Key Concepts in Nursing

Elizabeth Mason-Whitehead, Annette McIntosh-Scott, Ann Bryan, Tom Mason, Elizabeth Mason-Whitehead, Annette McIntosh-Scott, Ann Bryan, Tom Mason

• Publisher: SAGE Publications Ltd
• Year: 2008
• ISBN:
  9781473903562
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Nursing can be complex and challenging to new students and trainee practitioners. Key Concepts in Nursing provides a much needed guide to the central topics and debates which shape nursing theory, policy and contemporary practice. From assessment to ethics, and leadership to risk management, the book offers a comprehensive yet concise guide to the professional field.

Each entry features:

"a snapshot definition of the concept;

"a broader discussion addressing the main issues and links to practice;

"key points relevant to the entry;

"case studies to illustrate the application to practice;

"examples of further reading.

Highly readable, with clear indexing and cross referencing, this is an ideal book for trainees to turn to for learning more about key issues in nursing practice and education. It meets the validation requirements of all training programmes and will also be invaluable for nurses continuing their professional education, those returning to practice and for mentoring.

Key Concepts in Nursing

 

1  Accountability

Mike Thomas

 

DEFINITION

Accountability has two different areas of applicability and has two different definitions. In a narrow sense accountability is used in reference to financial and commercial transactions. It involves responsibility for recording and processing the balance of money so that the accounts can be scrutinised by others in authority (that is, auditing processes). A second wider definition has more relevance for healthcare workers. This describes accountability as that which is applied to a person having responsibility for certain activities and who has to provide rationales for these activities to those in authority so that both the actions and the reasons behind them can be judged. This concept of accountability is intrinsically related to responsibility and authority (the use of power). The application of authority and power can be seen in professional autonomy. This refers to the accountability and responsibility taken in certain situations where decisions for oneself or the actions of others are taken without direct supervision. The senior secular authority to which nurses are accountable is the law.

Accountability is a legal duty. This confers certain obligations and duties on the practitioner which empowers decision making and the improvement of care for patients. It also provides constraints on the abuse of power and authority through the process of legal proceedings. The system of healthcare law in the United Kingdom confers the responsibility and authority for ensuring nurses comply with law to the Nursing and Midwifery Council (NMC). The Council has responsibility to protect the public. It monitors the compliance with its Code of Professional Conduct which came into force on 1 June 2002 (NMC, 2002).

The NMC code stipulates that there is a public expectation of the level of conduct which is required to be demonstrated in the practice setting. This is viewed as ‘professional’ accountability. Of equal value is the expectation that nurses and midwives actively protect the interests and dignity of their patients and clients. This is the practitioner’s ‘personal’ accountability. The nurse is answerable to the NMC in these areas. In turn the NMC is accountable to Parliament and the public.

KEY POINTS

 

• Accountability for nurses means that one is responsible to others for one’s own actions and decisions (and in certain situations the actions of others).
• Accountability is intrinsically linked to responsibility and authority.
• There are professional, statutory and regulatory guidance on accountability in professional nursing and midwifery.
• Accountability can have applicability in different environments and circumstances.
• Related concepts are responsibility, authority, power and trust.

DISCUSSION

Being accountable for professional conduct is a requirement for all NMC registered practitioners. But accountability covers a wide range of different situations and can answer to a number of different statutory requirements. Pragmatically and in general terms accountability can be more easily presented in three different sections: personal accountability, professional accountability and public accountability.

Personal accountability

Personal accountability is related to issues of care, ethics, conscience and trust. The NMC code specifies the need for nurses to respect the dignity and interests of patients and clients. Within this section the code already covers the legal requirements under the European Union Equal Treatment Framework Directive. This requires all member states to extend their current discriminatory laws to include sexual orientation, religion or beliefs (including political beliefs), disability and age. The United Kingdom has combined the work of its three equality commissions and operates under a diversification agenda to meet the Equal Treatment Framework Directive.

The NMC code also covers the caring relationship, the information and advice regarding access to healthcare resources and the support and guidance on action to be taken in response to any conscientious objections to practice held by the nurse. Personal issues of conscience cannot override the care of others. There is a clear responsibility on the nurse to report issues of conscience to a person of authority as soon as possible and to continue to provide care until alternative arrangements are in place.

As well as personal ethics, personal accountability centres on the degree of trust that can be achieved in the nurse–patient relationship. Robinson (2001) discussed the importance of these relations in a moral context by professing that the psychological relationship between the carer and cared for can empower the client to make positive changes. This does not only mean changes to personal lifestyles but also positive changes to the system of care itself.

The accountable nurse has a duty to come to terms with their own understanding of the moral complexities of practice and to place this understanding in context. Furthermore, the level of insight has to be demonstrated in favour of the client or patient. The use of interpersonal skills is paramount to an effective nurse–patient relationship. The nurse communicates in order that the level of understanding of given information can be assessed; to determine the medium for providing knowledge and to establish the parameters of confidence in the care given and the confidentiality of information revealed. In essence, in its totality, communication can build rapport and trust so that there is some equality in the caring relationship.

