Lecture six: Professionalism in Nursing

Question 1

What are the 5 key NCNZ documents?

Answer 1

• Competencies for registered nurses (2012, amended 2016)
• Code of conduct for nurses (2016)
• Guidelines for cultural safety, the treaty of Waitangi and Maori health in nursing education and practice (2011)
• Guidelines : Professional boundaries (2012)
• Guidelines : Social media and electronic communication (2012)

Question 2

Tell me about the NCNZ document “Competencies for registered nurses” and what arethe four domains?

Answer 2

The Nursing Council’s Competencies for Registered Nurses describe the skills and activities of registered nurses.

Four domains of competence -
 Professional responsibility
 Management of nursing care
 Interpersonal relationships
 Interprofessional healthcare and quality improvement

You self assess your meeting of competencies at placement by giving examples for “learning outcomes”

Question 3

Tell me about the NCNZ document “Code of conduct for nurses (2016) -
MANDATORY”

Question 4

Tell me about the NCNZ document “Guidelines for cultural safety, the TOW and Maori health in Nursing education and practice (2011)”

Answer 4

The Council’s broad definition of cultural safety:

“The effective nursing practice of a person or family from another culture, and is determined by that person or family.”

Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomicstatus; ethnic origin or migrant experience; religious or spiritual belief; and disability.

Question 5

How can you be culturally safe?

Answer 5

• Awareness
• Forming a connection
• Communication
• Negotiation
• Advocacy
• Partnership

“Nurses need to develop the knowledge, skills and practice to
work effectively with Maori to achieve positive health outcomes and health gains”

“Involves the recognition, respect and acceptance that Maori are a diverse population and have worldviews that differ from most nurses”

“We need to understand the historical processes and sociopolitical and economic power relationships that have contributed to the current status of Maori health in this country”

What do each of these statements look like in practice ?

Question 6

Tell me about the NCNZ document Guidelines : Professional boundaries (2012)

Answer 6

Document that gives advice about –
- appropriate professional relationships
with clients

• personal, financial, sexual boundaries
• social media use

Question 7

What is an example of over involvement?

Answer 7

“I like this patient I will give their medication first”

Question 8

What are some indicators of boundary violations?

Answer 8

Favouritism – emotionally close – ‘special’ patient

Co-dependent – reluctance for self management

Lack of empathy or patronising attitude

Inappropriate touch

Inappropriate sharing of personal life

Contact continues after the episode of care / therapeutic relationship has concluded

Personal contact details exchanged

The patient is only willing to see a specific nurse

Question 9

What are three questions to ask yourself when navigating difficult situations?

Answer 9

• Is my action fostering independence in my patient
• Is there confusion about my role – friendly NOT friends!
• Would I be happy for my colleagues to know about this

Question 10

How can you conclude professional relationships?

Answer 10

1. Remember Peplau’s phases of therapeutic communication
2. Termination MUST occur when a patient can manage their own needs or referral has been made
3. Prepare your patient by discussing the nature of the therapeutic relationship (from day one)
4. Involve other members of the team if needed – avoid professional isolation (may need chaperoning)
5. Maintain appropriate boundaries from the outset
6. Terminate the relationship every shift

Question 11

Talk about nurse/ patient sexual relationships

Answer 11

A sexual or intimate relationship is ALWAYS inappropriate within the context of the nurse / patient relationship

May harm patient, trust in the nurse and the nursing profession

‘Consent’ is not acceptable defence

NEVER a truly equal relationship

This includes former patients AND their family

If it feels murky – SEEK advice!!

Question 12

Talk about gifts and bequests

Answer 12

MORE THAN A TOKEN VALUE MAY
COMPROMISE THE PROFESSIONAL RELATIONSHIP

COULD BE VIEWED AS NURSE TAKING ADVANTAGE OR PATIENT SEEKING PREFERENTIAL TREATMENT

WEIGH UP CONSEQUENCES IN
REFUSING – CULTURAL / FAMILY RESPONSE?

ALL HOSPITALS SHOULD HAVE A CLEAR POLICY – GIFTS TO THE WHOLE TEAM MAY BE ACCEPTABLE E.G. CHOCOLATES / FLOWERS / DONATION

CASH GIFTS MUST NEVER BE ACCEPTED BUT REFER TO THE LINE MANAGER – MAY PURCHASE EQUIPMENT TO BENEFIT PATIENTS

MUST NOT ASK FOR / ACCEPT / BORROW MONEY

Question 13

Talk about the NCNZ document “Guidelines : social media and electronic communication (2012) –
aligns to each principle in the code of conduct)”

Answer 13

Maintain heath consumers confidentiality and privacy by not discussing health consumers or practice issues in public places, including social media. Even when no names are used a health consumer may be identified.

Keep personal and professional lives as seperate as possible. Avoid online relationships with current or former health consumers. DO NOT used social media to build or pursue relationships with health consumer.

Consider your online image -
background checks WILL include your social media profiles

Avoid online relationships with current / former patients

Think confidentiality, context, defamation

AVOID patient identifiers or work images