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Course: Oncology Nursing

Topic: Scope of Nursing Practice

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Define scope of nursing practice.
Recognize provision of nursing care within the scope of practice.
Discuss the liabilities and limitations such as negligence and malpractice in the scope of nursing oncology practice.
Identify the ethical considerations in documentation and medical record-keeping.
Identify the legal considerations in documentation and medical record-keeping.
Discuss the role of documentation and medical record-keeping in oncology nursing.

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Definition of Scope of Nursing Practice

ANA, 2021

“Scope of practice describes the services that a qualified health professional is deemed competent to perform, and permitted to undertake – in keeping with the terms of their professional license”

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Definition of Scope of Nursing Practice

The Nursing Scope and Standards of Practice describe the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice:

Who:

Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who”

What:

Protection, promotion, and optimization of health and abilities
Prevention of illness and injury; facilitation of healing
Alleviation of suffering through the diagnosis and treatment
Advocacy in the care of individuals, community

ANA, 2021

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Definition of Scope of Nursing Practice

ANA, 2021

Where:

Wherever there is a patient in need of care.

When:

Whenever there is a need for nursing knowledge, compassion, and expertise.

Why:

The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society.

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Ethical Principles

South African Nursing Council

These Ethical Principles should be upheld at all times by all practicing nurses:

Justice: Nurses are at all times expected to act fairly and equitably where there is competition of interest among parties, groups or individuals.
Non-maleficence: This requires a nurse to consciously refrain from doing harm to any health care users.
Beneficence: Nurses are required to do good and to choose the “best option” of care under given circumstances.

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Ethical Principles

South African Nursing Council

Veracity:

This principle requires the nurse to act with truthfulness and honesty and to ensure that the information provided to and on behalf of the healthcare user is always in the best interest of the healthcare user.

Fidelity:

This entails adherence to factual and truthful accounting and balancing that with respecting, protecting and maintaining confidential information pertaining to the delivery of healthcare, including health records of healthcare users.

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Ethical Principles

South African Nursing Council

Altruism:

Nurses are at all times expected to show concern for the welfare and wellbeing of healthcare users.

Autonomy:

Respect for the autonomy of eligible persons to make their own decisions and choices in matters affecting their health.

Caring:

Nurses demonstrate the art of nurturing by both applying professional competencies and positive emotions that will benefit both the nurse and the healthcare user with inner harmony.

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Code of Ethics for Nursing

South African Nursing Council

The Code of ethics is based on the belief that nurses value:

Human life
Respect, dignity and kindness for oneself and others
The uniqueness of individual healthcare users
The right to access to quality nursing and healthcare for all
The provision of accurate and truthful information in accordance with informed consent or refusal of treatment to enable individuals to make informed decisions in respect of matters affecting their health

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Code of Ethics for Nursing

South African Nursing Council

This Code is based on the belief that nurses value:

Integrity of persons in their care as well as the image of the profession
Confidentiality and privacy of personal information and belongings of healthcare users;
A culture of safety and an ethically-friendly environment, which includes the protection of healthcare users from colleagues who may be unfit to practise due to impairment or disability, posing a threat to the health and wellbeing of healthcare use

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Professional Misconduct

South African Nursing Council

Examples of acts and omissions which are regarded as professional misconduct

Failure to give the required treatment to a patient
Neglect obtaining medical assistance for a patient
Failure to prevent injury or accident to a patient
Theft from a patient, or a deceased person
Patient assault (physical, sexual or verbal)
Patient left unattended
Misuse of medication
Forcing a patient to sign a consent for a surgical procedure

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What would the nurse do?

What are the ethical principles a nurse has to follow while practicing a nursing?

Reflect on what this means for your practice as a nurse.

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Negligence and Malpractice

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines negligence as a "failure to use such care as a reasonably prudent and careful person would use under similar circumstances."

JCAHO defines malpractice as "improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position; often applied to physicians, dentists, lawyers, and public officers to denote negligent or unskillful performance of duties when professional skills are obligatory”

Croke, Eileen M., 2003

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Negligence and Malpractice

Croke, Eileen M., 2003

Several factors have contributed to the increase in the number of malpractice cases against nurses:

Delegation
Early discharge
The nursing shortage and hospital downsizing
Advances in technology
Better-informed consumers
Expanded legal definitions of liability

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Reducing Potential Liability

The following can help nurses reduce potential liability:

Maintain open, honest, respectful relationships and communication with patients and family members

Patients are less likely to sue if they feel that a nurse has been caring and professional
Don't make a statement that a patient may interpret as an admission of fault or guilt
Don't criticize health care providers or their actions when you are with patients
Maintain confidentiality in the health care setting

Croke, Eileen M., 2003

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Reducing Potential Liability

Croke, Eileen M., 2003

Maintain competence in your specialty area of practice:

Attend relevant continuing education classes.
Attend relevant hospital in-service program.
Expand your knowledge and technical skills.

Know legal principles and incorporate them into everyday practice:

Keep up to date on your state's nurse practice act.
Keep up to date on hospital policies and procedures.

Practice within the bounds of professional licensure:

Perform only the nursing skills allowed within your scope of practice and that you are competent to perform.

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Reducing Potential Liability

Croke, Eileen M., 2003

Know your strengths and weaknesses:

Don't accept a clinical assignment you don't feel competent to perform.
Evaluate your assignment with your supervisor.
Accept only those duties you can perform competently.
Let an experienced nurse on the unit assume responsibilities for the specialized duties.
Document all nursing care accurately, If care is not documented, courts assume it was not rendered.

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Case Study/Critical Thinking Question/What would the Nurse do?

