Professional Behavior

1. Professional Behavior Module E

2. Historical Perspectives

3. HIPPOCRATES 460-370 B.C. • First to develop rational theory & treatment • Health is seen as balance between mind, body, & spirit • A physician should act appropriately & look clean & healthy • Hippocratic oath still valid today

4. ROMANS • Many physicians were slaves • Women had status as midwives • Public baths • Developed sanitation system & water supply • Military hospital without nursing • First universities

5. MEDIEVAL MEDICINE 0-1200A.D. • The rise of Christianity • Sickness = sin • Cure through grace • Touch very important for healing (hands on healing) • Hospitals had extensive TX & nursing care • First nurses • Many healers were saints

6. MEDIEVAL (CONT’D) • The dark ages • Decline in nature & science • Increased interest in magic • Superstitions, amulets, prayer, laying on of hands, holy oil, relics of saints, etc • Surgical techniques were lost

7. THE MIDDLE AGES 476 A.D.-1000 A.D. • Renewal in surgery • Dissections to learn anatomy • Crusades brought many new diseases; Worst was black death(bubonic plague) • Doctor-more academic, less care; High fee for advice • Diet for illness-broth, milk, eggs

8. THE RENAISSANCE 1450 A.D.-1600 A.D. • Return to teachings of ancient Rome • Exploration of new world • First epidemic of syphilis • First theory of infection by invisible germs • More surgery • Art related to medicine (Leonardo De vinci, Michelangelo)

9. 17TH CENTURY (1600’S) • First recognition that air was made up of gases • Galileo – motion & gravity of earth • Sir Isaac Newton – movement of solar system influenced by gravity • Leewenhook – first microscope • William Harvey – proved continuous circulation of blood w/in a contained system; Heart has left & right separate circuits & was a pump; Valves made blood go one way

10. 17TH (CONT’D) • First thermometer; Took 25 min to get reading • Quinine for malaria • Mentally ill were imprisoned

11. 18TH CENTURY (1700’S) • Advancement in anatomy & surgery • TX practices still have not advanced • Pinel – father of modern psychiatry • Edward Jenner – vaccination for smallpox; Reduction in postpartum sepsis

12. 19TH CENTURY (1800’S) • Discovery of anesthesia • Microorganisms cause disease • Cells • American civil war evolved ambulances, field hospitals, & surgeons (union)

13. 19TH (CONT’D) • Laennec – Invented & used first wooden stethoscope • Formation of AMA 1847 • Ignaz Semmelweiss – transmission of infection by contaminated instruments & hands; Hand washing!

14. 19TH (CONT’D) • Joseph Lister – sprayed carbolic acid over pt & wound to sterilize • Louis Pasteur – used heat to kill bacteria in wine; Identified aerobic & anaerobic bacteria; Anthrax vaccine; Anti-rabies; Vectors for disease

15. Florence Nightingale • Founder of Modern Nursing • Established first school of Nursing • Knowledge of nursing distinct, different from medical knowledge • Recognized influence of environment to health • Had systematic method of assessing clients • Individualized care to clients needs • Maintained confidentially

16. 20TH CENTURY (1900’S) • Eradications of smallpox, cholera, diphtheria • Genetics; Prenatal testing • Adv. Immunology • Electron microscope; Detect viruses, cancers • TX mental illness w/ therapy, shock; first antipsychotic medication was Thorazine

17. 20TH (CONT’D) • Concept of rehabilitation rose from care of WW1 vets • WHO • Discovery of x-ray by roentgen • Radiation Tx for cancer • Cardiac catheterization 1929 • Heart-lung machine 1953 • Blood typing 1901; Safe transfusion by 1930’s

18. Nursing Roles • Direct Care Provider • Protector/Client Advocate • Manager of Care • Client/Family Educator

19. Nursing Caring Behaviors • Can caring behaviors be taught? • Do entry level nurses exhibit the same caring behavior as expert nurses? • What are some examples of caring behaviors?

