Professional Adjustment

PROFESSIONAL ADJUSTMENT -growth of the individual and development of his capacities- physical, mental, emotional, social and spiritual.

Characteristics of a profession:

1. Altruism- work for the good of society 2. Autonomy- self- determination 3. Authority- based on knowledge 4. Accountability- answerable for their conduct and responsible for their practice. 5. Code of Ethics- relevance to social values 6. Distinct identity

A profession is best defined as: a. b. c.

d.

The work that suits the person An activity which one engages Calling that requires special knowledge skill and preparation Any of these

A nurse is considered a professional when she is: Goal oriented 2. Person oriented 3. Autonomous and accountable 4. Ethical a. 1,2,3 b. 2,3,4 c. all d. 1,3,4 1.

Nursing as it is today, is best defined as: b.

c.

d. e.

The act of utilizing the environment of the patient to assist him in his recovery Assisting the individual, sick or well, in the performance of those activities Providing care for the dying patient Direct, goal oriented, adaptable to the needs of the individual, family and community during health and illness

TRENDS IN NURSING PRACTICE: 1. Automation 2. Independent Practice 3. Specialization 4. Primary Care Nursing 5. Team teaching

FIELDS OF PRACTICE: I. Hospital First level position staff nurse

A. General Staff Nurse General wards  Surgical Ward  Medical Ward



Pediatric Ward



ObstetricGynecology ward



Communicable Disease Nurse



Orthopedic Nurse

B. Nurse in the Special Areas 1. Emergency Room Nurse



Disaster Nursing

2. Intensive/ Critical Care Nurse

3. Operating Room Nurse

Nurse Anesthetist

4. Delivery Room

5. Nursery

6. Diagnostic Nurse

7. Psychiatric Nursing

8. Hemodialysis Nurse

9. Post mortem Nurse

2. Community Health Nurse A. School nurse

B. Occupational/ Company Nurse

C. Public health Nurse

D. Military Nurse

3. Private Duty Nurse

4. Para- legal Nurse

5. Forensic Nurse

6. Flight Nurse

7. Nurse Entrepreneur - nursing homes, review centers

8. Nursing Education

9. Nurse Researcher

10. Independent Nurse practitioner - self- employed; reach out and offer their service - Make referrals and collaborates with physicians

11. Advanced Practice Nursing/ Specialist

The focus of nursing is on: a. b. c. d.

Health promotion Health maintenance and restoration Care of the dying Holistic care

VIRTUES: VIRTUES to do what is MORALLY RIGHT PRUDENCE-FORESIGHT; “look before you leap COMPASSION- Loving kindness; selfsacrifice RESPECT- Listening to patients or colleagues HUMILITY-Recognizing one’s capabilities & limitations

INTEGRITY- WHOLENESS; acting in the same way one says HONESTY- TRUTHFULNESS FIDELITY- FAITHFULNESS COURAGE-Doing what one sees as right without undue fear

1.As a professional, you should be described with the1.professional following:competence 2.autonomy 3.accountability 4.discipline a. 1 b. 1,2 c. 1,2,3

d. all

2.As a staff nurse, which of the following is your most important 1.nursing function? process 2.caring 3.intravenous injection 4.giving comfort measures a. 1,2

b. 2

c. 4

d. 2,3

3.Nursing as a profession is characterized by: 1.service orientation 2.body of knowledge 3.accountability 4.concern for the well being of its practitioners a. 1,2,3 b. 2,3,4 c. 1,2,3,4 d. 1,3

4. A nurse should be able to initiate nursing action even in the absence of a physician’s order. This is called: a. authority b. autonomy

c.independence d. all

5. A graduate of nursing in the Philippines is expected to 1.scientifically be: informed 2.desirous of material wealth 3.proficient in the use of computers 4.skillful in health promotion and disease prevention a. all b. 1,2,3 c. 1,4 d. 1,3,4 

6. Like other professions, what is unique in professional nursing? a. It’s compassionate and caring role b. c.

d.

It’s caring role A well-defined body and knowledge and expertise It’s involvement in nursing research

7. A patient is: a. An individual which uses a commodity b. A person who is waiting for or undergoing medical treatment c. A person who engages the advice or services of another who is qualified to provide this service d. Any of these

8. The degree to which a nurse behavior as a professional is perfected in which of promotes the following? a. Accepts, and maintain interdependence of theory and practice b. Work in coordination of other professional group c. Demonstrate the ideals of nursing d. Is a member of the accredited professional groups

9. Florence Nightingale views nursing as: a. Assisting patient’s towards early recover b. Utilizing the patient’s environment for health c. Caring for both healthy and ill individuals d. Helping patients deal with health problems

10. Professionalism is demonstrated in which of the following behaviors? a. Maintains interdependence of members of the health team b. Observes moral and ethical values c. Supporting, counseling and assisting other nurses d. Communicates and disseminates health knowledge

NURSING ETHICS 

ETHICS- study of the norm of human acts as guided by human reason.

