CHAPTER SIX Professional Gatekeeping as a Function of Role Fidelity Edited by Brenda Holmes MSN/Ed, RN
May 06, 2015
CHAPTER SIXProfessional Gatekeeping as a Function of Role Fidelity
Edited by Brenda Holmes MSN/Ed, RN
ELEMENTS OF A PROFESSION
Being professional vs. being a member of a profession
Historical criteria for a profession Specialized body of knowledge Education standards Practice standards
Professional etiquette which is your behavior that is expected in the workplace
Code of Ethics Self-regulating Fiduciary relationship with those served
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PROFESSIONAL CODES OF ETHICS
An important tool for self-regulation found in most health care specialties
HOWEVER An all encompassing code of ethics, which covers
every conceivable ethical problem, does not exist Common problems:
Vagueness as to duties and prohibitions Incompleteness to duties Excessive concern with promotion and prestige of
profession Vagueness in regard to self-regulation and peer
enforcement Excessive concern with financial and business
interest
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PROFESSIONAL CODE OF ETHICS
Obligations To be a peer to others on a health care team
Can be seen as gatekeeping functions whereby you look out for the interests of the profession Gatekeeping: comes as a result of professional
obligations and training Whole series of activities needed to protect the
profession those who would misuse the appropriate functions for the specialty
Monitoring system Sense of collegiality and mutual support
Flow naturally as a result of our professional obligations and educations
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PROFESSIONAL CODES OF ETHICS (CONTINUED)
Review the professional code of ethics for your specialty (Do an internet research for CNA code of ethics or code of ethics for your profession) C
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DISPARAGEMENT OF PROFESSIONAL COLLEAGUES
Disparagement Definition: belittle or criticize the skill, knowledge, or
qualification of another professional Many of us have heard of Cain’s questioned about
“Am I my brother’s keeper?” Health care you are “brother’s keeper”
Responsible for our actions but also charged with the duty to ensure that the rest of the health team is practicing appropriately
Need to protect patients from exploitation, regulatory licensing mechanisms, legal remedies, and peer review system
Code of ethics Not only ethical rules but symbolizes that this group
of professionals is differentiating itself from the broader group of occupations and technical careers
Characteristic: generate a code of ethics and self-regulating
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CONFLICT OF INTEREST
Fiduciary relationship Special relationship of loyalty and responsibility
between the patient and practitioner Practitioner will practice with good faith and candor Patient has the right to believe that the practitioner
will maintain a higher level of accountability in regard to health care
Conflicts of interest where patient-interests are served Owning a health care supply business can be
considered conflict of interest if any health care professional recommends their business. This is called joint venture i.e part owner to a nursing facility.
Caring for your own family in a health care facility Does intent make the difference? Rule of thumb: due to emotional conflict, many
practitioner are advised not to care for family and family members.
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SEXUAL MISCONDUCT
Sexual relations between practitioners and patients Basic principles involved
Considered unethical nor condonable Effects on therapeutic relationship
Places the practitioner in the advantage in the critical areas and personal vulnerability
Intimate relationship of roles and can be powerful and intense for both
As soon as the practitioner feels like there is a potential misunderstanding, it is time to end the professional relationship
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SCOPE OF PRACTICE Scope of practice
Definition: Tasks that are included within the practice of a specialty (legal regulations that allow practice within a state; determination of questions regarding role-fidelity) Role-fidelity: requires that we remain within our scope of
legitimate practice. Problem of role evolution, for example, nursing
Legislated practice acts General elements
Scope of professional practice Requirements and qualifications for licensure Exemptions Grounds for administrative action Creation of an examination board and processes Penalties and sanction for unauthorized practice
Legal sanctions
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IMPAIRED COLLEAGUES Basic problem
6-8% nurses in the US today are addicted to drugs/or alcohol
In one state, 90% of the disciplinary hearings within the state were related to substance abuse
Rationale for a duty to act: Protection of patients
You are the patient’s advocate in which you can mediate patient’s problems and complaints in relation to health care
Reporting an impaired colleagues, is for the safety of a patient
Protection of specialty Protection of colleague Protection of institution
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STEPS IN PROBLEM SOLVING
1. Problem sensing – gather and review facts2. Formulate and state problem3. List solutions of initial credibility4. Evaluate consequences to individuals
involved5. Evaluate solutions in regard to basic
principles
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STEPS IN PROBLEM SOLVING (CONTINUED)
6. Select solution7. Prepare a defense C
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WHISTLE-BLOWING Definition:
where the colleague or institution is reported for misconduct.
A process of gatekeeping, a function of role duty and professionalism that cannot be ignored
In nursing facility: Office of Long-Term Care Ombudsman (patient advocate and staff)
Downside Harassment, avoidance, demotion, termination
What principles are involved? Everyone that is involved
Making the decision Elements to consider
Understand that whistle-blowing is high risk, lonely, and rarely appreciated
Process Clear and concise documentation and information Follow facility protocol and chain of command
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INSTITUTIONAL ETHICS COMMITTEE Definition:
As an interdisciplinary body of health care providers, community representatives, and nonmedical professionals
Membership Include: physicians, nurses, social workers,
philosophers, laypersons, lawyer, administrators, and religious leaders
Common functions: Policy and procedure development Educational role Case consultation Retrospective case review
Decision making not function of IEC
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KEY CONCEPTS
Key elements of a profession Codes of ethics as important statements of
self-regulation Problems associated with disparagement of
colleagues
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KEY CONCEPTS (CONTINUED) Problems associated with sexual misconduct
with patients Problems associated with conflicts of
interests Functions of institutional ethics committee Requirements for role fidelity
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DISCUSSION
Discuss case study: Is There a Duty to Lie?
Questions1, 2, 3, 4 An Old Friend, a New Relationship.
Questions 1, 2, 3
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