AUTONOMY
Introduction
• Autonomy is derived from a Greek word "Autos" means
"Self and "Nomo's" means "Laws".
• The right of self government acting independently or
having the freedom to do so.
• It's the right of personal freedom of action, which is
regarded as one of the hall marks of the profession
Definition
• Autonomy means that individuals are able to act for
themselves to the level of their capcity.it is the right of
individuals, governing their actions according to their own
purpose and reason
• Professional nurse autonomy is define as belief in the
centrality of the client the client when making responsible
discretionary decision, both independently and
interdependently, that reflect advocacy for the client
BENEFITS OF AUTONOMY
• Professional autonomy leads to work autonomy and job satisfactions
• Freedom to act on the binding decisions the nurse makes
• For example, the nurse does not need to obtain permission from
others to carry out actions she has decided on. Instead, the nurse’s
education has prepared her to enact the decisions
• . For example, a nurse can decide to initiate an educational teaching
plan with a new mother who is trying to initiate breast feeding her
newborn but who is not being consistently successful. No one needs
to give the nurse permission to do this education with the mother.
• Autonomy in nurses’ practice contributes to the well-being of
patients and add to the quality of services and care that patients
receive.
STRATEGIES FOR ENHANCING AUTONOMY IN NURSING
• Strategies for enhancing autonomy are based on setting
clear expectations for autonomous decision making and
providing support for increasing the knowledge and
expertise of nurse
• Clarifying expectations about clinical anatomy
• Enhance competence in practice
• Collaboration with physicians works very well with
autonomy in nursing
CHALLENGES TO AUTONOMY IN INDIA
• Lack of recognition and valuing of nursing knowledge and
contribution to patient care goals by physicians and other Members
of health care team.
• Inability to raise and resolve concerns about treatment Plan.
• Interruptions to the nurse’s ability to access coordinate Resources for
the patient care.
• Relationship with nursing colleagues, physicians and managers that
undermine Shared collaboration, confidence and decision making
Accountability
• INTRODUCTION
• Accountability means an individual are answerable for
their actions and have an obligation to act.
• Manifesting accountability in nursing practice provides
the opportunity to evaluate nursing contribution within
health care and is a means of clarifying the significance of
nursing to society.
DEFINITION
• Accountability is the process that mandates that individual
are answerable for their action and have an obligation to
act.
• “Accountability is a sense of overriding concern for nursing
care, while Responsibility is the sense of duty in performing
special tasks”.
• Accountability can be defined in term of either of these
attribute but answerability for how one has promoted ,
protected and met the health needs of the client.
ELEMENTS OF ACCOUNTABILITY
• 1.Clarity:-expectations and goals are clear and specific. if
staff members know about reason behind the expectations,
they are more likely to commit themselves to meeting it.
• 2.Commitment:-the accountable person must listen,
understand, agree, and commit to achieving the objectives
• 3.Consequence:-consequence are the after of the
negligence to commitments, a person should bear the
consequences of being accountable.
ACCOUNTABILITY OF NURSING PERSONNEL
• Providing For providing safe and therapeutic environment
• Maintaining adequate supplies material equipment for smooth function of
working unit
• Protecting client's legal rights.
• Maintaining accurate records and reports
• Working within ethical boundaries
• Delegating responsibility appropriately
• Delivering component and personalized care
• Maintaining good interpersonal relationship
REASONS FOR LACK OF ACCOUNTABILITY
• Job description not available.
• Lack of guidelines, standards and control.
• Authority not specified.
• Overburdened staff due to shortage of staff.
• Lack of adequate training and efficient experience.
• Lack of up to date knowledge, skill and competences
• Unwilling.
• Inadequate supervision by ward managers.
• Out-dated policies, protocols & procedures.
• Lack of decision making
Assertiveness
Introduction
• Assertiveness is the quality of being self-assured and
confident without being aggressive.
DEFINITION:-
• Assertiveness is a tool for expressing ourselves confidently
and a way of saying yes and no in appropriate way. It is
considered as a healthy behaviour for all people against
personal powerlessness and results in personal
empowerment.
AIMS OF ASSERTIVENESS
• Find the best solution for all the people.
• Increase the chance of nurses needs being met.
• Greens greater self confidence among nurses.
• Reduce the stress among nurses.
• Allowing nurses to remain control.
• Beings greater self confidence.
CHARACTERISTICS OF ASSERTIVENESS
• A -Act as if
• S- Speak clearly
• S- Stick to the point
• E- Express an interest
• R- Respect others’ point of view
• T- Towards focus
• Self-presentable
• Ability to share
• Good attitude towards work
• Fearless expression
• Straight forwardness
• Self-control
Assertive Behaviour
• Standing up for one’s right no matter what the circumstances.
• Correcting the situation when one’s rights are violated.
• Seeking respect and understanding for one’s feelings about particular
situation.
• Interacting in a mature manner with those found to be offensive,
defensive, aggressive, hostile, blaming, attacking or otherwise
unreceptive
• Those using assertive behaviour confront problems, disagreement, or
personal discomforts head on, and their intent is unmistakable to others.
• Verbal “I” statements, where individuals tell others how they feel about a
situation, circumstances, or the behaviours of others
• Taking the risk of being misunderstood as aggressive, abrasive, or
attacking.
• Being able to protect ones rights while protecting and respecting the rights
of others.
• Risk taking behaviour that is not ruled by fear of
• Those using assertive behaviour confront problems, disagreement, or
personal discomforts head on, and their intent is unmistakable to others.
