace, nurses must be able to communicate clearly with their co-workers and with patients and their families. They must be able to take instructions from co-workers and supervisors, especially in high-pressure situations.. They must be able to read charts and understand a treatment plan without in-depth instruction..
e) Optimistic: Successful nurses bring an optimistic attitude to their job. They can see the bright side of situations and encourage their patients. Nurses know how to remain positive and focus on serving others. Further, nurses who have a positive attitude can act as leaders in their practice, inspiring optimism in others as well.
f) Compassionate: One of the most important qualities of a good nurse is compassion. In their career, nurses will see patients suffer. Beyond simply offering a solution, they must be able to express compassion for patients and their families. This allows them to form meaningful relationships with their patients.
g) Empathetic: Nurses can listen to patient concerns without interrupting or questioning what patients think might be causing their illness. For some, empathy can be as simple as being told what to expect during a treatment process. The way most healthcare professionals develop empathy for patients is by imagining what they would want if the roles were reversed.
h) Event-Tempered: Healthcare is an emotionally demanding industry, and each day brings highs of joy and lows of sadness. Not getting visibly angry or upset with patients is important no matter how difficult the day has been. Nurses must be able to manage their responses to difficult situations in order to solve problems and concentrate on their patients’ health and safety.
i) Flexible: Remaining calm under pressure also helps nurses stay flexible in their work since shifts are typically long. Nurses may have to work nights, weekends and holidays. They may be called in on their days off to cover shifts. On the job, flexibility is a must for nurses. They cannot predict what the day will bring and what illnesses or injuries they will have to treat.
j) Detail-Oriented: A successful nurse pays close attention to detail. From keeping medical records to developing a care plan, a nurse must avoid making errors at all costs. In this field, mistakes can have severe consequences.
k) Critical Thinker: Nursing requires strong analytical and problem-solving skills. to put together pieces of information and draw rational conclusions. They have to think quickly under pressure to troubleshoot patient needs. A bad nursing practice is when nursing practice has a significant negative impact on client care and the outcome of nursing care provision (Zane Wolf, 2012). All acts involving negligence, abuse and incompetence are qualified poor nursing practice rather than error (Ion et al., 2016a; Ion et al., 2016b). It is also a nursing care provided with poor or low quality level including acts of neglect, abuse or incompetence which occur for any reason not always explicable.
A bad practice can make a significant negative impact on patient and can even lead to negative outcomes. E.g.: administration of a drug to a wrong patient, wrong drug, wrong dose, wrong route, and wrong time and without documenting can lead to fatal consequences to the patient.
Self-assessment 1.1
After understanding the meaning of negligence and malpractice
1. Explain 2 examples of malpractice in nursing care
2. Explain 2 possible consequences of malpractice on the client
1. 2. Concepts of malpractice and negligence
Learning activity 1.2
Each day, patients seek medical treatment from physicians, surgeons, and other health professionals including nurses in low levels of health institutions. Patients place their health, trust, beliefs and lives into the hands of their doctors and nurses. In return, doctors assure their patients that they will provide the best medical care and attention possible in order to promote health. Unfortunately, nurses mistakes have been often observed and left a patient with permanent damages.
a) Considering what you have seen in health institution about the work of nurses, how can you explain a malpractice?
b) Differentiate a mistake and negligence in the nursing practice.
Definition of Nursing malpractice & Nursing negligence
Nursing malpractice is the breach of the duty of care by a health provider (nurse) or medical doctor. Nursing negligence applies when a health provider makes a “mistake” in treating patient and that mistake results in harm to the patient.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines that negligence is a failure to use such care as a reasonably prudent and careful person would use under similar circumstances.” JCAHO defines malpractice as “improper or unethical conduct or unreasonable lack of skill by a professional nurse
Specifically, nursing malpractice or negligence refers to a nurse failing to adequately complete his or her tasks, ultimately resulting in harm to the patient. Failing to properly monitor vital signs or administering the wrong medication can be life altering errors, and sometimes even fatal.
It is described as an act of omission or commission of duty. The components of professional negligence include:
1) Duty to use due care;
2) Failure to meet the standard of care or breach of duty;
3) Anticipation of harm and injury
4) Direct relationship between failure to meet the standard of care and injury.
Examples of nursing negligence: a nurse failing to follow a doctor’s orders for treatment, a nurse administering the wrong medication to a patient, a nurse may fail to: monitor a patient call a doctor for immediate help, perform a nursing procedure properly etc…
Nursing Negligence and its Impact in the Nursing Profession
The nursing profession is a very sensitive work motivated by altruism; it has an autonomy that governs its right and ability to make decisions; it has authority which makes nursing practice updated because of its evidence-based principles; it has accountability for its conducts and responsibilities; it has code of ethics, referring to its professional, social values and it has a distinct identity. As defined by Virginia Henderson, it is done with the heart, the head, and the hand.
Self-assessment 1.2
A male client has attended the district hospital for headache, loss of appetite and body general weakness and dizziness. While the client was standing with others, he starts vomiting, others clients call for help but the nurse who was around did not pay attention to the client. When he approaches for vital signs monitoring, he vomits again and the nurse decide to give a drug against the vomiting. However, she mistakenly gave a somniferous drug.
a) Identify mistakes committed by the nurse
b) Which act of negligence he has done?
c) Explain the impact of this nursing practice on the client health and trust
d) Read the following acts and in 2 columns separate nursing negligence and malpractice
– Failure to assist a client with ambulation
– Administration of a wrong medication
– Failure to call a doctor for immediate help
– Giving a drug in wrong route
– Improper insertion of urinary catheter
– Record vital signs while they are not taken
1.3. Legal issues in nursing practice
Learning activity 1.3
Mr M. was admitted in surgical unit after road accident with head injury and high blood pressure. When he was asleep and unaware, he has not been informed by the nurse and no verbal or written consent given to the nurse. The client has known the event by a friend. The nurse has not followed the code of professional conduct and may face consequences as the client and his family was very unhappy. During that situation, a nurse was taking photos of him and posted then on social media.
1) Enumerate the nursing values violated the nurse
2) The above action is it a malpractice or negligence?
Definition of concepts
The most common legal issues that impact on nursing and nursing practice are those relating to informed consent and refusing treatment, licensure, the safeguarding of clients’ personal possessions and valuables, malpractice, negligence are relating to fights. When the nurse fails to respect nursing values while practicing the profession, this create ethical, legal and professional issues for the nurse.
Legal Issues: are legal implications of nursing practice tied to licensure, scope of practice and a public expectation that nurses practice at a high professional standard. The nurse’s education, license and nursing standard provide the framework by which nurses are expected to practice. When a nurse’s practice falls below acceptable standards of care and competence, this exposes the nurse to litigation/lawsuit. Acts of omission and commission will also subject the nurse to litigation and professional license review. Both litigation and professional license review can result in reprimand of a nurse’s license or loss of a license.
