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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
Everything you need to know about The Nursing Associate ... at a Glance! The Nursing Associate at a Glance is a comprehensive guide developed to support trainee nursing associates with revision and practice-based learning, helping readers to uphold and maintain their Code of Conduct, promote healthy behaviours, treat ill health, and provide and monitor care effectively. Aligned with the six Nursing and Midwifery Council standards of proficiency for nursing associates, the book provides indispensable information about a range of areas of care including: * How to contribute to integrated care, including how to be resilient and how to understand the various roles of health and social care teams * How to improve the safety and quality of care, including an examination of health and safety legislation and the use of risk assessment tools * How to effectively work in teams, including positive interaction with other members of the care team and how to manage data * How to provide and monitor care, including discussions of deteriorating, anxious and confused patients Perfect for trainee nursing associates seeking to successfully graduate from the nursing associate programme, The Nursing Associate at a Glance provides readers with the skills and knowledge required to be competent, confident and compassionate nursing associates.
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Table of Contents
Cover
Series Page
Title Page
Copyright Page
Preface
Terminology
References
Acknowledgements
Platform 1: Being an accountable practitioner
1 The Code
The Code
Prioritise people
Practise effectively
Preserve safety
Promote professionalism and trust
2 Legal and ethical
The law and ethics
Ethics
Law
3 Duty of Candour
The Duty of Candour
Openness and Honesty
Whistleblowing
Challenges to the Duty of Candour
Courage
4 Non‐discriminatory behaviour
Protected characteristics
Discriminatory behaviour
Challenging discriminatory behaviour
Chapter 5: The demands of professional practice
Vulnerability
Stress
Recognising vulnerability
Responding to stress
Chapter 6: Health and well‐being
The Nursing and Midwifery Council (NMC)
Health and well‐being
Resilience
Self‐care
Chapter 7: The principles of research and evidence‐based practice
Research
Evidence‐based practice
8 Emotional intelligence
Definition
Emotional intelligence
Resilience
9 Effective communication
Effective communication
Engaging with patients and their families
Effective communication
Connecting with patients
Unconditional positive regard
10 Maintaining appropriate relationships
The Nursing Associate–patient relationship
Professional boundaries
Boundary violations
Use of social media
11 Advocacy and person‐centred sensitive care
Person‐centred sensitive care
Advocacy
12 Reporting adverse incidents
Safety and effective care
Adverse incidents
Reporting
Duty of Candour
13 Numeracy, literacy, digital and technological skills
Numeracy
Literacy
Digital and technological skills
Digital literacies
14 Record keeping
Keeping clear and accurate records
Countersigning records
Good record keeping
Legal standards
15 Reflective practice
Reflective practice
Models of reflection
The Nursing and Midwifery Council (NMC) and reflection
16 Promoting public confidence in the profession
Professionalism
The Code
Good care
Platform 2: Promoting health and preventing ill health
17 Principles of health promotion
Health promotion and health education
Definition
Health promotion models and approaches
The Stages of Change model
18 Health behaviours
Definition
Health behaviours
Patterns of behaviour
19 Epidemiology, demography and genomics
Epidemiology
Demography
Genomics
20 Health inequalities
Health inequalities
Types of inequality
Who experiences inequalities?
