Ma te môhio ka mârama Through awareness comes understanding (as cited in Mason, 2017). Nurses are accountable by law to protect and promote the rights of health consumers while delivering safe and competent care. The practices of a registered nurse demonstrate how statutory law and legislation produced by the Nursing Council of New Zealand underpin a nurses professional, ethical and legal responsibilities. Nursing today has evolved an awareness and respect for the values and needs of health consumers and how to best meet them in order to achieve positive health outcomes. Task 1The interaction occurred between a registered nurse and a patient who will be called Jacob in order to maintain patient confidentiality. The interaction took place during the day on a busy medical/surgical ward of a hospital. Jacob is a young adult of M?ori descent. He was placed in a four-bedded rooms with three other patients whom were of varying ages and ethnic backgrounds.
Jacob had a large group of whanau and friends visiting and staying with him throughout the day. At times the large amount of people in the room made it difficult for patients and staff to move about. Loud singing and the playing of the guitar from Jacob’s family members was considered unwelcome to some of the neighbouring patients who only had a thin curtain to separate themselves from the noise. Jacob would also have a group of close friends who would stay with him most of the day till past visiting hours and who were seen by staff and neighbouring health consumers on multiple occasions to be lying on his bed as well as displaying disrespectful behaviour and language. The interaction between the registered nurse allocated to Jacob and his family occurred as a result of multiple complaints being made from staff and surrounding patients concerning lack of space and the behaviour of Jacob and his visitors. As a response to the complaints and the breaches in health and safety policies the nurse consulted with colleagues before they asked to speak with the young man and his mother in private. The nurse explained the concerns of the staff and neighbouring health consumers, hospital protocol as well as the nurses responsibilities to their patients.
It was further discussed and agreed upon that when the group was becoming too large or wish to sing and play music that they would relocate to the Whanau room, a designated space made to accompany visitors. It was also agreed upon that in future the family and friends would try to respect neighbouring health consumers by refraining from using inappropriate language and speaking at a reasonable tone.Task 2 Through the HPCA (2003) the NCNZ are empowered to set and monitor standards and competencies to ensure that safe and competent care provided by registered nurses (Nursing Council of New Zealand, 2011a). The Code of Conduct (2012a) is a code of practice. Written by the NCNZ the Code applies to all registered nurses within their professional practice. Consisting of eight principles and standards, all of equal importance, the code encompasses the values of respect, trust, partnership and integrity (Nursing Council of New Zealand, 2012a). These values are underpinned in the standards of professional conduct for nurses practicing in New Zealand.
Nurses have access to private and privileged information with the public expectation that this power will not be abused. The Code of Conduct sets an expectation for the standard for nursing behavior in regards to all professional interactions. Nurses working in small population, rural areas struggle to maintain professional boundaries and practices while providing care for health consumers they may be familiar with.Codes of practice and legislation protect the public and guide nursing practice.
Documents such as the Code, Treaty of Waitangi, Competencies for Registered Nurses, Guidelines: Professional Boundaries and the Code of Ethics all support registered nurses in making sound professional and ethical decisions. Providing safe and appropriate care and whilst protecting patient confidentiality (Nursing Council of New Zealand, 2012b). The Nursing Council of New Zealand produced the Code of Conduct to oversee that the nursing profession meets a level of standard and competencies within its members thus ensuring that accountability to the public, patients, their employer and their profession and strengthens the public’s trust in the healthcare system (Nursing Council of New Zealand, 2012a).Task 3Principle 2 of the Code of Conduct (2012) acknowledges the need for respect and appreciation of cultural values and needs of health consumers. Cultural safety is ingrained into New Zealand nursing in compliance with the Treaty of Waitangi and is seen as a necessary component of M?ori health (Nursing Council of New Zealand, 2011). In practice, cultural safety is demonstrating the ability to effectively provide care for a health consumer from another culture and is determined by the health consumer or whanau (Nursing Council of New Zealand, 2011). Effective culturally safe practice is achieved when your actions as a nurse do not disempower or bring harm upon the health consumer (Nursing Council of New Zealand, 2012a). Mutual respect and an understanding of M?ori culture enabled the nurse to respond to the situation in an appropriate and professional manner.
By allowing the family to stay with the health consumer and continue their cultural practices exercises their right to autonomy. Moving the group away from neighbouring health consumers removes their cause of distress and practices non maleficence and beneficence on behalf of the nurse. This is consistent with the standards outlined in principle 2 of the code. Standard 2.5 outlines the importance working with M?ori culture and whanau has in achieving positive health outcomes and the improved health status of health consumers (MidCentral DHB, 2010; Wepa, 2015).Maori have a holistic approach to healthcare.
