Introduction
Knowledge is an indispensable resource in every health system. The history of the development of knowledge about health and disease is, of course, as long and complex as the history of mankind. Since the origins of science in the ancient world, scientific knowledge in the health-related disciplines has become increasingly abundant and complex. To cope with the enormous accumulation of facts and concepts about the diseases of human beings, how they may be treated or prevented, and how positive health may be promoted, increasingly elaborate specialization has been necessary. The domain of medicine has become subdivided into some 50 or more specialties and subspecialties, and the process of health service has been subdivided among dozens of allied health professions. Within each of the subdivisions, research, observation, and experience are contributing new knowledge all the time. The discovery of new facts is invariably dependent on previous discoveries. The protection of individuals against the hazard of contracting communicable disease, of course, depended on the massive additional research necessary to elucidate immunization. The knowledge of nutrition, sanitation, immunization, childbirth, and infant care is essentially equal in both countries. The difference lies in the application of this knowledge in the daily lives of the people, their environment, and their health systems (Link 2005).
Knowledge is indispensable in every national health system, but it is sterile unless it is applied. The application of available knowledge is the task of society in every country and the mission of its health system (Kanyogonya & Museveni 2000). Knowledge is an important aspect of the medical profession particularly nursing. One should have the proper knowledge before practicing in the medical field. In nursing, hospital administrators recognized that economic advantages accompanied the operation of a nurses’ training school because student nurses were low-cost, relatively skilled workers; the numbers of these nursing schools expanded exponentially. Nurses looked to the legislature to ensure standards within nursing education and to protect the title of nurse through formal registration. However, as women they still did not have the vote and were unable to directly influence legislation. The topic of registration for nurses was also noted as it passed through the legislatures of various states during this period, with occasional more extensive discussion (Donahue 1996). Modern nursing emerged as a distinct entity only during the last 150 years or so in Germany, England, Scandinavia and North America. It became an idea so formidable, and so seemingly inevitable, that nursing now encircles the world. In turn, modern nursing rests, however uneasily, on a time-immemorial idea of nursing or mutual aid among humans that seems to date from ancient. Whether modern or ancient, nursing deals with birth and death, health and illness; it is ubiquitous and essential. Those who study the history of nursing have a broad field indeed, and several audiences for their musings. Modern nursing developed in the context of the worldwide spread of industrialization and an increasingly cash-based economy. Inherently, the occupation of modern nursing involves transferring part of the family, tribe or village care-taking responsibility to a paid worker, a stranger, whose work is somehow deemed and guaranteed to be trustworthy (Mcgann & Mortimer 2004). This paper intends to understand the professional boundaries in Nursing. It wants to know the different boundaries connected to the nursing profession.
Main body
Qualitative methodology
Case 1
Nurses cannot go beyond their professional boundaries. The professional boundaries come in different forms and come in accordance with the culture of a country or its people. The professional boundaries of nurses should be a sacred thing and should be followed to make sure that excellent health service would be provided to patients. A general question about the structure of health care is how far professional boundaries prevent ethical issues being identified or raised or resolved, and indeed how far the boundaries even define and create them in the first place. Thus one comes across situations in which apparently doctors are absolved from ethical worries by a strict concern with science and technique, nurses absolved by a subordinate preoccupation with executing procedure, managers absolved by a concern with money and efficiency, politicians by a concern with the economy, and the public and patients are disempowered (Burke, Spencer & Unsworth 2001). Nurses should be applying pressure for the reform of ethical. It is unsatisfactory that such review is still medically dominated, nurses being grossly under-represented. Depending on the nature of the investigation, there may be a conflict between the nurse’s respect for the pursuit and advancement of scientific knowledge and concerns about whether investigation and or assessment are in the client’s considered best interest (Hunt 1994). Nurses are often required to assist doctors with the execution of research, often administering prescribed drugs or treatments on their behalf. The drugs intended, for example, as a cancer treatment may be given as part of a clinical trial, but the nurses may worry about possible iatrogenesis or medically induced complications. The nurse may question her own role and responsibilities when asked to administer treatments or medications to patients which she may feel should have been administered by the doctor. The most fundamental question for anyone considering ethical practice in nursing is whether such a thing is possible. Particular ethical concerns arise where there is responsibility, and responsibility presupposes freedom. It is still far from clear whether nurses are free to judge and act as carers and scrutiny of this leads one to fall back on the deeper question of what a nurse is (Johnstone 1999). Talk of accountability arises with the fundamental transformation which nursing is undergoing between countries. The transformation that it is actually undergoing may not be the same that is officially claimed. In fact, it is still too early to say definitely what kind of transformation this is, except that it already appears that the age-old gap between nursing ideals and practice is taking yet another form (Traynor 1999).
