National Competency Standards for Registered Nurses, Code for Ethics and Codes of Professional Conduct for Nurses in Australia - Case Study Example

Advanced Care Practice Name Institution Advanced Care Practice Introduction The term, Advanced Practice Nurse (APN), is a broad term that is used to refer to Registered Nurses (RNs) who possesses high expertise, knowledge base, skills in making complex decisions, and clinical competencies of a health care practitioner (Kleinpell et al., 2014). To be acknowledged as a fully-fledged APN, one is required to have advanced education level and at least 3 years’ experience in a given clinical specialty. Due to their high level of education, APNs are able to function collaboratively and autonomously in extended roles, such as the management and assessment of patients, by utilizing their knowledge and skills. Due to technological changes and the emergence of more complex needs of patients, there is a specialized workforce to meet such increasingly multifaceted patient requirements (Giltenane, Dowling, & Kelly, 2015). This has been a challenge to major stakeholders in the health care sector of all countries across the globe. The situation has been worsened by the shortage of the health care workforce to attend to patients’ needs. Concerning this, there emerged a great need to find a solution to deliver reliable and high-quality health care services (Karabulut, Aktaş, Gürçayır, Yılmaz, & Gökmen, 2015). It is in the process that governments across the world have embraced the idea of APNs. Thesis Statement To ensure order, all economic sectors are controlled by particular rules and regulations; the health sector is not an exception. Health care issues fall within a highly sensitive sector that should not be left unregulated. It is very complex, and, therefore, needs proper rules and regulations to ensure that all activities and operations are done with professionalism. To ensure the highest standards of professionalism, governments across the globe have formulated and implemented well-established policies and directives to be followed by APNs. This paper will analyze the various policies pertaining to advanced care directives with regards to cancer patients in Australia. A critique of the implementation of these directives in daily nursing practice will also be carried out. Advanced Care Policies and Directives In order to fulfil their duties to the highest level of standards, advanced practice nurses in Australia have to follow particular policies and directives. Such directives act as a guideline for their continuous development and daily practices. The policies and directives include: i. National competency standards for registered nurses; ii. The codes of professional conduct for nurses in Australia; iii. The national decision-making framework; iv. A nurse guide to professional boundaries; v. Guidelines for mandatory notification under the law. The section below is going to analyze and critique three of the above-mentioned policies and directives. Description and Analysis of Advanced Care Directives a. National Competency Standards for Registered Nurses To provide quality care to old aged patients diagnosed with cancer, advanced practice nurses need to be competent. Competent refers to the possession of skills, knowledge, attitudes, and values that will ensure high standards and quality performance by such nursing practitioners (Reed & Shearer, 2011). It is a requirement that all practitioners should meet the competencies of their respective field; for example, midwives should meet the standards set by the Australian Nursing Federation (ANF) in the year 2005. To ensure that the advanced caregivers remain competent all through, the practitioners are required to sign a declaration on an annual basis in order to affirm that they are able to do so (Scanlon, 2013). According to the ANF Competency Standards, APRNs dealing with old age patients with cancer are expected to meet the following competency standards. Competency Standard 1: According to the ANF, the first competency standard requirement for advanced practice caregivers is the ability to make use of observation, experience, and evidence to make decisions (Dolansky & Moore, 2013). With regard to this, it is the responsibility of an advanced caregiver of patients with cancer in Australia to engage in the gathering of information related to causes and treatment of cancer through evidence-based research from various credible sources. The caregivers should analyze this information to ensure a proper decision-making process. There are various categories of cancer affecting the old aged population in Australia. These include breast cancer among women, as well lung and heart cancers. The treatment approaches of these types of cancer differ from one another, showing the need for different treatment approaches (Sollecito & Johnson, 2013). This is one of the major reasons advanced caregivers need to make use of their skills and knowledge. In order to deliver high quality health care services to cancer patients, the advanced caregivers are required to make use of their previous experiences to determine the most important aspects of the various types of cancer affecting patients under their care. Competency Standard 2: The second level of competency that is required among the advanced caregivers of cancer patients is the ability to use nursing and health models (Czarnecki, Turner, Collins, Doellman, Wrona, & Reynolds, 2011). It is important to make use of nursing models in the delivery of health care services to old aged cancer patients. The models are useful in providing guidance on the best way to approach a medical problem. The