Art Question

Any topic (writer’s choice)

” Your essay should contain NUMEROUS references and citations from the article by David Kamp, and at least four of the authors, and poets (you may use five authors but no more) along with their literary works we have studied this semester. Do not use an author or work that was not assigned during the semester. Be sure to also identify which major movement the author belongs to. Each of the four authors you choose must be from different literary periods (see handout posted Week 1 in Moodle)! Remember it must be an author and work that was assigned.             Explain and provide detailed examples of how each of the authors/works defines the American Dream, and how that dream may be the same or different from what we now consider the American Dream. Again, identify and briefly explain which literary movement the author is part of. The major goal is to illustrate how the idea of The American Dream has transformed over time through a discussion of Kamp and your authors.            One way to organize your essay is to use the Kamp article as the foundation for all your points, and then use the four authors/works to support your points. You will want to conclude the essay with a discussion about current events such as immigration, race, gender equality, etc., and how these issues impact the American Dream for those who are different or come from a different country/background. In other words, is the American Dream accessible to ALL Americans? To everyone equally?             Please note this is an informative/argumentative type essay and not a simple opinion paper. The difference is that in the first case you must use data and facts (from research) to support your points. In the second case, you simply state your own personal opinion! I want information based on facts!             Please follow the correct MLA format (see MLA handout posted in moodle). All papers must be typed and contain at least 7 entries on the works cited page: the Kamp article, biographies, and literary works from your textbook for each of your four authors, and the remaining research must be found through the Southeastern Library Database. No other outside research is required or acceptable. If you have any questions about what may or may not be acceptable please email me.[supanova_question]

Deliverable 2

For this assignment, you have three location options to choose from to conduct your direct observation (you MUST choose one of these locations):
A coffee shop you’ve never been to in a neighborhood you are unfamiliar with.
An outdoor sporting event

Guidelines for conducting Direct Observation
Decide on a location. Make sure the location is a public place. Invasion of privacy is unacceptable. You must choose from the list of locations you have been given.
Set a time line. You should plan on spending a minimum of one hour, but not longer than two hours observing. Make sure you plan your schedule so that you can do the observation at the most appropriate time.
Take notes! The more detailed and factual, the better. You can handwrite your notes while in the field (if this is easier and makes you less conspicuous) but you should type up your notes as soon as you have the opportunity (usually right after leaving the field so the memories are fresh). Your notes can be written in the first person (e.g. I arrived at the coffee shop and sat in the far corner of the store at a table that was facing the center of the room. I saw a man with a red hat come in and sit down without ordering anything). Your notes should detail everything you observed related to your research goals, from the seemingly mundane to the more interesting/exciting. It is ok to note what you think is happening (e.g. “the man sat down at the table and seemed angry at the woman who was with him”) but you shouldn’t add any of your own judgement into your field notes (e.g. “he had no right to be angry at her, she was just waiting for him”).
Be aware of your surroundings and be courteous to your subjects. In some situations, people may not notice your presence, but if they ask questions, answer briefly, politely, and honestly. If they seem offended or annoyed, stop asking questions or leave the location. If you interview anyone, you must get their informed consent (you won’t be doing this, just FYI). If anyone makes you feel threatened or uneasy, leave immediately
You will submit your detailed field notes from your observation. Be sure to include the location you observed, date of the observation, your arrival time, departure time and all other details of what you observed while you were there.
Drawing on your field notes as your “data,” answer the following questions:What are the norms for behavior in this location?
What happens when someone deviates from these norms?
Who typically adhered to the norms?
Who were the norm-breakers?

Finally, consider how YOU played a role in the research process. How did your personal experience, perspective, opinions, or behaviors influence the things you paid attention to, and the way you interpreted your data? How did this “structured” observation differ from “everyday” observation? If you observed in the field, what did it feel like? Were you comfortable or uncomfortable – why? Would you do anything differently next time? What did you learn from the experience?

done
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Nov 28th, 2021[supanova_question]

Excerpt from the textbook to familiarize yourself with concepts before writing the

Writing Assignment Help Excerpt from the textbook to familiarize yourself with concepts before writing the paper.

Themes of nursing ethics

As you study the various codes of nursing ethics, you will notice the ethical principles discussed in Chapter 3. You will also notice other strong and consistent themes. These themes depict a number of important facets of ethically appropriate nursing care. The following section discusses the themes of caring, expertise, nursing autonomy, accountability, authority, and unity that appear in nursing codes of ethics.

Caring

It has been proposed that care is the root of ethics (May, 1960). The notion of caring developed throughout history in various forms—mythological, religious, philosophical, psychological, theological, and moral (Reich, 2003). We can trace the origins of caring in nursing to the work and writings of Florence Nightingale. However, the connection between nursing and caring strongly emerged during the advent of feminist ethics in the 1980s.