20. Nursing Caring Behaviors • Basic Nursing, p 403. • Providing Presence • Comforting • Listening • Knowing the client • Spiritual caring • Family care

21. HEALTH CARE PROFESSIONALS Professionalism, Accountability, Responsibility

22. PROFESSIONALISM A group of people with specialized education, knowledge & skills who serve a specific social need

23. CRITERIA • A vital human service is provided to society • Possess a special body of knowledge that is continuously enlarged through research • Practitioners are accountable and responsible • The educational process takes place in institutions for higher education

24. CRITERIA (C0NT’D) • Practitioners are independent and control their practice • Practitioners are committed to their work & are motivated by doing well • A code of ethics guides professional decisions and conduct • A professional organization oversees & supports standards of practice

25. APPEARANCE • Clothing according to institutional policy • Good personal hygiene • Minimal jewelry • Appropriate name tag/id badge • Appropriate make-up/hair

26. CULTURE • Healthcare professionals, in providing care, promote an environment in which the values, customs, & spiritual beliefs are respected • Care is not restricted by nationality, creed, age, sex, color, social status

27. DILEMMAS • Excess/shortage of personnel • Working hours (shifts) • Pay scale • Job security • Unions • Image portrayed by media

28. Nursing Practice: • “The diagnosis and treatment of the human response to actual or potential health problems” (1980, ANA Congress for Nursing Practice)

29. Standards of Practice: • Purpose • Developed by: • Provide clients with assurance that: • They are receiving high-quality nursing care • The nurses know how to provide the care • There are measures to determine if the care meets the established standards and expected outcomes.

30. Standards of care • Purpose: • Define & describe competent levels of nursing care p 529 • Demonstrated through nursing process: • Assessment • Nursing diagnosis • Planning • Implementation • Evaluation

31. Nurse Practice Acts • Definition: • Mechanism through which licensure & scope of nursing practice is regulated. • Purpose: • Primary purpose is to protect the public from unskilled, under-educated and unlicensed nurses.

32. Licensure • Mechanism through which each state regulates the practice of safe and competent nursing practice. • RN • Education-Associates, diploma, baccalaureate degrees, then pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) • focus • LPN • Education-usually one year, then pass the NCLEX-LPN • focus

33. Unlicensed Assistative Personnel • Education • Focus

34. Career Roles • Nurse Educator • Focus • Education • Advanced Practice Nurse • Preparation & Education • Clinical Nurse Specialist • Nurse Practitioner

35. Career Roles (cont.) • Nurse Administrator • Focus • Positions • Responsibilities • Education • Nurse researcher • Focus • Education

36. Nursing skills for today’s nurse: • Team building p 528 • Collaboration • Coordination • Delegation • Right task • Right person • Use right communication techniques • Give right feedback in a timely manner.

37. Ethical/Legal Issues • Law vs Ethics

38. Law • Refers to the codification of values that a community holds in common • Content is determined by systems of government and law is enforced by that system

39. Ethics • Refers to the consideration of standards of conduct or the study of philosophical ideals of right & wrong behavior • Includes personal behavior & issues of character • Term sometimes used interchangeably with Morals

40. Profession/Professional • Refers to a group of people with specialized education, knowledge, and skills who serve a specific social need. • A professional is a person who: • Acquires specific skills & then • agrees to practice those skills in accordance with standards that a community of practitioners agree to uphold

41. Code of Ethics • Definition p 48 • Serves as guidelines • Fundamental principles • Responsibility (for specific actions) • Competence • Judgment • Accountability (for consequences) • Advocacy

42. Principles of Health Care Ethics • Autonomy – person is reasonably independent in decision making and practice • Justice - fairness • Fidelity – agreement or obligation as a nurse to carry out care for a client • Beneficience – to do good, to act in best interest of the client. • Nonmaleficence – promotes a continuing effort to consider the potential for harm, even when it may be necessary to promote health. Do no harm

43. Legal Limits of Nursing • Nursing practice is subject to: • Statutory law • Regulatory law • Common law

44. Statutory law • Created by elected legislative bodies • Example: • Americans with Disabilities Act

45. Regulatory Law • Created by administrative bodies such as state boards of nursing • Example: • Duty to report incompetent or unethical nursing behavior to state board

46. Common Law • Created by judicial decisions made in courts • Example: • Client’s right to refuse treatment

47. Terms • Assault • Battery • Invasion of privacy • Defamation of character • Slander • Negligence • Malpractice • Pertains to professional standards

48. Patient’s bill of rights • Basic Nursing, p 37

49. Student Nurses • Responsibility • Liability • Scope of practice

50. Minimizing Liability • Short Staffing • Floating • Incident/Variance Reports • Risk Management • Advance Directives • Patient Self-Determination Act • Living Wills • Durable Power of Attorney