Professional Values | : Professionalism - | elie Ethics in Nursing As per the Revised Syllabus for BSc Tete) Suresh K Sharma i Asha P Shetty oO —“‘i‘é€;w &sChapter 1: Chapter 2: Chapter 3: Chapter 4: Contents Unit 1: Professionals in Nursing Profession and Professionalism Tohnsy Rani, R Beutlin Profession 3 Criteria ofa Profession 6 Nursing asa Profession 8 Characteristics of the Nursing Profession 13 Professionalism — 16 Challenges of Professionalism 24 Professional Conduct Biji P Varkey, Deepak Professional Conduct 36 Ethical Principles and Professional Conduct 40 ‘Adherence to Policies, Rules, and Regulations ofthe Institutions 43 Professional Etiquettes and Behaviors 44 Professional Grooming: Uniform, Dress Code 45 Professional Boundaries: Professional Relationship with the Patients, Caregivers, and Team Members 47 Regulatory Bodies and Professional Organization Urvashi Goyal, Jaison Joseph Regulatory Bodies: Roles and Responsibilities 57 Professional Organization 53 International Professional Organizations $4 Indian Professional Nursing Organizations 56 * Unit 2: Professional Values Professional Values 'vashri Sasmal, Rakhi Gaur Professional Values 63 Professional Socialization: Integration of Professional Values Su * * with Personal Values a” ° Professional Values in Nursing 7 ° ring: Definition and Process 78 & Compassion: * Conscientioy: * Dedications Sympathy Versus Empathy and Altruism 82 sness 86 Devotion toWork @9 36 51 63_—_ Chapter 5: Chapter 6: Chapter 7: Chapter 8; Index mma > Respect for the Person Human Dignity 97 Privacy and Confidentiality: Incidental Disclosure 93 > Honesty and Integrity: Tuth-Teling 96 + Trustand Credibility: Fidelity and Loyalty 98 se Advocacy 100 Unit 3: Ethics and Bioethics Ethics and Bioethics 107 Shiv Kumar Mudgal, Rakhi Gaur Meaning ofthis, Morality, Bioethics 107 Ethical Principles 109 Applicaton of Ethical Principles 109 Ethical Issues and Ethical Dilemma 118 Rakhi Gaur, Shiv Kumar Mudgal + Meaning of Ethical Dilemma 118 Conflict of Interest 179 Patemalism 120 Deception 127 Confidentiality and Privacy 122 Informed Consent and Refusal 124 Allocation of Scarce Health Resources 126 Conflicts Conceming New Technologies 127, Whistleblowing 128 Issues Related to Beginning of Life 130 Issues Related to End of ife 142 oS Issues Related to Psychiatric Care 157 Ethical Decision Making 137 Jaison Joseph, Rakhi Gaur Ethical Decision-making in Nursing 157 ‘Significance of Ethical Decision-making Process 157 ‘The Process of Ethical Decision-making 158 % Issues in Ethical Decision Making 162 Fthics Committee 163 Code of Ethics and Patient Rights 170 ‘Navjot Kaur, Shiv Kumar Mudgal % Code ofEthics 170 * Patient's Rights 179 ee tee eee ° too > 191Profession and Professionalism TJohnsy Rani, R Beutlin Learning Objectives Aenean Upon completion of this chapter, the student should be able to: Define the profession Explain the criteria of a profession Describe nursing as a profession Define professionalism and its characteristics Explain the concepts, attributes, and indicators of professionalism Discuss the challenges of professionalism eee HE PROFESSION ‘There are many educational courses one can opt after the school education, such as academic programs and professional programs. The academic programs focus more on the theoretical aspects and are referred to as liberal courses which include Bachelor of Arts (BA), Bachelor of Commerce (BCom), etc. On the contrary, professional Programs, such as Medicine (Bachelor of Medicine and Bachelor of Surgery), Engineering (Bachelor of Engineering), Nursing (Bachelor of Science in Nursing) and Paramedical courses (Physiotherapy, Occupational therapy, Laboratory technology, etc.) are aimed at the cultivation of practical skills that enables a person to work ina Particular field with specific skills. The professional courses prepare Specialized experts in a specific field through intensive training that Can be applied to a variety of job-related situations. Meaning The term + me 4:'™ “profession” is derived from the English word “profess” ‘ch Means ‘to proclaim something publicly: A profession is a job,upations possessing vritted, and responsible visa based on specialized intellectual ocermpose of which is to SUPPLY Skilled f venwhos ore element swork based upon the mastery ‘ Sole todv of knowiedge and skills. Iris a vocation in which ae ‘ce or learning or the practice nowiedge of some department ofscien l soe fed upon itis used in the cervice of IRETS —Sylvia RC, 2010 ofan needs special training or a .d because it involves a high —Cambridge Dictionary fat requires a prolonged —Oxford Dictionary is any nye of work that Profession that is respecte’ particular sil, often one ievel of education profession ise chosen, paid, occupation th training and formal qualification” “an occupation in which an individual uses an intellectual skill ‘based on an established body of knowledge and practice to provide a specialized service in a defined area, exercising independent judgement following «code of ethics and in the public interest” —The UK Inter- professional Group In nutshell, « profession can be viewed as an occupation with specialized study and training bounded by ethical standards to serve mankind, Differences between Occupation and Profession Although the terms “aecupation” Although ih ems ecopton” and “profession” are sometimes tse imerchangeabh the meanings ofthese terms in a more gener ese a ee Profession is an occupation, but all fejuraton. are nore, Understanding hese dilerences ind distinguish between an occ nv occupation and prolession, Reler Table 1 | for differences See dillerences between an occupation jual work and has received \ of eearson ‘Occupation Probesion occupation terstos Redes ae isan occupation ne person's regula actty that needs high level that be or he does a earn enowedage ard 8 09 aiving partir sector coteotcondct 0 Yes Kemataining —Wesnotmandony sesentit equated bystatute NO tes mest. and Notconsedaihe | Consdeed nar etal a nos essential component component 2 in = oftraining a Characteristics ofa Profession characteristics refer to features that stand unique and difeensate fom common things. The main characteristics of a profession are illustrated in Figure 1.1. ‘specialized body of knowledge: Professionals renderspecialized knowledge, and skills that are most often services based on theory, peculiar to their profession. This provides the framework fr the practice, 4 Professional stan based on a general body of co concerned regulatory bodies of the profession. “& Set of skills for specific services: A profession stands 10 provide specialized services based on a set of skills distinct ro thar profession, Therefore, each profession is entrusted with great responsibilities and obligations toward society. 