‘Te whare tapa wh?’ is one model used by health professionals to understand the four cornerstones of Maori health. Maori believe that a person’s overall health is formed by four elements: taha tinana (physical health), taha wairua (spiritual health), taha wh?nau (family health) and taha hinengaro (mental health).When Maori are sick the person’s wairua (spirit) must also be tended to alongside treatment using mostly western forms of medicine. In Maori culture, family unity and music are common place when a loved one is unwell (Kahui, 2008). It is a traditional Maori belief that song and music have the ability to heal. Music is an empowering and liberating form of therapeutic healing which is a form of emotional expression and helps to raise the spirits of individuals when experiencing bad health (Wirihana & Smith, 2014).In this instance the nurse on duty was able to acknowledge the difference in culture and was able to meet the cultural needs of both Jacob and his wh?nau as well as the other health consumers staying in the room.
Meeting the standard competency for practising in a manner deemed culturally safe (Nursing Council of New Zealand, 2012b). The code acted as a guide, enabling the nurse to continue the role Jacob’s whanau had on his recovery whilst not diminishing the cultural needs and wellbeing of the other health consumers thus working towards achieving positive health outcomes for all.Principle 3 of the Code of Conduct (2012a) recognises the importance of working in partnership with health consumers to promote and protect their well-being.In accordance with the Treaty of Waitangi, partnership is one of the three principles inherit within the treaty and is therefore a legal requirement of nurses to incorporate these principles into the basis of nursing practice. Partnership being the collaboration of two groups, Maori and health professionals, to work towards a common goal. Standard 3.
3 to support and respect the contribution health consumers make to their own care and well-being can be related back to the interaction between the nurse and the health consumer/wh?nau. Actively involving the wh?nau in the decision making process transfers some of the power of decision making of care from the nurse to the health consumer and wh?nau. By being open to input and sharing ideas between each other allows for a greater degree of autonomy over the decision making process and chosen path of care. The nurse could have chosen to take complete control of the situation and risked jeopardising the relationship between the health professionals and M?ori. Utilising the knowledge and guidance from documents such as the Code of Conduct (2012a) and Guidelines for cultural safety, the Treaty of Waitangi, and Maori health in nursing education and practice (2011) the nurse was able to resolve the conflict with the integrity and well being of both parties being preserved. The nurse managed to situation with professionalism and followed through on there legal obligation as an employee of the Crown to honour the Treaty of Waitangi (Nursing Council of New Zealand, 2012b).Multiple complaints had been made against the health consumer and his group of visitors. Standard 3.
6 of the Code states that nurses should respect health consumers’ right to complain and respond by working with them to resolve the issue. In order to maintain fairness and equity of care the nurse must work to respect the rights, needs and values of each and everyone of the health consumers occupying the hospital room (Fry & Veatch, 2006; Grace, 2009). Practising equity within the healthcare system is linked to better health outcomes, upholding the public’s good perception of the healthcare system and nursing profession (Grace, 2009).
Accepting M?ori customs and treating them as taonga empowers M?ori and gives the health consumers and whanau autonomy over the methods in which they choose to treat their own. To have stopped the music would be jeopardising the relationship between the nurse and health consumer and wh?nau. Principle 4 of the Code of Conduct (2012a) is to maintain the trust of health consumers by providing safe and competent care. Trust in the nursing profession is crucial to positive health outcomes.
The Nursing Council of New Zealand (NCNZ) is the governing regulatory body for registered nurses practicing in New Zealand. Under the HPCA act the NCNZ hold nurses accountable for their practice and malpractice thus protecting the public and installing trust within the nursing profession. Standard 4.5 encourages registered nurses to ask for advice and assistance from colleagues especially when care may be compromised by your lack of knowledge. Given the nurse was not of the same culture or exceedingly experienced dealing with such situations they first sought the consult of more experienced colleagues before approaching Jacob and his wh?nau.