Australian advanced caregivers make use of various models of nursing, for example, the primary care model of nursing in order to meet the needs of cancer patients under their care (Baisch, 2012). Primary care involves taking care of all the needs of a patient within the health care facility. Cancer patients who are in hospitals and other care centers are taken through all the necessary procedures of treatment. After diagnosis and admission, it is required that the advanced caregivers take full responsibility of patients under their care. The nursing practitioners should engage in giving medication to patients as well as helping them with their daily basic activities. Competency Standard 3: The third requirement in the category of competency among advanced nursing practitioners in Australia is the ability to manage complex nursing and clinical situations (Christie & Bunting, 2011). The nursing environment is full of complex situations requiring the use of knowledge and skills for proper decision-making. Such complex situations include the common dilemmas that medical practitioners encounter in their daily activities. These include making choices between using palliative care on a patient and opting for euthanasia (Moore & Tenbrunsel, 2013). Such decisions are very sensitive, considering the professional ethical codes of conducts of nursing. It is the responsibility of a nurse to protect the patient’s life. Therefore, they should engage in activities that are in the best interest of their patients. Despite this fact, it becomes complex if the patient demands for an end to their life. Such complex circumstances need a highly competent advanced caregiver to handle (Hamric, Hanson, Tracy, & O’Grady, 2014). b. Code for Ethics and the Codes of Professional Conduct for Nurses in Australia In the health care sector, it is necessary to implement the ethical codes of conduct in order to guide the behavior of the involved practitioners. Codes of conduct help nurses in determining what is good and bad in the process of delivering health care services (Sulivan, 2012). This helps in establishing responsibility and accountability among nurses. In order to analyze the codes of conduct as applied in Australia, this section is going to discuss the four major elements below: i. Acceptance of accountability and responsibility; ii. Accountability for nursing judgment and action; iii. Responsibility for nursing judgment and action; iv. Delegation of nursing activities. According to the nursing ethical codes of conducts of Australia, it is the duty of every nursing practitioner to protect the life of the patients under their care. In order to effectively do this, the nurses bear personal responsibility and accountability for their actions and everything that is done to such patients (Macha & McDonough, 2012). With regard to this, advanced care providers throughout Australia are required to accept accountability and responsibility. Advanced caregivers are incessantly faced with complex and ever-changing patterns in their daily routines that demand the making of appropriate choices. Such caregivers are responsible and accountable for the choices that they make, whether right or wrong. As a means of assistance and guidance, they have the professional ethical codes of conduct to consult. Concerning this, it is of great importance for the advanced care providers in charge of old aged cancer patients in the country to base their practice on the professional ethical codes of conduct. The professional code of conduct for all nursing practitioners is very important because it acts to protect the interests of the patients (Sternberg, 2012). Cancer patients have complex needs that should be met with high standards of care. The complexity of these needs is known to present a huge challenge to the care providers involved, and if not guided or regulated, they may succumb to the pressure and make the wrong decisions (International Council of Nurses, 2012). Sometimes, the patients themselves may demand a treatment alternative that is not right according to the professional ethical codes of conduct (Colline-Bride, & Saxe, 2011). Here, advanced caregivers are forced to make decisions based on the applicable professional ethical codes of conduct (De Nisco, & Barker, 2013). As required by the nursing policy and advanced care directives, it is the responsibility of the nurse to protect the health of the patient under all circumstances. Therefore, all advanced caregivers of cancer patients should adhere to the professional ethical codes of conduct as stipulated by the ANF (Cody, 2013). c. Guidelines for Mandatory Notification Under the Law In Australia, there is a mandatory law that requires health care providing centers to provide all the relevant information to the members of the public (De Nisco & Barker, 2013). This is a policy that requires health care practitioners to engage in patient survey exercises in order to gather relevant information regarding them and care giver feedback across the country. The government of Australia has prioritized the delivery of quality health care services that are patient-centered. Patient centeredness is associated with a number of benefits, including the satisfaction of both the patient and the involved caregiver (Crawford & Brown, 2011). To achieve the highest standards possible when discharging health care services, hospitals are mandated by the law to publish the feedback received from their patients. The advanced caregivers in charge of taking care of the old aged population with cancer strongly embrace this directive. The publications are important for the members of the public and for the involved advanced caregivers (Lattime & Gattone, 2014). To the public, the information is useful for decision-making. By accessing and evaluating information regarding the feedback from various hospitals, the members of the public are able to make informed choices on the particular hospital they want to visit. Similarly, patients as well as their family members are able to choose the kind of treatment that they want their patient to be subjected to (Harmer, 2011). For the advanced caregivers, such information is important for various reasons. Firstly, patient feedback enables the caregivers to identify the most effective type of treatment they should give to patients under their care. For example, the feedback from patients enables the health care practitioners to evaluate how patients responded to a certain type of treatment. This enables them to identify the most appropriate method of treatment to use in the future of similar cases re-occur. For instance, if the majority of cancer patients responded positively to chemotherapy as a treatment method, health care providers will prefer the use of this method in respect of this particular parameter (Howard & Whittaker, 2012). Secondly, patient feedback helps advanced caregivers to improve their performance. After evaluating the feedback from patients, the caregivers are able to know the strengths and weaknesses of the various treatment methods that they are using (Wiart, 2013). With this information, they are able to identify where to improve, as well as the procedures and processes that they need to abandon or continue utilizing. This is useful in ensuring high-quality patient treatment. Critique of the Implementation of Competency Standards The competency standards are established with the aim of ensuring the delivery of high-quality health care services to patients. The major goal of the standards is to improve patient safety and satisfaction. The ANF has set the standards to be followed for one to be regarded as a competent advanced practice nurse. There are many caregivers who have met the competency standards; however, competency standards have incessantly been abused. Some advanced care nurses taking care of cancerous patients in Australia do not fully apply the requirements of the competency standards in their daily practices. Some advanced caregivers do not base their practices on evidence-based research information. An advanced practitioner is expected to make use of their personal skills and the experience they acquired in the course of practice to make reasonable judgments for the sole benefit of the patients. Secondly, there is a lack of proper collaboration among advanced care providers as required by the competency standards of Australia. Teamwork is essential for advanced practice nurses; however, the majority of the practitioners fail to observe this requirement. Thirdly, some health care centers do not follow the appropriate procedures for recruiting advanced care providers. It is required that advanced care providers should possess a degree in a relevant field of study; however, these regulations are not fully observed. This has contributed to the recruitment of under-qualified advanced caregivers, leading to poor quality medical services. This is because there lack appropriate and effective management rules and regulations in some health care centers to enforce the implementation of all the competency standards. Critique of the Implementation of Ethical Codes Across the globe, health care practitioners are incessantly faced with the challenge of sticking to the nursing ethical codes of conduct (Nee, 2013). This is mainly due to the dilemmas they encounter in the process of delivering health care services to patients. The advanced caregivers of cancer patients in Australia score high in relation to their adherence to the professional codes of conduct in their daily practices. This has been one of the major factors contributing to the improved high-quality medical services rendered to cancer patients in the country. Despite this challenge, a high percentage of advanced caregivers have remained responsible and accountable for implementing the requirements of the nursing professional ethical codes of conduct. The establishment of the ethical codes of conduct does not guarantee 100% patient safety. This is because its observation highly depends on various factors, including the involved caregiver, patients, and their family members. There are various occasions in which the observation of the professional ethical codes of conduct is compromised. The complex situations that present themselves in the treatment processes sometimes make ethical conducts lose value. Events of euthanasia, which are widespread in health care facilities dealing with cancer patients, is enough evidence of the abuse of ethical codes of conduct (International Council of Nurses, 2012). In addition to this, there are various ways through which doctors manipulate and abuse the directives of such ethical codes of conduct. These include not following the right treatment procedures, abandoning nursing duties, neglecting patients, and instances of corruption within the health care sector (Kalra, 2011). These reveal that there are major weaknesses in the implementation of the ethical codes of conduct. Critique of the Implementation of Mandatory Law Despite the advantages associated with the observation of the mandatory law of providing information, the majority of hospitals do not follow this rule. The quality that is published to the public by some hospitals is questionable. This is because the involved hospitals do not engage in comprehensive surveys of the patients they handle. Hospitals avoid the task of