4 Standardized formal education: Every profession is based on 2 standardized formal education controlled by various regulatory bodies. This helps in the preparation of competent members with dards and code of ethics: 4 profession is re values and standards set by the | Characteristics of a profession i - - : | a t | Seated | Professional | | Set of skils| | ody of | | standards 1 spectic | cle muuauaan esosSEED onsen protected environment thats typically practical experience inthe required fora Autonomy an freedom formal while rendering their services. ion. Membersof area particular profess «accountability? king decisionsand HECRITERIA OF A PROFESSION principles or standards fr evaluating a profession, Jained the criteria ofthe profession in diferent teria which explain a profession are listed Criteria ae the Many authors have ex sways Some ofthe major crt below According to Flexner (1915) er has stated six criteria fora profession (Fig, 1.2): llectual activities (as opposed to dl by a high degree of individual Abraham Flexn 1. A profession is based on int physical) and is accompante responsibility ‘The practice ofa profession is founded on a body of knowledge thet may be learned and is expanded and improved via research. In addition to focusing on theory, the professional activities emphasize practical application. 1 Precice | (Sat) Fig. 1.2: Flexner criteria of a profession, SE _— \ 4 Chapter 1: Profession and Profesional ~ CZ secinquesofa profession ar taught through a highly spec rveess of formal education igh ahighly specialized pi pression has a well developed group consciousness and a ie internal organizational structure of members. fiioners in the profession ae driven by altruism (a willingness rr Prat others) and af interested in public concerns, According to Bixler and Bixler (1945) the ° * followingare considered as the criteriafra profession (Fig. L.3); tual and has body of knowledge: The members practicing fession utilizes highly specialized knowledge and ll for their practice. The members of the profession II domains - cognitive, affective, and psychomotor intellect in the pro technical ski are trained in al to develop competency. sential services: The services provided by a profession should be ultimately aimed at providing service to human and social welfare. The services are necessary for survival and they cannot be substituted by others. Continuous professional growth: The profession should offer jts members organized opportunities for continued professional fb. It can be done through continuing education, on-job grows! seminars, workshops, conference, etc traning, (Finsionatand toy tenon | ‘J Provides essential services (@ Seoninemetots 1) Requires higher education 1) Service-oriented : Economic secuity Fig. 1.3: slr criteria fr profession.* Chapter; Profession and Professionals Cra Unit: proesonlin Nusnd cent muse empartti7es with each | to putonesein the Shes Of they forte are more incined 10 regard thei he eine an a person-centered APDrORch pan erty fOllOwINE protocol. An empathetic than wane expenence oF thet pallenty Empathy: A compere and makesan honest 00 P patients. Empat! patient as ‘P* to care rather nurse can ena dramatically Problem-sotving sills: Pr! kills are essential is: Problem-solving S| solving { oftheir time with patients, ores generally spend most " : wee oen Keponsible for much of the decision-making aren ther care. ren small decisions can have majorimpacts on outcomes _ Farr ot amor: Possessing strong Sense of humor aids in i sivityin fellow professional colleagues, patients, and attain ate for any efions to cfer brightness, particularly during stressful periods, Wingnes tern: Development in educational methodologies ‘eg. collaborative training, individual lized learning, etc.) may “a in the creation of successful learning environments, but a competent nurse must have an innate desire to learn to be ‘ages, from young graduates to genuinely effective, Nurses ofall reasoned experts, can benefit from this critical skills in every phases oftheir employment. Critical thinking: A strong drive to learn is an important teristic of a professional nurse. Nevertheless, putting Inowledge into practice successfully requires critical thinking. While this skill can be developed over time, it often comes more readily with experience, % Time : Import ‘management: Important personality feature for nurses is he apa ap gl ne management Allocating time for tis alvo an essential element of time management. 4 Leadership: Leader ip: Leadership skills are more valuable in the nursing proessin a8 it promotes pro plein st ots poseslonl advancement, Exercising ny role or level shows a willingness to grow an aap at ones on (wn pace. Mentorshiy are the sources Pea 2 souces of pressionalisi in nursing ihe WS cotcat oth ry a yo i a poles an ne ofthe the he following pursing PEO id Responsibilities ofa Nurse important aspects of professional nursing practice in individuals, families, and communities. I roles entrusted to professionals in the most y tursing is 10 assist i re the essential fession (Fig. 1.5): er: It encompasses all efforts aimed at assisting the client ily and psychologically while maintaining his or her rhisincludes complete or partial care for the clients based fon their ability to perform the activities of daily living. The nurse m Njdes educational and supportive care to help the cen © Prrteve their optimum level of health and welines and delegates, ihe responsibilities tothe caregivers. ie gher. As 2 teacher, the nurse lps the clients 0 earn about Tea neath and health care practices that they need 9 perform tne otore of maintain ther health. The nurse asseses he client's toresingneeds and readinesto eam, sets spciileaming goa following the priorities, and utilizes various teaching strategies. Gomanunicator: Effective communication is an integral factor Conursing care. To address the clients health care needs the in Fee must be able to communicate effectively ané propery Nurses communicate with cients and assist family members and ‘Nurses who play the job of communicator community members. recognize clients’ problems and then communicate them to other tof nl physica dignity: Fig. 1.5: Roles and responsibilities of 2 use._— 1 Chapter 1: Profession and Professionalism Cee —— ee itt: Professions ig mt Professionals. are sonal developme tora inaplement ew ideas and Procedey testion and assess what is being dong Fapportnities co improve and develop Per swith the confi we the right 10 4 have a foto recause of this freedom ‘¢ selt governing: A genuine profession wil ge a culate se ean aes among. is members: hey Fel ale the reac ahmen of poticis and norms for professional activities, & Scientific: A professiona 1s education Is bullt on g peraion of scientific Knowedge Every profession has its own teed ot knowlege from which the membersutlize the knowledge afessional practice. A genuine profession will eoninue to research while also tiling the developing amount scnformation and the expertise of its practitioners. 4 Requires higher education: A professional person should be ‘educated in a higher educational institution, ie, colleges that are regulated by the universities. Apart from it, higher qualifications snd specialization can be done to improve professional practice, Service-oriented: Members of the profession are supposed to spend most oftheir energy on i for the rest of their lives. 