Legal, ethical and professional aspects of duty of care for nurses

Duty of care is a fundamental aspect of nursing, and many nurses consider this to be an important part of their professional duties as a nurse. However, the legal underpinnings of duty of care are often overlooked, and, as such, nurses may be unsure about when to act if they encounter emergency situations or serious incidents, especially when they are off duty. This article examines the legal, ethical and professional aspects of duty of care, what these mean for nurses in practice, and how duty of care is intrinsically linked with standards of care and negligence.

Development and regulation of advanced nurse practitioners in the UK and internationally

The NHS in the UK is under increasing pressure as a result of financial and recruitment issues, as well as an ageing population. Nursing has continued to adapt to this challenging time. Over the past few years, the advanced nurse practitioner (ANP) role has been implemented widely in primary and secondary care. However, the ANP role has lacked consistency in scope of practice, training and regulation. This article summarises the development of the ANP role in the UK and internationally, and issues relating to regulation. Globally, ANPs are regulated by one of three different bodies: nationally by central government or a professional body, or locally by employers. In the UK, the role is regulated by local procedures, relying on employers to make decisions about the scope and preparation for practice. Some of the challenges in the UK in relation to ANP regulation are discussed, including variations in scope, organisational constraints and lack of support. These challenges are exacerbated by a lack of role clarity, thereby indicating there is a need to improve regulation of ANPs. The Royal College of Nursing has responded to these challenges by introducing 'credentialing', a system for recording qualifications, skills and experience, but the uptake of this process is yet to be evaluated. Therefore, employers and ANPs should be aware of their collective responsibility for ensuring appropriate role regulation.

Understanding and meeting your legal responsibilities as a nurse

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.

Tainted love: Gothic imaging of nurses in popular culture

AIMS

To discuss representations of nursing in popular culture using the Contemporary Gothic theory.

BACKGROUND

Nursing is stereotypically known as a caring profession. Caring in both the natural and professional perspectives is inextricably attached to love and love, we are told, is universal. In popular culture, however, there are numerous examples of nurses being portrayed in ways where love-its expression and its practice-has been transgressed or tainted. Exploring this dark side of nursing, even if fictitious, is significant because it illuminates social and cultural tensions.

DESIGN

Discussion paper.

DATA SOURCES

CINAHL, Scopus and Humanities International Databases were searched for terms related to nursing, love, abject and the gothic, published between 1990-2016. Four popular culture texts which ranged in genre and gothic elements were selected for analysis.

IMPLICATIONS FOR NURSING

The types of transgressive love these nurses express to patients ranges from the obsessive and the pornographic, to the monstrous. We suggest this positioning illuminates a hidden reality that nursing work is at once intimate and personal but also hidden, profane, repellent, horrifying and feared. Nursing's allure for storytellers may rest in its association with the abject. How nurses find redemption, satisfaction and meaning in these locations is relevant for how we can imbue our lives and work with greater humanity.

CONCLUSION

The Contemporary Gothic is a useful tool in exposing and exploring ambiguous, challenging and taboo aspects of nursing in society. Such and analysis helps to explain phenomena-including nursing itself-which exists in the shadow of dominant and often stereotyped discourses.

Improving nurses' level of reflection

Reflecting on practice is an important aspect of nursing. There is widespread acknowledgement of the value of reflective practice and it has a significant role in coursework assessment and revalidation requirements. However, less attention has been given to the various levels of reflection and what constitutes a higher or lower level of reflection. This article aims to assist nurses to understand how identifying the various levels of reflection can improve their practice. A case study example is used to demonstrate how mentors might support nurses in incorporating reflection into their practice.

Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations

OBJECTIVES

The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice.

METHOD

We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations.

RESULTS

We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles.

CONCLUSIONS

We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings.

PRACTITIONER POINTS

Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested.