THEORIES: 1. EGOISM- self-interest of the doer determines goodness of the act. 2. UTILITARIANISM- consequentialism Ethical if: a. minimizes pain and suffering  b. maximizes pleasure  c. seeks happiness of the majority

3. DEONTOLOGISM- legalistic view 

“ what is legal is not necessarily ethical”

4. RELATIVISM/ SUBJECTIVISM- standard of right or wrong is relative to people, to time and to place.

5. SITUATIONALISM- “ love theory” 6. NATURAL LAW THEORY- work of creator 

if act preserves life, it is good; if rejects life, it is bad.

ADDITIONAL: 1. HEDONISM- the principle of pleasure, of what is easy; of what is profitable for self. * honest attitude and commitment 2. PLURALISM- to do what majority of people are doing. * priorities in life/ proper decorum 3. CONSUMERISM- “ madness sale” principle of buying all that is advertised. * simple lifestyle

1. EGOISM- self-interest of the doer determines goodness of the act. 2. UTILITARIANISM- consequentialism Ethical if: a. minimizes pain and suffering  b. maximizes pleasure c. seeks happiness of the majority

DEONTOLOGISM- legalistic view 

“ what is legal is not necessarily ethical”

RELATIVISM/ SUBJECTIVISM- standard of right or wrong is relative to people, to time and to place.

SITUATIONALISM- “ love theory” NATURAL LAW THEORY- work of creator 

if act preserves life, it is good; if rejects life, it is bad.

BIOETHICS - is the study of human conduct in the area of the life sciences and health care using moral values and principles.

PRINCIPLES IN BIOETHICS

1. BENEFICENCE- means to do good and not to do harm. 2. NON- MALEFICENCE- one ought not to inflict evil or harm. 3. AUTONOMY- means self-determination

4. JUSTICE- refers to the obligation to be

fair to other people. Types of justice: a. Distributive Justice- fair, equitable and appropriate distribution. b. Criminal Justice- just infliction of punishment or penalty. c. Rectificatory Justice- just compensation under civil laws.

5. STEWARDSHIP- not harm our body because it is God’s not ours. 6. TOTALITY- body should function as a whole 7. FIDELITY- refers to the obligation to be faithful to the agreements, commitments and responsibilities that one has made to oneself and others 8. VERACITY- refers to telling the truth or not intentionally deceiving or misleading patients

9. RESPECT- treat all individuals as persons with rights with or without abnormality. 10. SHARING OR ALLOCATION OF RESOURCES- applies when resources are scanty or very limited

STEWARDSHIP- not harm our body because it is God’s not ours NON- MALEFICENCE- one ought not to inflict evil or harm. BENEFICENCE- means to do good and not to do harm. AUTONOMY- means self-determination VERACITY- refers to telling the truth or not intentionally deceiving or misleading patients

FIDELITY- refers to the obligation to be faithful to the agreements, commitments and responsibilities that one has made to oneself and others JUSTICE- refers to the obligation to be fair to other people. SHARING OR ALLOCATION OF RESOURCES- applies when resources are scanty or very limited TOTALITY- body should function as a whole RESPECT- treat all individuals as persons with rights with or without abnormality.

BOARD QUESTIONS ( JUNE 2005 )  Situation: Bioethics in caring for children capitalizes on some important principles. You are expected to know these by heart because nurses care for children as well as adults.

1. What is the principle to hold on when caring for children who have been abandoned and abused?  a. consistent assurance b. respect  c. allocation of resources d. autonomy

2. The principle that tells children are to be treated accordingly as persons is  a. beneficence b. non- maleficence  c. autonomy d. respect

3.When there is only one pacemaker and there are many patients needing it, the principle to be used is  a. autonomy b. justice  c. respect d. beneficence

4. When the nurse triage patients to render care accordingly, you are using this particular principle  a. respect b. allocation of resources  c. beneficence d. autonomy

5. In choosing sharp intramuscular needles for injection, you are practicing this principle  a. beneficence b. justice  c. respect d. non-maleficence

Situation: In rendering care to a handicapped child, the nurse has many responsibilities, most of all the nurse should be ethical. 1. What principle should a nurse carry when caring for a handicapped child? a. respect b. non-maleficence c. beneficence d. justice