4 Economic security: A profession provides economic security to iismembers fortheir service. Economicsecurity means havingan adequate amount of money tomeet the daily expenses without any interruption which is important for an individual. This economic security isan asset during retirement time as well. They ha Professionals their practice person for their routine pro IE NURSING AS A PROFESSION The word “nurse” is derived from the Latin word “nutire” which means “to mrtare ost someone Therefore the nursing profess i oe looking to serve humanity. aie elestnbecausei eqs dedication and commitment " passion and compassion. Apart rom these, hursing, has indeed a very profitable a, Y profitable career and has international ‘the unig | sick oF well, in the function of the nurse performance of those neouraged {0 Wor) ities contributing health or its recovery (or to peaceful death) act ge would perform unaided ithe had thenecessary steng, ddd, ad to do thin uch a way a5 0 help him gain wil idly as possible” jependence as rap qualities of a Nurse sre ae certain fundamental qualities that a nurse must possess Hr fnering thelr service in thelr professional areas which are while Fe : jsted below (Fig 1A): ise sing: Quality of caring makes a diference in patients. A nurse ad jtural tendency to truly care about how their patients showing anal feat will havea significant impact on their success inthe nursing id, which makes caring a key indicator ofa nurse's succes. 4 Communication skills:Communication is sharing of nfrmasion ‘To be a successful healthcare provider nurses need exceptional communication ability. The capacity of a nurse to communicate tifectivelyis crucial. A nurse's ability to communicate successfully nurses, and other health team members across different with other! i a tinits, patients, and their families is vital o their job. Communication skills Time management : / aN ( auaities of | \ { Emoaty | a nurse citer) \ writing). ; \ 7 (vet \( sot tolearn // Sense of |S Fig. 14:Qualtesofenuse;> ee U it 1: Presa sng aihcam verbally v1 WH. The quay ofthe hes professianals¢ animportant factor inn cation is 2 aamurse's communication x afar pte: As aint ares HESS ES Ore * oN “jiensin exercising thet rights. and help they, client. Nursesassist «peak up fr themselves speak Peeing ithe press of helping a client jy + Couns 2 Se social problems, speelenterpersonalelationships ancl rome growth. Anurse atic and helps the person to develop new attitudes, ang aor encouraging te cient to Fook a alternative behavog and recognize the choices. «Change agent: The nurse ats a8 a change agent when assisting clients to make modifications in the behaviors. Leader: leader influences others to work for accomplishing a specific goal. A nurse takes up the leaders role, by performing ‘han ascertive and self-confident manner for bringing effective ‘change and functioning in professional activities. + Collaborator: A nurse acts as a collaborator with effective use of skill in organization, communication, and advocacy to facilitate the functions of all health team members as they provide patient + Expanded Educational and Career Roles of Nurses The nurse performs certain advanced roles based on the qualification and regulations of the governing body, Some ofthe extended roles of the nurses are listed below: % Clinical nurse special Cline! mares nurse with an advanced degree, = eee ‘s regarded as.a specialist in a specialized ; A nurse having this expertise provides direct on, and educatior staff and also conducts research, ae Nurse practitioner: A nurse the qualification of nurse p Dractitioner is a nurse who attained practione i“ practice (power granted w 4 ranean: Their scope of oF heath facies ate governed ya lees (spectrum they work Sume nanan by the laws of the state In which linies without the supervision of phys with doctors as part of a "48 Par Of a mulidiscipting ‘Siclan. Others collaborate any health care team, ay» ae Chapter Profesion nd Potesionalsm wife: A nurse who accomplishes a program in rovides prenatal and postnatal care to women with Meompuicaed pregnancies and delivers thelr babies vrge educator: A nurse wth an advanced degre i involved in tional activities in academic or clinical settings to impart ‘al and practical information serge administrator: Anurseisresporable forthe management iministration of resources and staffin providing patient care ai various levels of management in health care settings. aise researcher: Nurse researcher is the one who has an wiyanced degree and who conductesearch for thelmprovement rnursing practice and education. Nurse entrepreneur: A nurse entrepreneurs & nurse usually wwith an advanced degree who manages 2 clinic or a health- wwgted business, conduct research, provides education, or serves eran advisor or consultant o institutions political agencies, or nurse mid niclwifery P? & edu theorel and businesses. 4 Forensic nurse: Individuals who are victims or perpetrators of trauma receive specialized care from forensic nurses. Forensic vhurses understand the legal system and are skilled at dentiving evaluating, and documenting injuries. Nurse informatics: Nurse informatics is nursing specialists that integrate their nursing expertise with their understanding of computer science. They work with data gathering organizing and interpreting to improve the efficiency and quality of patent care. ‘They work ina variety of contexts, including insurance companies hospitals, and consulting organizations. Ih CHARACTERISTICS OF THE NURSING PROFESSION Certain characteristics make nursing a unique profession as compared to other professions which are listed below (Fig. 1.6): + Nursing is caring: Caring is the dynamic core and most vital quality in nursing. Caring is essential in the nursing profession because it helps with the healing process. tis a way for nurses to show empathy and compassion towards their patients. Being kind is the essential quality that must be possessed by the nurse through which the patients can understand caring,>> Service-oriented) \ Goalorionted \ Fig. 1.6: Characteristics ofthe nursing profession, ‘+ Nursing is service-oriented: Nursing considers persons as physiological, psychological, and sociological beings. Nursingis a call to service focusing on the preventive, promotive, curative, and rehabilitative aspects ofthe person as a whole. Nursing services are rendered with dedication and commitment. ‘Nursing is goal-oriented: Nursing is intended to help people achieve their personal, family, community, and universal healthcare goals in the most effective way possible. Nurses formulate specific and realistic goals that can be measured in ‘real-time to ensure patient progress within a specified time frame. % ‘Nursingiis impartial: Nursingis dedicated to provide individualized cate to all people, regardless of race, religion, economic or social Position. All persons are treated with utmost respect ani without any discrimination. me | Nursing requires personal contact: Nursing involves close Petsona coat with the recipient of care, such as patients, unites. Care and cure coordinated concept hagher: Proesion nd Petesiontom erm Criteria of the Nursing Profession cnsiered the “ysngest ofthe patessons Mga ted pression sche ene an Rraraing isa science, Which requires a sound type of education and MMonugh knosledge of human behavior. Nursingsan arin which {hills are developed by practice. In addition to scientific knowledge sid skills, desirable attitudes are necessary for nursing, Therefore a asi requirements fora nurse are the knowledge of nursing uence (head), the desire to nurse, che spirit of nursing hear), and the attitude and the skill of nursing (hand), Nursing fulfills most ofthe criteria of a profession. The following are the criteria that Fulfill nursing as a profession ae gssential services: Nursing services are critical o mankind and the well-being of society. Nursing is a service to the well-being of individuals and society asa whole. Nursing fosters the preservation ‘and recovery of individuals, groups, and communities’ health ‘The prime objective of the nursing profession is to help others 0 achieve the best level of well-being in which they are competent. Caring means nurturing and helping others and itis the basic component of professional nursing. ea Body of knowledge: There is a special body of knowledge, which is continually enlarged through research in nursing. In the pas, nursing was based on principles borrowed from the physical and social sciences and other disciplines. Today, however, there is 2 body of knowledge for nursing. Currently, the nursing profession relies more on research as a basis for practice than on task orientation, intuition, or tril and error. Intellectual activities: The nursing services incorporate intellectual activities. Nursing has developed and refined its unique approach to the practice called the nursing process. The nursing process is essentially a cognitive (mental) activity that requires both critical and creative thinking and serves as the basis for providing nursing care. Accountability is the process in which individuals are answerable for their actions and have the obligation to act. Nurses are accountable to themselves, clients and their families, and the general public. : % Formal higher education: Practitioners in nursingare educate : institutions of higher learning. After the formal basic qualificatioree EE yee Chapter 1: Profession and Professionalism ae aoe a9 nit: Profesional in Nuns —sgiom tedemanstrares an unwavering COMM vas anes HAMS diver the igh the woation ad isreaized through pueposetl relationship, quality care 0 par irons facilitate professional pray eae “omafesionalisminursingae described elon fi 4 Self-regulation: and practices through licensure. accreditation regulating organization ieincades the contol of professional activig ality assurance approaches, such etc. In India, a national independent ne ludian Nursing Council, monitory eee Meese nursing profession in conjunction with each aan e oe eae nursing council. The Indian Nursing Counc] aananaee « nationwide database registry. In general, state eae pcouncils have the authority to approve nursing education programs incollaberation wth the Indian Nursing Council. ach eee nursing council in India is responsible forthe registration, licensing and disciplining of nursing professionals. State nursing councils have the authority to implement nursing laws and regulations and to regulate for the protection of the public. 4 Self-determination: The nursing profession is still striving to determine its own choices, role onthe health care team, and future professional destiny. Nurses themselves are the best personnel to understand the demands of their profession and are therefore entitled to devise strategies for its future direction. Nurses assert themselves and tum increasingly to collective bargaining for negotiating professional issues, ip Reaponstblityand accountability: Currently, nursesare involved pefnare complex patient care activities and the responsibilities ive shifted from traditional nursing care to independent nursing practice. AS tesult ofthe increased freedom in practice, ie responsibility for nursing actions is further moved to ecountability. Nurses have to achieve a balance between their aeaponsibility and accountability to safeguard the public and Concern for their welfare Increasing autonomy: Autonomy refers o the freedom to practice ite rendering service among the members of a profession Nursing utilizes the existing body of knowledge, code of ethics, nd professional conduct while making decisions related to the Various aspects of Patient care activities. Economic security: Economic gains are the most observable and socially understandable needs sought by the nursing profession ‘Though the economic picture for murses has changed radically in the past two decades, economic security has still become a top priortyin the nursing profession. The low wages and poor working ‘Conditions are the major constraints faced by the nurses due to disparities in the legislation inthe various employment seing. Critical Thinking 1. Whats the best ttle for nursing inthe context of professionalism? 3 What ate the major characteristics that make nursing distinct fram other dlsciplines in the health cae system? Attributes of Professionalism Professionalism means the actofbehavingin a manner thatis expected by a given profession. The attributes or the expected fundamental qualities of nursing professionals were initially advocated by Florence Nightingale. They included patient care, cleanliness, and management, to achieve a higher degree of professionalism and standards. The following are the essential attributes or fundamental features of professionalism in the context of nursing. (Fig. 1.8): Knowledge: The knowledge regarding the various aspects of nutsingis critical for the nurse while performing nursing practice nurse to apply thatp ve ae ai i Chayer: Poles a0 Pesos ec contine their higher ede ation a8 poy | a critical part in the development of a functional in sing ee al programs in colleges and Universtgg riries play graduation and doi" Tn nursing are relatively indepeng, anaes MeytenIrencompasses the unt nowledge and abies, Autonomy: Pract nd activities. Autonomy oF contro 7 ie nce of routine aks leadership, self disciphine, roessionl and contr th controversial area fOr NUTSing, Why, rename soa deals one’s prac ree rerndependent the MTSE Practice agy ae to countryand across the globe, Meaning «bMcafo Ais means ing sess ied forthe wel. riessionatsm snore joborsine ask te professional dies but being of others. Nursing profes a eer eee meee way of doing the job or the task hers and see her work as an important PAT ett ven, it messionalism is 2 set of activities, asks, and nurse's duties ics governs the decisions and actions vont by registered nurses, at any time whenever it's required carried tne person's health as their priority ethics: Acode ofethi aa '. An