Professional Practice

Josephena Campina-Bacote

'Cultural competence is the process of becoming not a state of being' Consists of five constructs: 1. Cultural awareness Self-examination of own biases/cultural background 2. Cultural knowledge Cultural diverse groups; values; health-related beliefs/practices; disease incidence 3. Cultural skill Culturally-based physical assessment and data collection 4. Cultural encounters Seek to modify existing beliefs; prevent stereotyping 5. Cultural desire Genuine, authentic motivation

NMBA Decision Making Framework

- A national framework for the development of decision- making tools for nursing and midwifery practice - reflects a whole-of-health workforce perspective - a set of principles that form the foundation for the development and evaluation of decision-making tools - Foster's consistency across jurisdictions by: identifying the agreed foundation principles for decision- making tools and demonstrating the application of the principles and concepts in the two professions - The framework guides nurses on remaining within their scope of practice. - The framework also guides nurses in delegation tasks to others. Tasks that are within the scope of practice of those others.

Giger and Davidhizar transcultural assessment model

- Communication: language spoken, voice quality, pronunciation, use of silence, use of nonverbal - Space: degree of comfort observed (conversation), proximity to others, body movement, perception of space - Social organization: culture, race, ethnicity, family (role, function), work, leisure, church, friends - Time: use of time, measures, definition, social time, work time, time orientation (future, present, past) - Environmental control: cultural health practices (efficacious, neutral, dysfunctional, uncertain), values, definition of health and illness - Biological variations: body structure, skin colour, hair colour, other physical dimensions, enzymatic and genetic existence of diseases specific to populations, susceptibility to illness and disease, nutritional preferences and deficiencies, psychological characteristics, coping and social support.

Ethnicity vs. Culture

-Nursing, medicine & policing are cultures, they are ways of doing things & thinking about things. -Ethnicity refers to socially constructed group identification or belonging based on kinship, history traditions in language, food, dress etc.

Health Professional Councils Authority (HPCA)

. An administrative body of the Health Administration Corporation . Can receive notifications in NSW . Provides administrative support to Health Councils in NSW . Director reports to the NSW Ministry of Health Similar to APRA in NSW, umbrella authority, do not deal with licenses, administrative authority.

Nursing and Midwifery Board of Australia (NMBA)

. Maintains the register of nurses . Criminal record checks . Registers and imposes restrictions with AHPRA . Approves accreditation standards, codes and guidelines . Assesses English language and education requirements . Monitors continuing professional development (CPD) . Assess notifications referred from AHPRA . Publish accountability guidelines for nursing practice decisions

Nursing and Midwifery Council (NMC)

. Receives and manages notifications about nurses in NSW . Implements NMBA rules and guidelines to promote safe effective and efficient nursing practice in NSW

Health Care Complaints Commission (HCCC)

. Regulates health care professionals . Can receives notifications in NSW . Accepts referred notifications from AHPRA . Investigates and prosecutes notifications about nurses in NSW . Refers notifications for management by NMC

Biomedical principles

1. Autonomy - the right of persons to make their own decisions, free of interference 2. Non-maleficence - is this going to hurt someone else? the practitioner's imperative to do no harm (a negative, requires one to not act to cause harm) 3. Beneficence - the imperative to remove harm then to do good (requires a positive action) 4. Justice - getting what you deserve/need the imperative to ensure a fair and equitable distribution of goods or services based on individual need

Clinical Reasoning Cycle

1. Consider the Patient situation - Describe or list facts content, objects or people 2. Collect cues/information - Review current information, gather new information, Recall knowledge 3. Process information - Interpret, Discriminate, Relate, Infer, Match, Predict 4. Identify problems/issues - Synthesize facts and inferences to make a definitive diagnosis of the patient's problem 5. Establish goal/s - Describe what you want to happen, a desired outcome, a time frame 6. Take action - Select a course of action between different alternatives available 7. Evaluate outcomes - Evaluate the effectiveness of actions and outcomes 8. Reflect on process and new learning - Contemplate what you have learned from the process and what you would do differently next time

Gibbs' Reflective Cycle

1. Description 2. Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action Plan (repeat)

ICN Code of Ethics for Nurses

1. Nurses and people: The nurse's primary professional responsibility is to people requiring nursing care. 2. Nurses and practice: The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. 3. Nurses and the profession: The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. 4. Nurses and co-workers: The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields. It outlines the standards of ethical conduct and gives a framework for the standards of conduct.