2. Regarding idiosyncracies of a handicapped child, how should the nurse deal with the tantrums? a. respect b. justice c. beneficence d. non- maleficence

3. In apportioning candies and other nice goodies among children, what bioethical principle should a nurse observe? a. respect b. non- maleficence c. beneficence d. justice

4. What is the nursing ethical guiding principle during invasive procedures being done to children? a. non- maleficence b. justice c. respect d. beneficence

5. A handicapped child like any other child should be loaded with  a. care b. toys  c. food d. love

PATIENT’S BILL OF RIGHTS 1. Right to considerate and respectful care  - nurse avoids discriminating acts that tends to bring the appearance of favoritism  - “ tender loving care attitude”

2. Right to information about diagnosis, treatment and prognosis 3. Right to informed consent  - refers to the capacity of the patient to accept or refuse treatment options offered by the health care provider.  Elements:  Voluntariness  Information  Capacity

4. Right to an advance care directive 5. Right to Privacy

6. Right to confidentiality  - all records and communications held in confidence when to divulge information:  1. patient placed in serious danger  2. public welfare  3. legal proceeding

7. Right to go over records 8. Right to services and to transfer  - referrals 9. Right to know relationship with other health care and educational institutions 10. Right not to be subjects of research or experimentation

11. Right to expect reasonable continuity of care  - follow up consultations 12. Right to examine and receive an explanation of his bill, Right to know what hospital rules and regulations apply to his conduct as a patient

PATIENT’S RESPONSIBILITIES: 1. Providing information 2. Complying with instructions 3. Informing the physician of refusal to treatment 4. Paying hospital charges 5. Following hospital rules and regulations 6. Showing respect and consideration

ETHICAL DILEMMAS

1. ARTIFICIAL INSEMINATIONis a procedure or process whereby the fertilization of an egg is the result of the sperm being introduced into the female reproductive system other than the natural, that is, other than the sexual act or intercourse.

Types: 1. Artificial Insemination by the Husband (AIH) or Homologous Type 2. Artificial Insemination by a Donor(AID) or Heterologous Type

Argument that support A.I  strengthens and enhances family relationship. Ethical Objections:  Ethically wrong by reason of the manner of procuring semen.  Contrary to the signification of the Human Sexual act.

2) IN VITRO FERTILIZATION Laboratory procedure whereby one or a few eggs are surgically taken from a woman’s ovary, fertilized with sperm in a petri dish, and transferred to and implanted in the woman’s uterus, hoping for a normal pregnancy to happen.

Argument that support IVF  “ Technological Imperative”  opens infertile couples to joy of having children  Guarantee society with healthier children

Ethical Objections:  manner of procuring semen  “product” factor  “ surrogate mother” factor  disadvantage of pregnancy in later years

3) HUMAN CLONINGRefers to the production of one or more living human beings that are genetically identical to an original human being.

Types: 1. Embryo Cloning- “ Artificial Twinning”



POSSIBLE EXAMPLE OF DEFECTIVE CLONING

2. Adult DNA Cloning 3. Therapeutic Cloning ( Somatic Cell Nuclear Transfer)

Argument that support Cloning:  improvement to humanity  production of human tissues or organs  a fundamental human right- Reproductive freedom

Ethical Objections:  Violates the autonomy of the individual  Diminishes the value of human life  Disadvantageous to child  Humans subjected to exploitation for commercial purposes

1) CONTRACEPTION is any act done before, during, or after the act of intercourse that purposely frustrates begetting of new life.

Types: 1. Direct- deliberately intended A. Artificial  Mechanical 1. condom

2.diaphragm  3.cervical cup  4.IUD  Chemical = cervical sponge, vaginal suppository, vaginal jelly  Surgical = tubal ligation, vasectomy B. Natural 2. Indirect 



Argument that support contraception:



Woman’s autonomy or right Situationalism ( Love Theory) Utilitarianism (Sexual pleasure or happiness) Population “Time Bomb”

 



Ethical objections:  Meaning of human Sexual Act  Population “Time Bomb” Scare

5) ABORTION Termination of pregnancy.

Q: When will termination of pregnancy be called abortion punishable by law? If terminated a. First trimester b. 20 weeks age of gestation c. Moment of conception d. 7 months pregnancy

Types: 1. Spontaneous Abortionmiscarriage, kind that occurs without medical or some other kind of intervention.  Complete- all content in uterus expelled  Incomplete- part or entire placenta is retained  Missed abortion- fetus is retained in the uterus for a period of time after its death.