Case 2
Nurses cannot provide services that are more than what they were trained for. Nurses cannot engage in a personal relationship with the client. Nurses cannot engage in business dealings or business relationship with their clients. A part of the professional boundaries of Nurses is their accountability for their every action. Accountability may provide the means to make sure that nurses would not go beyond their duties. It would appear that accountability is about the liberation of nurses, about a new freedom, responsibility and professionalism. On the other, the evidence is of accountability functioning as the central idea in a new ideology of disciplined accommodation to structural changes required by a quasi-market in public health care provision. There is a deep ambivalence in the use of the term. Put a cross-section of the health care hierarchy around a table and very often one will find them disagreeing about almost everything, only finally to agree about the importance of accountability. It appears that here is a concept serving an ideological function, one which papers over deep conflicts of interest. In a reversal of the story about blindfolded people feeling an elephant, all of whom come up with different ideas about the object before them, here everyone thinks they have an elephant when they are really feeling quite different animals. Demanding accountability does not in itself say anything about whom one is accountable to, or who has the right to hold one to account. It neither says what things one is, or ought to be, accountable for, nor what the limit to these things is. It does not say by what criteria, or on what basis, one is held to account. There will be many contexts in which demands for accountability come into conflict with one another (Lee & Winters 2006). The existing political and ideological background to health care accountability pre-empts the very question which is most in need of an answer: what is the moral basis of nursing? If nursing is about executing the orders of the biomedical and increasingly the economic expert then it follows that a whole series of fundamental ethical questions have been pre-empted. It appears, for instance, that there are two kinds of people, experts and lay, and to be accountable to the lay is necessarily secondary to being accountable to one’s professional and managerial superiors. While the professional may feel some obligation to give an explanation to a patient, if the patient does not accept it then the presumption is that the patient is ignorant. Patients, far from determining the character of health care are, for the most part, merely tolerated (Sacks 2003). Accountability cannot always assure that Nurses will be stay within the boundaries. Urgent decision making may force a nurse to do something that goes beyond the boundaries.
Review methodology
The liabilities of Nurses root from medical malpractices. Malpractices by Nurses have a certain punishment that depends on the laws of a country or territory. Malpractices do not give a good image to both the Nursing profession as well as the healthcare system of a country. When one disregards professional boundaries then that means he/she is doing malpractices. Disregard of professional boundaries show that one is not fit for the nursing profession and one will not do what he/she learned to do. Malpractices entails not only creating errors in doing the job but it involves the intentions of one in involving oneself in the job. Disregard of professional boundaries show that one wants not only to serve but to make use of a position for personal gain. The context of nurses’ learning has always been institutional: either a hospital, or currently, a university or equivalent. After all, nurses learned traditionally by doing the work, as part of the labor force of a hospital. Nursing education has emerged from a hospital-based apprenticeship model of workplace learning, and is seeking to maintain a nurturing ethic as the basis of professional work. But the nature of the work and the formation of an identity are closely linked. After all, nursing is about caring for those in need of restoration to health, and it strives to mark itself as a profession on that basis, as well as maintain its links with other professions’ knowledge bases, principally medicine, which is about curing (Johnstone 1999).
Nursing is about bodily effort and bodily functions: communication with patients starts with body language, in that how a nurse touches, handles and thereby carries out the caring communicates the ethic of the work in general Nurses’ reflection on the common experiences at work, and their communal ownership of the judgments that result, have shaped the profession, and driven the identity issues. The learning about nursing comes from this sort of hot action, and the decisions under pressure, and also through routine, which nurses find themselves making (Lumby & Picone 2000).Nurses learn things such as ethics in the course of their education. Nursing codes of ethics around the world have made explicit that nurses have a stringent moral responsibility to promote and safeguard the wellbeing, welfare and moral interests of people needing and/or receiving nursing care. What is often not stated, however, is how nurses ought to fulfill their moral responsibilities and to deal effectively with the many ethical issues they encounter on a day-to-day basis. In the case of postgraduate nursing education, so long as students have completed an undergraduate foundational unit on the subject of ethical issues in nursing, the number of contact teaching hours required to teach the subject can be more flexible and, to a larger extent, determined by students’ interests and practice needs. It should be noted, however, that the ethical issues associated with clinical specialty areas for example, critical care, cancer care nursing, aged care, mental health nursing, and the like are complex and many (Beckett & Hager 2001).