How inequalities are experienced
21 Early years and childhood: life choices
Adverse childhood experiences
Toxic stress
Consequences of ACEs
Preventing ACEs
22 Health literacy
Definition
Health literacy
Nutbeam’s Health Literacy Model
23 Health screening
Health screening
Purpose of screening programmes
Screening and testing
Population screening
24 Immunisation and vaccination
Immunisation
Immunisation and public health
Immunity
Vaccination
Herd immunity
25 Infection, prevention and control
Infection prevention and control
Principles of infection, prevention and control
Health care acquired infection
Antimicrobial resistance
Antibiotic stewardship
Platform 3: Provide and monitor care
26 Human development
The lifespan
Prenatal
Infancy
Early and middle childhood
Adolescence
Young and middle adulthood
Late adulthood
27 Anatomy and physiology
28 Commonly encountered conditions when delivering care
Parity of esteem
29 Pre‐procedure information giving
Information giving
Ideas, concerns and expectations (ICE)
Giving information
Information leaflets
30 Shared decision‐making
Personalised care
Shared decision‐making
Shared decision‐making: care settings
31 Escalating concerns
The deteriorating patient
Measurement, documentation and reporting
SBAR
RSVP
32 Dignity and comfort
Patient safety
Dignity and privacy
Comfort
Sleep
33 Nutrition and hydration
Malnutrition
Hydration
Bladder and bowel health
34 Mobility
Disease processes
Respect
Nursing interventions
35 The deteriorating patient
Failing to detect or to act on the deteriorating patient
Deteriorating patients
Factors impeding deterioration
36 Anxiety and confusion
Generalised anxiety disorder
Prevalence and risk
Symptoms
Treatment and support
Confusion
Symptoms
Treatment and support
37 Discomfort and pain
Pain
Acute and chronic pain management
38 End‐of‐life care
End of life
Ethics
Recognising end of life
When death has occurred
39 End‐of‐life decisions and orders
The law
Approaching the end of life
Advance care planning
Discussing death
40 Medicines management I
Medicines optimisation
Effective administration of medicines
41 Medicines management II
The effects of medicines
Contraindications
Allergy and drug sensitivity
Adverse drug reaction
42 Medicines management III
Oral
Injection
Sublingual and buccal
Rectal
Inhalation and nebulisation
43 Working in partnership with people, families and carers
Partnership working
Person‐centred care
Monitoring effectiveness
44 Co‐morbidities and holistic care provision
Co‐morbidities
Holistic assessment
Holistic care
45 Capacity: understanding information and making decisions
Capacity
Assessing capacity
Principles
46 Self‐harm and suicide
Definitions
Suicidal ideation
Suicide
Self‐harm
47 Sharing information
General Data Protection Regulation, Data Protection Act 208 and Human Rights Act
Sharing information
Consent
Platform 4: Working in teams
48 Roles and responsibilities
Nursing Associates
Scope of practice
Collaborative practice
Continuing professional development
49 Interacting with members of the care team
The Code of Professional Conduct
Emotional exhaustion
Delegation
50 Human factors and team working
Human factors
Never events
Learning from never events
The Nursing Associate’s input
51 Data management
Data
The Professional Record Standards Body (PRSB) and the electronic health record
e‐Health technologies
52 Prioritising care and co‐morbidities
Co‐morbidities
Targeted interventions
Shared decisions
Primary care
53 Giving and receiving constructive feedback
Feedback
How to give feedback
54 Role modelling
Role models
Supporting and supervising others
Supervising and assessing: Nursing Associates
Platform 5: Improving safety and quality of care
55 Health and safety legislation
Legislation
Risk assessment
Hazards
56 Clinical audit
Florence Nightingale
Audit
Stages of the audit cycle
57 Risk assessment tools
Risk assessment tools
Tools and instruments
Limitations
58 National Early Warning Score (NEWS2)
National Early Warning Scores (NEWS)
National Early Warning Score 2
A holistic approach
59 Hazards and incidents
Hazards to staff
Incidents, error and near misses
Patient safety reporting systems
Escalating concerns
60 Staffing and safe care
Skill mix
Impact of inadequate staffing levels
The Nursing and Midwifery Council
61 Revalidation
Revalidation
The Nursing Associate’s responsibility
Practice‐related feedback
Written reflection
Platform 6: Contributing to integrated care
62 Being resilient
Resilience
Basic needs
Emotional stability
Confidence
Social support
Speaking your truth (be honest with yourself)
Self‐awareness and insight
Having faith
63 The roles of health and social care teams
Integrated care
Effective working relationships
Understanding roles
64 Long‐term conditions
Long‐term conditions
Personalised care planning
The pyramid of care for those with long‐term conditions
65 Promoting independence
Intermediate care
Core principles
Risk
Personalised goals
66 Accessing care
The NHS England
Access to services
Barriers to accessing services
Improving access to services
67 Discharge planning
Discharge planning
Transfer of care
Hospital passport
Appendix (i): Annexes A and B (NMC, 2018)
Annexe A: Communication and relationship management skills
Annexe B: Procedures to be undertaken by the Nursing Associate
References and bibliography
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1 Governance.
Chapter 3
Table 3.1 The 6Cs.
Chapter 4
Table 4.1 Types of discrimination.
Chapter 8
Table 8.1 Four factors of emotional intelligence (Source: Hefferman 2010).
Chapter 9
Table 9.1 Communication exercise SPIKES (Source: adapted Webb, 2011).
Chapter 11
Table 11.1 The four principles of person‐centred care (Health Foundation, 201...
Table 11.2 PANEL principles (Scottish Human Rights Commission, 2020).
Chapter 12
Table 12.1 Encouraging the reporting of adverse incidents.
Chapter 13
Table 13.1 The PEACE mnemonic.
Chapter 14
Table 14.1 Using the four senses.
Chapter 15
Table 15.1 Three components associated with reflection.