In nursing profession common causes of nursing lawsuits include for example, a failure to advocate for a client by asking precision about a medical order can lead to medication and treatment error. The following errors can lead to lawsuits:
Medication and treatment error, failure to follow standards of care (examples: Institutional policies, medications orders), failure to assess and monitor.
Failure to communicate (example: failure to report in timely manner, failure to report significant changes in patient status, poor communication)
Failure to use equipment in responsible manner, use of defective equipment
Failure to act as a patient advocate (e.g to question incomplete medical orders) , Infection caused or made worse by poor nursing care and failure to document ( Basavanthappa, 2006).
Self-assessment 1.3
Inmate client calls the nurse for help as he has bleeding from the noise and headache. The nurse was doing many other inmates to examine and provide medication and she doesn’t go to see the person who was bleeding until he develops coma status
1) Which ethical problem may arise in that case?
2) Identify the legal issue that this nurse may face?
1.4. Legal Sanctions in nursing practice
Learning activity 1.4
Observe the above pictures, read the scenario below then answer to the questions:
A five years old child have been admitted in Pediatrics unit for general weakness, diarrhea and vomiting, inability to eat and fever. The mother explains the signs and symptoms that had lasted for 3 days. After assessment, the child was dehydrated, has fever and thirsty. The physician ordered fluid replacement, antipyretics drugs and close monitoring of the child. The nurse has given medical order to the mother to bring medication from pharmacy. The nurse has not considered the emergency of fluid replacement and he left the child alone on the bed. While the mother and the nurse were absent, the child has developed seizures, falls down and died. After two hours, the mother come back and found her child already died still lying on the ground
She decides to address a legal complain.
1. Considering this scenario, has the mother right to complain?
2. Enumerate what would be the nurse course of action for this child to avoid the death
3. Which malpractice committed by the nurse that can be legally punished for?
The basis for litigation (legal action or process) can be related to negligence or malpractice, failing to exercise the level of care that a reasonable, cautious nurse would under similar circumstances and professional nurse must avoid.
Acts of omission will also subject the nurse to litigation and professional license review. Both litigation and professional license review can result in loss of a license to practice.
The Board of Nursing in keeping with its mission to protect the public health, safety, and welfare, believes it is important to take a strong position regarding the licensure of individuals who have engaged in dishonest, that may place the public or patients at risk.
The law requires examining what lies behind the purpose of sanctions, which is not to be punitive but to protect the public interest and to promote the profession. The public interest includes protection of patients and clients, maintenance of public confidence in the profession. Therefore, the regulatory body declares and upholds proper standards of professional conduct and behavior.
Possible sanctions may include Suspension order and caution order. A suspension order results in the suspension of the nurse or midwife’s registration for a period of up to one year. They may not practice as a registered nurse or midwife during the period for which the order is in force. A caution order can be imposed for a period of between one and five years, and can be disclosed to anyone enquiring about the nurse or midwife’s fitness to practice history.
Self-assessment 1.4
Considering the role and types of sanction that can be applied to the nurse:
a) Explain 3 public benefits of imposing sanction to the nurse in case of litigation
b) Organize a role play in which we have the mother who has lost the child, the nurse explaining what was happened, the unit manager, 4 from nurses different units as observers and a member of the tribunal court who impose sanction of suspension order
c) What is the main cause of litigation in nursing practice?
1.5. Disclosure of clinical information
Learning activity 1.5
Mr. J. is a nurse working in the health center, he is talkative and a clients treated by him would not like to come to him again, and prefer to change their appointments to avoid him. According to the expected relationship between the nurse and the client, what are probably the problems met by client when cared by Mr. J.?
Nursing staff treat everyone in their care with dignity and humanity.They understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally. A health provider must not disclose patient’s information for any purpose other than providing health care services to the specific patient. It will be considered as violation of confidentiality once patient’s information is disclosed outside delivering care. It is prohibited to disclose patient’s information without their consent, for the client will encounter social outcome like lose confidence from family or society, and for the nurses will lose trust from patient and bad image of the profession.
Self-assessment 1.5
While caring a client in all clinical setting (Health center or Hospital)
a) Explain why a patient information should not be disclosed
1.6. End unit assessment / Summative assessment
End unit assessment
After covering this unit, understanding the legal issues in nursing profession and how to behave in order to promote client health and avoid any action against nursing practice, answer to the following questions:
A. Multiple choice questions (MCQs)
1. Law is defined as those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner. The following are functions of law in nursing except:
a. It provides a framework for establishing which nursing actions in the care of client are legal.
b. It differentiates the nurse’s responsibilities from those of other health professional.
c. It helps establish the boundaries of independent nursing action.
d. It recommends nurses to respect Doctors in medical services
2. While taking care of Mrs. Aurelia, the nurse knows that avoiding deliberate harm or risk of harm that occurs during the performance of nursing actions she is applying which principle among the following?
a. Autonomy
b. Beneficence
c. Justice
d. Non-maleficence
3. Currently, in clinical setting, the client has right to give consent before any medical or nursing intervention. The client consent is:
a. A patient’s right based on the ethical principles of autonomy, respect and decision making about the individual life
b. It is an obligation document that every client must sign if he/she wishes to be cared in health setting
c. It is a document used only before major medical intervention like caesarian section
d. It is a phantom document that explain in mass media but which is not used in practice
B. Read carefully the following statements then, give appropriate answer using True (T) or False (F):
1. The nurse documentation is a way of communication within the health care team
2. When the nurse violated standards of nursing practice, this may lead to litigation and loss of license to practice
3. During the exercise of nursing profession, the nurse has right to opportunities for career mobility and continued education
4. The purpose of law in nursing profession is only to decide sanction against nurses in case of negligence and malpractice
5. Disclosure of clinical information is prohibited in nursing practice
6. Malpractice and negligence can cause negative outcomes for the patient’s health
7. Legal sanctions in nursing include dismissal of the nursing licence
C. CASE STUDY
A 10 years old child is admitted in Paediatric unit for general weakness, diarrhoea, abdominal distension and fever. The mother explains that the signs and symptoms have lasted for 10 days.
After the assessment, the child was found dehydrated and anaemic. The physician orders to withdraw blood sample for laboratory investigations in preparation for to blood transfusion, fluid replacement with Ringer Lactate, antipyretics drugs , and monitoring of vital signs and hydration status every 2 hours. Then, a nurse forgot to take blood sample; the amount of fluid to be given in 4 hours was given in 2 hours. He recorded vital signs not taken and the blood transfusion was not given. The mother decided to address a legal complain.