Effective preventative ethics education in these and similar areas would, as in the case of undergraduate courses, require discrete units in their own right taught over a 26-hour contact teaching time period. It should not be assumed that, upon completing a unit in ethics as part of a formal nurse education program, a graduate’s ethics education has been completed. To be effective, preventative ethics education must be continuous. It is important that nurses do not fall prey to the idea that once they have completed a unit in ethics as part of a formal education program, they have done ethics and that they would not benefit from any further education on the subject. Just as nurses need to continually update their clinical knowledge and skills, so too do nurses need to continually update their moral knowledge and skills both as knowing that and knowing how (Narváez & Rest 1994). Violating the boundaries means that a nurse has committed unethical acts and must be punished for malpractice. Malpractice costs are directly related to the claims paid frequencies and the payment amounts. When a patient undergoes medical treatment, an adverse outcome can occur. The frequency of malpractice lawsuits against a physician depends on several factors. News stories and attitude toward litigation could increase the frequency of claims. New technological developments, although they improve the delivery of health care, can increase the chances for adverse outcomes. Higher expectations of new technologies may increase the likelihood of filing malpractice lawsuits when adverse outcomes are encountered. Tort reforms, improved patient-doctor relationships, increased use of defensive medicine, and emphasis on risk management are likely to reduce frequencies of malpractice lawsuits (McKenna 1997).
States with high malpractice claims per physician also have high malpractice claims per population. However, relationships of claims per physician with other variables are not similar to the relationships between claims per population and other variables. A variety of strategies can be adopted to alter physicians’ behavior in order to cut malpractice claims. Merit rating involves charging malpractice insurance premiums based on past malpractice claims. Increased training, supervision, high deductibles or coinsurance, restriction on medical procedures that can be done, and so on, can be used to reduce malpractice claims Patient compensation funds established by states typically pay malpractice awards above certain limits. This is because whenever a payment exceeds the limit for the patient compensation fund to pay; two malpractice payments are generated one from the insurance carrier and the other from the fund (Bhat 2001). Mandatory periodic payments of awards also increase the probability of having more than one malpractice payment per physician. Typically, periodic payments of awards are mandatory only when payments exceed certain limits. Because such reforms impact only large payments, their influence on the frequency number of awards is limited. Statutes that limit time for filing claims are expected to reduce the frequency number of claims per physician. However, a positive sign indicates that the impact is contrary to the conventional wisdom (Nichols 2003). Mandatory screening increases the probability of having more than one claim per physician. Caps on legal fees should reduce the frequency number of malpractice claims. Contrary to conventional wisdom, both frivolous lawsuit penalties and joint and several liabilities increase the likelihood of having more than one payment for a physician. In summary, the impact of various tort reforms on the frequency number of malpractice payments per physician is mixed. Mandatory collateral source modifications, caps on damages, court-approved legal fees, and arbitration provision reduce the probability of having more than one claim per physician. By contrast, tort reforms involving a patient compensation fund, mandatory periodic payments of awards, statutes of limitation, mandatory screening panels, sliding and maximum legal fees, frivolous lawsuit penalties, and a joint and several liability rule increase the probability of having more than one claim per physician (Hogan 2003).
Discussion
A patient and his/her relatives should have autonomy rights and conditions over medical information and decision making whenever the patient is on a life threatening condition. A patient or a relative should be allowed to make important decisions or release medical information whenever the patient is on life threatening information. The patient or their relative should be allowed to make important decisions on medical procedures and process that will be used towards the patient. The autonomy rights will not and should not mean that Nurses and medical practitioners should be given the equal right. The autonomy rights of patients and their relatives should not translate into similar rights with the nurses and other medical practitioners. Professional boundaries entail that the nurse and other medical practitioners should not try to force the patient or his/her relative to lift their autonomy rights. This means that the medical professional should not coerce the patient so that he/she will make decisions that will violate his/her rights. Professional boundaries entail that the nurse or other medical professional would not try to convince the patient or his/her relative to do something that contradicts with their autonomy rights. This means that the medical professional should not say something that might change the patient’s decision and thus violate the autonomy rights. This also means that the medical professional should make sure that all his/her actions will be in according to the patient’s rights.
The new ethos of patient autonomy comes with certain clear and generally espoused principles and agendas. Given the perception that patients have regularly been as uninformed as they are powerless in health care, the basic prescription has been to inform them and alter that power structure. Impeaching all forms of paternalism, at least for competent patients, the new ethos has advanced the doctrines of informed consent and the right to refuse treatment toward enabling and empowering patients to retain control of their lives in health care. The insistence on truth telling is added to this prescription in recognition of both patients’ need for information and insight as to whether there are decisions to be made, and the alleged widespread presence of deception within health care (O’Neill 2002). In any clinical encounter between competent patients and their health care providers, the essential details of the recommended intervention must be presented to the patient, the patient’s consent must be obtained before proceeding, the patient has the right to refuse the intervention without prejudice, and any such interaction must proceed honestly without the presence of lies, deception, or coercion. As the proponents of the new ethos recite their case, one might well wonder how physicians managed to attract any patients at all over the last two millennia. Most people do not appreciate being lied to or deceived, resent being coerced, and supposedly like to retain control of their own lives. In truth, the usual physician-patient interaction was much more benign. Physicians often saw little point in informing patients, preferring to make recommendations that their patients were supposed to accept and with which they were expected to comply (Wear 1998).