ethical code does not describe how specific situation; rather, it provides framework for decision-making, a rust laced inthe nursing profession by the public requires thatthe nurses must act with integrity. To aid them in doing so, both the International Council of Nurses (ICN) and the Indian using Counc (INC) have developed codes of nursing ethics that establish, promote, and refine standards of practice. Professional associations: The professional associations promote and support high standards of nursing practice. A variety of professional associations in nursing have been established to advance the profession. The goal of which is to create high standards of nursing practice, promote the professional and educational advancement of nurses, and promote the welfare of nurses to improve nursing care for all Bea eae for nursing concerns associations in nursing. pated of nursing professional an individual should actin a professional standards and a IE PROFESSIONALISM. aa» oping t seepigessionalism in nursing means embodying core values of ntegrity, responsibility, advocacy, and accountability. itep essionalism isa practice that can benefit everyone in the peaktnare eting. including pains, caregivers, co-workers and se Definitions professionalism is defi attributes, interactions, professionals in relation to ined as “the conceptualization of obligations, attitudes and role behaviors required of individual clients and society as a whole’ —Richard LC, 2000 professionalism is defined as “the consistent demonstration of core values evidenced by nurses working with other professionals co achieve optimal health and wellness outcomes in patients, families, ‘and communities by wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability” —American Association of Colleges of Nursing, 2008 sonally held beliefs of a rofession. It and Professionalism is defined as “the per professional about their conduct as a member of a pr is often linked to upholding of the principles, laws, ethics, conventions of a profession in the form of a code of practice” Australian Council of Professions, 2003 Characteristics of Professionalism Professionalism is characterized by auto! decision-making by members of occupat nomous evidence-based jion who share the sameFag reed APA BE ONIG prpesssnabisen tare onuege: bats esses elemens of nursing, rihessnsivts ie vepecsiied ty; tbe hub or cemer of the wheel. im elas election Jase academic setting and a ere tatsigiests h oimbetiyp ate unsideted cont Con verehe ta eomsidered core concepts for vanstooy ehesourcalven i ristsing (Ply 19) ” Anareepyrih ners uf the wheel depict the a oes which are \inted below imac - zs ‘ssionalinsn, Professionalism wanes “en lees a and beliels, The NCE eh Ay when W instewmvent that ‘ling with ethical 21>) — 4 hagter rohen wirteren OS cnasin their nursing practice. in India, the code of ethics “professional conduct for nurses were formulated and ee indian nursing cenncil and state nursing coun and utilization: 4 functional element Judes the development and utilization ier Space anced Tpeory development emesis iN 2 etevant te naring profession, The evaluation ot tres and iegation 9 findings ins rons aah of ces serve 28 20 nIATE of prohessionalism in the nursing Froession petmunsty Service: TUT Ses and public education Comey bic of presen 2 on importa spf Dal FO One promotion of public health and well-being by assisting I ies, and communities Nuri ei seen aes a commis rng ats evices to pres Competenceand has been proposed as a reflection of professionalism in qursing professional competency includes the combination of vies tones wataes seclabmaoethatleog = cece in occupational and professional positions. or high performance i pate in continuing professional development Nurses must learn new pew and expanded responsibilities. esearch development: A sound understanding and parocipston in research help to understand and overcome the Doundanes ‘and limitations of nursing practice. The involvement of nurses in id research itself is an indicator of professionalism evidence-bave laboration and dignity within ‘sit promotes inter-professional col: ‘and outside the profession. Self- regulation and autonomy profession in which professionals pract and ethical manner. The regulation of Jndia is achieved through the self-regulat and state nursing council inthe form of professional 1 license, ete, Autonomy oF speridence in nursing refers the hevdoms wa anake judgement and use clinica deisions within he Stopol andar of price Development ana implementation ursing is a self-regulated ce in a safe, competent. he nursing profession in tory mechanisms of INC ation,— -sr01ae42d squasaxdas gnu 2 qppou ay wSHTEUO! samgeay aup 277180291 01 ]qe IA a japo , Susi i thy exoqaeg Futsanu ut sidaou09 Teuo}ssajoud JO UOISSTOSEP 20} sponanen sopisand SuSINN UF wsTeUOESsaoLd JO AAU 5 ‘Buysany uy wisy}oUoyssaxO4d 40 /24M 542NH -AysBarut pur rea arp Sumpjoydn osje ayes ‘swuaned ru ur wuSHPUOISSAjOLE pul pue sydau0) aoadsas saqenumoade Jo Sany on area Aagenb-dor Surpraoid suzauy Suysim Bursany u} wisijeuoyssayord 30 403221 -gonoead uy saBu9yTey? 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However, sometimes It woalg be uninvePgpen communication is essential for (rust in the aoa a ladonship and tespect for autonomy. Withholding from patients creates tension between relevant medical information Jha need to promote patient welfare and the obligation to protect potion autonomy. Withholding information without the patients Phowledge or agreement isunethical, except in emergency instances ‘here a patient is incapable of making an informed decision. When {Information has been withheld in such circumstances, the nurse must provide that information once the emergency has been resolved. The treatment the patients base Withholding ofr Strategies to Orca te Challenges Related to Dsosing or Wetton infomation Assess the patient pref i references regarding communication of medical information, preferably before the in pd Pt the information becomes © Accept the patient’ righso {cepthc pater sighs receingorethholdingnformation inated representative. Determine the client's at a {he client sabiltylevel and reveal information to full the patient’s demands anc iatean ekimands and expectations while respecting the 7: fe _cmeapeeeaieen aaa chapter Potesion nd Pesonaion QE ing Records snidit e858 ta be truthful int with the intent own as doc Jal principle of nursing documentation is and accurate, Making a false statement on 1 to defame the patient or their primary ment falsification, Document or record abst long 1 woul that any doce yroviders are i id thorized alteration or transmittins fasifca ents to another person. The document in which te ee atte ad are pancreas medion ation jan records, patient treatment records, patients’ vital cords, eC nce of Set-integrty in Nursing Practice “most crucial things a nurse can do for herself, her patents, of am isto practice self-integrty. The practice of self ntemiy in nue ine health team members and patients and cei caregivers among tice of elt integrity in nursing also hep 9 enhance patient outcomes. “strategies to Demonstrate Se-integrity in Nursing Practice amor the most effective strategies to develop solid nurse-patient One of Sesslonal relationships is to act with the highest levels of a ie, Maintaining integrity asa nurse means having a core set of vere ples and demonstrating them in all professional practices Some aac reategies to demonstrate sel-integrity in nursing practice are described below: Be honest: Integrity in nursing practice means hhurse can provide the truly granted care while being truthful. 