carrying out surveys, citing financial expenses and the lack of time to do so. As a means of formality, they engage in shallow survey activities using sub-standard questionnaires. This results in poor, unreliable feedback. In addition to this, the hospitals engage in the selective publication of information. They select information that favors them in order to appeal to the general public. This information helps consumers in making informed choices while selecting hospitals and treatment methods to use; however, the manipulation of this process has undermined the true purpose of mandatory information law. Conclusion In conclusion, the delivery of high-quality health care services to patients is the key concern for all health care sectors across the globe, hence the implementation of advanced nursing practice. Since its introduction in the early 1960s, this category of health practitioners have revolutionized and improved the health care sector. They have been able to manage effectively, patients with varied needs and chronic illnesses. To ensure a continued delivery of high-quality health care services, the roles of APNs are established on the professional values, theories and practice, in addition to skills and knowledge, which encourage innovation in health care delivery. Australia has a higher number of old age individuals with chronic illnesses, including cancer. It is for this reason that the government of this country has formulated and developed well-established policies and directives. These are aimed at ensuring a proper guidance of the development, activities, and roles of advanced practice nurses in caring for old aged population diagnosed with cancer. Despite the presence of policies and directives aimed at ensuring patient satisfaction, some practitioners have failed to observe them, substantiating the various challenges experienced by the Australian health care sector. References Baisch, M. J. (2012). A systematic method to document population-level nursing interventions in an electronic health system. Public Health Nursing, 29(4), 352-360. Christie, J., & Bunting, B. (2011). The effect of health visitors’ postpartum home visiting frequency on first-time mothers: Cluster randomised trial. International Journal of Nursing Studies, 48(2011), 689-702. Cody, W. K. (Ed.). (2013). Philosophical and Theoretical Perspectives for Advanced Nursing Practice. Burlington, MA: Jones & Bartlett Learning, LLC. Colline-Bride, G. M., & Saxe, J. M. (2011).Clinical Guidance for Advanced Nursing: An Interdisciplinary Approach. 2nd ed. San Francisco, CA: University of California. Crawford, P., & Brown, B. (2011). Fast healthcare: Brief communication, traps and opportunities. Patient Education and Counseling, 82, 3-10. Czarnecki, M.L., Turner, H.N., Collins, P.M., Doellman, D., Wrona, S. & Reynolds, J. (2011). Procedural pain management: A position statement with clinical practice recommendations. Pain Management Nursing, 12(2), 95-111. De Nisco, S. M., & Barker, A. M. (2013). Advanced Practice Nursing: Evolving Roles for the Transformation of the Profession. 2nd ed. Burlington, MA: Jones & Bartlett Learning, LLC. Giltenane, M., Dowling, M., & Kelly, M. (2015). Public Health Nurse’ (PHNs) experiences of their role as part of a primary care team (PCT) Ireland. Australian Journal of Advanced Nursing, 32(3), 6-15. Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier. Harmer, V. (Ed.). (2011). Breast Cancer Nursing Care and Management (2nd ed.). West Sussex: Willey-Blackwell. Howard, P., & Whittaker, B. (2012). Placement learning in cancer & palliative care nursing: A guide for students in practice. London: Elsevier Health Science. International Council of Nurses. (2012). The ICN codes of ethics for nurses. Geneva: ICN. Kalra, J. (2011). Medical errors and patient safety: Strategies to reduce and disclose medical errors and improve patient safety. New York, NY: Walter de Gruyter GmbH & Co. Karabulut, N., Aktaş, Y. Y., Gürçayır, D., Yılmaz, D., & Gökmen, V. (2015). Patient satisfaction with their pain management and comfort level after open heart surgery. Australian Journal of Advanced Nursing, 32(3), 16-24. Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., & Beauchesne, M. (2014). Addressing issues impacting advanced nursing practice worldwide. The Online Journal of Issues in Nursing, 19(2), 1-12. Lattime, E. C., & Gattone, S. L. (Eds.). (2014). Gene therapy of cancer: Translational approaches from preclinical studies to clinical studies (3rd ed.). London: Elsevier. Macha, K., & McDonough, J. (2012). Epidemiology for advanced nursing practice. London: Jones & Bartlett Learning, LLC. Moore, C., & Tenbrunsel, A. E. (2013). “Just think about it”? Cognitive complexity and moral choice. Organizational Behaviour and Human Decision Process, 123(2014), 138-149. Nee, P. W. (2013). The key facts on cancer types: Everything you need to know about. Boston, MA: Medicalcenter.com. Reed, P., & Shearer, N. (2011). Nursing knowledge and theory innovation: Advancing the science of practice. New York, NY: Springer Publishing Company, LLC. Scanlon, A. (2013). The introduction of a nurse practitioner model of care into an australian outpatient setting. Clinical Scholars Review, 6(2), 138-144. Sollecito, W. A., & Johnson, J. K. (2013). Johnson McLaughlin and Kaluzny’s continuous quality improvement in health care. Burlington, MA: Jones & Bartlett Learning. Sternberg, R. J. (2012). A model for ethical reasoning. American Psychological Association, 16(4), 319-326. Sulivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis Company. Wiart, C. (2013). Lead compounds from medicinal plants for the treatment of cancer. London: Elsevier. Read More