Effective Decision Making

1. The problem: Complexity of the task. The more difficult the task, the higher the likelihood that an incorrect decision will be made 2. Level of experience of decision maker: Level of experience has an impact on all aspects of the decision-making process. 3. Level of knowledge: Necessary condition for all stages in decision making. Lack of knowledge leads to incomplete and erroneous plans 4. Personal variability in data collection or assessment: Collecting too much data can overload the system and impair the ability to sort and focus 5. Discipline to which decision maker belongs: The discipline in which the decision is being made can influence the decision

Registered Nurse Standards for Practice (7)

1. Thinks critically and analyses nursing practice 2. Engages in therapeutic and professional relationships 3. Maintains the capability for practice 4. Comprehensively conducts assessments 5. Develops a plan for nursing practice 6. Provides safe, appropriate and responsive quality nursing practice 7. Evaluate outcomes to inform nursing practice

Duty of Care

A duty to take reasonable care to ensure that a nurse's acts or omissions do not cause reasonably foreseeable harm to others.

Culture

A dynamic concept which identifies systems of rules, beliefs, attitudes, values and behaviors, shared by a group, taught across generations, relatively stable but capable of change across time. Culture is learned, shared, integrated.

Refugee

A person who has been forced to leave their country in order to escape war, persecution, or natural disaster

Mental Health First Aid

A: Approach the person, assess and assist with any crisis L: Listen non-judgmentally (active listening, empathy, positive regard) G: Give support and information E: Encourage the person to get appropriate professional help E: Encourage other supports

Australian Nursing & Midwifery Council (ANMC)

ANMAC helps to protect the health and safety of the Australian community by establishing high-quality standards of nursing and midwifery education, training and assessment. - independent accrediting authority for nursing and midwifery education under Australia's National Registration and Accreditation Scheme - skills assessing authority for nurses and midwives wishing to migrate under the Australian Government's General Skilled Migration program

cultural awareness

An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people

Three points for reflection:

Before action: requires prior knowledge i.e. to use a similar experience to prepare for the experience due to be encountered Reflection in action: takes place whilst you are involved with the situation (patient interaction), like thinking on your feet with the focus on gaining a new perspective, rather than just solving the problem. Intuitive type of reflection. After action: involves stepping back from the situation, meaning that it happens at some time after the situation has occurred.

Ethnocentrism

Belief in the superiority of one's nation or ethnic group.

Written consent

Consent given through signing. This is important for invasive procedures or those that may have serious side- effects or risk of an adverse outcome

Code of Conduct for Nurses Principle No. 3

Cultural practice and respectful relationships: Nurses engage with people as individuals in a culturally safe and respectful way, foster open and honest professional relationships, and adhere to their obligations about privacy and confidentiality.

Irihapeti Ramsden - Maori nurse educator (1946-2003)

Cultural safety is "the effective nursing practice of a person or family from another culture, and is determined by that person or family" Cultural awareness -> cultural sensitivity -> cultural safety

Madeleine Leininger American nurse theorist (1925-2012)

Developed the concept of transcultural nursing Theory of Culture Care Diversity and Universality Sunrise Model. 3 modes of action: 1. Professional actions or decisions that help cultures to retain, preserve or maintain beneficial health care beliefs and values 2. Professional actions or decisions that help cultures to adapt to, or negotiate with others, for culturally congruent, culturally safe care 3. Professional actions and decisions that help people re-order, change, modify or restructure their life ways or institutions for better health

Negligence

Failure to exercise reasonable care and skill

Code of Conduct for Nurses (domains)

Four domains 1. Practice legally 2. Practice safely, effectively and collaboratively n 3. Act with professional integrity 4. Promote health and well-being "Professional conduct refers to the manner in which a person behaves while acting in a professional capacity"

Wellness

Has 7 components: physical, social, emotional, intellectual, spiritual, occupational, environmental.

Code of Conduct for Nurses Principle No. 7

Health and well-being: Nurses promote health and well-being for people and their families, colleagues, the broader community and themselves and in a way that addresses health inequality.

Statutory regulation

How profession is regulated/the minimum standard. - It is created under legislation enacted by parliament and deals with regulation of the progression, including protection of the public - NMBA regulates Nurses & Midwives - Protects the public - Establish a national registration and accreditation's scheme

Self-regulation

How we are able to regulate ourselves within the rules we are given. - self regulation is the governance of nurses by nurses in the public interest (aimed at providing evidence that we are meeting society's expectation and maintaining standards of practice) - the standards set by the profession determine the minimum acceptable standards required for nursing practice - it is grounded in the ideals of professional behaviour and conduct - aims for protection of the public

Ethnicity

Identity with a group of people that share distinct physical and mental traits as a product of common heredity and cultural traditions.

