In the home health care field, benefiting each client is best accomplished in part by providing continuing education. In order to do this, a high level of skill and knowledge, including ongoing training is needed. Health care providers are charged with doing all they can to benefit a patient, with all recommended procedures and treatments intended to do the most good for the patient. Consistent written policies and training are both needed for nurses, aides and other staff to handle such difficult ethical dilemmas. Patient autonomy is also critical when it comes to how home health care agencies handle incapacitated patient and life-sustaining treatment decisions and the procedures providers have in place. If there is any conflict of interest based on the patient’s beliefs or values, the staff should immediately notify their home health care agency/employer to determine next steps. Professionals (RNs) and para-professionals (personal care aides, home health aides, nursing aides) can suggest or advise a course action based on the physician’s assessment and directives, but the ultimate decision lies with the patient. It’s also important that while assisting a patient with daily activities, including skilled nursing, personal care, physical therapy, dietary and nutritional services, speech therapy, medical management and other related services, that the patient continues to “have a say” in his or her own decisions. As a home health care provider, this decision must be respected. He or she made this decision because of the desire to age in place in the comfort of home. In the home health care environment, it begins with the patient’s decision to receive care at home in lieu of a nursing home or assisted living facility. In the medical field, autonomy refers to the right of the patient to retain control over his or her body. Let’s take a closer look at the definition of each of these principles and how they are put into practice in the home health care environment. Individual levels of autonomy can vary depending on legislative, organisational and individual factors.There are four commonly accepted principles of health care ethics that providers follow to ensure optimal patient safety: autonomy, beneficence, non-maleficence, and justice. Professional autonomy stems from the ability to use various kinds of knowledge in a critical manner, which offers safe, quality health care to patients. Autonomy refers to a nurse or midwife’s ability to “make some decisions within their own profession and their right and responsibility to act according to the shared standards of that profession” (Varjus et al. Legal accountability involves nurses and midwives being responsible for ensuring they have appropriate professional indemnity insurance, as patients have a right to expect them to hold this insurance in case there is a substantiated claim of professional negligence.Īccountability cannot be achieved unless the nurse or midwife has autonomy to practise. Nurses and midwives are accountable to the patient, the public, their regulatory body, their employer and any relevant supervisory authority. Nurses and midwives are accountable both legally and professionally for their practice, that is, for the decisions they make and the consequences of those decisions. A nurse or a midwife should be able to give reasons for the decisions they make in their professional practice and should justify their decisions in the context of legislation, professional standards and guidelines, evidence-based practice and professional and ethical conduct. Accountability is about maintaining competency and safeguarding quality patient care outcomes and standards of the profession, while being answerable to those who are affected by one’s nursing or midwifery practice.Īccountability means being answerable for the decisions made in the course of one’s professional practice. A nurse or midwife who is considering expanding their scope of practice should realise that this will involve greater responsibility.Īccountability is understood as being able to give an account of one’s nursing and midwifery judgements, actions and omissions. Responsibility is explained as the obligation to perform duties, tasks or roles using sound professional judgement and being answerable for the decisions made in doing this. Responsibility and accountability are the cornerstones of professional nursing and midwifery practice, and are represented as a key principle in the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives. Nurses and midwives hold positions of responsibility and are, therefore, expected to be accountable for their practice. The concepts of responsibility, accountability and autonomy are intrinsically linked in determining the scope of nursing and midwifery practice. Considerations in determining scope: responsibility, accountability & autonomy
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