Cultural differences of age, ethnicity and spiritual beliefs existed between Jacob and each of the neighbouring health consumers. Due to the variation in culture each health consumer had a differing set of beliefs on what did and did not constituted appropriate behaviour. In the interest of fairness it was not recommended to the nurse by her colleagues that Jacob should be moved into a seperate one bedded room. However, as time progressed it became evident that the tension between Jacob and his neighbouring health consumers was still present despite the nurses reasoning with Jacob and his visitors. Eventually, the charge nurse suggested that it was within the best interests of everyone to move Jacob into one of the single bedded rooms once it had become evident that the tension between Jacob and his neighbours was still unresolved. The solution offered by the charge nurse meant that each affected party was satisfied. The input of the more experienced and knowledgeable nurse was indispensable as it helped to resolve the conflict between Jacob and the other health consumers sharing the room with him. This is an example of practicing non maleficence as it prevented further harm to both of the parties involved.
The senior nurse taught the registered nurse the value of asking for help otherwise the nurse may not have thought of the solution herself. By taking in the advice of the more experienced, the registered nurse was able to apply her nursing competencies and preserve the right of each of the health consumers to hold their own set of beliefs and values (Nursing Council of New Zealand, 2012b). Principle 8 of the Code of Conduct (2012a) refers to maintaining public trust and confidence in the nursing profession. Trust and confidence are established when registered nurses are proficient in there area of work and can maintain a professional conduct within the workplace (Daly, Speedy, & Jackson, 2013). Standard 8.2 asserts the need to respect the property and resources of your employer. To maintain high standards of professional behavior in your relationship with your employer.
Adhere to organisational policy and standards that protect public safety. During the interaction matters of disregard for hospital property was an issue. Staff had witnessed Jacobs visitors lying in the hospital bed alongside him, placing their shoes on top of the bed and showing a general disregard for the hospital area. Hospital policy states that it is the responsibility of the health consumer to treat the facilities and equipment with care and to assist in retaining a pleasant, healthy and safe environment (MidCentral District Health Board, 2016).
As a guardian of the environment and its resources registered nurses have a responsibility to maintain the respectability of there clinical area (New Zealand Nurses Organisation, 2010). The registered nurse in charge of the care of Jacob informed him and his visitors of his responsibilities as a health consumer. The registered nurse and other hospital staff were forced to reminded Jacob of these obligations on several occasions in a respectful and polite manner. Maintaining the respectability of the area plays a part in maintaining a culturally safe practice as neighbouring health consumers were of an older and more respectful generation. Health and safety protocol was being breached due to the amount of visitors which were crowding into the room. The curtains surrounding the bed were insufficient in containing everyone and maintaining the privacy of the health consumer. When alerted to the the breach in the health and safety standards the nurse quick to follow hospital protocol and move people out of the room.
The registered nurse demonstrated professional responsibility and competence by promoting a safe environment, enforcing infection control standards and meeting the needs of the health consumers and public (Nursing Council of New Zealand, 2012b). Task FourThe core values of the Code of Conduct and key aspects in professional nursing are respect, trust, partnership and integrity. These values underpin professional nursing conduct (Nursing Council of New Zealand, 2012a).
Throughout the registered nurses interactions with Jacob and his wh?nau the nurse displayed each of these values within their practice. Perceiving the cultural needs of Jacob and his wh?nau enabled the nurse to provide space in which the group could fulfill their cultural needs. This would not have been possible if the nurses didn’t first have an understanding or respect for culture and the traditional practices of health consumers. Respect for the opinions of colleagues, especially those with more experience, shows a commitment to learning and a respect for the nursing profession.Complying the ‘right to information’, ‘right to care’ and ‘right to be informed’ principles allowing an open and honest discussion with Jacob and his wh?nau about care options and pathways, maintaining the health consumers trust in the profession.Working together in partnership with Jacob and his wh?nau with the mutual aim of providing the best care for him.
Involving the wh?nau in the planning of care is the best way to promote recovery and autonomy thus leading to increased positive health outcomes.The registered nurse showed integrity when she challenged the behaviour of Jacob’s friends when they began to act inappropriately and rebel against the policies and procedures set out by the hospital. The practice of the registered nurse in this interaction is an attribute to the advancements of the nursing profession in New Zealand. Each of these examples taken from the registered nurses practice work to build up the reputation of professionalism within nursing. Acknowledging ones responsibility to ensure that their actions fulfill the professional, legal and ethical standards set out by applicable legislation (Nursing Council of New Zealand, 2012b). Legislative documents such as the Treaty of Waitangi and the HPCA guide and enable nurses to reflect on their own professional, ethical and legal obligations and practices put in place to protect health consumers. Given the key aspects of respect, trust, integrity and partnership the practice of the registered nurse involved in the care of Jacob and his whanau contributes to professionalism within the nursing profession.