Chapter 19
Table 19.1 Genomics glossary of terms.
Table 19.2 Genomic versus genetics.
Chapter 23
Table 23.1 Screening and testing (Public Health Action and Support Team, 2017...
Chapter 24
Table 24.1 NHS vaccination schedule (NHS, 2019).
Chapter 25
Table 25.1 Personal protective equipment (RCN, 2017).
Table 25.2 Health care acquired infection (HCAI) – key facts (WHO, 2016).
Chapter 28
Table 28.1 Spheres of practice.
Chapter 29
Table 29.1 Ideas, concerns and expectations (ICE).
Chapter 31
Table 31.1 SBAR.
Table 31.2 RSVP.
Chapter 32
Table 32.1 Appropriate sleep duration for specific age groups (National Sleep...
Chapter 34
Table 34.1 Some disease processes directly affecting mobility.
Table 34.2 Some hazards of immobility (Source: Adapted Peate and Wild, 2018; ...
Chapter 35
Table 35.1 Aspects of prevention.
Chapter 36
Table 36.1 The Stepped Care Model (NICE, 2019).
Chapter 37
Table 37.1 Some common misconceptions about the nature of pain (McGann, 2007)...
Chapter 39
Table 39.1 Having end‐of‐life conversations.
Chapter 41
Table 41.1 Type A and B adverse drug reactions.
Chapter 42
Table 42.1 Some routes of administration.
Chapter 46
Table 46.1 Risk factors (Source: WHO, 2014).
Table 46.2 Protective factors.
Chapter 48
Table 48.1 Key differences between the roles of Nursing Associate and Registe...
Chapter 50
Table 50.1 Human and ergonomic factors (Source: https://www. pngfuel.com/free...
Chapter 52
Table 52.1 Six practical approaches to help develop care provision (Source: Adop...
Chapter 53
Table 53.1 Some types of feedback.
Chapter 55
Table 55.1 Three steps to the identification of risk assessment.
Chapter 57
Table 57.1 Some assessment tools.
Table 57.2 Components of Malnutrition Universal Screening Tool (British Assoc...
Chapter 58
Table 58.1 NEWS2 early warning scores and responses (Source: RCP, 2017).
Chapter 59
Table 59.1 Some potential staff hazards.
Table 59.2 Mistakes.
Chapter 60
Table 60.1 The Code and safe staffing levels.
Chapter 66
Table 66.1 Barriers to accessing services.
List of Illustrations
Chapter 1
Figure 1.1 The Code.
Chapter 2
Figure 2.1 The law and ethics.
Figure 2.2 Ethics.
Chapter 3
Figure 3.1 The duty of candour.
Chapter 4
Figure 4.1 The nine protected characteristics.
Chapter 6
Figure 6.1 Some components of good health and well‐being.
Chapter 7
Figure 7.1 The stages of the nursing research journey.
Figure 7.2 Planning: the research process.
Figure 7.3 Implementation of evidence‐based practice (EBP).
Chapter 10
Figure 10.1 Getting the balance right.
Chapter 11
Figure 11.1 Eight principles associated with quality improvement (Picker Ins...
Chapter 13
Figure 13.1 Digital literacies.
Chapter 15
Figure 15.1 A reflective process.
Chapter 16
Figure 16.1 The Code.
Chapter 17
Figure 17.1 The Stages of Change Model.
Chapter 18
Figure 18.1 Factors impacting health behaviours.
Chapter 19
Figure 19.1 Demographics.
Chapter 20
Figure 20.1 Health inequalities.
Chapter 21
Figure 21.1 Adverse childhood experiences.
Figure 21.2 Three toxic stress responses
Figure 21.3 Adverse Childhood Experiences – the Life Course
Chapter 22
Figure 22.1 Health literacy responsiveness of services.
Chapter 26
Figure 26.1 Life stages (Public Health England, 2019).
Figure 26.2 Influencing factors.
Chapter 27
Figure 27.1 Levels of organisation of the body.
Figure 27.2 Anatomical position: anterior and posterior views of the body.
Figure 27.3 Anatomical position.
Figure 27.4 Anatomical planes.
Chapter 28
Figure 28.1 The interrelated elements affecting people’s physical health (Nu...
Chapter 30
Figure 30.1 Shared decision‐making.
Chapter 32
Figure 32.1 The Dignity Challenge.
Chapter 35
Figure 35.1 A systematic approach to raising issues concerning the deteriora...
Chapter 38
Figure 38.1 Various steps associated with end‐of‐life care (NHS, 2014).
Chapter 40
Figure 40.1 Principles of medicine optimisation
Chapter 42
Figure 42.1 Drug administration.
