law and ethics in nursing 2014 diploma of general nursing diploma of physiotherapy diploma in...

Law and Ethics in Nursing 2014

Diploma of General NursingDiploma of PhysiotherapyDiploma in Enrolled Nursing

Legal and Ethical Dr Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration)TAE Master Trainer (Australia)IVLP (USA)

Topics for the module

1. The Law

2. Ethics

3. Organizational standards

4. Clinical standards

5. Professional standards

1. Professional Nursing practice

2. Professional Physiotherapy practice

6. Forensic Medicine

1. Introduction to the Legal and Ethical environment in Nursing & Physiotherapy practice

Learning Outcomes

• When you have completed this competency you should be able to:

1. Practice within legal frameworks, which govern enrolled nurse practice, registered nursing practice

2. Apply ethical concepts to clinical practice

3. Support the rights, interests and needs of clients and families

4. Supports reflective practice

Human Body and Health condition

• The best ever system ever created……..!

• Well balanced – input and out put – internal controls

• Also tries to adopt to the highly dynamic external environment

• External environment creates –Physical , Chemical , Psychological and biological changes on the body

• Body imbalance of the systems – Sickness , Health condition , Diseases , Illness

Health Interventions • Healthcare providers will try to regulate the imbalance of the body ,

transform the body from “Sickness” to “Wellness “

• So they intervene the body systems through , Physically ( Surgery) , Medically ( Drugs ) , Psychologically ( Psychiatric ), life style changes etc.

• Healthcare Interventions

• Stake holders for intervention – Doctors and staff , Patient , Hospital

• Everyone could respond differently for the same treatment

– PATIENT – allergy to a drug , response to pain

– Staff – Negligence

– Hospital – services and equipment and supplies faults

The unpredictability of healthcare services

• Health interventions are highly unpredictable

• There is high probability for changes

• There is no black or white area – more gray areas in healthcare

• More gray areas lead to more issues , conflicts , miShaps …….IMPORATNT TO LEARN THIS AREA

V 01

• http://www.youtube.com/watch?v=6wQWkKQ0ZMg

• http://www.youtube.com/watch?v=oF1CmtKyHNw

• http://www.youtube.com/watch?v=bf1Wzy1amuw

Human Body and Health condition

• The best ever system ever created

• Well balanced – input and out put – internal controls

• Also tries to adopt to the highly dynamic external environment

• External environment creates –Physical , chemical , Psychological and biological changes on the body

• Body imbalance of the systems – Sickness , Health conduction, Diseases

Health Interventions

• Healthcare providers will try to regulate the imbalance of the body , transform the body from “Sickness” to “Wellness “

• So they intervene the body systems through , Physically ( surgery) , Medically ( Drugs ) , Physiologically ( Psychiatric ), life style changes etc.

The unpredictability of healthcare services

• Health interventions are highly unpredictable

• There is high probability for changes

• Stake holders for intervention – Doctors and staff , Patient , Hospital

• Everyone could respond differently for the same treatment

• PATIENT – allergy to a drug , response to pain

• Staff – Negligence

• Hospital – services and equipment faults

• there is no black or white area – more gray areas

Introduction

• What is the difference between human & Animals

• Needs and wants

• Why need rules & regulations

• Products and services

• What are the differences of health Vs. Other services

Human needs , wants and demand

Needs• Essential “Need of

the hour” !

• I am hungry …..!

• I need a meal ….!

Wants • Preference “ What do I want…….. my preference ”

• I want a hamburger ……!

• With cheese and ham please …!

04/19/2314Quality in Healthcare services session 01 Dr Kithsiri Edirisinghe

Black & white and Grey

• Black

• White

• Grey

• Ethics

• Compassion the human factor

Controlling Unpredictability of health

2. Difference in Law and Ethics

Define Ethics

• Ethics is the study of what should be done

• It is more than simply a description of behavior, custom or current practice

• Concerns human well being

• More what we should do than we actually can do

• What is right and wrong

Defining Ethics

• What ought or ought not be done

• Ethics are relevant to all individuals and moral concepts should apply to all persons equally.

Ethics and Morals

• Ethics are a formal set or rules or values that are publicly stated to be adhered to by all members of a profession or group.

• Morals are the values or principles that you as an individual are committed to.

What are situation examples of ethical dilemmas for nursing staff?

3. Origin of Law

What is Law?

• Law is not the same as ethics

• The law may be influenced by moral considerations, but in the end the law is only of limited assistance in the discussion of moral issues.

Rule of Law

• Basic principal in the Australian ( any) legal system

• People must obey the law and be ruled by it.

• No person is beyond the law

• ‘govern by the law and not by men’

Where does law come from

• 2 main sources of law in Australia are the common law and legislation

• Common law consists of the principles developed by judges in cases that come before them

• Legislation is the law passed by the Parliament, or some other bodies under delegation.

Federal and State Legislation

• Each State through their individual constitutions may pass laws for the peace order or good government of the State.

• Federal parliament may pass legislation as specifically determined by the Commonwealth Constitution

Parliamentary law

• One of the functions of a parliament is to enact legislation, known as Acts or Statutes, they are designed to regulate certain aspects of society

• An Act of parliament is considered to the primary source of the law.

• This means that the law contained in legislation has priority over common law.

Procedure

• An item of legislation will be known as a ‘Bill’ prior to it being finally passed in law when it then becomes and Act.