1. Identify ethical principles not respected with this client
2. After reading the case study, explain the concepts of malpractice and negligence and illustrate your answer by 2 examples from the above scenario
3. If this client dies due to anaemia, do we have a litigation issue against the nurse? Explain your answer.
UNIT 2: LEGAL PRINCIPLES IN NURSING
Key Unit Competence
Effectively use ethical principles during nursing practice
2.0 Introductory activity
Mr J. is a senior nurse working in Medical unit for more than 10 years. He is experienced in caring different clients coming in that service. A client suffering for hemiplegia (paralysis of one side of the body) was admitted for further investigations and better management. Many blood samples had to be taken, the client consented for procedures and while the nurse has inserted a catheter in the vein, the phone rings and takes it, the catheter drains the blood in bed and when he resumes the procedure, the catheter was obstructed. The client refused to be punctured again and complained to the in charge of unit about the incident. Read the above scenario and answer to the following question:
1. Has the client right to refuse a care while he is hospitalized?
2. Which legal principle is not respected by the nurse in this scenario?
2.1. Concepts of law and Legal principles
Learning activity 2.1
The client Mrs.K. 55 years old was admitted in Emergency referred by a nearest health center for better management for a long lasting disease. She has body weakness, fever and high blood pressure. She was awake but very weak to get up alone and to satisfy the need of urination. After a short assessment, the nurse Ms.S. decide to insert urinary catheter and an injection of an analgesic drug even if the client was able to use a bed pan assisted by the care giver. She continued vital signs, and implement medical order
1. Which preliminary task the nurse has omitted?
2. After two days, the client complains about the painful catheter and don’t’ understand why they have inserted it, why this complaint?
The Law is a body of rules of action or conduct prescribed by controlling authority and having binding (obligatory) legal force (Doreen, 2017)
Law are also rules made by humans who regulated social conduct in a formally prescribed and legally binding manner.
Basic nursing laws
All nurses should be familiar with nursing laws and ethics and they should understand as to how nursing legal issues can affect them. Basic nursing laws which all nurses should know are:
Signatures are Golden: when a physician or another health care provider orders that a procedure be done on a patient, it is the nurse’s responsibility to obtain the patient’s informed consent and signature. If the nurse does not obtain his/ her signature, both the nurse and the health care provider can be held liable for damages.
Legislation is all the laws and statutes put into place by elected officials in a state or a country.
Legal principle: are principles that guide nurses in their profession which are linked to the code of professional conduct. They are rules human behaviour that used to be considered as just, before the law started being written.
The importance of principles in Nursing practice : The principles of nursing practice describe what everyone, from nursing staff to patients, can expect from nursing profession. The principles describe what constitutes a safe and effective nursing care, and cover the aspects of behaviour, attitude and approach that strengthen a good nursing care (Royal college of Nursing, 2012). Understand what patients, colleagues, families and caretakers can expect from nurses, reflects on the practice and personal development as a professional. The principles help to generate discussions with colleagues on the aspects of nurse behaviour, attitude an approach that underpins good nursing care. Patients and their families can use the principles to evaluate the care they have received and provide their own appreciation.
Self-assessment 2.1
Show the importance of principles in nursing practice
2.2. Beneficence, Non-maleficence and Empathy
Learning activity 2.2
The client Ms. D. 38years old was admitted in Emergency referred by a nearest health center. She has body weakness, fever and high blood pressure. She was awake but unable to get up alone and to satisfy the need of elimination. The nurse Mrs.S. after assessment gives her a drug to reduce fever but give higher dose than required.
Analyze this scenario and outline the good and bad acts of the nurse Mrs.S.
a. Beneficence is doing or active promotion of good. This is done by providing health benefits to the clients, balancing the benefits and risks of harm, considering how a client can be best helped.
b. Non-maleficence is avoiding harm as a consequence of good. The nurse must weigh the harm against the expected benefit and avoiding deliberate risk of harm that occurs during the performance of nursing actions. Determining if using technological advances provides benefits that outweighs risks.
c. Empathy: It’s the ability to understand and share another person’s thoughts and feelings in a situation from their point of view, rather than your own. It differs from sympathy, where one is moved by the thoughts and feelings of another but maintains an emotional distance.
In nursing practice, there is need of compassionate empathy, with this kind of empathy the nurses not only understand a person’s difficulty and feel with them, but he/she spontaneously moved to help, if needed.”
Self-assessment 2.2
1. Explain the meaning of empathy
2. Using example, explain how you can promote empathy and beneficence in caring clients.
2.3. Self-determination, Justice and Veracity
Learning activity 2.3
Ms.M. a 20 years old female patient, has a hip fracture after a road accident. She was admitted in surgical ward for better management of the fracture. She will probably stay there for a long time as the fracture is diagnosed complicated
The nurse Mr.T. is working in that unit and spends a lot of time near that girl while other clients claim that they don’t receive drugs on time.
What do you think about the nurse professional behaviour?
a. Self-determination: ways by which each nurse professional controls and guides his /her own life, this includes the own life in link with the practice of the profession
b. Justice (fairness, equitability): Justice refers to fairness. Most often used in discussions about access to health care resources, including the just distribution of resources. Justice is the promotion of equity or fairness in every situation a nurse encounters.
The following nursing implications promote justice:
• Care must be fairly, justly, and equitably distributed among a group of patients.
• Ensuring fair allocation of resources. (example: appropriate staffing or mix of
• staff to all clients)
• Determining the order in which clients should be treated. (example: setting priority)
c. Veracity means telling the truth. It is essential to the integrity of the client-provider relationship, to be honest with clients and the client must receive accurate, unbiased, and understandable information.
Self-assessment 2.3
1. What it is the meaning of self- determination for a professional nurse?
2. Using an example, illustrate how a nurse can apply the principle of justice in patient care
3. Give an example of the truth to tell to the client
2.4. Accountability, Autonomy, Fidelity
Learning activity 2.4
The client M. W. 60 years old was admitted in surgical word with surgical wound and has medicine to receive Ceftriaxone 1g BID. The nurse Mr. J. after initial assessment for admission discovered a typing error that the drug is given TID instead of BID. He called the Doctor and asked to change the frequency of medicine which is BID and the Doctor agreed.
Which principles Mr J. is using?
a. Accountability: Nurses have professional responsibility to ensure and they must be competent to practice. They have an obligation or willingness to accept responsibility or to account for one’s actions, it is taking assigned responsibility for something that you have done or something you are supposed to do.
b. Fidelity is the duty to be faithful to one’s commitments including to keep promises, faithful devotion to duty. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner
c. Autonomy is the promotion of independent choice, self-determination and freedom of action, the Independence and ability to be self-directed in health care provision. This means that patients are entitled to make decision about what will happen to their body.
Self-assessment 2.4
1. By using an example, explain how a nurse can involve the client in the nursing care, in order to respect the autonomy and promoter his/ her wellbeing
2. Explain briefly the meaning of fidelity in nursing care, does it have impact in the client recovery?
2.5. End unit assessment / Summative assessment
End unit assessment
Read the following options carefully and choose the right answer
1. While practicing nursing profession, each nurse
a. Ignore their personal values when acting in a professional role
b. Maintain professional values but be aware of personal values
c. Be aware of professional values and always act on personal values
d. Be aware of client values and ignore professional values
2. Autonomy in nursing is concerned with:
a. Respecting people’s right to be self-determining
b. Stopping people making their own decisions
c. Making sure that people make the right decisions
d. Making shared decision taken for the client
3. A nursing student documents the client’s full name and date of birth on a
flip chart for a course in a seminar and put it in the room for presentation.