Globalisation and global health: issues for nursing

'Globalisation' is the term used to describe the increasing economic and social interdependence between countries. Shifting patterns of health and disease are associated with globalisation. Global health refers to a health issue that is not contained geographically and that single countries cannot address alone. In response to globalisation and global health issues, nurses practise in new and emerging transnational contexts. Therefore, it is important that nurses respond proactively to these changes and understand the effects of globalisation on health worldwide. This article aims to increase nurses' knowledge of, and confidence in, this important area of nursing practice.

Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center

BACKGROUND

Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units.

AIMS

The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress.

METHODS

A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress.

RESULTS

The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress.

LINKING EVIDENCE TO ACTION

Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions.

LGBTQ Youth Part 1

In order to provide holistic care, school nurses must be culturally competent by being sensitive to health disparities experienced by students in at-risk populations. Despite the growing acceptance toward gender and sexual minorities, LGBTQ youth remain an at-risk population in our communities and our schools. School nurses as well as school counselors, social workers, and psychologists can increase their cultural competence in caring for this group of students by increasing their understanding of appropriate terminology and risks associated with this vulnerable group. This article is Part 1 of a two-article series designed to increase school nurses' abilities to advocate and care for LGBTQ youth in school settings. This first article provides information regarding proper terminology and current percentages of youth who identify as LGBTQ and concludes with implications for school nurses, including resources for nurses, school staff, and families.

Protection against allegations of sexual assault when undertaking ultrasound examinations

The Medical Defence Union has reported an increase in the numbers of sexual assault allegations against doctors, although these are still thankfully rare. This short article discusses the experience of the Society of Radiographers in advising members who have been accused of sexual assault and identifies ways in which ultrasound practitioners can reduce the risk of having such an accusation made against them.

Creating a Culture of Accurate and Precise Data

There are many stakeholders for school health data. Each one has a stake in the quality and accuracy of the health data collected and reported in schools. The joint NASN and NASSNC national school nurse data set initiative, Step Up & Be Counted!, heightens the need to assure accurate and precise data. The use of a standardized terminology allows the data on school health care delivered in local schools to be aggregated for use at the local, state, and national levels. The use of uniform terminology demands that data elements be defined and that accurate and reliable data are entered into the database. Barriers to accurate data are misunderstanding of accurate data needs, student caseloads that exceed the national recommendations, lack of electronic student health records, and electronic student health records that do not collect the indicators using the standardized terminology or definitions. The quality of the data that school nurses report and share has an impact at the personal, district, state, and national levels and influences the confidence and quality of the decisions made using that data.

Improving Departments of Psychology

Our procedures for creating excellent departments of psychology are based largely on selection-hiring and promoting the best people. I argue that these procedures have been successful, but I suggest the implementation of policies that I believe will further improve departments in the behavioral and brain sciences. I recommend that we institute more faculty development programs attached to incentives to guarantee continuing education and scholarly activities after the Ph.D. degree. I also argue that we would do a much better job if we more strongly stream our faculty into research, education, or service and not expect all faculty members to carry equal responsibility for each of these. Finally, I argue that more hiring should occur at advanced levels, where scholars have a proven track record of independent scholarship. Although these practices will be a challenge to implement, institutions do ossify over time and thus searching for ways to improve our departments should be a key element of faculty governance.

The Role of the Designated State Data Champion

Step Up & Be Counted! (Step Up!) is a joint project of the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC). The goal of the initiative is to develop a National School Nurse Standardized Data Set that will be used by nurses across the country to uniformly collect data the same way. The data will be used to determine the health of children and youth, the care that is delivered in schools, and the impact of school nurses on academic success and well-being. This article focuses on the role of the Designated State Data Champion in the initiative.

Effective design, implementation and management of change in healthcare

Changes in healthcare organisations are common, and their implementation is often complex and challenging. Change is often implemented suboptimally, and can have several negative effects on staff turnover, patient care and budget targets. To minimise and avoid negative outcomes, a systematic three-stage change process that comprises preparing for change, implementing change, and evaluating and sustaining change can be followed. In the first stage, before commencing any change activities, time and attention should be given to conducting detailed analyses and preparatory work to establish the foundation for the implementation phase. In the second stage, a clear set of multiple implementation tactics are used to ensure the change process is effective. In the final stage, an evaluation of the success of the change is undertaken and measures are put in place to ensure it is sustained over time. It is only by following a methodical change process such as this that changes can be implemented effectively in healthcare organisations.