• Rejection or disapproval but is directed by the rational belief that “I
deserve to stand up for my rights”.
• Rational thinking and self-affirmation of personal worth respect and rights.
• A healthy style in which to conduct interpersonal relationship.
• Finding a win-win solution in handling problems between two individuals
VISIBILITY OF NURSES
Meaning
• Degree of exposure to public notice.
• Capacity of providing a clear un obstructed view.
• A quality or fact of, degree of being visible.
• DEFINITION
• “Visibility is the way a person appears to others in the
case of profession, the way that profession appears to
other disciplines and to general public the consumer of
the health."
FACTORS AFFECTING VISIBILITY
EXTRNAL FACTORS
• Hand maiden role means not an independent role)
• Hierarchical structure:-structure of health care
organization limited the role of nursing in decision making
• Perceived authority and defectiveness:-limits the role of
nurse
• Hospital policy:-also limits the nursing role
• Threat of disciplinary actions or loss of the job might
limit a nurse when he or she needs to speak out-advocacy
INTERNAL FACTORS
• Role confusion
• Lack of personal confidence
• Timidity
• Fear
• Insecurity
• Inferiority
IMPORTANCE OF VISIBILITY
• Recruitment of students
• Enhance public view
• Funding for nursing
• Relationship with administrators
• relationship with government
• profession self-identity
STEPS TO INCREASE VISIBILITY
• Advertising nursing
• Nurse for health care tomorrow
• Raise the voice campaign
• Institute of medicine quality reports
• Power and empowerment
• Assertiveness
• Advocacy
RESPONSIBILITY OF A NURSE FOR PROFESSIONAL
RECOGNITION ANDA VISIBILITY
• Identify professional base activity in practice
• Take a stand if someone saying wrong about nursing and
nurses warns about the facts that nursing profession and
communicate important aspects of nursing
INTRODUCTION
• As a nurse it has been become an important necessity to
be aware the legal aspects associated with caring and
helping people in health industry today.
• Knowledge of legal aspect in nursing is absolutely
essential for each nurse to safe guard self and client from
legal complications
NURSING LEGISLATIONS
• The first nursing created was that of nursing registration
in 1903
• Law and regulation related to nurse in India are
controlled by state legislation,as state registration acts
and central acts, the Indian nursing council which was
enacted in 1947 And amended in 1957.
• Employment as a nurse does not only require a nursing
degree but knowledge of the medical laws that will apply
to you.
LEGAL COMPLICATIONS ARE FOLLOWING
• TORTS
• ASSAULT
• BATTERY
• NEGLIGENCE
• MALPRACTICE
• FRAUD
• FALSE IMPRESSMENT
• INVASION OF PRIVACY
• . LEGAL DOCUMENTS
• INFORMED CONSENT
TORTS
• Torts are when others interferes in individuals privacy mobility,
property or personal interests
ASSAULT
• Assault occurs when a person puts another person in fear
harmful or offensive contact. the victim fears and believes that
harm will result as a result of threat.
BATTERY
• It is intentional touching of another's body without the others
consent.
Negligence
It is conduct that falls below the standards of care that a
reasonable person ordinarily would use in a seminar
circumstances or it is described as lack of proper care and
attention carelessness.
Malpractice
Failure to reach the standards of acceptable care which
results in harm to another person,
FALSE IMPRISONMENT
• It occurs when a client is not allowed to leave a health care
facility when there in know legal justification to the client or when
restraining devices are used without an appropriate clinical need
INVASION OF PRIVACY
• It includes violating confidentiality intruding on private client or
family matters, sharing client information to unauthorised person
LEGAL DOCUMENTS
• Advance directive:-written documents recognized by law
that provides directions concerning the provision of when a
person is unable to make his or her own treatment choices
• Do not resuscitate:- written by a physician when a client
has indicated a desire to be allowed to die if the client stop
breathing or the client's heart stop beating
• Informed consent:-it is client approval or the client legal
representative to have his or her body torched by a specific
individual.
LEGAL RESPONSIBILITY
• 1.Registration
• 2.Act of negligence
• 3. Medico legal case (M.L.C.)
• 4. Correct identity
• 5. Left against medical advice (L.A.M.A)
• 6. Patients property
• 7. Dying declaration
• 8. Wills
• 9. Examination of rape
• 10. Artificial human insemination
• 11. poison case
CONSUMER PROTECTION ACT (1986)
• The consumer protection act, 1986 is a benevolent social
legislation that lays down the rights of the consumers also
provides means for their promotion and protection
• In1913 the supreme court brought the medical profession under
the section 2 (1)(o) of CPA
Feature of CPA
• safeguard and protect the interest of consumers
• simplifications of procedures for seeking redressal of grievance of
patients or their relatives
• . less expensive
• . within a limited time frame
RIGHTS OF CONSUMERS
• Right to safety
• Right to be informed
• Right to choose
• Right to be heard
• Right to seek redressal
• Right of consumer education
NURSE ROLE TO PREVENT COMPLICATION
• Review nursing practice periodically update knowledge
and improve skill by attending short term courses ,in -
service education and continuing education programme
• Should have complete knowledge of all rules and
regulations of hospital know their descriptions(duties and
responsibilities)
• Follow nursing practice stranded and protocol
• Be a clean observer
• Written instruction must have rules and code of practice
laid downs the safety and wellbeing of patient
• Maintain record and reports