Which of the following the client rights he is going to violate?
a. Right to full disclosure
b. Right to self determination
c. Right to privacy and confidentiality
d. Right to avoid harm
4. When an ethical issue arises, the nurse must assume responsibility and
behave as a professional. Among the following, which one is the most
important nursing responsibilities in managing client care situations?
a. Remain neutral and detached when making an ethical decision.
b. Ensure that a team is responsible for deciding ethical questions.
c. Follow the client and family wishes exactly
d. Be able to defend the morality of one owns’ action
Read carefully the following statement and answer by T if it is true or by F it is false
1. Fidelity is the duty to be faithful to one’s commitments including to keep promises, faithful devotion to duty
2. They nurse has obligation or willingness to accept responsibility or to account for one’s actions
3. During the exercise of nursing profession, the client has right to participate in nursing acts done on her/his body
4. Empathy: it is the ability to understand and share another person’s thoughts and feelings in a situation from its point of view rather than your own
5. The truth telling is not practical in nursing profession but reserved to medical profession
6. The respect of the client privacy while providing care is not necessary if the client is not aware about surrounding events
Short answer questions
1. Explain the following principles of nursing practice:
Justice, Confidentiality, Beneficence
2.6. Additional activities
a. Remedial activities
1. What are the legal principles respected in nursing practice?
2. Which principles are respected in the following statement
• All clients’ needs respect at the same level , without any discrimination
• Client secret should not be disclosed
• A nurse is responsible to acts done to the patient
b. Consolidation activities
3. How a nurse can promote these principles in healthcare?
• Justice
• Autonomy
4. As a student in the program of associate nurse, suppose you are going to be a proud and competent nurse associate, after learning the conduct of a nurse towards the client and colleagues, your colleague has posted information given by the client, another he promises to the client to help him to get a wheelchair but the client has not received the feedback and he has provided information to the client using medical terms and the client did not understand the meaning
Explain 3 moral principles that the nurse have not respected
c. Extended activities
5. Using examples clarify implications of a nurse to apply the principle of justice in healthcare?
UNIT 3: LEGAL RESPONSIBILITIES IN NURSING
Self-assessment 3.1Key Unit Competence
Practice nursing in a standardized and responsible manner
3.0 Introductory activity
Look at the following image of the nurse in the nursing station then read the following case study
A female client of 39 years old have undergone a surgical intervention for suspicion of peritonitis. During the immediate postoperative period, the client has complained of abdominal pain, vomiting and pain not controlled before she left the recovery room.
She called the same day surgery nurse later in the day complaining of increasing pain and vomiting, weakness and significant fatigue. The nurse assigned to monitor clients after surgery made the assumption that these symptoms were related to her surgery as it happens to many others clients and don’t pay attention to the complaints. The caregiver also go to ask to the nurse to come and see the client but she keeps quietly seated on the chair in the nursing station. Later she come and advised the patient and care giver to wait and see the evolution and don’t inform the surgeon. The patient had, in fact, during vomiting effort ruptured some hemostatic sutures and started to bleed in the peritoneal cavity. The patient later died of hypovolemic shock not corrected on time. The vital signs were not monitored and no further assessment done
This case is an example of the nurse negligence and jumping to a conclusion about the cause of the patient’s complaints and failing to error on the side of caution. Even if pain and vomiting are frequent complaints following abdominal surgery, the nurse have not been aware about possible complications which may arise. After the client death the family has addresses a complaint to the court
1) Identify the nurse responsibilities that were not assumed
2) List the complications which have occurred due to no accomplishment of the nurse’s responsibilities 3) Has the family member right to complain legally? Why?
3.1. Functions of Law in Nursing
Learning activity 3.1
Read carefully the case study below and answer to the related questions A male client of 25 years old named N have attended the health center complaining for lower abdominal pain, fever and pain during urination. These problems are evolving since 3 days and has taken some drugs for relieving pain but he has still abdominal pain and burning urination. On admission, the nurse was busy on personal issues on phone, has received 3 clients who come after Monsieur N and don’t pay attention to the client for a while. When the nurse receive the client N, he starts by blaming the client about his sexual attitude and other clients were following the conversation and at the end he asks to the client to go somewhere else without a reference note as the health center has no Doctor to manage such case and the nurse says that he is not able to treat the client N.
Monsieur N was very unhappy and decide to complain against the nurse for being not well cared.
1) Identify the activities carried out by the nurse which are not correct in nursing profession
2) Identify 2 legal nursing responsibilities not assumed by the nurse
The term “legal responsibilities” means that responsibility which the law attaches to particular conduct of a nurse.
Law can be defined as those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner. Laws are very important for fairness and justice, and bring order in society 22 Ethics and professional code of conduct - Student book - Senior 5 It has developed over the centuries to balance the rights of individual. However laws always respond to changes, to customs, advancement of technology and needs of the society. Law imposes a duty on everyone to conform to certain standards of conduct for the protection of others
• It provides a framework for establishing which nursing actions in the care of patient are legal.
• It differentiates the nurse’s responsibilities from those of other health professional.
• It helps to establish the boundaries of independent nursing action.
• It assists in maintaining a standard of nursing practice by making nurses accountable under the law.
• To protect the rights of the individuals according to the needs of the society.
• To correct inequalities in the society.
• To punish people engaged in forbidden behavior
• Law governs the relationship of private individuals with government and with each other.
Self-assessment 3.1
After reading and understood the content summary on legal issues, answer to the following questions:
1) Explain 2 roles of the law in the practice of nursing profession?
2) Is the law helps you to practice better the profession or impede with your practice?
3.2. Legal responsibilities of nurse
Learning activity 3.2
Mr.T was admitted in Medical unit after having severe headache following a long lasting high blood pressure. The nurse on night duty have not observed that the client blood pressure was high and the client have not received the drug prescribed as the caregiver was not informed or receiving the medical order to buy them in the pharmacy. After the morning shift, the caregiver call the nurse H for help as the client has epistaxis (blood from the noise) and was agitated. The nurse was doing many tasks including completing files in the machine for discharging clients and don’t pay attention to the complaint addressed by the care giver about the nose bleeding until the client develops coma status.
When the Physician arrives he concludes to a probable stroke due to a very high blood pressure not well managed
1) Identify the responsibilities of the nurse that he has not assumed
• Responsibility in the appointment at work: Each nurse has legal responsibility to make full disclosure of her or his background knowledge and skills and notify the nurse manager when given an assignment for which she or he is not qualified. Less experienced or less skilled employees need more professional support and advice from the manager
• Responsibility for Equipment: To protect patients, colleagues and self from injury, a nurse must ensure that all patient care equipment are fully functional and that defective equipment is promptly repaired or replaced.
• Responsibility for observation and reporting: Nursing personnel have more frequent and prolonged patient contact than other care-giver. Nurses are trained to detect and report significant symptoms and reactions.