4 Behaving respectfully: Patients, regardless of their physical or mental ability or cultural background, should be treated with respect. It exhibits strong professional and personal integrity 0 treat everyone with the same regard and consideration. Being accountable: Being accountable in own actions is one of the best ways of demonstrating sell integrty. Acknowledging others: Recognizing the efforts of peers and patients is one of the methods to practice sel-integeity in nursing It further improves professional and patient outcomes as it upholds self esteem. ‘one ofthe beinghonest. The—_e! ' practices and assumingada eA practy {effective parient care eee atone are way oF AEMONStgyy ales sg profession sutonom organization: Professio i 7 dye professional aly 4 Participation int gsicipation in Numerous Professigngy also rsing professional organizations ( maintaining self-regulation and cont) ie safety. Participation i professiona, 1c work atmosphere ag os Varou vmmirted t0 axis on pul velpe promotes a creat 2 sional afiiations and moral «on and communication: Publication ang ihe various perspectives Of Nursing is ay nal professional behavior demonstrating professionalism, season in nursing forms @ primary Source of eeeeacg iterature Communication of findings helps inthe vaecscoment of 2 structural or scientific base for the nursing profession, Reflecting critically and disseminating judiciously on eee candards and effectiveness of practice forms the essence of professional activity in nursing organiza Nal) are ¢ addi Writing for pul IE CHALLENGES OF PROFESSIONALISM \arious factors might be challenging for the various dimensions of professionalism. Some of the factors that affect professional kcuowhedge. professional competence, and professional commitment are described below |. Personal Identity vs. Professional Identity P oup isa sense eecene thon erm of achievements leat singushed i rehectsthe ‘ene ese er tena ientifes wth his is eijerad ns 3 pression or wore, theron, there 3 wie Seite the al ertiny fran in the preston he er gn 9 HO SRI ET, fn, the Steere tie AURIS ORI A 3 range tn heron tain Seth) Ee ome wt cr equity econ wrong which i owe be Bore reste pane te peso racic 0 wien, he at of mae on ty FON 18 RTOS TS IES TIA RD Oe ent Sevelogrer f PH 2 HORI vecalinfuences ht the prinal et the nie might be ng fot Hist ised competion wth ater health peor! wth om they cote er ou he Pree ed es 54S, via be able to exores the unique knowege.expesence and Foie coneson: Despite the achievement of higher eaten ring Pe ceive 2 lack of recognition regarding the implication oftheir res ten ee tog ret peas pe to mare eel oreo MSPS ok ‘srotegiesto promote a professional identity 1p ciate a persona nursing philosophy to serve as framewor or race * tie actively involved in professional nusingasecatons + eemaus striving for professional advancement hvoughcontinang eccsien f ectng 2 professional image through academic sucess, pubicaton work Ciperence and verbal and nonverbal communication alites -te formation of a professional identity involves the acquistton of knowledge, competencies, attitudes, and valves. Il, Preservation of Self-integrity ‘The trait of being fair and honest, and possessing strong moral principles are considered as characteristics of integrity. In nursing integrity is concerned with the behaviors that promote trustworthiness inthe patient and their family members. Threats to Self-integrity Threats to self-integrity in nursing include Patient, withhold information, oF falsify re abuse from patients or coworkers. A threat t0 integrity is in requests to deceive & cords, as well as verbal directa —e ‘Unit 1: Profssionalsin Msg nd regulations: Adhering (0 the policies 2 Adherence 10 re ar es tosis Offering help: ( onduct in nursing. + Creating a positive work environment: Creating a Positivg ser csegnere improves self-confidence and results in strong ene ye nections. Thiscan contribute co he development and confidence. professional c respect. professionalism, Ill. Communication and Relationship with Team Members Health care deliver is team effort and is the process of achieving 2 goal through collaboration with a group of individuals. Each team, member performs a crucial function and is interdependent on the other team members for various elements of patient care. Some team members aid in disease diagnosis, while others specialize in specific elements of patient care, such as physical and emotional requirements. While working as a team member, communication skills are vital for nurses, but they can be tough to master. The level of communication between nurses and other members of the team has a significantimpact on health outcomes. Therefore, a nurse must always strive to enhance his or her communication abilities, as poor communication can be harmful and lead to problems. ‘Strategies to improve communication among team members ‘ fative listening without eterruping the conveyed facts. ‘Conveying an accepting attitude and empathy ‘Showing enuine interest by staying focused onthe conversation. + sent oo tnpuge test rd cca ah nig ov listening carefully, maintaining eye contact, etc. — 4 fe c lomtennd wet aegis sing tector anesaing te eins od panna Se Se ‘Open communication: Open communica tong the menses en onmunatonavays improves te rlaonship CS Chapter 1: Prolession and Professor Gre pespecttuland Open Communication respectful communication is crucial for @ healthy workplace psphere. Creating a culture that encourages goed, en effective, and communication in the nursing profes. courteous cOmn fon can promote cermwork, efficiency, and cohesion. Open communication ieveadtie ‘paring information between people in a transparent, honest consistent, and dependable way. When team members openly communicate, they express their thoughts, feelings emotions ang plans clearly and assertively. Open communication happensin a eam pen its members are empowered to share their thoughts fear of rejection or disapproval ‘The following are the challenges of professionalism in nursing that can arise while encountering professional relationships with team members of the health care system: {Use of inclusive language: The use of inappropriate language that may discriminate against a person based on color. caste religion, gender identity et. is always a threat professionalism. Further, aggressive, passive, or passive-aggressive words also hamper professional interactions. Consequentiy, itis the