List the two factors that can contribute to the malpractice of a nurse.

Answer:

_________________________________________________

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Ethical Considerations in Documentation and Medical Record-Keeping

Ozair et al., 2015

An electronic health record (EHR) is a record of a patient's medical details (including history, physical examination, investigations and treatment) in digital format
Implementing EHRs offer several advantages over paper records

There are four major ethical priorities for EHRS:

Privacy and confidentiality,
Security breaches,
System implementation, and
Data inaccuracies.

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Ethical Considerations in Documentation

and Medical Record-Keeping

Privacy and confidentiality:

Information of a patient should be released to others only with the patient's permission or as allowed by law. If a patient is unable to do so because of age, mental incapacity the decisions about information sharing should be made by the legal representative or legal guardian of the patient.
The administrator identifies the user, determines the level of information to be shared and assigns usernames and passwords.
The user should be aware that they will be accountable for the use and misuse of the information they view.

Ozair et al., 2015

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Ethical Considerations in Documentation

and Medical Record-Keeping

System implementation:

The implementation of EHRs requires adequate funds and the involvement of many individuals, including clinicians, information technologists, educators, and consultants.
Poorly designed user interface can lead to unintended adverse consequence leading to decreased time efficiency, poor quality of care and increased threat to patient safety and used dissatisfaction.
Maintenance and testing of these interfaces on a routine basis is essential in controlling the impact the quality of care or endanger patient safety along with financial loss.

Ozair et al., 2015

Contact info: info@nursesinternational.org

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Ethical Considerations in Documentation

and Medical Record-Keeping

Data inaccuracies:

EHRs serve as a way to improve the patient's safety by reducing healthcare errors . However, concerns have been raised about the accuracy and reliability of data entered into the electronic record.
Inaccurate representation of the patient's current condition and treatment occurs due to improper use of options such as "cut and paste" and is unacceptable because it increases the risk for patients and liability for clinicians and organizations.
Another feature that can cause a problem in the data integrity is the drop down menu and disposition of relevant information in the trash.

Ozair et al., 2015

Contact info: info@nursesinternational.org

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Ethical Considerations in Documentation and Medical Record-Keeping

Security breaches:

Cloud storage, password protection, and encryption are all measures health care providers can take to make portable EHRs more secure.
Usage of two factor authentication system with security tokens and password are helpful in securing EHRs.
Specific policies, For example, employees must not share their ID with anyone, always log off when leaving a terminal and use their own ID to access patient digital records.
Routine random audits a regular basis to ensure compliance with hospital policy.

Ozair et al., 2015

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Legal Issues in Record Keeping

Ausmed, Online Cpd, 2018

The patient’s records are occasionally required as evidence in a court of law, or to investigate a complaint at a local, organisation level.
Records may be requested by professional governing bodies when investigating claims related to misconduct.
Therefore, a nurse must be careful about writing a report.

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Legal Issues in Record Keeping

Practices of record-keeping also provide:

A comprehensive nursing assessment of the patient including care that has been provided and planned;
Relevant information is included together with any actions that have been taken in response to changes in patients’ conditions
The duty of care to the patient has been provided and that no acts or omissions have compromised a patient’s safety;
Arrangements have been made for the ongoing care of the patient

Ausmed, Online Cpd, 2018

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Roles of Record keeping

Ausmed, Online Cpd, 2018

Record keeping makes the continuity of care easier;
Record keeping promotes better communication and dissemination of information between members of the multi-professional team;
Helps to address complaints or legal processes;
Supports clinical audit, research, allocation of resources and performance planning;

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Roles of Record keeping

Ausmed, Online Cpd, 2018

Helps to identify risks and enables the early detection of complications
Supports patient care and patient-centred communication;
Supports effective clinical judgement;
Supports delivery of services
Helps improve accountability
Shows how decisions were made relating to the patient’s care

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Role of the Nursing Documentation

Education:

Students in various schools of the health science often use patients’ files as educational tools.

Compensation:

The documentation also assists in obtaining easily a compensation from the public and private insurances.

Legal documentation:

The information of the files can assist the professionals of the health system to point out the needs of the particular nursing institution, as well as the hospital’s services.

Loanna, Stiliani, & Vasiliki 2021

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Case Study/Critical Thinking Question/What would the nurse do?

What are the purposes for nursing recording in nursing practice?

Answer:

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References:

American Nurses Association. 2021. Scope of Nursing Practice. Retrieved from https://www.nursingworld.org/practice-policy/scope-of-practice/

Ausmed Education Pty Ltd. 2018. Record Keeping and Documentation. Online CPD. Retrieved from https://www.ausmed.com/cpd/articles/record-keeping-documentation

Croke, Eileen M. (2003). Nurses Negligence and Malpractice. American Journal of Nursing, 103, 9. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=423284&Journal_ID=54030&Issue_ID=423107

Loanna, P. Stiliani K., Vasiliki, B. 2021. Nursing documentation and recording systems of nursing care. Health Science Journal. Retrieved from: https://www.hsj.gr/medicine/nursing-documentation-and-recording-systems-of-nursing-care.php?aid=3680

Contact info: info@nursesinternational.org

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References:

Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in clinical research, 6(2), 73–76. https://doi.org/10.4103/2229-3485.153997

South African Nursing Council (n.d.). Code of Ethics for Nursing Practitioners in South Africa. Retrieved from https://www.sanc.co.za/wp-content/uploads/2021/04/Code-of-Ethics-for-Nursing-in-South-Africa.pdf

South African Nursing Council (n.d.).Guidelines for reporting a case of Professional Misconduct. Retrieved from https://www.sanc.co.za/misconduct/

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