Consequently, nurses have a legal duty to observe patients frequently and report findings that have diagnostic or treatment value for the patient’s physician and other members of the patient’s treatment team. The nurse also must report all observations and care provided to the client including drugs, routes of administration, and patient outcomes.
Acts not recorded = acts not done
The nurse is expected to observe a patient more closely when his or her condition indicates increased health risks like infants, children, aged, disoriented psychiatric and critically ill patients who require more frequent observation than other patients.
When the patient’s condition deteriorates to the point that immediate action is needed to save life, the nurse must report observations of the patient’s worsening conditions to the concerned doctor, health care team and direct supervisor. A clear, accurate, and accessible documentation is an essential element of safe, quality, evidence-based nursing practice. It is an important document for the continuity of care, Communication within the Health Care Team and Communication with Other Professionals
• Responsibility for Record Keeping
Nurses have legal responsibility for accurately reporting and recording patient’s conditions, treatments and responses to care. The medical record is a written or computerized account of a patient’s illness and treatment that includes information submitted by all members of the patient’s health care team. The medical record is an information source document that should be used to plan care, evaluate care, allocate costs, educate personnel, research care measure, and substantiate legal claim
• Responsibility to Protect
Public The nurse has a legal duty to protect the public from injury by dangerous patients. Each nurse manager or administrator should ensure that the health care setting in which she or he is employed has a policy describing the procedure to be followed when a patient with violent tendencies or who threatens violence to others is discharged or escapes from the health care setting. Reporting information about criminal acts obtained during patient care, should be done only to the concerned authority, because it is considered a privileged communication.
Self-assessment 3.2
What are the legal responsibities of a nurse?
3.3. End unit assessment
End unit assessment
1. Law is defined as those rules made by humans who regulated social conduct in a .formally prescribed and legally binding manner. The following are functions of law in nursing except:
a. It provides a framework for establishing which nursing actions in the care of client are legal.
b. It differentiates the nurse’s responsibilities from those of other health professional.
c. It recommend nurses to respect Doctors in medical services
d. It helps establish the boundaries of independent nursing action.
2. In which of these situations could the nurse in collaboration with medical team take responsibility about the treatment decision of the client is legally made?
a. Never, patients or their legal guardians, always have the right to make their own treatment decision
b. When the patient’s initial decision may do more medical harm than good
c. When the physician disagrees with the patient’s decision
d. When the patient is not competent to make a decision and there is no family or legal guardian available
SECTION II : ANSWER BY TRUE OR FALSE
Read carefully the following statement and answer by T if it is true or by F it is false
1) The nurse documentation is a way of communication only within the health care team report
2) When the nurse violated standards of nursing practice, litigation and loss of license to practice can occur
3) The purpose of law in nursing profession is only to decide sanction against nurses in case of negligence and malpractice
4) They nurse has obligation or willingness to accept responsibility or to be held accountable for one’s actions
5) During the exercise of nursing profession, the nurse has responsibility in proper and safe use of medical equipment
SECTION III: SHORT ANSWER QUESTIONS
1) Explain 4 examples of data to record in nursing documentation
2) Enumerate four characteristics of the nursing documentation and records
3) Explain two (2) importance of the nursing documentation
4) Explain 3 benefits of legal sanction for the nurse in order to assume his /her responsibilities
5) Enumerate 3 types of legal responsibilities of a nurse
UNIT 4: CLIENT AND PATIENT
Key Unit Competence
Perform clients’ rights and responsibilities when providing care
1.0 Introductory activity
Mrs Q. is working in the service of Accident and Emergency (A&E) as associate nurse and Mr N. a male patient is presented to the ward having life threatening signs. He is in unconscious status with GCS of 8/15, SO2 of 85%, pulse of 112beats/minute, BP of 200/165 mmHg and temperature of 38.9 Celsius degrees. He needs an emergency treatment and some important exams to be done like blood sugar test and head CT scan that require some payments. However, the patient does not have any health insurance and any contact from his family.
1) What are you going to do?
2) Explain some aspects related to the client’s rights and responsibilities that are presented in this case
4.1. Concepts of clients, patients and clients ‘rights
Learning activity 4.1
Mrs T. a 40 years old female patient female patient is presented to the ward where Nurse Mr H. is a nurse working with other two associate nurses. She presents acute abdominal pain with temperature of 38.8 degrees Celsius and tachycardia with pulse of 122 heartbeats/min and hypotension of 80/45 mmHg. However, the patient does not have any health insurance and any contact from his family.
1) Which rights of the clients that are challenged for Mrs T.?
2) How Mr H. will proceed to respond to those challenges?
Despite outlining the rights that every patient is expected to exercise, legal and human rights activists feel that much should have been done to educate the public on the document and make them aware of the rights they have when it comes to attain the best health care.
a) Clients: nursing client refers to an individual designated to be a recipient of nursing service in a health care situation. Nursing client may refer to groups of people such as families who receive nursing care as groups, or as aggregates such as a community or population especially in the context of public health and community health nursing. The concept of patient-centred/person-centred care has been developed in nursing as well as in medicine as an approach to uphold clients’ autonomy and self-determination.
b) Patient: an individual who sought the assistance of a healthcare professional
c) Client’s / patient’s rights: patient rights are those basic rules of conduct between patients and medical caregivers as well as the institutions and people that support those ones (Davis &Williams, 2020).
Self-assessment 4.1
Differentiate client and patient
4.2. Patients rights
Learning activity 4.2
Mrs Y. a female patient is presented to the health centre family planning services, where Mrs F. is a Registered Midwife (RM). However, his husband does not accept the use of family planning and Mrs Y., is asking the RM to keep secret so that his husband will not know that she is using those services.
1) Which right is Mrs Y is concerned about?
2) How Mrs F. will proceed to help Mrs Y. effectively
a. Access to health care
According to the patient’s right charter, every person should be able to access promotional, preventive, curative, reproductive, rehabilitative and palliative care without struggling. To access health care, the facility must be within the patient’s reach.
“This right also allows you, as a patient, to access health care without discrimination or stigma whatsoever”. Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (Institute of Medicine, 1993).
Everyone has the right to access health care services that include:
• receiving timely emergency care at any health care facility that is open regardless one’s ability to pay, treatment must be made known to the patient to understand the consequences thereof;provision for special needs in the case of, children, pregnant women, the aged or disabled persons,
• counselling without discrimination, coercion or violence on matters such as reproductive health, cancer or HIV/AIDS; palliative care that is affordable and effective in cases of incurable or terminal illness; receive health information that includes the availability of health services, how best to use health services and health information shall be in the language understood by the patient.
b. Right to receive emergency treatment at any health facility and be informed health insurance policy : any patient who is in need of emergency treatment should receive treatment. ‘Emergency Care’ means inpatient and outpatient hospital services necessary to prevent the death or serious impairment of the health. Examples of cases with emergency treatment: bleeding, breathing difficulties, fit/epileptic seizure, severe pain and active labour. Patients are entitled to know all the privileges accorded to them by their health insurer.Those ones include the contents and decisions of the medical scheme and health insurance policy. The insurance coverage should be without discrimination on the basis of age, pregnancy, disability or illness (including mental disorders). c. Right to choose a health care provider and continuity of care: the patients have the right to choose, the doctor or nurse they would like to treat them. Furthermore, this right is also hard to exercise in public hospitals where human resources are overloaded.