Factors contributing to poor health outcomes for Australia's emerging communities, recently arrived immigrants and refugees

Lack of knowledge about the health care system, primary health care and support available Language difficulties Lack of trust Cultural differences Belief that should be able to cope on one's own; not wanting to burden others Shame, embarrassment, guilt Economic and employment Lack of access Fear that situation may become worse if known Poor communication between staff and clients Limited access to culturally appropriate standardised assessment tools Lack of specific training and education for health care staff Difficulties of health services to respond equitably Difficulties of health services to meet health care needs of new and emerging communities

Code of Conduct for Nurses Principle No. 1

Legal compliance: Nurses respect and adhere to their professional obligations under the National Law and abide by relevant laws.

Continuing Professional Development (CPD)

Lifelong self-guided learning - assists the professional development of the RN. The RN is up to date with practice and procedure related to the profession. The RN is aware of new developments in nursing knowledge. Must complete a minimum of 20 hours of continuing professional development (CPD) per year. CDP is a pre-requisite to ongoing registration and nursing practice.

Privacy and Confidentiality

Nurses have ethical and legal obligations to protect the privacy of people. People have a right to expect that nurses will hold information about them in confidence, unless the release of information is needed by law, legally justifiable under public interest considerations or is required to facilitate emergency care.

Open disclosure

Open disclosure is a process for ensuring that open, honest, empathic and timely discussions occur between patients and/or their support person(s) and Health Service staff following a patient safety incident.

Code of Conduct for Nurses Principle No. 2

Person-centred practice: Nurses provide safe, person-centred and evidence-based practice for the health and well-being of people and, in partnership with the person, promote shared decision- making and care delivery between the person, nominated partners, family, friends and health professionals.

Principles of First Aid

Preserve life Prevent further harm Promote recovery Provide comfort to the person who is ill or injured

Code of Conduct for Nurses Principle No. 4

Professional behaviour: Nurses embody integrity, honesty, respect and compassion.

Code of Conduct for Nurses Principle No. 6

Research in health: Nurses recognise the vital role of research to inform quality healthcare and policy development, conduct research ethically and support the decision-making of people who participate in research.

Australian Health Practitioner Regulation Agency (AHPRA)

Responsible for the implementation of the National Registration and Accreditation Scheme across Australia.

Asylum seeker

Someone who has migrated to another country in the hope of being recognized as a refugee

SMART goals

Specific, Measurable, Achievable, Realistic, Timely

Code of Conduct for Nurses Principle No. 5

Teaching, supervising and assessing: Nurses commit to teaching, supervising and assessing students and other nurses, in order to develop the nursing workforce across all contexts of practice.

Bioethics

The study of ethics related to issues that arise in health care. Bioethics is a field of practical ethics that impacts on nursing. It is often described as the ethics of biological research, experimentation and the implementation of technological advances including uses of human tissue; it is a specialised field.

Nurses have four fundamental responsibilities:

To promote health To prevent illness To restore health To alleviate suffering The need for nursing is universal.

NSW Civil and Administrative Tribunal (NCAT)

a notification is referred to the occupational division of the NCAT if it were proved it would result in suspension or cancellation of a nurse or student's registration

Technical Reflection

a structured method of generating and validating knowledge through rigorous means

Cultural Sensitivity

being aware that cultural differences exist and have an effect on values, learning, and behavior.

culturally and linguistically diverse

broad term that evolved to recognize the diversity of cultures and languages throughout the world, including speech variations, such as dialects and foreign accents

Practical Reflection

focuses on interpretation leading to description and explanation of human interaction in social existence

Implied consent

for simple procedures within the patient's knowledge base. For example, the nurse requests to do a blood pressure and the patient silently extends their arm

Emancipatory Reflection

how to manage the taken for granted assumptions and oppressive forces that may be holding you back

Informed consent

obtaining of permission from a patient before a healthcare procedure. Based in a clear appreciation and understanding of the fact's, implications and consequences of an action.

Health

the absence of disease or infirmity, physical, social & psychological functioning, mental well-being, safe environment and community e.g. food, shelter, family, employers, lovers.

Cultural Diversity

the existence of a variety of cultural or ethnic groups within a society.

Verbal consent

through speech by explicit verbal agreement. This is important for non-invasive or very simple procedures to ensure patient understands

Migrant

traveler who moves from one region or country to another