Such behavior may well not have enhanced freedom and self-determination, but neither was it outrageously paternalistic or disrespectful. Both parties in the relationship simply felt that the doctor knew best; such decisions were seen as matters of medical expertise and judgment. The real impetus for the new ethos of patient autonomy seems to have developed from other, more specific sources and insights, not, at least initially, from concern over the silence within the usual physician-patient interaction (Kuczewski & Pinkus 1999). Patients come to physicians to be healed or at least, restored to function and relieved of suffering as much as possible. Given this overriding agenda, the primacy of which both parties agree upon, anything that enhances healing is appropriate, anything that diminishes or undermines it is to be avoided. What enhances it seems quite clear: the trust that brings the patient in and generates acceptance, compliance, and cooperation with the physician’s recommendations. As to decision making, effective and appropriate management of illness dictates that this is the physician’s function. Often there is a clear and primary treatment of choice and the patient comes to the physician to have this identified and provided. There were other ways to enhance this process as well. Patients also came seeking reassurance, and the physician was loath not to provide it, even if he diverged from or stopped short of the truth (Coward & Ratanakul 1999).Truth telling can be counter therapeutic and the whole new ethos quite misguided. Even now, physicians who are consciously committed to patient autonomy routinely err on the side of emphasizing the benefits of treatment and the likelihood of success (Dowrick & Frith 1999).
Often it is argued that patient autonomy should take precedence, as freedom of action is seen as an unqualified good in the society and any measures that limit people’s freedom, even if it is for their own good, are seen as unwarranted. Patient centered care is becoming a key principle in modern medical practice. However, some argue that people have swung too far the other way in allowing such unfettered patient autonomy and that it threatens doctors’ ability to do the best for their patients. Informed consent is a sine qua non of medical treatment and that full disclosure is a necessary corollary of respect for autonomy. There are, however, circumstances under which non-disclosure is held to be permissible. The first of these relates to the concept of therapeutic privilege which actually enjoys some recognition within the legal requirements of informed consent. Where a doctor judges that disclosure might harm the patient it may be permissible for the doctor to proceed with treatment without the need to fully inform the patient of all its consequences or potential consequences. For instance, if telling a patient about all the risks of a potentially life-saving drug might lead to his refusing it one might, at least temporarily, hold back some of the information under therapeutic privilege. The notion of therapeutic privilege is under attack in modern ethical thinking and now it is a privilege which needs to be deployed, if at all, under much more stringent conditions (Candib 1995). Cases of moral duty occur under three conditions: the behavior makes a great difference to someone else, it harms them or blocks some very significant benefit; one’s duty must not be so difficult that most people cannot realistically, easily do it; some expectation or understanding one has helped to foster creates a special relationship with the person to whom one owes the duty. Moral duty can be clearly seen in organ donation. Organ donation entails that the patient is knowledgeable of the situation, it entails that the medical professional can perform the procedure with high standards and it entails that the autonomy of the patient would be fully realized. Organ donation confers a huge benefit on someone else, and unless one has religious or ethical objections against it, it is not the least bit difficult to do (Breen, Cordner & Plueckhahn 1997).
Conclusion
Knowledge is an important aspect of the medical profession particularly nursing. One should have the proper knowledge before practicing in the medical field. Nurses cannot go beyond their professional boundaries. The professional boundaries come in different forms and come in accordance with the culture of a country or its people. Nurses cannot provide services that are more than what they were trained for. Nurses cannot engage in a personal relationship with the client. Nurses cannot engage in business dealings or business relationship with their clients. The liabilities of Nurses root from medical malpractices. When one disregards professional boundaries then that means he/she is doing malpractices. Disregard of professional boundaries show that one is not fit for the nursing profession and one will not do what he/she learned to do. Malpractices entails not only creating errors in doing the job but it involves the intentions of one in involving oneself in the job. Disregard of professional boundaries show that one wants not only to serve but to make use of a position for personal gain. A patient should have autonomy rights and conditions over medical information and decision making whenever the patient is on a life threatening condition. A patient should be allowed to make important decisions or release medical information whenever the patient is on life threatening information. The autonomy rights should not mean that Nurses and medical practitioners should be given the equal right. Professional boundaries entail that the nurse and other medical practitioners should not try to force the patient or his/her relative to lift their autonomy rights. Professional boundaries entail that the nurse or other medical professional would not try to convince the patient or his/her relative to do something that contradicts with their autonomy rights.
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