Historically, caring has been a major theme in nursing literature and an essential facet of nursing ethics. Martha Rogers (1966) famously said, “Nursing is the compassionate concern for human beings. It is the heart that understands and the hand that soothes. It is the intellect that synthesizes many learnings into meaningful administrations.” Leah Curtin (1980) claimed that the distinctiveness of nursing is located in the “moral art of nursing” in which nurses are committed to care for other human beings. The first nursing theorist to explicitly write about the process caring was Leininger (1984), who wrote “care is the essence and the central, unifying, and dominant domain to characterize nursing” (p. 3). Newman, Sime, and Corcoran-Perry (1991) defined nursing as the “study of caring in the human health experience” (p. 298). Swanson (1991) developed a five-process middle-range theory of nursing, which includes knowing, being with, doing for, enabling, and maintaining belief. Watson (2010) contends that caring is a professional and ethical covenant that nursing has with society. Clearly, caring is part of the moral essence of nursing (Fig. 6.2). Fig. 6.2Caring is the moral essence of nursing. Source: (©iStock.com/Cecile Arcurs.)

In terms of health care ethics, there are two distinctly different aspects of care: “caring about” and “taking care of” (Reich, 2003). Nursing codes of ethics guide nurses to practice both types of caring. Both caring about and taking care of are integral to ethical nursing care.

Many contend that caring about goes to the heart of nursing. This suggests a virtue of devotion of concern for the other person. Caring about another leads a person to be with the other person in his or her world (Mayeroff, 1971; Swanson, 1991). It is mindful and reflective, delivered with conscious intentionality (Watson, 2002) and compassionate concern. A nurse who cares about a patient is authentically committed to alleviating vulnerabilities, centering attention and concern on the person, and preserving dignity and humanity (Smith, 1999). Moral virtues and principles come naturally to the nurse who genuinely cares about the patient.

The second type of care, “taking care of,” encompasses competence in the technical aspects of delivering care. This type of care focuses more on knowledge of the scientific aspects of health care and on skillful practice. As you will see in the section that follows, giving expert technical nursing care is also a moral imperative.

Expertise

Expertise relates to the characteristic of having a high level of specialized skill and knowledge. It is a composite of knowledge gained through long years of study in an academic setting and superior skill. Expertise is an essential characteristic of professionals. Professionals must have the knowledge and functional skills required to meet the needs of society and thereby fulfill the purpose of the profession. Expertise also helps ensure that the nurse’s actions are beneficent and nonmaleficent. Expertise allows professions to maintain autonomy because society trusts that professionals are the only ones who fully understand the work of the profession.

Nurses must maintain competence. Each nurse must recognize and not exceed his or her own boundaries of competent practice. Codes of ethics from around the world specify that nurses utilize the best available evidence base for practice and maintain knowledge and skills (ANA, 2015; Canadian Nurses Association, 2017; ICN, 2012; NMC Nursing & Midwifery Council, 2015; Nursing and Midwifery Board of Australia, 2018; Nursing and Midwifery Board of Ireland, 2014; Nursing Council of New Zealand, 2012).

Nurses gain expertise in a variety of ways. Florence Nightingale recognized the importance of an education consisting of depth and breadth of general knowledge, combined with a specific nursing focus. Extensive educational requirements, intense guided practice, examination for licensure, certification, and mandatory continuing education are ways that nurses attain, maintain, or assert expertise. Having completed basic nursing education and successfully demonstrated a minimum level of competence through licensure examination, nurses are further required (either ethically or legally) to continue the learning process and maintain up-to-date knowledge and technical proficiency. Continuing education programs assist us in this process. Nursing expertise is also advanced through graduate nursing education, specialty preparation, and the certification process. Today the discipline of nursing has a knowledge base that continually expands through research.

Moving beyond the idea of competence, the Institute of Medicine (IOM) report, The Future of Nursing (2010), suggests that in order to correct many problems of the current health care environment, nurses must practice to the full extent of their education and training. This means that nurses must practice competently, and they must unapologetically practice to the full extent of the nursing role. Recognizing society’s faith in the profession, merely claiming expertise is not enough. Through the various mechanisms of accountability, nurses must prove that they are faithful to the promise the profession makes to the broader society. In response, society grants nurses the authority to practice with a certain measure of autonomy—as illustrated in the IOM report. Thus the professional realms of expertise, accountability, autonomy, and authority are closely interrelated.

Autonomy

Autonomy, as described in Chapter 3, is usually discussed in terms of respect for the autonomy of others, especially our patients. But to maintain integrity and fully exercise ethical practice, nurses must also be autonomous. The concept of nursing autonomy can be discussed on two levels: autonomy of the profession and autonomy of the individual practitioner. Self-regulation is the mark of collective professional autonomy. Individual autonomy involves self-determination, responsibility, accountability, independence, and a willingness to take risks. Autonomy is generally considered an important criterion of professional status. People who are considered professionals have the power and authority to control various aspects of their work, including goals toward which to work, whether to work and with whom, details of how the work is to be done, choice of clientele, and so forth (Jameton, 1984). We continue to debate whether nurses have autonomy.