Figure 42.2 Sublingual and buccal routes.
Chapter 43
Figure 43.1 Patient‐centred care
Chapter 44
Figure 44.1 An example of coordinated care for the elderly and those with co...
Chapter 47
Figure 47.1 When and how to share information
Chapter 48
Figure 48.1 Components of revalidation
Chapter 49
Figure 49.1 Some symptoms of emotional exhaustion.
Chapter 51
Figure 51.1 Potential benefits of sharing data.
Chapter 52
Figure 52.1 Two populations at risk of comorbidities across the life span...
Chapter 53
Figure 53.1 Situation, behaviour, impact
Chapter 54
Figure 54.1 The practice assessment relationship.
Chapter 56
Figure 56.1 Stages of the audit cycle
Chapter 58
Figure 58.1 NEWS2 physiological parameters
Chapter 61
Figure 61.1 Some aspects of revalidation (NMC 2018a and b).
Chapter 63
Figure 63.1 The four key factors.
Chapter 64
Figure 64.1 The pyramid of care.
Chapter 65
Figure 65.1 Personalised goals.
Chapter 67
Figure 67.1 People and services that may be a part of the discharge process....
Guide
Cover Page
Series Page
Title Page
Copyright Page
Preface
Acknowledgements
Table of Contents
Begin Reading
Appendix (i) Annexes A and B (NMC, 2018)
References and bibliography
Index
Wiley End User License Agreement
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This title is also available as an e-book.For more details, please seewww.wiley.com/buy/9781119724308or scan this QR code:
The Nursing Associate at a Glance
Ian Peate OBE FRCN
Principal, School of Health StudiesGibraltar Health AuthorityGibraltar
This edition first published 2021© 2021 John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication Data
Names: Peate, Ian, author.Title: The nursing associate at a glance / Ian Peate.Other titles: At a glance series (Oxford, England)Description: Hoboken, NJ : Wiley‐Blackwell, 2021. | Series: At a glance series | Includes bibliographical references and index.Identifiers: LCCN 2021008652 (print) | LCCN 2021008653 (ebook) | ISBN 9781119724308 (paperback) | ISBN 9781119724360 (adobe pdf) | ISBN 9781119724353 (epub)Subjects: MESH: Nursing Assistants | Nursing Care–methods | Nurse’s Role | United Kingdom | HandbookClassification: LCC RT41 (print) | LCC RT41 (ebook) | NLM WY 49 | DDC 610.73–dc23LC record available at https://lccn.loc.gov/2021008652LC ebook record available at https://lccn.loc.gov/2021008653
Cover Design: WileyCover Image: © sturti/iStock/Getty Images
Preface
Nursing, being a practice‐based discipline, requires the theoretical knowledge provided to be grounded in practice so as to facilitate professional competence with regard to fitness for practice, purpose, award as well as professional standing.
The role of the Nursing Associate was developed in response to a number of key policies and drivers, including the NHS Five Year Forward Plan (NHS, 2014), Shape of Caring: Raising the Bar (Health Education England (HEE) 2015), Nursing Associate Curriculum Framework (HEE, 2017) and the Skills for Health (2017) Nursing Associate Apprenticeship Standards. The Nursing and Midwifery Council (NMC) confirmed in January 2017 that the Nursing Associate will be a new regulated nursing role, in England, from January 2019.
In response to the NMC’s confirmation that it would become the Nursing Associate regulator, actions needed to be taken to ensure that standards were in place. Standards were produced in 2018 for the Nursing Associate proficiencies (NMC, 2018a) and for Nursing Associate programmes (NMC, 2018b). The NMC revised its Code of Conduct in 2018 to include the Nursing Associate (NMC, 2018c).
Locally, nationally and globally, health and care settings are experiencing complex challenges. There has been an increased demand on services with the imperative that patients receive the right care, at the right time and in the right place. Key to this is the building of new health and care partnerships, integrating care provision and developing new roles. The Nursing Associate role is a response to the need to develop the healthcare support worker role and to offer support to the Registered Nurse. A role in its own right, the Nursing Associate acts as a bridge between, and complements, the unregulated healthcare workforce and the Registered Nurse. Furthermore, it widens access to further career development as a Registered Nurse.
Approved Nursing Associate programmes are aimed at individuals who are employed in health and care settings. Programmes of study have to be flexible, authentic work‐based learning programmes that develop competent, confident and compassionate Nursing Associates who will be proficient in the provision of high‐quality, safe and responsive person‐centred care that traverses the lifespan in a variety of diverse settings. As programmes of study involve learning from practice, and learning in practice, they draw upon the principles of work‐based learning in supportive environments.