Using the Framework for 21st-Century School Nursing Practice in Daily Practice

NASN recently developed a Framework for 21st-Century School Nursing Practice (Framework) to guide school nursing activities. The principles and components of the Framework can be used as a guide in achieving high-quality school nurse practice. The purpose of this article is to share how school nurses can use the Framework in their daily practice, invite nurses to identify one new way the Framework can be used in your practice this school year, and implement and evaluate the change.

Correlating Emotional Intelligence and Job Performance Among Jordanian Hospitals' Registered Nurses

PROBLEM

Emotional intelligence (EI) is an ability to recognize our and others' emotions, and manage emotions in ourselves and in relationships with other people. A large body of research evidence outside nursing shows that measured (EI) abilities correlated with employee performance, motivation, and job satisfaction; and preliminary nursing research evidence shows the correlation between EI ability and nurses' clinical performance. There is less research on the EI ability of Jordanian nurses, and the present study was undertaken to address this gap.

METHODS

A descriptive, cross-sectional, correlation comparative design (nonexperimental) was employed. Six Jordanian hospitals were included in the study. Two hundred fifty questionnaires were distributed to prospective participants. One hundred ninety-four questionnaires were returned, giving a response rate of 78%. EI was measured using the Genos Instrument. Clinical performance was measured using a self-report measure.

FINDINGS

Findings demonstrated significant positive relationships between all subscales of EI and job performance, ranging from r = .250, p = .000 to r = .193, p = .007. Regression analysis indicated working in medical-surgical wards, recognizing and expressing emotions scores (β = 0.186, p = .048), and controlling emotions (β = 0.255, p = .027) explained 19.1% of variance in nurses' job performance.

CONCLUSIONS

The study findings confirm the correlation between nurse EI ability and clinical performance.

Leading Change: Implementation of a New Care Coordination Model

Today's healthcare environment is characterized by a multitude of changes: acquisitions and mergers, streamlining of operations, restructuring and leadership shifts, new regulatory requirements with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, implementation and meaningful use, and advances in technology driven by the employment of electronic health records. The impact of these changes is complex and fraught with challenges in an industry that historically and culturally is cautious and slow to change. 
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Role of the nurse in managing complaints in their clinical area

Complaints and their management are an important indicator of the quality of care. Therefore, effective management of complaints is central to improve services and prioritise an open, honest and transparent health service. However, there is scope for NHS organisations to improve their response to complaints. This article outlines the NHS complaints procedure, focusing on how nurses can develop essential skills to help them to improve their management of any complaints that arise in their clinical area. It provides a structured framework, identifying useful communication skills, and explores how managing complaints relates to a nurse's statutory duty of candour.

Care of the Student With Special Healthcare Needs: The Development of the WISHeS Unlicensed Assistive Personnel Training

Care of the Student With Special Healthcare Needs is a free resource that can assist school nurses in ensuring they are providing the most up-to-date, evidence-based care to children. Although the training module was developed to improve the care provided to Wisconsin children, the module can be accessed by school nurses and unlicensed assistive personnel (UAP) across the United States and internationally. School nurses in other states would need to review their state's nurse practice act and school district policies to evaluate which procedures they are allowed to delegate.

Developing effective therapeutic relationships with children, young people and their families

It is imperative that nurses caring for children, young people and their families develop and maintain effective, trusting and collaborative therapeutic relationships that sit within the scope of professional boundaries. This relationship is the nurse's responsibility and should be positive and mutually acceptable to all stakeholders. A unique challenge for children's nurses is to address and prioritise the child's care needs, while meeting the needs of, and empowering, the family. The 6Cs--care, compassion, competence, communication, courage, commitment--should underpin care and enable nurses to overcome challenges such as time pressures, acute situations or disturbed family expectation. Confidentiality and safeguarding should always be observed.

