This document discusses several topics related to nursing including autonomy, accountability, assertiveness, and visibility. Autonomy refers to a nurse's independence and right to make decisions regarding patient care. Accountability means nurses are responsible for their actions and accepting consequences. Assertiveness is communicating confidently without aggression. Visibility refers to how nursing is perceived by the public and other disciplines. The document outlines definitions, benefits, and challenges for each topic. For autonomy, professional autonomy can lead to job satisfaction but challenges include lack of recognition from physicians. Accountability requires clarity on expectations and commitments. Assertiveness involves standing up for rights while respecting others. Factors like role definitions and hierarchies can impact nursing's visibility.

1. Autonomy
Accountability
Assertiveness
Visibility in nursing
Legal consideratión in nursing

2. 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.

3. Conti….
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

4. Conti…..
PROFESSIONAL NURSE
AUTONOMY:-it 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

5. 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.

6. Conti…..
• Autonomy in nurses’ practice
contributes to the well-being of
patients and add to the quality of
services and care that patients
receive.

7. 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

8. Conti….
• Clarifying expectations about
clinical anatomy
• Enhance competence in practice
• Collaboration with physicians
works very well with autonomy in
nursing

9. 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.

10. Accountability

11. 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.

12. DIFINITION
• Accountability is being responsible for one’s
actions and accepting the consequences of one’s
behaviour. Accountability is not a vague feeling or
an obscure concept. It is a clear obligation which
must be manifested as a structured component of
nursing practice, based on responsibility, authority
and autonomy.
• “Accountability is a sense of overriding concern
for nursing care, while Responsibility is the sense
of duty in performing special tasks”

13. LINES OF ACCOUNTABILITY
• UPWARD: accountability (looking up the line
and doing what managers and administers
require)
• LATERAL: accountability (accountability as a
self-regulation in which practitioners are
accountable to and judged by, criteria set by
their peers).
• DOWNWARD OR PUBLIC ACCOUNTABILITY:
Where staff are accountable for/to patients.

14. TYPES OF NURSING
ACCOUNTABILITY
• Fiscal Accountability: This accountability is concerned
with financial probity and the ability to trace and
adequately explain expenditure.
• Process Accountability: This accountability is
concerned with the use of proper procedures.
• Programme Accountability: It is concerned with the
activities undertaken and their quality.
• Priorities Accountability: This deals with the relevance
or appropriateness of chosen activities.

15. ELEMENTS OF
ACCOUNTABILITY
 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.
 Commitment:-the accountable person must listen,
understand, agree, and commit to achieving the
objectives
 Consequence:-consequence are the after of the
negligence to commitments. a person should bear the
consequences of being accountable.
•

16. ACCOUNTABILITY OF
NURSING PERSONNEL
• ACCOUNTABLE FOR WHAT
• You can only be accountable for which you are
responsible, and you can only be responsible for
those things which are clearly designated as
accepted as your responsibility.
 For providing safe and therapeutic environment
 Maintaining adequate supplies material equipment
for smooth function of working unit

17. Conti..
Protecting client’s legal rights.
Maintaining accurate records and
reports
Working within ethical boundaries
Delegating responsibility
appropriately

18. Conti….
• ACCOUNTABLE TO WHOM
 Nurses are accountable to nursing council.
• This relates to practicing within scope of practice, according to
register or roll in which your name is entered, and being
accountable for your professional conduct.
• The nursing council’s code of conduct for nurses and midwives
further outlines professional accountability in terms of ethics,
standards of practice, rights of patients/clients and justifying
public trust and confidence.

19. 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 competence.

20. cont.…
Unwilling.
 Inadequate supervision by ward
managers.
Out-dated policies, protocols &
procedures.
 Lack of decision making.

21. WAYS FOR ENHANCING ACCOUNTABILITY IN
NURSING
 Well defined duties and job description.
 Written policies, protocols and
procedures.
 Nursing audit and standards of practice.
 Proper delegation of responsibilities.
 Proper training and education of the
self.