The aim of the Nursing Associate programme should be that on completion of their programme the Trainee Nursing Associate will demonstrate passion and confidence in their practice, committed to supporting the holistic delivery of person‐centred care across the life span, embracing the notion of lifelong learning and taking on responsibility for working within their scope of practice.
The six platforms used by the NMC in the Standards of Proficiency for Nursing Associates (NMC, 2018a) have been used to structure the text. Annexes A and B are provided as appendices.
The Nursing Associate at a Glance provides the Trainee Nursing Associate with a revision aid that will support their classroom and practice‐based learning. The text aims to help develop Nursing Associates who are competent, confident and compassionate, providing high‐quality, evidence‐based, holistic, non‐judgemental person‐centred care.
Terminology
The words that are used to describe people are important. The importance of the terms chosen is that they have the potential to create a particular perception of a person that could be positive, encouraging, enriching or destructive and stigmatising.
Alternatives to the term ‘patient’ like ‘clients’, ‘service users’ and ‘consumers’ have arisen as a consequence of attempts to empower patients by transforming their relationships with illness, society and health and social care professions. Where ‘patients’ is used in this text, this also means those people who are in your care and would include service users. In contemporary health and social care, patients are justifiably seen as experts who have valuable lessons to teach practitioners. It should be noted that any form of labelling will always have the potential to do harm.
References
Health Education England (HEE) (2015). Shape of caring: Raising the bar.
https://www.hee.nhs.uk/sites/default/files/documents/2348‐Shape‐of‐caring‐review‐FINAL.pdf
. Last accessed August 2020.
Health Education England (HEE) (2017). Nursing Associate Curriculum Framework.
https://www.hee.nhs.uk/sites/default/files/documents/Nursing%20Associate%20Curriculum%20Framework%20Feb2017_0.pdf
. Last accessed August 2020.
NHS (2014). Five Year Forward Plan.
https://www.england.nhs.uk/wp‐content/uploads/2014/10/5yfv‐web.pdf
. Last accessed August 2020.
Nursing and Midwifery Council (NMC) (2018a). Standards of proficiency for nursing associates.
https://www.nmc.org.uk/standards/standards‐for‐nursing‐associates/standards‐of‐proficiency‐for‐nursing‐associates/
Last accessed August 2020.
Nursing and Midwifery Council (NMC) (2018b). Standards for pre‐registration nursing associate programmes.
https://www.nmc.org.uk/standards/standards‐for‐nursing‐associates/standards‐for‐pre‐registration‐nursing‐associate‐programmes/
Last accessed August 2020.
Nursing and Midwifery Council (NMC) (2018c). The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates.
https://www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/nmc‐code.pdf
. Last accessed August 2020.
Skills for Health (2017). Nursing Associate Apprenticeship Standards.
https://haso.skillsforhealth.org.uk/wp‐content/uploads/2017/04/2018.01.12‐L5‐Nursing‐Associate‐ST0508‐Standard.pdf
. Last accessed August 2020.
Acknowledgements
I would like to thank my partner, Jussi Lahtinen, for his support and encouragement.
I am grateful to all of the Trainee Nursing Associates and Nursing Associates who inspire and motivate me.
Platform 1Being an accountable practitioner
Chapters
1
The Code
2
Legal and ethical
3
Duty of Candour
4
Non-discriminatory behaviour
5
The demands of professional practice
6
Health and well-being: self-care
7
The principles of research and evidence-based practice
8
Emotional intelligence
9
Effective communication
10
Maintaining appropriate relationships
11
Advocacy and person-centred sensitive care
12
Reporting adverse incidents
13
Numeracy, literacy, digital and technological skills
14
Record keeping
15
Reflective practice
16
Promoting public confidence in the profession
1The Code
At the point of registration, the Nursing Associate will be able to: understand and act in accordance with the Code – professional standards of practice and behaviour for nurses, midwives and Nursing Associates – and fulfil all registration requirements.
Figure 1.1 The Code.
Top Tip
The standards within the Code are what the Nursing Associate commits to when joining or renewing their registration with the Nursing and Midwifery Council (NMC). The professional standards of practice and behaviour are fundamental to being a part of the nursing profession.
The Code
The Nursing and Midwifery Council (NMC) functions so as to protect the public. They do this is in a number of ways, for example, by ensuring that only those who meet their requirements are permitted to practise as a nurse or midwife in the UK, or in England, as a Nursing Associate. The NMC will take action if there are any concerns raised about whether a Nursing Associate is fit to practise. In serious cases, this action can lead to the Nursing Associate’s name being removed from the professional register.