• There are many Acts of parliament at both State and Federal levels which regulate and control the practice of health professionals and the provisions of health services

Acts

• At the State level there are Acts which control the registration and regulation of health professionals, occupational health and safety and for providing avenues for complaints by health care consumers

Acts

• At the Federal level the legislation is primarily directed to issues of funding and regulating the Commonwealth health care agencies and services

Regulations

• One of the last section in an Act confers on the Governor-General the power to make regulations that may be necessary for the administration of the Act. Regulations provide the essential details of administration which can alter more frequently than an Act can be amended by parliament

Few words • Autonomy - self determination –Choose right to choose

• Fairness

• Legislature

• Bill - Act –

• Judiciary

• Policeman of law

• Common law

• Parliament law

The Nurses Act 1999 Australia

• Determines there will be a Nurses Board responsible for the regulation of nurses in South Australia.

• The board must fulfill all of its functions under the Act with a view to ensuring the community has access to nursing care of the highest standard and to regulate nursing in the public interest

Review of the Nurses Act

• Currently under review

• Consultation is occurring between a number of key organizations such as:

• RCNA (SA branch)

• ACMI (Aust College of Midwives)

• ANZCMHN (A&NZ College of Mental Health Nurses)

• ANF

• Members of general of nursing professions

Review of Nurses Act

• The Nurses Board of South Australia is a key collaborator in this review and has the mandate, functions and powers to administer the Act in the public interest

Other legislation

• Mutual recognition (SA) Act 1993 utilised by the Nurses Board of South Australia and Mutual Recognition Act 1992

( Commonwealth Act) adminstered by all Australian States and Territories

• Trans- Tasman Mutual Recognition (SA) Act 1999

• Administrative Appeals Tribunal Act1975

Other Legislation

• Births, Deaths and Marriages Registration Act 1996

• Children’s Protection Act 1993

• Coroners Act 1975

• Consent to Medical Treatment and Palliative Care Act 1995

• Controlled Substances Act 1984

• Drugs Act 1908

• Drugs of Dependence (general) Regulations 1985

Other Legislations

• Equal Opportunity Act 1984

• Firearms Act 1997

• Freedom of Information Act 1991

• Guardianship And Administration Act 1993

• Juries Act 1927

• Limitations of Actions Act 1936

• Medical Practitioners Act 1983

• Mental Health Act 1993

Other Legislation

• Occupational Health Safety & Welfare Act 1986

• Occupational Health Safety & Welfare Regulations 1995

• Ombudsmen Act 1972

• Pharmacists Act 1991

• Public and Environmental Health Act 1987

• Racial Vilification Act 1996

Other Legislation

• South Australian Health Commission Act 1976

• Supported Residential Facilities Act 1976

• Therapeutic Goods Act 1989

• Therapeutic Goods Regulations 1990

• Whistleblowers Protection Act 1993

• Privacy Act

• Aged Care Act 1997

The Register and Roll

• The 1999Act established a single register which records all persons that have met the entry to practice requirements for the registered nurse

• The roll records all persons who have met the entry practice requirements for the enrolled nurse.

The Enrolled nurse

• Is a second level nurse who works under the supervision of the registered nurse

3. Introduction to Professional standards

Nursing National Standards

National Standards

• The Australian Nursing and Midwifery Council Council (ANMC) facilitates national standards for statutory nurse regulatory authorities. These define the minimum core competencies and expected standard of behavior/ conduct of all nurses

National Standards

• ANMC National Competency Standards for the Registered Nurse and Enrolled Nurse

• ANMC Codes of Professional Conduct for Nurses in Australia

• ANMC Codes of Ethics for Nurses in Australia

Board Endorsed Standards

• There are a number of standards that have been developed by national professional nursing/ midwifery organizations.

• These can be endorsed by the Nurses Board

Board Standards

• The Board has developed standards which apply to the practice of nursing/midwifery and development of education programs leading to registration and enrolment

• Board standards reflect the Nurses Act, Regulations and contemporary regulatory practices

Board Standards

1. Standard for Medication Management

2. Standard for the Use of Restraint

3. Standard for Therapeutic Relationships and Professional Boundaries

4. Standards for Approval of Education Courses

5. Standards for approval as an Education Provider

Board Standards

6. Standards for Authorization for an Enrolled Nurse to practice without the supervision of a registered nurse

7. Professional standards statement for Nurse Practitioner Practice

Direct supervision• Means that a registered nurse is present and works with the

enrolled nurse observing and directing his or her activities.

• The proximity of this supervision is such that immediate intervention is possible if problems occur.

• The registered nurse is able to observe and monitor the execution of the enrolled nurse’s activities and retains accountability.

Indirect Supervision

• Means the registered nurse is not present and supervision is provided by other than direct observation, of an enrolled nurse by a registered nurse.

• The absence of proximity of the registered nurse requires processes being in place for the direction, guidance, support and monitoring of the enrolled nurse activities. The registered nurse retains accountability

Physiotherapy National Standards

4. Introduction to Organizational standards

Hospital Policies and Procedures

• Policies

• Protocols

• Administrative

• Human resource

• Finanace

• Clinical

4. Introduction to clinical standards

Clinical Protocols and standards

• Clinical standards

• Technical quality

• Services quality

• Quality standards

• Quality assurance and quality audits

• Protocols

Thank you !Caption