RUP1: Professional Roles and Values in Nursing
Allegra Connors
Western Governors University

Functional Differences

There are many differences in functions of a regulatory board of nursing such as the Illinois Board of Nursing (IBN) and a professional nursing association such as the Hospice and Palliative Nurse Association (HPNA). The Illinois Board of Nursing functions as the licensing body for professional nursing, regulatory enforcer and where complaints about nurses or nursing practice can be addressed. It’s role is to protect the public safety in regards to nursing and it’s practice (Cherry & Jacob, 2010). The role of the HPNA is one of advocacy for it’s members and their profession, including lobbying for laws and policies, communicating with members about issues that affect us as in end-of-life care, they allow networking and sharing among hospice professionals, they disseminate knowledge of new practices and issues and they offer professional development through courses and seminars as well as credentialing in the specialization of a nurse in hospice and palliative care. (Matthews, 2012) In regards to credentials the IBN sets the standards and scope of practice that nurses are responsible for in the state of Illinois. In essence they define nursing and what that means in their state. They are responsible for verifying through transcripts that an individual has obtained the correct schooling required and they administer the NCLEX-RN exam that an individual must pass to earn the designation of Registered Nurse (RN). They also set the parameters to renew a license and what continuing education is needed and how it is to be documented. They are responsible for making sure that the minimum standards are met for licensure ( Cherry & Jacob, 2010). In contrast, the HPNA has no part of the RN licensing but they do offer testing for designation of their specialty. A nurse may sit for an exam after two years of practice as a full-time hospice or palliative nurse and if they pass they receive the designation of Certified Hospice and Palliative Care Nurse (CHPN). This certification indicates the level of knowledge and professionalism and excellence that this nurse has obtained in this specialty (Certification, 2014). The HPNA does not require continuing education but offers it for professional development. They do this through seminars, online classes and conferences. The regulation that the IBN handles is in regards to the nurse practice act of the state and enforcing it’s standards and definitions. The board has the responsibility to, through due process, review a nurse’s possible violation of state or federal acts. They must come to a decision and if appropriate inact actions of consequence to the nurse or nurses involved. “Actions may include restrictions on the license or suspension or revocation of a nurse's license” (Cherry& Jacob, 2010 ). A professional board may give advice or referral to a nurse who is called before the IBN but they have no say in the decision made and/or penalties enacted by the IBN. In contrast, the professional organization sets standards and ethics for it’s members, a specialization organization like the HPNA, sets standards that it believes it members should adhere to but they are not enforceable. Rather they are a way to advocate for both the profession of nursing and their clients. These standards and ethics are often used as members who join the organization combine as one voice to lobby for those issue that are important to both their profession and healthcare in general (Matthews, 2012).

Provisions from the Code of Ethics
“Provision 1: The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of each individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (American, 2014).”
This provision brings to mind the way that I have to treat many of my terminally ill patients and their families. many of my patients die from lung cancer with smoking as a major contributor to the development of the disease. Some of my patients continue to choose to smoke all the way until they are physically incapable of doing so. As their nurse I know that this practice aggravates and causes exacerbation of their already compromised pulmonary functions. The very symptoms I am trying to relieve for their comfort they are further aggravating. But my ethics in regards to this provision make me aware of the uniqueness of each of my patient’s situations and personalities. My judgement of the nature of their health problem as arising from their smoking habit is not something I can allow to affect how I practice. Their values are not necessarily my own. I inform them that the smoking will continue to aggravate their pulmonary problems but listen carefully as they explain the reasons they may want to continue to smoke. I then try to do my best to continue to relieve their symptoms regardless of their individual choice. I also try not to make judgements about their continued smoking in either voiced comments, attitude or body language. In a second example, in end of life care different individuals have different requests as to how they want to handle a disease and the symptoms it brings. My patients are often afraid of having fluids and food withheld at the end of life. I carefully explain the nature of the interventions in that most people will voluntarily decide to stop eating or drinking prior to death. It is a physiologic response that permits the patient’s body to direct energy to more vital resources and also that it often is a natural process of desiccation that provides comfort from an overload of pulmonary fluids at the end of life. But from the code of ethics I recognize that I must respect the self-determination of each individual allowing them, after giving them understandable information about both their disease, its progression, and the effects of continuing fluids and food, to make a decision. There are many times I want to use coercion or emphasize the penalties of their decision, but know that it would violate the ethics in this provision, even though I think that withholding fluids and foods is the better more comfortable choice. I allow them to have their own decision and support them both in the process and in the application.