The NMC (2018) publishes its Code of Conduct (The Code. Professional Standards of Practice and Behaviours for Nurses, Midwives and Nursing Associates) setting out common standards of conduct and behaviour for those on the register. This aim of the Code is to provide a clear, consistent and positive message to others including patients, service users and colleagues about what it is that they can expect from the Nursing Associate who provides nursing care. The Code describes the professional standards that Nursing Associates must uphold.
Nursing Associates must act in line with the Code, irrespective of whether they are providing direct care to individual people, groups or communities or they are drawing on their professional knowledge to influence nursing practice in other roles, for example, leadership, education or research. The values and principles in the Code are relevant in a range of practice settings; they are not, however, negotiable or optional.
There are four key themes in the Code (see Figure 1.1). The Code applies to all Nursing Associates regardless of where they are practising, for example, in primary care, community, acute care, with adults, older people, children and young people or in places of detention. The Code is generic in nature in so far as it not applicable to any one specific field of nursing, it pertains to learning disabilities nursing, children and young people’s nursing, mental health nursing and adult nursing and across the lifespan. The Nursing Associate may also be working in a social care setting, criminal justice setting, with the homeless, working with families and other agencies; regardless, the Code applies.
Prioritise people
At all times the Nursing Associate is required to ensure that the interests of people using or needing nursing services will come first. The care and safety of people are the Nursing Associate’s key concerns; dignity is to be preserved, and needs are to be acknowledged, assessed and responded to. Those who receive care are to be treated with respect, their rights upheld and discriminatory attitudes and behaviours challenged.
Practise effectively
Care delivery or the provision of advice on treatment or providing help (including preventative or rehabilitative care) must be done without too much delay, to the best of abilities. Care is provided on the basis of the best evidence available and best practice. The Nursing Associate must communicate effectively, maintain clear and accurate records and share skills, knowledge and experience where appropriate. They must reflect and act on any feedback received so as to improve their practice.
Preserve safety
When practising, the Nursing Associate must ensure that patient and public safety is not affected, working within the limits of their competence. Exercise the professional ‘duty of candour’ and raise concerns without delay whenever there are situations that put patients or public safety at risk. Where appropriate take necessary action to deal with any concerns.
Promote professionalism and trust
The reputation of the profession must be upheld at all times, and the Nursing Associate is required to display a personal commitment to the standards of practice and behaviour set out in the Code. The Nursing Associate should be a model of integrity and leadership that others would wish to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other health and care professionals as well as the public.
The NMC provides a framework against which the Nursing Associate practises. The Nursing Associate’s primary duty is to the people whom they care and offer support to; actions (or omissions) will be judged against the backdrop of the Code. Nursing Associate is a protected title and may only be used by someone on the NMC’s register.
2Legal and ethical
At the point of registration, the Nursing Associate will be able to: understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.
Figure 2.1 The law and ethics.
Figure 2.2 Ethics.
Table 2.1 Governance.
Clinical governance addresses activities that can help to maintain and improve high standards of patient care.
Policies
National policies have a major impact on the resourcing of services; they also set performance indicators and evaluation criteria. Policies exist that define and integrate appropriate standards for delivery of care, addressing conditions necessary for that care to occur.
Protocols
A document developed to guide decision‐making around specific issues. Protocols exist for a wide range of activities. These can range from clinical issues such as caring for someone with an infection through to the procedures required to provide nurse‐led physical exercise intervention for people with dementia.
Standards
These reflect a desired and achievable level of performance against which a Nursing Associate’s actual performance can be compared. The key aim/purpose is to direct and maintain safe and clinically competent nursing practice.
Guidance
Guidelines are evidence‐based recommendations for health and care. They set out the care and services suitable for most people with a specific condition or need and for people in particular circumstances or settings.
Procedures
Using an evidence base. These detail how to do things, for example, the principles of hand hygiene and the procedure for cleaning the hands.
Top Tip
With regard to policies, protocols, standards, guidance and procedures – know them, read them, use them.
The law and ethics
The law and ethics permeate every aspect of nursing practice. Often Nursing Associates and others ask the questions ‘what is legal' and 'how do I decide what is right' so that I might practise safely and ethically. The law and ethics are intimately related to each other, often overlapping (Figure 2.1). Legal and regulatory frameworks come in the form of law and the Code (NMC, 2018).