• Access to health care consists of four components (Healthy People 2020):
– Coverage: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
– Services: Having a usual source of care is associated with adults receiving recommended screening and prevention services.
– Timeliness: ability to provide health care when the need is recognized.
– Workforce: capable, qualified, culturally competent providers.
b. Right to receive emergency treatment at any health facility and be informed health insurance policy : any patient who is in need of emergency treatment should receive treatment. ‘Emergency Care’ means inpatient and outpatient hospital services necessary to prevent the death or serious impairment of the health. Examples of cases with emergency treatment: bleeding, breathing difficulties, fit/epileptic seizure, severe pain and active labour.
Patients are entitled to know all the privileges accorded to them by their health insurer. Those ones include the contents and decisions of the medical scheme and health insurance policy. The insurance coverage should be without discrimination on the basis of age, pregnancy, disability or illness (including mental disorders).
c. Right to choose a health care provider and continuity of care: the patients have the right to choose, the doctor or nurse they would like to treat them. Furthermore, this right is also hard to exercise in public hospitals where human resources are overloaded.
d. Right to refuse treatment: the charter of patient’s rights states that any patient or client may refuse treatment provided if it does create an immediate danger to them or the health of other people. However, it states that such refusal shall be documented in writing by the medical service provider in the presence of an independent witness. It is wise to document that the patient clearly understands the risks and benefits of their decision. Patients with an altered mental status because of alcohol, drugs, brain injury, or medical or psychiatric illness may not be able to make a competent decision. Although laws have established the right of an adult to refuse life-sustaining treatment, they do not allow parents or guardians to deny children necessary medical care. “The right to practice religion freely does not include the liberty to expose the community or child to communicable disease, or the latter to ill health or death.
e. Right to confidentiality: while every person has a right to have their medical information kept confidential. Confidentiality shall be upheld except where consent has been expressly given. Confidentiality should be maintained even after the patient dies.
f. Right to information: Patients should be able to get their information concerning his/her diagnosis and treatment. A patient has a right to be given accurate information about his/her health status in a language that is easily understood. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions.
g. Right to complain: the charter notes that you have a right to complain about the health services of any health facility to the relevant authorities and have such complaints investigated and a response from the authority received within 12 months (one year), many patients are not even aware of this provision.,
h. Right to a second medical opinion: patients have a right to a second opinion about their diagnosis, procedures and treatment to undergo, if they wish Patient should receive quality drugs e.g. check expiration date. Allergies or other severe side effect s of drugs have to be taken into consideration to ensure patient’s safety.
i. Right to informed consent to treatment: art of communication in medicine involves informed consent for treatment and procedures. This is considered a basic patient right. This is not only about the health care provider seeking the patient’s permission to perform a procedure. Thereafter, decision should be made willingly and free from compulsion.
Informed consent involves the patient’s understanding of the following:
• What the health care provider is proposing to do
• Whether the health care provider’s proposal is a minor procedure or major surgery
• The nature and purpose of the treatment
Intended effects versus possible side effects
• The risks and anticipated benefits involved
• All reasonable alternatives including risks and possible benefits.
Some factors may make a patient incapable of providing competent consent either temporarily or permanently. Those include the following: mental illness or mental retardation, alcohol or drug intoxication, altered mental status, brain injury, being too young to legally make decisions concerning health care.
j. Right to be treated with respect and dignity: every person has inherent dignity and the right to have that dignity respected and protected.
Self-assessment 4.2
1) What are situations to give patients emergency care?
2) What elements the patient need to understand before giving informed consent?
4.3. Clients’ / Patient’s Responsibilities
Learning activity 4.3
Mr B. a male patient with 24 years old is admitted in the ward of Internal Medicine where he receives treatment for leukemic cancer. He receives pain killer every four hours and is waiting for an appointment to the oncologist. However, during his hospitalization, he was disturbing other patients due to the noise in his room. He plays his radio to the maximum volume and receives too much visitors who have long discussions and shouting with laughs in the room. All the patients are claiming that they are not comfortable with the noise from the room of Mr B. He says that it is his right to listen to music and have conversations with his friends.
As a nurse what advise will you give to Mr B.?
a) Provide accurate and complete information: patients are responsible for providing correct and complete information about their health condition and past medical history.
b) Patients are responsible for taking care of own health: they are expected to report on unexpected health changes in their general health condition, symptoms, or allergies to the responsible health care provider.
c) Compliance to the treatment: patients are responsible for reporting if they do not understand the planned treatment.
d) Acceptance on informed consent: patients are responsible for what happens if they refuse the planned treatment.
e) Relation to others: patients are responsible for treating others with respect, respecting the property and rights of others; they are responsible for respecting the rights of health providers and other patients.
f) Protection of environment: patients are responsible for following facility rules regarding smoking, noise, and use of electrical equipment assisting in the control of noise and the number of visitors in their rooms. Patients are responsible to access and use the health system properly and not abuse it
g) Adopt positive attitudes toward their health and life: patients are responsible to follow the recommended treatment plan they have agreed to, including instruction from health personnel. Patients are responsible to follow all instructions and adhere to treatments prescribed
h) Respect of appointment: patients are responsible for keeping appointments
Self-assessment 4.3
1) Use an example to illustrate at least five among the client’s responsibilities
2) Explain the responsibility to adopt positive attitudes toward their health and life
4.4. End unit assessment
End unit assessment
A. MCQ
1. Which one among the following is not included in the patient’s rights?
a. Access to healthcare
b. Confidentiality
c. Taking photos of other patients
d. Informed consent
2. Access to health care include the following component
a. Coverage
b. Services
c. Timeliness
d. Workforce
e. All of the above
3. A patient has got right to an informed consent that comprises the following:
a. What the health care provider is proposing to do
b. The nature and purpose of the treatment
c. Intended effects versus possible side effects
d. All reasonable alternatives including risks and possible benefits.
e. All of the above
4. Risks for drug products include the following except
a. Allergies
b. Drug forms
c. Medical errors
d. Side effects
5. Organ donation include the following organs except
a. Kidney
b. Brain
c. Lungs
d. Liver
6. Which one among the following is included in medical emergencies?
a. Breath difficulties
b. Bleeding heart attack
c. Stroke
d. All of the above
7. The following factors influence the choice of health care provider by the patient except
a. Interpersonal factors
b. Availability of information
c. Educational qualification
d. Quality of treatment.