2. Direct, induced or procured Abortion- elective or therapeutic abortion 







Early Uterine Evacuation or Vacuum aspiration- suctioning Dilatation and Evacuation, Dilatation and Curettage (D & C) Prostaglandin and Saline injectionthrough amniotic sac Hysterectomy

3. Indirect Abortion- necessary result of another medical procedure.

Right of the mother versus Right of the unborn/ fetus Principle of Double Effect refers to an act that causes two immediate effects: one good, the other bad.

Conditions: 1. The act must either be good or at least indifferent. 2. The intention is to achieve the good effect. 3. The expected good effect must be equal to or greater than the harmful effect that is expected. 4. The good effect must follow from the action,or at least,must happen as immediately as the bad effect.

6 ) EU THA NA SIA“ MERCY KILLING”, is the intentional taking of the life of an ailing person. rea son s:  Incurability of illness  Unbearable intensity of physical or emotional pain  Unbearable financial burden arising from the illness.

Types: 1. By Reason of the manner of attaining death  a. Active or Direct Euthanasia- the active taking of steps by the physician or the caregiver to end the life of the patient.

b. Passive or Indirect Euthanasia- the intentional omission or nonadministration of medical treatment to cause or hasten the death of the patient.

2. By reason of patient’s consent a. Voluntary Euthanasia- the patient consciously and directly requests the health care provider to take the steps to put an end to the patient’s life. b. Involuntary Euthanasia- the act of seeking the death of the patient is without the patient’s consent or knowledge.

a. b. c. d.

Q: If a nurse stops giving medications with the consent of the family, what type of Active voluntary euthanasia? Inactive involuntary Active involuntary Inactive voluntary

“ DO NOT RESCUCITATE ORDER”

Q : A patient has been in the ICU for two weeks. The relatives consented to a “DNR” order. What should the nurse do? b. Only medications will be given c. All ordinary measures will be stopped d. Basic and advance life support will not be given e. Mechanical ventilation and NGT stopped

Types of treatment: 1. Ordinary treatment 2. Extraordinary treatment a. not easily available b. risky c. expensive d. gravely inconvenient or burdensome

7. PHYSICIAN ASSISTED SUICIDEthe patient requests from the physician to provide the means to end his life.

8. HUMAN TRANSPLANTATIONsurgical procedure whereby an organ or tissue is transferred from one part of the body to another or from one organism to another organism.

TYPES: 1. Autotransplantation- donor and recipient are one and the same Ex: skin and bones

2. Heterologousdonor and recipient are two different individuals. a. animal to human b. human to human  cadaver donor  living donor

Ty pes of o rg an s used : 1. Those that regenerate - bone marrow, skin 2. Those that come in pair - kidneys, eyes

Q: What Ethical consideration is violated in human transplantation? b. c. d. e.

Principle of totality Stewardship Autonomy Respect

ADVANCE CARE DIRECTIVE

-makes known in writing the wishes or preferences of the patient when no longer able to speak for himself. SUBJ ECTS: 1. Show risk for early dementia 2. Show risk for stroke 3. Activities- severe head injuries 4. Severe and recurring psychiatric illness 5. Terminally ill

TYPES: 1. INSTRUCTIVE DIRECTIVE- specifies life- sustaining treatment to be withheld or withdrawn.  Ex: living will 2. PROXY OR DURABLE POWER OF ATTORNEY- assigns a surrogate if becomes unconscious or mentally incompetent

BOARD QUESTIONS: 1. Which of the following Ethical Philosophies makes obligations and rules primary? a. teleontologism b. relativism c. deontologism d. utilitarianism

2. The PRC Board of Nursing adopted certain rules and regulations in professional nursing practice as the “ The Code of Nursing Ethics in the Phils” through: a. BR # 223 s 1989 b. RA 7164 c. House Bill 264 d. BR # 220 s 2004

3. The Code stresses that: 1. the need for nursing is universal 2. respect for life, dignity and right of man is inherent in nursing 3. the nurse’s primary responsibility is the family 4. the nurse carries personal responsibilities for nursing practice  a. all b. 1,2 c. 2,3,4 d. 1,2,4

4. As a nurse, maintaining privacy and confidentiality is an important aspect of which of the following: a. Hospital policy b. Nurse Code of Ethics c. What all client expect d. It is an accepted practice

5. Which of the following principles apply to the action of the nurse to refrain from discussing the disease condition of the patient with those who are not involved in his care? a. beneficence b. non-maleficence c. justice d. autonomy

6. Which statement is true concerning informed consent? a. minors are permitted to give informed consent b. professional nurse and physician may both obtain informed consent c. the client must be fully informed regarding treatment, surgery and risks and benefits prior to giving informed consent d. mentally competent and incompetent clients can legally give informed consent