Ethics
Ethics can be described as moral philosophy. This is a system of moral principles that are concerned with what is good for individuals and for society. Each interaction the Nursing Associate has with patients involves making a judgement about right or wrong, good or bad. Underpinning each interaction, the principles of patient‐centred care are utilised, engaging with the patient at all times. The Nursing Associate needs ask whenever providing care or offering support: is this in the best interests of the patient?
The ethical principles
The four key ethical principles address a value that arises in interactions between healthcare providers and patients. The principles address the issue of being fair, honest and having respect for fellow human beings (see Figure 2.2).
Autonomy
Everybody has the right to control what happens to their bodies (self‐determination) based on their values and belief system. Respecting the principle of autonomy means that an adult person who is informed and competent can refuse or accept treatment, drugs and surgery aligned with their wishes. People have the right to control what happens to their bodies because they are free and rational. Decisions made must be respected by everyone, even if those decisions are not in the patient’s best interest.
Beneficence
Those who provide health and social care must strive to improve the health of those whom they provide care and support to, to do the most good for the patient in each situation. However, what might be good for one patient may not be good for another, and each situation is considered individually. This principle is about doing good and avoiding malevolence.
Non‐maleficence
This principle is the essence of healthcare ethics and is concerned with ‘First, do no harm’. At all times the Nursing Associate must avoid causing harm to patients, protecting them from harm.
Justice
The final principle requires the Nursing Associate to be as fair as possible when offering treatment to patients and allocating scarce resources. Access to care should be equitable. At all times the Nursing Associate must be able to justify their actions in each situation.
Law
Law is a system of rules and guidelines enforced through social institutions such as the criminal justice system to govern behaviour. Law plays a key role in the provision of contemporary health and social care. Much legislation has been passed that has a profound effect on how care is delivered, for example, the Children Act, The Mental Health Act, Capacity Act and the Health and Social Care Act.
Parallels with ethics and law
Ethics and law are closely related. Laws are made based on the moral values of society (in general), describing the basic behaviour of people. They represent the minimum standards of human behaviours, that is, ethical behaviour. Laws and ethics are systems that maintain a set of moral values, preventing people from violating them, providing people with guidelines on what they may or may not do in specific situations.
Ethics comes from people’s awareness of what is right and what is wrong. The Code, for example, is enshrined in ethics (see Chapter 1). Laws however, are written and approved by governments. Ethics can vary from person to person as different people can have different opinions on a particular issue. Laws describe what is illegal regardless of the different opinions people might have. In general, ethics are not well defined; however, laws are defined and precise.
Governance requirements are usually in the form of policies, protocols, standards, guidance and procedures (see Table 2.1). Clinical governance activities can help to maintain and improve high standards of patient care.
3Duty of Candour
At the point of registration, the Nursing Associate will be able to: understand the importance of courage and transparency and apply the Duty of Candour, recognising and reporting any situations, behaviours or errors that could result in poor care outcomes.
Figure 3.1 The duty of candour.
Box 3.1 Six criteria laid out in law that have to be met for a whistleblowing concern.
The person raising the concern is a ‘worker’ (includes employees, agency workers, trainees, volunteers, trainee Nursing Associates, student nurses and student midwives).
The person raising the concern must believe they are acting in the public interest.
The person raising the concern must believe that it shows past, present or likely future wrongdoing.
The person raising the concern must believe that the matter falls within a regulatory remit.
The person raising the concern must believe that the information they disclose is true.
In raising the concern, the individual must not themselves be committing an offence.
Table 3.1 The 6Cs.
Courage
Being courageous enables the Nursing Associate to do the right thing for the people we care for, to speak up when there are concerns and to respect the Duty of Candour.
Communication
Central to successful caring relationships is communication, caring relationships and effective teamwork.
Commitment
The foundation of successful caring relationships is commitment to patients and communities.
Competence
Being competent means that the Nursing Associate must have the ability to understand an individual’s health and social needs.
Compassion
Compassion can be explained as intelligent kindness and is central to how people perceive their care.
Care
Caring defines the Nursing Associate. Those receiving care expect it to be right for them throughout every stage of their life.
Top Tip
The Duty of Candour is the legal duty to be open and honest when things go wrong. The Nursing Associate has a statutory and professional duty to be open and candid with patients about any errors in their care and treatment.
The Duty of Candour
Any culture of secrecy or cover‐up in healthcare must be challenged. This has led to a focus on making candour in healthcare mandatory. The definition of Candour by the Professional Standards Authority means being honest when something goes wrong. When health and care systems are open, transparent and honest, there are many benefits for the care and treatment of people. The Nursing Associate has a professional duty of candour under the Code, and a statutory duty applies to organisations also. When organisations fail to adhere to this duty, they run the risk of criminal sanctions. One aspect of the duty is to report back to the patient or relatives if there has been any unintended or unexpected incident that could result in, or appears to have resulted in the death of the patient or severe harm, moderate harm or prolonged psychological harm to the patient; these are known as notifiable safety incidents. The duty of candour is all encompassing and impacts widely (Figure 3.1).