primary obligation of each member to provide respect, decency, and thoughtfulness in personal and professional relationships. + Body language and non-verbal cues: Nonverbal cues including eye contact, smiling, facial expressions, attitude, etc., play a significant partin the effective transmission ofinformation among team members. Movements, such as fidgeting express disinterest and hinder the professional relationship. Being dishonest and untruthful: The foundation of a respectiul professional relationship is honesty and impartiality. Adopting a disrespectful attitude will break down team cohesion and cust among the team members. The nurse should guarantee that they are stating the truth when delivering information, * Problems in communication dialogues: Too much criticism of- ten results in undesirable conduct or activity. However, requesting the team members to engage in different activities fosters positivity and respect. joutany STi Re tecognze the work or efforts of other members E-encourage open communication and listen to others S-speak directly withthe person rather than talking about them to others P-practice kindness and politeness E-empathy and emotionality fr others consider dissenting opinions or csagreements of others ‘treat everyone fairly and equally eeeeece> ae Unit: reson ’ lationship with Team Member, 5 and Ri WV. Communication about Relevant Interests for Ethical Decision-making a guide a person's bel aslor which wy he principles th ron While makingetle aldecisions, the ny bahies are th helifsand moral standards of yy , differ from person t0 7% 7 «to consider both the person? oe persokrpe wea. amucal COC makingisthe procegyy anatase Frematvesfollowingethical ideals. To may evaluatingand selecting a ei rpc decisions itis requied 19 Feces and eliminate immoray ‘alternatives and choose the most ethical option. Dh dilemmas are arising in a ane quite stressful as westriveto determing * context of a specific situation, The thenurses when encountering certain ‘swhile working as 4 team member variety of scenarios the correctness of action in th following are the challenges for ethical decision-making situation in the health care system & Respect for human dignity: Respecting human dignity is sometimes « challenge for the nurses while rendering service, For example, the ethical dilemma while assisting a client in the abortion is «challenge for the nurse depending on their cultural and religious background. 4 Non-maleficence: The duty of non-maleficence places the members the profession not tobe an agent of harm. The ethical principle of do no harm operates at several levels depending upon the various contents. For example, assisting a case of physician- assisted dying or euthanasia isa great matter of ethical dilemma ‘among nurses while upholding the principle of ‘do no harm! Beneficence: The principle of beneficence highlights that all the members of the health care tean have a moral obligation to provide optimum care to all kinds of patients, 7 ‘Truth-telling: Many health professionals have the opini patients need professionals who always h a the opinion that itis worth noting that truth-telling, is often an ethical dilem hi ews nina for nurses pase # while conveying bad ne % Autonomy: his enables nurses s 0 appreciate and support a Pe rejec Nurses leas patent ceng to sale sustaining treatments. y informed at 0 ensure tha aaa hat patients are Ne potential risks, benefits, and ani ae 4 — Chagier |: Prlesion 8 Peril iunsafthelr treatment. Many elements, such as culture caonptical ‘ont mental health status, and the social support vm, lients pres agg imgacte patent acceptance he oc wpe eaten! eae en iol informed consent can * Mult ethical dilemma. For example, ater informing about head ot os whether 104 protecting Pa Prmtdentility of patents are i woes. Tis might have legal implications and result in serious Hrs for healthcare personnel if not performed core UU earerereeeiee = ‘nit: Professionals : \ ny The nurses who are committed tg, | ont and fam! re while striving (0 Work for needs of the patie tare ofession face certain mk uphold he wegen he eaionsmDS a they encounter The sionalism within the fessionalism in nursing tha professionalism challenges of proressionat that fwingar ee aos wih patien countering prores canarise while enc and sociew’ professional relationship is always + Conduct-related issu the product of right com en provider. Conduct refers (0 th ind moral svior, actions. beliefs, a behav Feta the set ofexpeced ebaons while acting the conduct refers nt aspects, su professional areas of nu ed per eeree as age, gender, ae and the patient determine the oo “inappropriate behavior. Because of pattems of appropriate and inapp" hy “i pare rerepancies the nurse is unable to fully comprehend the patient’ behaviors and reactions. : i “& htitude and inherent traitsrelated issues: positiveattitudeand — praiseworthy character tris results in an enduring professional relationship with the patient. The strength of nurse-client ‘elationshipisinfluenced bythe judgement about the personality traits and attitudes they possess, For example, expectations of society towards the nursing profession would be respect and signi while meting their health careneeds. However this largely depends onthe individual wats ofthe professionals involved init Context-related issues: The individual, social, and institutional contexts an influencing factor that determines the professional "elaionship. The emotional or physical condition of patients and family members may make it dificult for them to understand the totality of the imposed limitations within the treatment process ‘which might hamper the nurse-client relationship. For example, ‘heavy workload and shortage of manpower create disturbances in the nusse-client relationship, duct between the patient and the health ‘e acceptable standards of | practices. Professional ‘Measures to Demonstrate a Profesional Relationship sional Re it Patients and Society In a professional relationship, qualities to build a successful inte Simplicity: Concise use of co or unfamiliar terms always p the nurse must ascertain certain "munication without using dificult omotes professional relationship. iia (larity: Clarity in actions and reactions is very important for eupportinga professional relationship, Relevance: Acting upon the relevant needs of the patient within the professional boundaries fosters a healthy relationship, adaptability: The nurse has to consider the whole aspects of the thcare needs ofthe client and adapt the response that e patient Validation and accurate interpretation uf the actual and potential health problems eliminate misunderstanding and develop mutual respect and dignity unmet h BE CHAPTER HIGHLIGHTS 4 Profession and occupation are different in more general sense. 4 Aprofession possesses certain characteristics and criteria. 4 Nursing is profession as it has all the characteristics of a profession and fulfills ll its criteria, 4 Nurses have expanded educational and career roles in addition to their patient care roles. 