CASE PRESENTATION

Lewis Blackman Revisited Recall the case presentation of Lewis Blackman in Chapter 3. Lewis was a 15-year-old healthy student athlete who died from an easily recognized and preventable adverse effect of a common analgesic drug administered after elective surgery. Even though he demonstrated dramatic signs of an impending emergency and nurses were diligently recording his signs and symptoms, none recognized the crisis until it was too late. Lewis died 31 hours after experiencing the first signs, even though his mother had repeatedly asked the nurses for help. In a series of short videos, Lewis’s mother, Helen Haskell, talks about her experience. She says, “Most of Lewis’s nurses were very young. They were sweet. They were articulate. They were well intentioned. They very clearly knew very little” (Haskell, 2009, video 2). Having dedicated herself to patient advocacy since her son’s death, Ms. Haskell says that many nurses have shared stories about their feelings of helplessness when their own family members suffered because of medical or nursing errors.

Think about it

Nursing errors and patient helplessness • Lewis and his mother trusted the physicians and nurses to provide competent care. How would you feel if you found yourself in a similar situation? • Helen Haskell says that Lewis’s nurses were task oriented rather than goal oriented. What do you think nurses’ responsibilities were regarding their ability to competently care for Lewis? • Discuss your beliefs concerning an ethical requirement to maintain expertise in practice. • Does the profession have an obligation to society in this regard?

Because the profession of nursing is self-regulating, it can be said to be autonomous. Unlike in the early years of this century, most state boards of nursing are now predominately made up of nurses. Given the authority granted by statutory law, boards of nursing enforce the individual states’ nurse practice acts. This ensures the autonomy of the profession in each state. Among other tasks, boards of nursing oversee the schools of nursing within their states, control licensure, and discipline nurses.

The profession of nursing maintains autonomy through the combination of a claim to maximal competence and a continuing monopoly over nursing work so that other people are prohibited by law from practicing nursing. Credentialing such as licensure, educational requirements, certification, and so forth are the means by which nurses restrict others from doing the same work. This legally sanctioned monopoly helps establish autonomy.

Nurses are legally and ethically required to practice autonomously. Autonomous practice serves as a safeguard for the patient, nurse, physician, and institution. Nursing codes of ethics support the nurse’s responsibility to make autonomous decisions. The ANA Code of Ethics for Nurses (2015) explicitly calls for nurses to be autonomous, particularly in relation to their responsibility and accountability for nursing judgments and actions that protect the safety of patients. Similarly, the Canadian Nurses Association Code of Ethics for Registered Nurses (2017) and the International Council of Nurses Code of Ethics for Nurses (2012) implicitly and explicitly reflect nursing autonomy and responsibility. The purpose of autonomy as described in these codes is to protect the patient from harm and allow for the full benefit of professional nursing care.

Are nurses truly autonomous? We often hear questions about the autonomy of individual nurses. As a nurse, do you really have autonomy? Can you say that you are autonomous, even though you are required to follow physicians’ orders? Are you autonomous, even though you cannot get to know the patients because you have too many patients and too much work to do? The argument can be made that nurses are autonomous because they have the authority to make decisions about the care they provide that is within the boundaries of nursing practice. Confusion occurs because the work of nurses overlaps the domain of physicians. Some nursing actions require physician authorization and others require no authorization because they fall within the scope of autonomous nursing. This role confusion is a result of business practices.

Hospitals are businesses. They cultivate a population of physicians who bring patients, and thus profits, to their facilities. To prosper, hospitals must attract and retain a strong physician staff. So, as a practical necessity, they provide qualified staff to carry out physicians’ orders—an essential service. Although we, as nurses, are autonomous professionals, we are also employees. When we accept employment, we implicitly agree to perform the tasks that our employers desire (except those that may be illegal, unethical, or immoral). Even so, ethics and law require us to use autonomous judgment in our practice. Institutions and physicians should welcome independent nursing judgment because of the safeguards it provides. We commonly hear about nurses who refuse to carry out unsafe orders. Such actions protect patients from physician error and thus prevent litigation against nurses, physicians, and institutions. Courts not only recognize but also expect nursing autonomy, ruling against nurses who follow questionable orders or fail to alert the hierarchical chain of command when problems arise.

Autonomy does not mean that nurses have absolute control of every facet of practice. Although accepted as one of the three prototype professions, medicine, for example, is no longer totally autonomous. Government regulations now guide many facets of medical care such as reimbursement levels and length of hospital stays. Managed care organizations limit expensive procedures, referral networks, and prescription medications. Today, there are far fewer distinctions between the degrees of autonomy of the two professions than there was when Flexner made his comparison in 1915.