Nurses Identify Education and Communication Among Professionals as Essential in Serving ASD Children

Autism spectrum disorder (ASD) is a broad term encompassing a group of neurodevelopmental disabilities. Children with ASD present behavioral, communication, and social behaviors. One in 68 individuals is diagnosed with autism. With ASD prevalence continuing to rise, it makes sense for school nurses to identify areas that may be helpful in serving this population. This school nurse focus group study shared specific areas that would benefit school nurses when working with children with autism. Two glaring trends surfaced from the focus group--continuing education needs and communication among all school professionals (i.e., teachers, special education services).

Roles played by advanced practitioners in oncology: present status and future outlook

The 40th anniversary of the Oncology Nursing Society is the perfect time to reflect on the role that advanced practitioners in oncology (APOs) play in the care of patients with cancer. APOs have become an important part of cancer care. This group of professionals practicing in various settings includes physician assistants (PAs), clinical nurse specialists (CNSs), and nurse practitioners (NPs). Areas of practice include inpatient and outpatient settings, emergency departments, surgical centers, and community health clinics (Leonard & Grossman, 2015), as well as academia and pharmaceutical companies. In practice, APOs typically assume a wide range of roles that can involve direct patient care, education (of patients and in a professional capacity), administration, consulting, and research. APOs often take on more than one of these roles. 
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Changing course

Although the field of behavior analysis provided the formative experiences and much of the profession training that have fueled a long and satisfying career, I now find that I am turning away from behavior-analytic research and teaching. My reasons for making this change stem from concerns about the costs and potential benefits of basic behavior-analytic research strategies and the isolation of behavior analysis from mainstream science. I offer some suggestions for strengthening the profession.

Voice problems in the fitness industry: Factors associated with chronic hoarseness

PURPOSE

To determine factors associated with chronic hoarseness in Australian group fitness instructors (GFIs).

METHOD

A total of 361 GFIs (81 males, 280 females), aged between 18-67 years currently active in the Australian fitness industry, completed a 65-item self-completion questionnaire distributed via SurveyMonkey. Demographic, lifestyle and voice use variables thought to influence vocal health and voice production in the GFI population were examined using logistic regression analyses. GFIs' chronic hoarseness with response options "positive" and "negative" was considered as the outcome variable of interest.

RESULT

Approximately 39% of the study participants reported having chronic hoarseness. Multivariable logistic regression modelling revealed a set of statistically significant factors associated with chronic hoarseness. These include: younger age, partial voice loss while instructing, partial voice loss after instructing and using vocal volume louder than normal speaking voice whilst instructing.

CONCLUSION

This study has identified factors associated with the presentation of chronic hoarseness in the Australian GFI population. Prospective studies are required to validate the findings of this study in order to better understand predictive factors of chronic hoarseness among GFIs.

The rhetoric of patient and family centred care: an institutional ethnography into what actually happens

AIMS

This paper uses Dorothy Smith's institutional ethnography to examine technological advances designed to improve nurses' work. The analysis interrogates how nurses' work is coordinated, in disquieting ways, in an apparent commitment to 'patient and family centred care'.

BACKGROUND

The discussion is part of a larger programme of research that focuses ethnographic attention on nurses' activating technological managerial improvement strategies.

DESIGN

This discussion paper describes suboptimal hospital experiences to show how they were organized. The institutional ethnographic analysis addresses discrepancies that arise between the different organizational standpoints. Overall the discussion focuses on how institutional ethnographers enquire into people's everyday activities to discover and make understandable, in the material world, what actually happens that shapes them.

DATA SOURCES

Data include observations and interviews with nurses, nurse managers, patients and families. It also includes screenshots of computer fields and other documents being used by nurses.

IMPLICATIONS FOR NURSING

Nursing work is methodically being oriented to interests that undermine nurses' capacity to contribute their knowledgeable activity to intervene in people's health and well-being.

CONCLUSION

Nurses' work is overwhelmed with the imperative to discharge patients. This happens with an ideological construction of patient centred care that obscures what is actually happening.