Code of ethics professional traits “Integrity is an aspect of wholeness of character and is primarily a self-concern of the individual nurse (American, 2014).” I would bring this trait of integrity to an interdisciplinary team perhaps in regards to a family request to not tell a patient, who is able of consent, that the team treating him is from hospice. Often families are afraid of their patient’s reaction to the word, hospice. The difficulty arises when a family, who the team believes has the best wishes of this patient at heart do not want us to mention the words hospice, death or terminal. But as a nurse my integrity is to being truthful to my primary client the patient. And I would have to take the view amongst the team that the patient has the right to that knowledge and truthfulness. And if the rest of the team was of the opposite opinion I would need to make a conscientious objection if I am abiding by these ethics. A second trait of nursing that I would bring to an interdisciplinary healthcare team would be collaboration. “Collaboration is not just cooperation, but it is the concerted effort of individuals and groups to attain a shared goal.” When a patient of mine who was in very poor health expressed a desire as a WWII veteran to participate in an honor flight to the Veteran’s Memorial it took the concerted efforts of all of the team members to attain this goal. We each had to think outside our own specialty and see how it would need to work with the others, this included social workers who arranged the honor flight, the volunteer coordinator who found a volunteer to accompany the patient, and both the nurse and the medical director to provide education and medication for symptom management to the medical personnel on board. It was a difficult goal to attain with the safety and health of the client and his wishes but through the concerted effort of all it was attainable. A third trait I would bring would be acceptance of accountability and action. “Individual registered nurses bear primary responsibility for the nursing care their patients receive… (American, 2014).” I need to bring to a team meeting the individual responsibilities that I will carry out in the care of the patients and understand what is within the scope of my license and what standards of care I will carry out in the team planning. A fourth trait would be wholeness of character. “Nurse have both personal and professional identities that are neither entirely separate or entirely merged (American, 2014)” I would bring this to a interdisciplinary team meeting as in regards to encompassing my professional values with my own personal values in the decision making process. Understanding that my view is not the one that may or should take precedence. But I do need to expect myself to speak up and allow my values as a whole person to be understood while avoiding undue influence and persuasive techniques.
Nursing theory influences
“When the client incurs an insult that renders him or her in need, the transpersonal process between the client and the nurse is considered a healing nursing intervention (Cherry & Jacob, 2010).” This theory is perhaps the one that drives my professional practice the most. It is very holistic in that it talks of connectedness of the mind, body and spirit. This is very important at the end of life when people often realize that their body is dying but they are spiritually perhaps more active and alive than ever. It is my practice to bring a caring attitude, a respect for the patient’s and families own attitudes and find a way to find connection between us. Often it is through story even as my clinical care is being provided. I hear their stories and share my own that have relevance. I do believe as Jean Watson, the author of the Theory of Human Caring in 1978, that this provides a congruence between the clients perceived self and existent self. It also does provide a holistic harmony even in the midst of disease and eventual death (Cherry & Jacob, 2010). This theory is perhaps most important due to the fact that my nursing practice can no longer provide cure but it can provide a wholeness of spirit and connectedness through caring as well as collaborative management of symptoms with the patient and their caregivers.

Historical nursing figure and modern day practice.
Like many I am sure I see Florence Nightingale’s contribution in my everyday practice. Nightingale had a theory of practice that was labeled, chattering hope and advice (Cherry & Jacob, 2010). Cherry and Jacob describe it as attempts by the family and friends of the patient to cheer them up through false hope and minimizing their illness and exaggerating the probability of recovery (2010). When it comes to the words death and dying that are not things, as a culture, we are comfortable addressing or admitting are going to happen. And for my patients, this is a current reality they face. In my practice it is usually the families and other caregivers that I need to address. I do this first by using the word dying in my talking with them, for example, I may ask them if they understand they dying process? Generally they wince and look away. But it important for my patients to be able to talk seriously about where they are and what they are experiencing and so I tell their families and them the news of their expected prognosis and never exaggerate the probability of an extended or even partial recovery. I believe, like Florence, that this places a burden on the sick patient, who may have many emotions or questions about his situation and his death. Often I will, in front of the family ,ask the patient, “Do you know where you are at in your illness?” Families are often amazed when the patient states, “I am dying.” However, it opens up the conversation and relieves the patient from having to act as if nothing untoward is happening and allows all to address issues that need to be addressed.

Safeguarding principles
In my nursing practice the principle of beneficence is the one I identify with most strongly. I am always dealing with a patient who is vulnerable as all of my patient’s are terminally ill and usually it has been a chronic debilitating illness. I do no harm to these patients by making sure to find out what they know about their illness and what they believe in regards to it and their terminal diagnosis. Often I am supporting the patient by educating the patient and family as to all their choices in this situation and the predicted outcomes of those choices. Often I have family member’s who don’t want the patient to be lethargic or “drugged” and they withhold giving pain medication to the patient for fear of this side effect. In this scenario I have had to do different things. In some cases it is a matter of printing some educational materials and going over then with the family caregiver and patient and initiating further discussion. Sometimes I bring the problem to the interdisciplinary team meeting to increase support for the patient’s decision to have as pain free a death as possible. From this collaborative meetings I have had social workers make calls to work with family and even the medical director has phoned the family to help support my patient’s right to pain medication and symptom management on my request.
The other principle that I come across is justice. One particular scenario comes to mind. I was visiting a family who I advised over the phone to give a specific pain medication to before I got there. When I got there the patient was still in pain but very relaxed. I had the family show me what medication they had given and they had given him an anti-anxiety medication not the pain medication. Both were liquid and they administered the wrong one. I quickly realized that no one in the family could read, though they all spoke English well. I asked if perhaps we could use a color coding system for the bottles. The family agreed and we designated a specific color for each of the three medication they were using. It took more time but the family’s dignity was upheld and they were able to provide excellent safe care to their family member at home as the patient desired. Justice in this case meant treating the family fairly and in a non-judgemental way when an error was made due to their illliteracy. .

References
American Nurses Association. (2014). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Certification Preparation. (2014). Hospice and Palliative Nurses Association. retrieved from https://www.hpna.org/DisplayPage.aspx?Title=Certification%20Preparation
Cherry, B. & Jacob, S. (2010). Contemporary Nursing: Issues, trends and management. VitalSource bookshelf version. Retrieved from https://online.vitalsource.com/#/books
Matthews, J. (2012). Role of professional organizations in advocating for the nursing profession. Online Journal of Nursing Issues. Retrieved from http://www.medscape.com/viewarticle/766817_6