Ask Yourself

Judgments About Physicians’ Orders

Nurses are frequently asked to give medications with which they are not familiar or to administer a familiar drug in an excessive dose or uncustomary route of administration. Unable to quickly determine its appropriateness or safety, a nurse might trust the physician’s order and administer the drug without fully understanding the implications or might refuse to administer the drug. • What feelings, emotions, and values might be involved in the nurse’s decision to refuse to follow a physician’s order? • What are some predictable reactions of the nurse’s coworkers, supervisors, and physicians when a nurse refuses to follow a physician’s order? • What ethical principles can be used to guide such decisions? • What type of nurse would be empowered in these types of situations? What type of nurse would not be empowered? • How would it affect the nurse if the drug in question is later found to be safe and appropriate? How should this affect future decisions? • How would it affect the nurse if the physician’s order is later found to be a dangerous medical error? How would this affect the nurse’s future decisions? • How might a nurse gain authoritative information on the safety of the order?

Nurses do not always feel autonomous, and, in fact, some may not practice autonomously. Certainly, there are nurses who spend each workday following physicians’ orders and completing various nonautonomous tasks, never exercising independent nursing functions, making nursing diagnoses, initiating self-directed treatment, or engaging in critical thinking. Recall the case of Lewis Blackman in which nurses were busy taking and recording alarming vital signs yet were oblivious to clear indications of Lewis’s deteriorating condition. In the truest sense, these nurses were only marginally practicing professional nursing. When nurses practice in this manner, they fail the ethical duty to make autonomous nursing judgments.

Accountability

Accountability means that a person has an obligation to accept responsibility and to account for his or her actions. Accountability in nursing is tied to the moral principles of fidelity and respect for the dignity, worth, and self-determination of patients. Safe, autonomous practice is ensured through various processes of nursing accountability. Because society places trust in nurses (gained through recognition of nurses’ expertise), and because society gives the profession the right to regulate practice (professional autonomy), individual practitioners and the profession itself must be both responsible and accountable. Accountability is an inherent part of everyday nursing practice. Each nurse is responsible for all individual actions and omissions. The ANA Code of Ethics for Nurses (2015) makes it clear that each nurse has the responsibility and accountability for judgments made and actions taken in the course of nursing practice, regardless of circumstances and irrespective of the health care organization’s policies or provider’s orders. As has been previously noted, the courts consistently support this claim. Mechanisms of accountability Accountability is at the heart of the relationship between nursing and the larger society. The profession of nursing has developed several mechanisms through which this relationship between nursing and society is made explicit. These mechanisms include codes of nursing ethics, standards of nursing practice, nurse practice acts, nursing theory and practice derived from nursing research, educational requirements for practice, advanced certification, and mechanisms for evaluating the effectiveness of nurses’ performance of nursing responsibilities. In both a professional and a legal sense, it is necessary that we are familiar with various mechanisms of accountability.

Standards of nursing practice describe the minimum expectations for safe nursing care. Standards may describe in detail specific acts performed by nurses or may outline the expected process of nursing care. Nurses are professionally, legally, and ethically accountable to meet standards. We use standards, which may be developed within the profession or within larger organizations, to guide and evaluate nursing care. Criminal and civil courts rely on nursing standards to guide deliberations during malpractice cases.

Some standards of nursing practice are developed within the profession to describe practice and to establish the minimum level of safe practice. They help ensure that nurses are competent and safe to practice. These documents, which are developed by nurses, guide us in giving nursing care and can be used as a yardstick to measure the practice of individual nurses. They can also be used to determine whether the actions of nurses accused of malpractice are consistent with reasonable minimum expectations. The ANA Standards of Nursing Practice is an example of these types of standards. These comprehensive standards utilize the nursing process. They make nurses accountable for ensuring that each step of the process is followed in the delivery of nursing care. Nursing organizations also publish standards of care for nurses in advanced or specialty roles, such as nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists.

Other standards of nursing practice may be developed by non-nurses, the government, or institutions. These standards describe the specific expectations of agencies or groups that utilize the services of nurses. Examples include the nurse practice acts of each state, Joint Commission guidelines, and formal policies of individual agencies. Nurses are responsible and accountable to know and follow the standards of care for the profession, the specialty (if applicable), the geographic area, and the institution.

While ensuring safe patient care, nursing standards must be practical and reasonable. Nurses in administrative or advisory capacities are often responsible for developing institutional standards. These nurses sometimes develop standards that describe the highest ideal of nursing care. This type of standard may actually create a risk by placing both practicing nurses and the employing institution in jeopardy of malpractice litigation. Nurses might be held to unattainable standards. Because standards are used to judge nursing actions, they should reflect reasonable expectations for safe nursing care rather than optimal or ideal care.

Nurse practice acts are considered a form of nursing standards. As the foremost legal statute regulating nursing, the nurse practice act of each state protects the public, defines nursing practice, describes the boundaries of practice, establishes standards for nurses, and protects the domain of nursing. Courts use nurse practice acts to determine the appropriateness of accused nurses’ actions. Violations can result in civil or criminal prosecution.