7. Which concept refers to the role of the professional nurse in client advocacy? a. the nurse makes decisions for clients who can’t make decisions for themselves b. the nurse follows the basic standards for providing care for clients c. the nurse promotes and protects the client’s interest and rights d. the nurse adapts paternalistic approach to the care of clients

8. A basic structure against which competent care is objectively measured is which of the following? a. principles b. standards c. laws d. codes

9. Giving a lethal dose of morphine to a patient with terminal cancer is: a. passive euthanasia b. active euthanasia c. voluntary euthanasia d. indirect euthanasia

10. The ultimate Ethical Norm is:  a. Conscience  b. God  c. Natural Law  d. Man-made law 

Board Resolution # 220 CODE OF ETHICS FOR REGISTERED NURSES

Four basic ethical principles: 1. Fundamental responsibility of the nurse is four fold 2. Nurse renders service regardless of race, creed, nationality or political belief. 3. Nurse protects life and respects the dignity of man. 4. Nurse works in collaboration with members of the health team

REGISTERED NURSES AND PEOPLE Ethical Principles: 1.Values, customs and spiritual beliefs shall be respected 2.Individual freedom to make decisions 3.Personal information acquired must be held in confidence 

Guidelines to be observed: a.individuality and totality of patients b.respect c.uphold the rights of individuals d.take into consideration culture and values - in the event of conflict, welfare and safety take precedence 

REGISTERED NURSES AND PRACTICE Ethical Principles: a.Human life is inviolable b.Quality and excellence in the care of patients c.Accurate documentation- nursing accountability 

Guidelines to be observed: a.know the definition and scope of nursing practice b.be aware of duties and responsibilities c.acquire and develop competence in knowledge, skills and attitude 

d.optimum standard of safe nursing practice e.be morally and legally responsible f.patient’s records considered confidential

Guidelin es t o be observ ed: 1. duties in conformity with law 2.not allow to be used in advertisements that demean image of the profession 3.decline any gift, favor or hospitality from patient 4.not demand and receive any commission, fee or emoluments for recommendations made 5.avoid any abuse of relationship 

REGISTERED NURSES AND CO-WORKERS Ethical Principles: 1.work in solidarity with other members of the health team 2.maintains collegial and collaborative working relationships 



Guidelines to be observed:

a.maintain professional identity b.conform with group activities c.contribute to professional growth d.actively participate in prof organizations e.respect rights of co-workers

REGISTERED NURSES, SOCIETY AND ENVIRONMENT Ethical Principles: 1.preservation of life, respect for human rights and promotion of a healthy environment 2.establishment of linkages 



Guidelines to be observed:

a.be conscious of obligations as citizens b.equipped with knowledge of health resources within the community c.actively participate in programs, projects and activities d.right conduct and proper decorum e.project image that will uplift nursing profession

REGISTERED NURSES AND THE PROFESSION 

Ethical Principles:

1.maintain loyalty 2.compliance with by laws of accredited prof organizations 3.commitment to continual learning 4.contribute to the improvement of the socioeconomic conditions and welfare of nurses



Guide line s to b e o bs erv ed:

a.be members of Accredited Prof Organizations (PNA) b.strictly adhere to nursing standards c.strive to secure equitable working conditions through appropriate legislation and other means d.assert for the implementation of labor and work standards

BOARD QUESTIONS: 

Situation A. The Philippines Regulation Commission Board of Nursing adopted certain rules and regulations in the nursing practice.  1.The “ Code of Nursing Ethics in the Philippines” is also known as:  a. BR # 223 c. House Bill 264  b. RA 7164 d. Board resolution # 220



   

2.In the above mentioned code, the fundamental responsibility of the nurse is four fold: to promote health, prevent illness, to restore health, to alleviate suffering and to: a. protect man from disease b. give assistance toward a peaceful death c. promote cure of disease d. promote spiritual environment for patient

  

 



3.The Code further stresses that: 1.the need for nursing is universal 2.respect for life, dignity and rights of man is inherent in nursing 3.the nurse’s primary responsibility is the family 4.the nurse carries personal responsibility for nursing practice and for maintaining competence a. all b. 1,2 c. 2,3,4 d. 1,2,4



4. Professional Nursing is founded on ethics of health care. Which of the following concepts are pertinent guides for a nurse practitioner? 





 

1.health is a functional whole in which all necessary functions are present and acting cooperatively and harmoniously 2.health is freedom from superimposed or unnatural influences or disease 3.health is the state of being in which the individual does the best with the capacities he has 4.health is a state of complete well-being a. all of these b. 1,3,4 c. 2,4 d. all but 3

    

5. The ultimate Ethical Norm is: a. Conscience b. God c. Natural Law d. Man-made law