Professional accountability

Professional accountability does not operate separately to personal accountability and whilst inherently an aspect of the nurses’ own understanding of their part in care, it can be presented as a different type of accountability. In this area there is a more explicit applicability to the demonstration of practice and competence which is clearer than that contained in the complexity of conscience. Caulfield (2002) suggested professional accountability consists of the contract of employment, clinical law and regulatory guidance (personal ethics is also included).

The contract of employment is a legal document and stipulates the nature of responsibility and accountability for each employee. It also includes the constraints and flexibility for the application of authority and control for the post. This allows the employer to exercise their own accountability for public liability, health and safety issues and issues such as wages, benefits and entitlements. Clinical law applies to certain practices which seek to protect the interest of the patient.

Both contractual and clinical law provide a framework for the implementation of relevant national laws such as the Human Rights Act (HMSO, 1988); Freedom of Information Act (The Stationery Office, 2005) and the Data Protection Act (HMSO, 1998). Supporting such legislation are guidance and codes related to protection for ‘whistle blowing’, the requirements for good record keeping, confidentiality and access to health data and information.

The nurse is always accountable for the currency of their practice and the NMC code urges the practitioner to be aware of the limits of their competence and not carry out any activities which could not be supported demonstrably by knowledge and expertise. The other side of the coin is that the nurse is also accountable if she/he does not do something which would benefit the patient when they could clearly do so (an act of omission).

Public accountability

Public accountability is related to the public perception of the profession’s trustworthiness. The actions of the individual nurse, therefore, obviously play a part. For example, the NMC forbids nurses to use their registration status to promote commercial products or services, or to accept any inducements or gifts to promote commercial services. Furthermore, nurses should be wary of using their qualifications to support products or services if the patient or client perceives such support as endorsement. Nurses cannot accept any gifts or favours in any form which could be perceived as inducement for favouritism or preferential treatment and must not ask for, or accept, loans from clients, their relations or friends.

This preoccupation with public trust reached its peak in the early 1990s when the Cadbury Report (HMSO, 1992) provided recommendations for Public Institutions and the selection of Board members, their terms of office, the disclosure of remunerations and the separation of the roles of Chair and Chief Executives. This was followed in 1994 by the Codes of Conduct and Accountability for NHS staff (HMSO, 1994), which highlighted the need to uphold public service values and also implemented the Cadbury recommendations. The Nolan Report (HMSO, 1995) provided further impetus and suggested there should be even more transparency in appointments and for a declaration of interest to be recorded and made public and appointments to be made on merit. The NMC code incorporates these recommendations and they are now deeply embedded in the profession’s maintenance of public accountability.

Public accountability also covers research. This is broadly applied in the beneficence ethics of research (do no harm) and in the methodological approach and dissemination of data. Nurses active in research are expected to adhere to research guidelines and are accountable for their activities within research policies and regulatory requirements. This area of accountability also covers registered nurse academics and the organisations in which they practice their research and scholarly activities.

CASE STUDY

Julie, a district nurse with 17 years’ experience, found herself working in a new community team following a local reorganisation. Julie experienced a degree of anxiety about the regularity checks on the home visit records which were carried out by the team leader. Her anxiety was based on the fact that she was unsure about the new assessments to be carried out on initial visits (both in the format to be used and the clinical skills to be applied) and that her seniority based on experience would be undermined in public. This was made worse by a colleague, Cathy, who had recently completed her District Nurse programme and seemed to take every opportunity to demonstrate her knowledge of new policies and local initiatives. Their working relations became increasingly strained and culminated in the involvement of the team manager, who called Julie and Cathy to a meeting. Julie was dismayed to hear Cathy outline her lack of confidence in Julie’s record keeping and her view that Julie was a high risk to become a future legal case by a patient. Cathy expressed her anger at the lack of continuity of care because other team members did not know which assessment Julie had carried out.

Julie retorted that Cathy was not in a position to question her practice, was too inexperienced to understand, and had been undermining her role with team members because she lacked interpersonal skills. Julie then broke down in tears and revealed her anxiety to her manager. The manager pointed out to both that they were personally accountable under the NMC Code of Practice to co-operate with others in the team, and that Julie was professionally accountable to maintain her professional knowledge and competence and to identify and minimise risk to patients and clients. Her manager identified a development need and provided funds for Julie to attend a local Trust update course.

Both Julie and Cathy were accountable under their contract of employment to maintain good records of care. Julie had failed in her responsibility to inform her manager of her development needs and was therefore derelict in her professional duty. Cathy was correct in bringing this issue to the attention of her manager despite her apparent lack of good communication skills.