8. Patient’s responsibilities include the following except
a. Provide accurate information about their health status
b. Pay the cost relevant to their health services delivery
c. Protect the environment and respect other patients
d. Claim and bring health care providers to courts
B. True or false questions
1. A patients has right to be treated for free every time they are presented at the healthcare settings
2. A patient without money or insurance may receive essential health care in case of emergency
3. Patients ought to take responsibility to their own health
4. Patients are not obliged to accept treatment plan without consent
5. Patients are allowed to do whatever they want in the hospital for it is their right
6. Patient are allowed to donate their organ using only their verbal statement
7. Quality product include identity, strength and purity
8. Quality product does not present any side effect
9. Choice of healthcare provider by the patient depends on his qualification and specialty
10. The patient chooses a health care provider depending to the quality of care and interpersonal relationship
C. Short Answer Questions
1. Explain patient’s right regarding confidentialty
2. Clarify patient’s responsibility in regards to other patients
• CASE STUDIES
1. Mr G. RN receives a female patient Mrs I. in the ward of Internal medicine. Mrs I. has got Diabetes Mellitus and has been treated for 10 years with long acting Insulin and the nurse comes for checking blood sugar and he identifies a sudden rise of blood sugar that requires an immediate injection of rapid insulin. However, Mrs I. refused the treatment because the colour of the vial containing Insulin is different from the colour for vial containing long acting Insulin.
a. Clarify reasons that cause Mrs I. to refuses the treatment?
b. Illustrate how Mr G. will proceed enable the patient accept the treatment?
2. Mrs M. a 35 years old female patient is presented to the ward where Nurse Mr K. is a nurse working with other two associate nurses. She presents acute abdominal pain, hematemesis (blood vomiting) with temperature of 36.8 degrees Celsius and tachycardia with pulse of 122 heartbeats/ min and hypotension of 80/45 mmHg. However, the patient does not have any health insurance and is socially unable to pay for treatment. a. Identify the signs that may lead to the emergency care for Mrs T.? b. Describe which emergency care to be given to Mrs M. how Mr H. will proceed to respond to that challenge?
3. Mrs Y. a female patient is presented to the maternity ward for antenatal care services, where Mrs F. is a Registered Midwife and Mr J. is Gynaecologist. Mrs Y was told by her friends that that Mr J. is a good doctor and collaborative. She is Gravida 2, Para 1 in week 20 and has no special problems that require special examination. On the other side Mr J. is called for an emergency C-section for a woman who has got an abnormal labour with decreased foetal heart rate and requires an emergency to save the baby. Mrs F. is in the consultation room to provide antenatal care when Mrs Y gets in the consultation room. However Mrs Y. refuses to be examined by the registered Midwife claiming that she wants to be examined by a gynaecologist and says that it is her right. a. Which right of the client that is challenged for Mrs Y.? b. How Mrs F. will proceed to respond to that challenge?
UNIT 5: PROFESSIONAL NURSING ASSOCIATIONS
Key Unit Competence
Explain functions and roles of professional Nursing associations
5.0 Introductory activity
Look at the following image of the nurses in the nurses in the same room and one of them is having a speech. Read the following case study
Mrs.Y. a 32 years old female client, have undergone a surgical intervention for intestinal obstruction. During the immediate postoperative period, the client has complained of abdominal pain, vomiting and pain not controlled before she left the recovery room. She called the nurse who is working in post-operative room complaining for increasing abdominal pain and vomiting, weakness and significant fatigue. The nurse assigned to monitor clients after surgery would like to follow the post operative pain management protocol but there was no pain killer available in the service as it happened to many others clients and the nurse was really frustrated. The caregiver also go to ask to the nurse at least to have a medical order to buy medication out off the hospital. The nurse inform the doctor for the family wishes but the surgeon did not pay attention on the case. This case is an example of the nurse disappointment in the workplace and lack of client satisfaction towards nursing provision of care which are not linked to the nurse’s incompetence and which leads to client dissatisfaction
1) Identify 3 issues that nurses may discuss about in nurses meeting.
2) What would be the Professional Nursing associations’ roles in promoting the nursing profession?
3) Has the family member right to complain for insufficient medical and nursing care?
5.1. Functions and roles of nursing regulatory body
Learning activity 5.1
The nursing profession has special obligations that aim to provide high quality of care and particularly protect the public against harmful practice
After reading the functions of the regulatory body of nurses and midwives, discuss the importance of the regulatory and the ultimate necessity to be registered in it. Use the following link: https://www.ncnm.rw/
Nursing Regulatory Bodies (NRBs) are jurisdictional governmental agencies that are responsible for the regulation of nursing practice. NRBs achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing.
• Main roles of regulatory bodies
• To Monitor and enforce standards of nursing education
• To establish code of ethics and professional conduct
• To monitor and maintain standard of nursing practice
• To ensure the public rights to quality health care services
• To support and assist professional members
• Set the requirement for registration of nursing professionals
• Licensing of nurses
Nursing Council of Nurses And Midwives (NCNM)
Vision: The vision of the council is to create an environment where nursing and midwifery practice in Rwanda will be the safest and of the highest quality in the region and beyond
Mission: The mission of the Council is to protect the public and the integrity of the nursing and midwifery professions through the regulation of education and practice in collaboration with all stakeholders as well as the community within available resources.
• Core values: Respect, Integrity, Professionalism
Functions of NCNM
The principal function of the Council is to protect the public from harmful or unprofessional practices by ensuring that clients receive care from competent and ethically behaved nurses and midwives.
• The National Council set standards of professional education, practice including professional conduct of nurses and midwives and determine their scope of practice.
• The National Council ensure that the public receives care from only nurses and midwives who meet the required qualifications for provision of safe and effective care.
In order to ensure that educational and practice standards are met, the NCNM carries out the following:
a) Set up educational standards
• Establish pre-requisites for entry to the nursing and midwifery professions
• Set standards for opening and running nursing and midwifery institutions/ programmers
• Approve programmer curricula
• Collaborate with relevant educational establishments that have quality of education in their responsibilities
• Audit and approve nursing and midwifery educational institutions or programme
• Monitor regularly nursing and midwifery educational institutions to ensure that they continue to meet the set standards
• Take appropriate measures for the institutions that do not meet the standards
b) Set standards of Practice
• Register and issue certificates to all eligible nurses and midwives
• Issue and renew licenses to only those who continue to meet practice standards
• Withdraw license from anyone who abrogates the code of professional conduct
• Ensure that nurses and midwives continue to demonstrate that their professional knowledge is updated in relation to areas of their practice
International Council for Nursing (ICN): the ICN is a federation of more than 130 national nurses’ associations, representing the more than 27 million nurses worldwide
ICN Mission: to represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies.
ICN Vision: the global community recognizes, supports, and invests in nurses and nursing to lead and deliver health for all.
Self-assessment 5.1
In Rwanda, the ministerial order has put in place a regulatory body which is still functioning for nurses and midwives
1) Explain 2 functions of a regulatory body in nursing
2) List 2 consequences which may arise in nursing practice if the regulatory body is not established
3) Is each nurse or midwife need to register in the regulatory body? Explain briefly why
4) What would be the role of regulatory body in case of violation of professional code of conduct?