CASE PRESENTATION

When Standards Are Difficult to Meet Markko is a registered nurse in charge of a large inpatient psychiatric unit. His unit houses an average of 22 patients with a variety of diagnoses, ranging from drug dependence to acute psychoses. The unit is usually staffed by one registered nurse, two licensed practical nurses, and two attendants. Hospital policy requires that the registered nurse evaluate each patient’s physical and mental status at least twice per shift, supervise the administration of all psychotropic medication, participate in group activities, supervise the implementation of each patient’s plan of care, and be available to individual patients for one-to-one interaction. There are additional standards that describe the appropriate care for patients who are potentially suicidal: “Patients who are identified as suicidal will be isolated in private rooms and continuously monitored by a registered nurse.” On one particular day two of the patients are identified as potentially suicidal, six geriatric patients with dementia need to be fed and ambulated, one patient exhibits violent behavior, and all the patients need individual assessment. Markko calls the supervisor for assistance but is told that there is no one available to help. The reader will no doubt have noticed that in addition to the other duties, Markko is required to simultaneously and continuously monitor two patients in separate rooms—a physical impossibility. Markko tries to meet all obligations under these very strict standards, yet while he is answering a question raised by one of the staff members, one of the suicidal patients manages to injure herself attempting to jump out of a window.

Think about it

Problems posed by unreasonable institutional standards • What dilemmas are posed by these standards? • What were Markko’s alternatives? • What is the purpose of the standards that Markko is required to follow? • What do you see as the legal liability created by the standards? • Do you think the institution shares the legal blame for the situation? • What is the effect of the standards on Markko’s practice? • Is there any way that Markko can meet the standards? • What do you think you would do in similar circumstances? • What are the ethical implications for the institution and for Markko?

Each of the 50 states independently develops, updates, and interprets its own nurse practice act. Though both the ANA and the National Council of State Boards of Nursing have developed model nurse practice acts in the past, the laws continue to be different in each state. Some nurse practice acts are very general and are somewhat vague in describing the boundaries of the professional role. These laws are considered permissive, allowing nursing practice to evolve dynamically. Others list each act that nurses are permitted to perform. As nursing continues to evolve, the very specific nurse practice acts, although originally applauded as recognizing nurses’ legitimate authority to perform certain advanced tasks, have become restrictive. With nurses continually expanding the boundaries of nursing, these very specific and restrictive nurse practice acts have become a barrier to advanced nursing practice.

Because we are legally accountable to follow the standards set by the nurse practice acts within our own states, we must be particularly attentive to the language describing the definition of nursing and the scope of nursing practice. Nurses are accountable to know and follow their states’ nurse practice acts. Because legislatures meet and pass laws regularly, nurse practice acts can be changed unexpectedly. We are responsible to know even the most recent changes in our states’ nurse practice acts and to implement these changes in practice.

State boards of nursing interpret and carry out the provisions of the various states’ nurse practice acts. Their goal is to promote and protect public health, safety, and welfare through ensuring the safe practice of nursing. Boards accomplish this by establishing standards for safe nursing care, issuing licenses to practice nursing, monitoring the practice of nurses, and disciplining nurses as needed. Membership varies from state to state, but commonly includes a mix of registered nurses, licensed practical/vocational nurses, advanced practice registered nurses, and consumers.

Codes of nursing ethics address the nurse’s responsibility to participate in the profession’s efforts to implement and improve nursing standards. Recent changes in the health care delivery system, financing mechanisms, and roles of other health care professionals require careful study of existing nurse practice acts and judicious implementation of well-considered changes.

Delegation of nursing tasks

Nurses bear the primary responsibility and accountability for the nursing care patients receive, even when they delegate nursing activities to other registered nurses, licensed practical nurses, nursing assistants, or other licensed or nonlicensed staff (ANA, 2015) (Fig. 6.3). Upholding the ethical principles of respect for persons, respect for autonomy, beneficence, nonmaleficence, fidelity, veracity, confidentiality, and justice is the responsibility of the nurse and carries through to persons who report to the nurse. Delegation of nursing tasks must be consistent with nurse practice acts, organizational policy, and standards of practice. When delegating tasks, nurses are ultimately responsible to assess individuals’ knowledge, competence, and experience and to monitor and evaluate the quality and outcomes of the care provided. Organizational policies do not relieve nurses of this responsibility. Further, nurses must not delegate complex nursing tasks that require in-depth nursing knowledge and judgment such as assessment and evaluation. Fig. 6.3Nurses bear the primary responsibility for the nursing care when they delegate nursing tasks. Source: (©iStock.com/sturti.)

Nursing theory and practice derived from research

A frequently cited characteristic of professions is the existence of a unique body of knowledge derived from research. Recall that Genevieve and Roy Bixler’s (1959) first two characteristics of a profession relate to a unique body of knowledge. The Bixlers’ second characteristic actually calls for professions to constantly enlarge the body of knowledge by use of the scientific method. In the past, authorities debated whether nursing’s body of knowledge was unique to the profession or was borrowed from the behavioral and physical sciences and medicine. Responding to arguments that nursing was not a true profession because of this lack of a clearly unique body of knowledge, nurses in academic and clinical settings began gathering data and conducting legitimate research. The process of theory building and research in nursing continues to increase the unique body of nursing knowledge. The benefit of this process is twofold. First, the expanded knowledge base allows nurses to respond more knowledgeably and skillfully to the needs of society. Second, the presence of a clearly unique body of knowledge aids in validating nursing as a true profession.