CONCLUSION

A professional nurse or midwife is accountable for their actions at all times. Accountability occurs in different situations and can have simultaneous responsibilities to different authorities. The nurse is accountable for her or his own decisions, often without direct supervision and so is answerable to the patient/client, employer, regulatory legal guidelines and statutory bodies. Accountability is therefore not confined to a line manager and there is no situation wherein the nurse can abdicate their professional or personal responsibilities.

FURTHER READING

Gomm, R. (2004) Social Research Methodology – A Critical Introduction. Hampshire: Palgrave Macmillan.

Tadd, W. (2004) Ethical and Professional Issues in Nursing – Perspectives from Europe. Hampshire: Palgrave Macmillan.

Taylor, S. and Astra, E. (2006) Employment Law – An Introduction. Oxford: Oxford University Press.

REFERENCES

Caulfield, H. (2002) ‘Law: issues for nursing practice’, in J. Daly, S. Speedy, D. Jackson and P. Derbyshire (eds), Contexts of Nursing – An Introduction. Oxford: Blackwell.

HMSO (1988) Human Rights Act. London: HMSO.

HMSO (1992) The Committee on the Financial Aspects of Corporate Governance – The Cadbury Report. London: HMSO.

HMSO (1994) Codes of Conduct and Accountability for NHS Staff. London: HMSO.

HMSO (1995) The Committee on Standards in Public Life – The Nolan Report. London: HMSO.

HMSO (1998) Data Protection Act. London: HMSO.

Nursing and Midwifery Council (2002) Code of Professional Conduct. London: NMC.

Robinson, S.J. (2001) Agape – Moral Meaning and Pastoral Counselling. Cardiff: Aureus.

The Stationery Office (2005) Freedom of Information Act. London: HMSO.

Cross-References Autonomy, Clinical governance, Competence, Empowerment, Evidence-based practice, Manager, Professional development, Record keeping.

2 Advocacy

Moyra A. Baldwin

DEFINITION

Advocacy is an umbrella term for acting on behalf of another (Kohnke, 1982; Tschudin, 2003) by supporting and pleading that person’s cause. The numerous definitions and explanations of advocacy in the nursing literature range from counsellor, ‘watchdog’ and representative (Abrams, 1978) to potential whistle-blower (Andersen, 1...

Table of contents

• Cover Page
• Dedication
• Title
• Copyright
• Contents
• List of figures and tables
• About the editors and contributors
• Preface
• Acknowledgements
• Introduction – Elizabeth Mason-Whitehead, Annette McIntosh, Ann Bryan and Tom Mason
• How to use this book
• 1 Accountability – Mike Thomas
• 2 dvocacy – Moyra A. Baldwin
• 3 Assessment – Victoria Ridgway
• 4 Autonomy – Jill McCarthy
• 5 Biological determinants of need – Jan Woodhouse
• 6 Caring – Pat Rose
• 7 Clinical governance – Linda Meredith and Ian Pierce-Hayes
• 8 Common sense – Sue Phillips
• 9 Communication – Geoff Astbury
• 10 Compassion – Carole Capper
• 11 Competence – Andrea McLaughlin
• 12 Confidence – Carole Capper
• 13 Coping – Tom Mason
• 14 Crisis management – Janet Barton
• 15 Data, information, knowledge – Adam Keen
• 16 Dignity – Victoria Ridgway
• 17 Diversity – Julie Bailey-McHale
• 18 Educator – Jean Mannix and Annette McIntosh
• 19 Empathy – Tom Donovan
• 20 Empowerment – Ann Bryan
• 21 Environment – Elizabeth Mason-Whitehead
• 22 Equality – Mary Malone
• 23 Ethics – Alison Hobden
• 24 Evidence-based practice – Margaret Edwards
• 25 Feedback – Irene Cooke
• 26 Guilt – John Struthers
• 27 Holistic care – Kay Byatt
• 28 Inequalities in health – Alison While
• 29 Leadership – Geoff Watts
• 30 Manager – Jenni Templeman and Heather Cooper
• 31 Managing change – Linda Meredith
• 32 Managing technology – Neil Hosker and Peter Hinman
• 33 Mentoring – Helen Carr and Janice Gidman
• 34 Nurturing – Frances Wilson and Jan Woodhouse
• 35 Pain – Paul Barber
• 36 Problem solving – Jane Quigley
• 37 Professional development – Maureen Wilkins and Annette McIntosh
• 38 Realism – Cathy Thompson
• 39 Record keeping – Anne Waugh
• 40 Reflection – Janice Gidman and Jean Mannix
• 41 Rehabilitation – Sandra Flynn
• 42 Relationship between the individual and society – Andy Lovell
• 43 Researcher – Peter Bradshaw
• 44 Respect – Moyra A. Baldwin
• 45 Risk management – Bob Heyman
• 46 Role model – Dianne Phipps
• 47 Sense of humour – John Struthers
• 48 Teamwork – Alan Gee
• 49 User involvement – Julie Dulson
• 50 Value – Tony Warne and Sue McAndrew
• Index