5.2. Associations
Learning activity 5.2
Visit this site and state missions of this organization:https://rnmu.rw/
What are the roles of nursing association?
A Regulatory body is different from association as in association, a person is free to be member but in Regulatory body, there is obligation to registered and recognized.
Rwanda Nurses And Midwives’ Union (RNMU)
Functions of professional Nursing and midwifery associations
Vision
The vision of RNMU is to protect the Professional image, improve Socio-EconomicWelfare, and promote the interests of nurses and midwives
FUNCTIONS OF RNMU
Rwanda Nurses and Midwives Union (RNMU) is a combined professional organization and trade union in place to advocate and protect the nursing and midwifery profession in the aspects of labor, social and economic development.
RNMU has the following objectives:
– To have an empowered nurse and midwife who is motivated to provide high quality service
– To advocate for better socio-economic welfare for nurses and midwives
– To promote nursing/midwifery education and research
The RNMU has the following values:
• Dignity & respect of the client
• To uphold and protect the dignity and respect of every person regardless of their age, sex, race, status or religion
• Unity and Solidarity
• To promote partnership and collaborative working which encourages unity and solidarity at all levels
• Transparency and Accountability
• To be open about out work, transparent about our activities, and accountable to each other, our partners and government, as well as to our funders
• Excellence & Professionalism : all staff, members and volunteers are committed to excellence and professionalism in all they do
• Justice & Democracy
• To speak out for social justice, democracy for every human being in the society
• Participation and Ownership: RNMU uphold every member’s meaningful participation and full ownership of the association’s activities.
Self-assessment 5.2
Explain the following values owned by RNMU
5.3. End unit assessment
End unit assessment
After covering this unit, understanding the functions and roles of professional nursing associations and regulatory bodies, answer to the following questions:
1) The collaboration between health workers, patients /clients, families, and society in the provision of quality nursing care as recommended by professional nursing associations is called
A. Patient bye-laws
B. Patient charity
C. Patient responsibilities
D. Patient rights
2) The newly licensed nurse begins work at a hospital unit where staff nurses are allowed to start intravenous fluids. The physician orders intravenous fluids to be started on one of this nurse’s assigned clients. Which of the following actions would be most necessary on the part of this newly hired and newly licensed nurse before starting an intravenous on the client to promote the client safety and protect the nurse against any form of malpractice?
A. Check the hospital policy and check on any certification required
B. Ask another nurse to do a supervised check on administering IVs
C. Ask one of your nursing-school instructors to refresh your skill
D. Take a continuing-education IV course to make sure you have the skills
3) One of the expectations for nurses to join professional association primarily because of
A. Promote advancement and professional growth among its members
B. Works for raising funds for nurse’s benefit
C. Facilitate and establishes acquaintances
D. Assist them in securing jobs abroad
4) A confused client who fell out of bed because side rails were not used by the nurse caring the client is an example of which type of liability that professional nursing associations may advocate or not for the nurse ?
A. Organized physical attack
B. Intentionally malpractice
C. Negligence
D. A crime of high seriousness
5) You are the nurse working with an elderly, competent client who refuses a vitamin B injection ordered by the physician. The
family insists that this injection be given, and you give it while the client is objecting. Even though the client improves, the client contacts a lawyer. From your knowledge of nursing and the law, you realize that you:
A. Did the right thing because the client improved.
B. Should have had the family put their request in writing.
C. Have committed an assault against the client
D. Should have seek permission from the Physician to give the injection Ans work at a hospital unit where staff nurses are allowed to start intravenous fluids. The physician orders intravenous fluids to be started on one of this nurse’s assigned clients. Which of the following actions would be most necessary on the part of this newly hired and newly licensed nurse before starting an intravenous on the client?
A. Check the hospital policy and check on any certification required
B. Ask another nurse to do a supervised check on administering IVs
C. Ask one of your nursing-school instructors to refresh your skill
The newly licensed nurse begins work at a hospital unit where staff nurses are allowed to start intravenous fluids. The physician orders intravenous fluids to be started on one of this nurse’s assigned clients. Which of the following actions would be most necessary on the part of this newly hired and newly licensed nurse before starting an intravenous on the client?
A. Check the hospital policy and check on any certification required
B. Ask another nurse to do a supervised check on administering IVs
C. Ask one of your nursing-school instructors to refresh your skills
The newly licensed nurse begins work at a hospital unit where staff nurses are allowed to start intravenous fluids. The physician orders intravenous fluids to be started on one of this nurse’s assigned clients. Which of the following actions would be most necessary on the part of this newly hired and newly licensed nurse before starting an intravenous on the client?
A. Check the hospital policy and check on any certification required
B. Ask another nurse to do a supervised check on administering IVs
C. Ask one of your nursing-school instructors to refresh
6) When caring for a terminally ill client, it is important for the nurse to maintain the client’s dignity. This can be facilitated by:
A. Making decisions for clients so they do not have to make them
B. Decreasing emphasis on attending to the clients’ appearance because it only increases their fatigue
C. Placing the client in a private room to provide privacy at all times
D. Spending time to let clients share their life experiences
7) Nurses as they progress in the education and got more experience in the professional practice, they will most likely do which of the following things:
a. Learn to develop more critical thinking skills in nursing
b. Become less interested in bedside nursing
c. Lose the ability to think critically in clinical areas
d. Have increased enjoyment when doing research
8) Nurses/ midwives are professionals who constantly deal with customers (inside and outside the hospital). Midwife P is on morning shift and one of the patients, Madam K who had severe abdominal pain. The midwife acts to provide pain medication as soon as possible to relieve the patient of the pain. Madam K is booked for an ultra sound scan to help in her diagnosis. The midwife explains to the patient to seek her approval. Patient has repeatedly voiced fear over receiving a diagnosis of cancer, as she believes this is a death sentence. The physician decides not to reveal the diagnosis to the patient after she says she would kill herself if she had cancer. The nurse reveals the diagnostic to the client and this on kill herself. The family raise the complaint to nursing regulatory body.
9) State the nature of each sentence and explain it briefly
a. Show proof of Excellence & Professionalism
b. To establish code of ethics and professional conduct
c. To establish code of ethics and professional conduct
REFERENCES
1) Bandman Elsie L, (2004) Nursing Ethics Through the life span, 3rd edition, Stamford Connecticut
2) Zane Wolf (2012), Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses, 21(1):16-22, 36
3) Margaret Keatings (2019) Ethical and Legal issues In Canadian Nursing, 2nd edition, Saunders
4) Doreen M et al (2017), Ethical and Legal Issues for Imaging Professionals , 2 nd Edition. https://www.slideshare.net/lindadevi1/legal-issues-in-nursingppt-11889901
5) STEFEN P.O Keef (2021), https://www.gomedmalohio.com/practice-areas/medical-malpractice/hospital-or-nursing-negligence/
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7) https://www.medleague.com/same-day-surgery-nursing-malpractice/
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