Chapter06 professional gatekeeping


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Chapter06 professional gatekeeping

  1. 1. CHAPTER SIX Professional Gatekeeping as a Function of Role FidelityEdited by Brenda Holmes MSN/Ed, RN
  2. 2. ELEMENTS OF A PROFESSION Being professional vs. being a member of a profession Learning. All rights reserved. Copyright ©2009 Delmar, Cengage 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
  3. 3. PROFESSIONAL CODES OF ETHICS An important tool for self-regulation found in most health care specialtiesHOWEVER Learning. All rights reserved. Copyright ©2009 Delmar, Cengage 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
  4. 4. PROFESSIONAL CODE OF ETHICS Obligations  To be a peer to others on a health care team All rights reserved. Copyright ©2009 Delmar, Cengage Learning.  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
  5. 5. PROFESSIONAL CODES OFETHICS (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) Learning. All rights reserved. Copyright ©2009 Delmar, Cengage
  6. 6. DISPARAGEMENT OF PROFESSIONALCOLLEAGUES Disparagement  Definition: belittle or criticize the skill, knowledge, or qualification of another professional Learning. All rights reserved. Copyright ©2009 Delmar, Cengage  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
  7. 7. CONFLICT OF INTEREST Fiduciary relationship  Special relationship of loyalty and responsibility between the patient and practitioner  Practitioner will practice with good faith and candor Learning. All rights reserved. Copyright ©2009 Delmar, Cengage  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.
  8. 8. SEXUAL MISCONDUCT Sexual relations between practitioners and patients Learning. All rights reserved. Copyright ©2009 Delmar, Cengage  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
  9. 9. SCOPE OF PRACTICE Scope of practice  Definition: Tasks that are included within the practice of a specialty (legal regulations that allow practice within a Learning. All rights reserved. Copyright ©2009 Delmar, Cengage 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
  10. 10. IMPAIRED COLLEAGUES Basic problem  6-8% nurses in the US today are addicted to drugs/or alcohol Learning. All rights reserved. Copyright ©2009 Delmar, Cengage  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
  11. 11. STEPS IN PROBLEM SOLVING1. Problem sensing – gather and review facts2. Formulate and state problem List solutions of initial credibility Learning. All rights reserved. Copyright ©2009 Delmar, Cengage3.4. Evaluate consequences to individuals involved5. Evaluate solutions in regard to basic principles
  12. 12. STEPS IN PROBLEMSOLVING (CONTINUED)1. Select solution2. Prepare a defense Learning. All rights reserved. Copyright ©2009 Delmar, Cengage
  13. 13. 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 Learning. All rights reserved. Copyright ©2009 Delmar, Cengage  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
  14. 14. INSTITUTIONAL ETHICSCOMMITTEE Definition:  As an interdisciplinary body of health care providers, community representatives, and nonmedical professionals Learning. All rights reserved. Copyright ©2009 Delmar, Cengage 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
  15. 15. KEY CONCEPTS Key elements of a profession Codes of ethics as important statements of self- Learning. All rights reserved. Copyright ©2009 Delmar, Cengage regulation Problems associated with disparagement of colleagues
  16. 16. KEY CONCEPTS (CONTINUED) Problems associated with sexual misconduct with patients Learning. All rights reserved. Copyright ©2009 Delmar, Cengage Problems associated with conflicts of interests Functions of institutional ethics committee Requirements for role fidelity
  17. 17. DISCUSSION Discuss case study:  Is There a Duty to Lie? All rights reserved. Copyright ©2009 Delmar, Cengage Learning.  Questions1, 2, 3, 4  An Old Friend, a New Relationship.  Questions 1, 2, 3