The Nursing Associate
The Nursing Associate must be open and honest with patients when something has gone wrong with their treatment or care, or if it has the potential to cause, harm or distress. This means that the patient (or advocate, carer or family, where appropriate) must be told when something has gone wrong, an apology must be given to the patient (or, where appropriate, the patient’s advocate, carer or family), if possible an appropriate remedy or support offered to put things right. When an apology is made this does not mean that the practitioner is accepting legal liability for what has occurred, nor that the practitioner is accepting any personal responsibility for the mistakes of others or for systemic failings. The patient must be offered a full explanation of the short and long term effects of what has happened.
As well as being open and honest with patients, the Nursing Associate has to be open and honest with their colleagues, employers and appropriate organisations as well assisting with and taking part in any reviews and investigations when asked. There is also a requirement to be open and honest with the NMC, raising any concerns where appropriate and not preventing someone from raising concerns.
Openness and Honesty
As a Nursing Associate, the Code requires that you are open and honest with patients, colleagues and your employer. The obligation to be open and honest, the professional duty of candour, can sometimes be difficult for Nursing Associates and other health and social care professionals to do for a variety of reasons, nevertheless there is an expectation that they be candid. It is unacceptable that health and social professionals do not tell the truth when a patient has been harmed, be this by withholding or misrepresenting the facts.
Whistleblowing
Whistleblowing is when an individual reports workplace concerns about unsafe care or wrongdoing, it is not the same as a Duty of Candour but, there is an overlap. The law sets out several criteria that must be met for raising concerns to qualify as whistleblowing (see Box 3.1).
If all of the conditions in Box 3.1 are met, the person blowing the whistle enjoys legal protection to prevent them suffering any retaliation from their employer because of what they have done.
Challenges to the Duty of Candour
The workplace culture in which a Nursing Associate practises can influence candour towards patients. Environments that have an ethos of openness are more conducive to being open and honest with patients. Organisations where a blame culture, or a culture of defensiveness exist, are not environments in which the professional duty of candour will thrive.
Courage
Whilst achieving zero harm, is aspirational, it may, in reality be unachievable. Given that proposition, what needs to be put in place is to improve the responses made when harm occurs. Robust governance that would include incident reporting, audit, development of protocols and multidisciplinary education must be seen as central to any change in cultural.
The Duty of Candour requires moral courage, integrity, resilience and support. Courage is one of the 6Cs (see Table 3.1).
4Non‐discriminatory behaviour
At the point of registration, the Nursing Associate will be able to: demonstrate an understanding of, and the ability to, challenge or report discriminatory behaviour.
Figure 4.1 The nine protected characteristics.
Table 4.1 Types of discrimination.
Type of discrimination
Discussion
Direct discrimination
When a person with a protected characteristic is treated less favourably than others.
Indirect discrimination
If there is a rule, policy or protocol that puts a person at a disadvantage as compared to others, it may be considered indirect discrimination.
Discrimination by association
If a person is treated unfairly because someone you know or are caring for has a protected characteristic, this may be construed as discrimination by association. For example, you are refused service in a restaurant because the person you are with has a disability.
Discrimination by perception
Receiving unfair treatment because someone thinks the person belongs to a group with protected characteristics may be discrimination by perception. For example, a person with a mental health problem is refused a lease for a flat by an estate agent because they assume people with mental health issues behave in a certain way.
Harassment
This comprises unwanted behaviour making another person feel offended, humiliated or intimidated. Unwanted behaviour could include physical gestures, abuse, jokes, spoken or written words or offensive emails and expressions.
Victimisation
When a person is treated badly or subjected to disadvantage because they have complained about discrimination or they have supported another victim of discrimination, this could be considered victimisation.
Top Tip
Never ignore or excuse discriminatory behaviour any more than you would ignore someone if they were in pain.
Protected characteristics
In October 2010 the Equality Act came into force, providing a single legal framework with clear, streamlined law to help tackle disadvantage and discrimination in a more effective way. The Equality Act 2010 has identified nine protected characteristics (see Figure 4.1).
Because every person has at least some of these characteristics such as age, race or gender, the Act protects every person from being discriminated against. If a person is treated unfavourably because someone thinks that person belongs to a particular group of people with protected characteristics, this is unlawful discrimination.