4 Professionalism means the act of behaving in a manner that is expected by a profession. 4 Maintaining personal identity and professional identity, self integrity, communication and relationship with team members especially in times of ethical dilemmas, the patients and the sociery are major challenges of professionalism in nursing. 4 Nurses should adapt certain strategies like creating a professional image, being honest and accountable, listening actively, having respectful and open communication, protecting patient privacy confidentiality etc, to promote professionalism. TE MULTIPLE CHOICE QUESTIONS 1. What s the meaning of the word profession’? a, ‘toproclaim something publicly’ b. ‘tolead out’ ‘tomove out’ 4. ‘toprocaste 2. The following are the characteristics of a profession as compared to ‘occupation, except: @ Code of conductisessential _b. Aregulated bodys present ©. Formal raining is not mandatory d. Valuesandbelefsareessental4 E i Professional Conduct a ee | Bij PVarkey, Deepak an net es SASL ieee meth pe eters ee tr "Seeceynemrcrcnume "spree 20! ¢ ese bales es an regulon othe rcs «Bape pes 5 fag oprane of al etiquettes and behaviors sonal grooming IE PROFESSIONAL CONDUCT Conduct refers to the acceptable standards of behavior, actions, beliefs, and moral practices. Professional conduct refers to the set of expected behaviours while acting in the professional areas of nursing, The code of professional conduct isa series of statements {or guiding professional accountability, competency, and the quality of professional practice. These are the legal documents that provide a framework for professionally accountable behaviors. ‘Therefore, @ breach of professional conduct is considered a matter of professional misconduct, Professional conduct represents the ‘minimum requirements of the profession, such as the range of roles, functors and related profesional a ties. The code of professional ete high-qual ity services while performing nursing administra, education, and eseach Wg reference guide regarding the ethical obi Saran eel izations that are expected from the nurses whil i fom de 1 rendering their services within the nursing ar Purposes of Code of Professional Conduct following are the purposes of the code of professional conduct Jy promote safe and effective practice among nurses ‘To create an expected standard of conduct for the nursing profession. ¢ To inform the public about the minimum standards for the professional conduct of nurses, ‘To generate a reliable document for decisions involving ethical guidelines for professional behavior ‘To empower the nursing personnel to be accountable for their well-being and actions. ‘To identify the minimum obligations in practice and professional relationships. rhe * Code of Professional Conduct for Nurses in India In India, there are six codes of professional conduct for nurses. Each code is accompanied by certain subsidiary statements regarding the standards of conduct providing further information about the code (Refer Table 2.1 and Fig. 2.1). eyes ees 1.Professional responsibilty and accountability ‘Explanation ‘Asmembers ofthe professions, nurse must ‘Asense of selfrespectis fundamental value to uphald personal and profesional 1.1 Appreclates and nurtures one's sense of worth integrity 1.2 Upholds moral standards that are The nurse must maintain personal ‘commendable tothe profession behaviors attitudes, and actions within the scope of practice 13 Fulfils obligations within the parameters of ones profesional ‘boundaries 14 Isresponsible for upholding the Indian Nursing Councils practice standards 15 lsresponsible for ones actions and decisions Te nurse must be responsible and accountable for all the decisions and actions in one’ professional practice Contd.» | — ED \ cm Nk cond ame nurse must enact nterest of cont em im according to 16 sympathetic ty heping them according sympa pater emen ‘3, Communication and interpersonal se nurse must update ones professional _ she poe we 1 Response eowsing 2 edge and silt ensure evidence _nsmembers of the professions, nares must wally i 341 Develops and upholds successful The nurve must practic reflectively Resse eraecontialy MOU , aor st communicate the Dr aaa ehspaaie ne srsceea) nosgioason TINE fomies,and societies, : hsghirieed ur Gsprnienogh nomaton pons and ania communications and therapeutic sotteyanmate nim ponents acoring tthe evel of 4.2 Respects the worth of ‘ationships with patents and thei cis Understanding ofthe clentandreatives feammates and uphold heathy! members interpersonal lationship with The nurse must work for safeguarding interpe 19 Demonstrates Healthy tect patients rights and individual them fights and mainains profesional 4.3 Respectsand encourages teem These must ensure ne delivery reationshipat al levels Reembers contributions to of heaheare sees 'ncooreination enna planation profession wah the multidisciplinay team to meet . , 4a Meets te needs ofinaiviuals, ‘hehealth needs ofthe cents nd Aamembes ine pofesions nie familes,and communities Fomes 4 coor esata sands The ue ene the ee Seca are fo egcare quality of cae whl rendering service ee Lamia acre sithout compromising theclent safety belie Veluing human beng eas 12 modecreinthe weasot__TRenursemustesurethe provision of a veo cologcalematona, cut congruent are with human ‘smembes ofthe professions nurses must ao etonmancae wile dgty/intending to promote healthy Jan Takes the necessarystpsto There mustaclawful a initiate etl and fomiles—_pacesin the patients and tel familes TStequord people from unethical supporting actos inthe best resto eonduct that shart ind th respect for human dignity 23 Respects people and thei failes {42 Thinks about pertinent information ‘rom the perspective of customs while making moral decisions that ‘cur fostering heathy ate in people's best interests. habits and avoiding harmfulones 443 Encouragesindividuals toexercse The nurse must advocate fr patent thelright to speak out on matters safety and wel-being inal crcumstances 24 Helps pope ad fails The nurse mst rth dscus the ‘make autonomous decisions by treatment plans and helps to provide affecting their wellbeing reverting a factual accu the choices fr accepting or refusing the i ‘and complete picture inal ‘teatment decisions ‘44 Respects and encourages personal ceases. decision-making : ‘5. Management ‘Explanation Grete ‘Asmembers of the professions, nurses must fe 5.1 Makes sure that resources are used The nurse mustbe ecient to make The nurse must practice ina'afeand andalloated propery thebestuse of valle resources to cone nae oe heme maintain cost fective core 27 When a patients care needs ex . 5.2 Supervises and teaches students Thesurse responsible to educate When pant scenes exceed The nue must sek poessonal adie, and other formal healthcare “students and other care providers on the handing sheconsuleocednates ulance tom thee superior or 7 ‘workers while doing so ‘values, principles, and standards of health lapse eal cordeaes contre authoies wherever requed a ppeiiy necessary Contd