Authority

The term authority means that a person or group has legitimate power and sovereignty. The authority to practice nursing is granted by legal statute, based on the contract the profession has with society. The granting of authority acknowledges the professional’s rights and responsibilities and requires mechanisms for public accountability (ANA, 2010). Authority assumes a certain measure of autonomy.

Society acknowledges the authority of a profession by recognizing its existence in statute and granting its members the elite privilege of membership. Thus, like autonomy, authority is two-tiered. State legislatures create laws designed to protect the public’s health and safety. The establishment of nurse practice acts is the exercise of this type of power. Nurse practice acts define nursing, describe the scope of practice, and grant the state boards of nursing the power to oversee the licensure of nurses and the practice of nursing in the states. Thus the state boards of nursing have the legitimate authority to regulate the practice of nursing within each state.

Nurse practice acts empower state boards of nursing to grant individual nurses the authority to practice through the process of examination and licensure. Licensure benefits both the public and the professional. It protects the public from those who are unqualified, and it protects professionals’ job territory by establishing a monopoly. The authority given each nurse to practice is contingent on the nurse continuing to uphold the established standards of nursing. State boards of nursing have the authority and responsibility to discipline nurses who do not follow established standards or who violate provisions of licensure law.

Unity

There is general agreement that one of the defining characteristics of a profession is a sense of unity among its members. Unity is multifaceted and based on what Aydelotte (1990) calls moral uniformity and class ideology among its practitioners. Unity relates to the ability of nurses to organize for the purpose of fulfilling the profession’s promises and the relationships that nurses have with one another.

Unity enables nursing to coherently standardize the professional characteristics of competence, autonomy, authority, and accountability. Through political and policy processes, nurses work together to meet the health care needs of society and to improve the status of the profession. The structural component of a professional community is realized through a professional association. The professional association provides a collective identity and serves as the voice of the profession. Unity within the profession helps standardize the services provided by its members and provides a professional hub for members that assists with the educational and professional needs of members and performs political, advisory, and policy functions. Membership is an expectation within a profession.

Although systematic organization of professional groups is necessary to fulfill the profession’s responsibilities, we also need unity among individual members. Unity involves showing sympathy, care, and reciprocity to those with whom one appropriately identifies; working closely with others toward shared goals; keeping promises; making mutual concerns a priority; sacrificing personal interests to the relationship; and attending to these over time (Jameton, 1984). Nurses are members of a special group. They share language, educational background, mysteries of practice, clothing, and other symbols of the profession. Membership in the group is restricted. Nurses are connected with the group and set apart from others.

Though loyalty is a virtue, there are certain risks when we experience an overly strong sense of loyalty to each other. Jameton (1984) warns that nurses must be careful that their loyalty to each other does not supersede loyalty to patients. For example, mistakes that nurses or doctors make should be reported. Because of a sense of loyalty and friendship between coworkers, there is a risk that the duty to patients will be neglected when errors occur. We are required to examine and prioritize conflicting loyalties closely. Jameton identifies nurses’ main priorities as patients, nurses and the nursing profession, physicians, hospitals, other health professions, and society. Questioning which of these priorities should be central and which should be peripheral, he suggests that the best choices for first priority are patient, nursing, and society.

Ask Yourself

Are Nurses Loyal to Nursing? Nurses who are politically active in a state nurses’ association report an incident that led them to question nurses’ loyalty to the profession. At the prompting of hospital and physicians’ lobbying groups, a number of nurse administrators participated in writing proposed legislation that would dismantle the all-nurse board of nursing in favor of one composed of hospital administrators and physicians. • How would you characterize the loyalty of these nurses to the profession and to other nurses? • What circumstances could justify prioritizing employer loyalty above loyalty to patients or to other nurses? • What are the ethical implications of the actions of the nurses described in this situation? • What should the role of nurses’ associations be in these situations?

Summary

Codes of nursing ethics are a nonnegotiable guide for nursing action. Because ethics is one criterion proposed to judge the professional status of a discipline, the study of ethics must include a discussion of nursing’s professional status. Nursing codes of ethics were partially an outcome of nursing’s struggle to meet this criterion. First established in the mid-20th century, nursing codes of ethics continue to evolve with sensitivity to the moral standards of society. Current codes of nursing ethics in Western countries are similar. They instruct the nurse to behave in ways that honor traditional ethical principles such as respect of persons, beneficence, nonmaleficence, justice, and fidelity. They contain underlying themes such as caring, expertise, autonomy, accountability, authority, and unity that direct nurses’ ethical practice. Codes of nursing ethics serve as a foundation for the practice of nurses.