22. Conti…
 Periodical evaluation of each individual’s
nursing practice.
 Refine and modify outdate policies and
procedures.
 Conducive working environment.
 Availability of adequate number of
personnel and resources for patient care.

24. ASSERTIVENESS
• Introduction
Assertiveness is the quality of being
self-assured and confident without
being aggressive.

25. 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.

26. 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

27. CHARACTERISTICS OF
ASSERTIVENESS
• Self-presentable
• Ability to share
• Good attitude towards
work
• Fearless expression
• Straight forwardness
• Self-control

28. STYLES OF
COMMUNICATION
• 1. Passive
• 2. Aggressive.
• 3. Assertive

30. ASSERTIVE BEHAVIOR
• 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.

31. CONTI…..
• 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

32. CONTI…
• 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

33. CONTI….
• 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.
•

35. VISIBILITY OF
NURSING

36. VISIBILITY OF NURSES
Meaning
•Degree of exposure to public notice.
•Capacity of providing a clear un
obstructed view

37. 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.”

38. CURRENT VISIBILITY OF
NURSING
• Public view of nursing :-based on
personal experience consumers not
recognise the nurses public values
nurses, not know about the education
needed
• Nurses view of themselves:-response
of nursing towards the change, not
taking the leading role

39. FACTORS AFFECTING
VISIBILITY
External factors
•Hand maiden role:-(means not an
independent role)
•Hierarchical structure:-structure of
health care organization limited the
role of nursing in decision making

40. CONTI…
• 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

41. CONTI…
INTERNAL FACTORS
•Role confusion
•Lack of personal confidence
•Timidity
•Fear
•Insecurity
•Inferiority

42. IMPORTANCE OF
VISIBILITY
• Recruitment of students
• Enhance public view
• Funding for nursing
• Relationship with administrators
• relationship with government
• profession self-identity

43. STEPS TO INCREASE
VISIBILITY
• Advertising nursing
• Role of media
• Nurse for health care tomorrow
• Raise the voice campaign
• Institute of medicine quality reports
• Power and empowerment
• Assertiveness
• Advocacy

44. RESPONSIBILITY OF A NURSE FOR
PROFESSIONAL RECOGNITION AND
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

45. LAGAL
CONSIDRATION
IN NURSING

46. 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.

47. NURSING LEGISLATIONS
• The first nursing created was that of nursing
registration in1903
• 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 in1947
• 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.

48. LEGAL COMPLICATIONS ARE
FOLLOWING
• TORTS
• ASSAULT
• BATTERY
• NEGLIGENCE
• MALPRACTICE
• FRAUD
• FALSE IMPRESSMENT
• INVASION OF PRIVACY
• LEGAL DOCUMENTS
• INFORMED CONSENT

49. CONTI….
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.

50. CONTI….
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,

51. CONTI…
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.

52. CONTI….
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.

53. NURSING LIABILITIES AND
PREVENTIVE MEASURES
• All nursing observations should be noted carefully,
describing accurately not only typical change in the
patient conditions, but also lack in cooperation, or any
other behaviour problem
• Patient complain should be recorded accurately
• Nurse must reports through the proper channels, any
activity or lack of it by any sub ordinates which indicates
that they are not properly trained to carry out the
assigned functions and duties.
• Authorities must be informed regarding any kind of
equipment, material or supplies which for any reason less
than safe for use in client care .

54. 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:-

55. CONTI….
8. Wills
9. Examination of rape
10. Artificial human insemination
11. poison case

56. 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

57. 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

58. 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

59. CONTI….
• 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

60. FOLLOW 10 “R” OF
MEDICATION
A. Right drug
B. Right patient
C. Right dose
D. Route
E. Right time and frequency
F. Right documentation
G. Right history and assessment
H. Drug approach and right to refuse
I. Right drug-drug interaction and
evaluation
J. Right education and information

61. • check the treatment order and
use professional judgment
before implementing
• do not exceed the limits of
nursing procedure laid down
by statutory bodies

62. BIBLIOGRAPHY