Chapter highlights

• Acknowledgment of professional status is dependent on meeting specific criteria that include, but are not restricted to, expertise, autonomy, authority, accountability, and unity. • Historical and cultural influences have affected the definitions commonly used for the term professional. • A system or code of ethics is generally accepted as one trait of professions. • First established in the mid-20th century, nursing codes of ethics continue to evolve with sensitivity to the moral standards of society. • Codes of nursing practice are nonnegotiable standards. • Caring is a core value that undergirds nursing ethics. • Because society allows professionals a monopoly over the services they provide, ethics demands that those services must be provided with expertise. • Because it is self-regulating, the profession of nursing can be said to be autonomous. • There are legal and ethical imperatives for individual nurses to practice autonomously. • Autonomy does not mean full and absolute control over every aspect of practice. • Grounded in the moral principle of fidelity, accountability refers to being answerable to someone for something one has done. • Mechanisms of accountability include, but are not restricted to, codes of nursing ethics, standards of nursing practice, nurse practice acts, and nursing theory and practice derived from nursing research. • Authority for nurses to practice is granted through the legal processes of society. • Nursing unity relates to the profession’s ability to organize for the purpose of fulfilling the promises made to society.

Discussion questions and activities

1. Write your own definition of the term professional.

2. List five different occupations and compare their common characteristics. Which occupations meet your criteria for professional status?

3. Read two current nursing codes of ethics. Find concrete examples in the codes related to the ethical principles of autonomy, beneficence, nonmaleficence, justice, and confidentiality. For example, in the ICN Code of Ethics for Nurses, the sentence, “The nurse takes appropriate action to safeguard individuals, families, and communities when their health is endangered” is a practical example of the principle of beneficence.

4. Compare the ICN Code of Ethics for Nurses with the ANA Code of Ethics for Nurses or the Canadian Code of Ethics for Registered Nurses. What are the similarities? What are the differences?

5. Discuss the relationship between historical and cultural influences and Flexner’s method of identifying professions.

6. Discuss the relationship between the concepts of fidelity, professionalism, and expertise.

7. Discuss the statement, “To be less than maximally competent is unethical.”

8. Find recent examples of case law that relate to autonomy in nursing.

9. Observe a registered nurse at work. List tasks that the nurse performs and categorize them as autonomous or dependent.

10. Visit your state board of nursing website to find assistance in locating the law that regulates nursing practice. Is the code in your state vague or restrictive? Visit the websites of at least three states and compare the laws.

11. Discuss how specific language in your state law can be used as a standard of nursing care.

References

ANA. Nursing’s social policy statement. The essence of the profession 2010; Author Silver Spring, MD.

ANA. Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html 2015; Author Silver Springs, MD.

Aydelotte M. The evolving profession. The role of the professional organization N.L. Chaska The nursing profession A time to speak 1990; Mosby St. Louis, MO 9?15?.

Beletz E. Professionalization. A license is not enough N.L. Chaska The nursing profession Turning points 1990; Mosby St. Louis, MO 16?23?.

Bixler G.K., Bixler R.W. The professional status of nursing. American Journal of Nursing 8, 1959;59: 1142-1147.

Bochatay N. Individual and collective strategies in nurses’ struggle for professional identity. Health Sociology Review 3, 2018;27: 263-278 doi:10.1080/14461242.2018.1469096.

Canadian Nurses Association. Code of ethics for registered nurses. Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive.pdf 2017; Author Ottawa, Ontario.

Covert E.C. Is nursing a profession? American Journal of Nursing 2, 1917;18: 107-109.

Curtin L. Ethical issues in nursing practice and education Ethical issues in nursing and nursing education. 1980; National Leage for Nursing New York, NY 25-26.

Flexner A. Medical education in the United States and Canada. A report to the Carnegie Foundation for the Advancement of Teaching 1910; D.B. UIpdike, The Merrymount Press Boston, MA.

Gruending D.L. Nursing theory. A vehicle of professionalization Journal of Advanced Nursing 1985;10: 553-1338.

Haskell H. The Lewis Blackman story [Five-part video series]. QSEN 2009.

ICN. The ICN code of ethics for nurses. Retrieved from https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_eng.pdf 2012; Author Geneva, Switzerland.

IOM. The future of nursing Leading change, advancing helath. Retrieved from https://www.nap.edu/read/12956/chapter/1 2010; Author Washington, DC.

Jameton A. Nursing practice. The ethical issues 1984; Prentice-Hall Englewood Cliffs, NJ.

Leininger M.M. Care, the Essence of nursing and health. 1984; Wayne State University Press Detroit, MI. May R. Love and will. 1960; Norton New York, NY.

Mayeroff M. On caring. 1971; Harper & Row New York, NY.

Newman M.A., Sime A.M., Corcoran S.A. The focus of the discipline of nursing. Advances in Nursing Science 1, 1991;14: 1-6.

Nightingale F. Notes on nursing. What it is, and what it is not 1859; Harrison & Sons London, UK.

NMC Nursing & Midwifery Council. The code Professional standards of practice and behaviour for nurses, midwives and nursing associates. Retrieved from https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf 2015; Author London, England.

Nursing and Midwifery Board of Australia. Code of conduct for nurses. Retrieved from https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD1723849&dbid=AP&chksum=ki92NMPa9thp9f9ZhTQNJg 2018.

Nursing and Midwifery Board of Ireland. Code of professional conduct and ethics for registered nurses and registered midwives. Retrieved from https://www.nmbi.ie/nmbi/media/NMBI/Publications/Code-of-professional-Conduct-and-Ethics.pdf?ext=.pdf 2014. Nursing Council of New Zealand. Code of conduct for nurses. Retrieved from http://www.nursingcouncil.org.nz/content/download/421/1838/file/CodeofConductBookletfull.pdf 2012.

Parsons M. The profession in a class by itself. Nursing Outlook 1986;34: 270-275.

Rasmussen P. Factors influencing registered nurses’ perceptions of their professional identity. An integrative literature review Journal of Continuing Education in Nursing 5, 2018;49: 225.

Reed P.G. Nursing reformation. Historical reflections and philosophic foundations Nursing Science Quarterly 2, 2000;13: 129-136.

Reich W.R. Historical traditions of an ethic of care in healthcare. S.G. Post Encyclopedia of bioethics 2003; Thomas Gale, Macmillan Reference New York, NY 349?367?.

Robb I.H. Nursing ethics. For hospital and private use 1912; E.C. Koeckert Cleveland, OH.

Rogers M.E. The education violet. 1966; New York University Press New York, NY.

Sabanciogullari S., Dogan S. Professional self-concept in nurses and related factors. A sample from Turkey International Journal of Caring Sciences 3, 2017;10: 1676-1684.

Smith M.C. Caring and the science of unitary human beings. Advances in Nursing Science 4, 1999;21: 14-28.

Swanson K.M. Empirical development of a middle range theory of caring. Nursing Research 3, 1991;40: 161-166.

Viens D.C. A history of nursing’s code of ethics. Nursing Outlook 1, 1989;37: 45-49. Watson J. Intentionality and caring-healing consciousness. A practice of transpersonal nursing Holistic Nursing Practice 4, 2002;16: 12-19.

Watson J. Caring science and the next decade of holistic healing. Transforming self and system from the inside out Beginnings 2, 2010;30: 14-16. Zschoche D. Letter calling for national nurses’ congress. Issues in Critical Care 1983;12: 570-575.

Textbook reference:

Burkhardt, Margaret A; Nathaniel, Alvita K. Ethics & Issues In Contemporary Nursing – E-Book (pp. 85-96). Elsevier Health Sciences. Kindle Edition. [supanova_question]

Any topic (writer’s choice)

” Your essay should contain NUMEROUS references and citations from the article by David Kamp, and at least four of the authors, and poets (you may use five authors but no more) along with their literary works we have studied this semester. Do not use an author or work that was not assigned during the semester. Be sure to also identify which major movement the author belongs to. Each of the four authors you choose must be from different literary periods (see handout posted Week 1 in Moodle)! Remember it must be an author and work that was assigned.             Explain and provide detailed examples of how each of the authors/works defines the American Dream, and how that dream may be the same or different from what we now consider the American Dream. Again, identify and briefly explain which literary movement the author is part of. The major goal is to illustrate how the idea of The American Dream has transformed over time through a discussion of Kamp and your authors.            One way to organize your essay is to use the Kamp article as the foundation for all your points, and then use the four authors/works to support your points. You will want to conclude the essay with a discussion about current events such as immigration, race, gender equality, etc., and how these issues impact the American Dream for those who are different or come from a different country/background. In other words, is the American Dream accessible to ALL Americans? To everyone equally?             Please note this is an informative/argumentative type essay and not a simple opinion paper. The difference is that in the first case you must use data and facts (from research) to support your points. In the second case, you simply state your own personal opinion! I want information based on facts!             Please follow the correct MLA format (see MLA handout posted in moodle). All papers must be typed and contain at least 7 entries on the works cited page: the Kamp article, biographies, and literary works from your textbook for each of your four authors, and the remaining research must be found through the Southeastern Library Database. No other outside research is required or acceptable. If you have any questions about what may or may not be acceptable please email me.[supanova_question]

Write your analysis and conclusions, based on the data

1. Read Section 5.3 from the textbook.2. Read 5.3 Application on pages 330-331. Do not do the “personal seven-story building investigation.”3. Redo this project for a 5-story building, with each floor above the ground weighing 12 tons, and a horizontal restoring force of 4 tons per foot between adjacent floors.
4. Write your analysis and conclusions, based on the data that you obtain which should be presented in a table like one on Figure 5.3.17.
[supanova_question]