ADVANCE NURSING PRACTICE AUTONOMY ACCOUNTABILITY ASSERTIVENESS AIMS OBJECTIVES,GOAL TEACHING IS INCREDIBLE WITHOUT LEARNING

1. Subject: Advanced Nursing Practice
Topic: Autonomy, Accountability, Assertiveness
Gehloth Hiren Kanaiyalal
Roll No: 03
F.Y.M.Sc Nursing

2. ●The 4 A’s of Nursing
Autonomy
Accountability
Assertiveness
Advocacy

3. ► Autonomy:
 |Autonomy is derived from a Greek word.
 “Autos” means “Self”
 “Nomo's” means Laws”
 The right of self government acting independently
or having the freedom to do so.

4.  It’s the right of personal freedom of action which
is regarded freedom of action, which is regarded
as one of the hall marks of the profession.
 Nurses have ethical obligation to their clients and
to the agency that employs them, thus balancing
the clients need for autonomy with family
members responsibilities for the clients well
being.

5. DEFINITION:
 According to According to Lewis & Batey (1982):
 It’s the freedom to make discretionary and binding
decisions consistent with ones scope of practice
and freedom to act on those decisions.

6. AUTONOMY FOR CLIENTS
 The agreement to respect autonomy involves
the recognition that clients are “in charge of their,
own destiny in matters of health and illness”.
 For e.g.-
The preoperative
consent.

7. AUTONOMY IN NURSING PRACTICE:
 Nurses attain increased autonomy through
higher levels of education.
 In changing health care system, advance practice,
nurses are increasingly taking independent roles
in nurse run clinics, collaborative practice and
advance nursing practice settings.

8.  Innovation by nurses, increased productivity,
higher retention and greater client satisfaction
are results of autonomy.
 With increase autonomy, comes greater
responsibility and accountability.

9. BARRIERS OF NURSING AUTONOMY
 Lack of recognition and valuing of nursing
knowledge and contribution to patient care goals by
physicians and other members of health care team.
 Inability to raise and resolve concerns about
treatment plan.
 Interruptions to the nurse’s ability to access,
coordinate resources for the patient care.
 Relationship with nursing colleagues, physicians
and managers that undermine collaboration,
confidence and shared decision making.

10. ENHANCING AUTONOMY IN NURSING
 Organizing medical and teaching rounds.
 Clearing, addressing and identifying
expectations practiced for verbal medication
orders and cover order and unique situations in
the Particular units, that evoke issues related to
practice.
 Developing protocol for administration of the
medications and decisions regarding particular
procedures.

11.  Supporting continuing education and a climate
of enquiry and learning in every day practice.
 Enhancing clinical knowledge fosters
competence and clinical expertise that
strengthen autonomous decision making.
 Autonomous nursing practice depends on
mutually respectful relationships with nursing
colleagues and other healthcare personals.

12. ► Accountability :
 Accountability must become a structured
component of nursing practice which provides
tangible evidence of evaluation & decision making
in regard to nursing within health care.
 Manifesting accountability in nursing practice
provides the opportunity to evaluate nursing
contribution within health care and is a means of
clarifying the significance of nursing to society.

13. DEFINITION
 According to Sullivan and Deekan,
 “Accountability is being responsible for
one’s actions and accepting the
consequences of ones behavior.
Accountability is not a vague feeling or
an obscure concept. It is a clear
obligation which must be manifested as a
structured component of nursing
practice, based on responsibility,
authority and autonomy.”

14. HIERARCHY OF ACCOUNTABILITY:
 Individual level
 Institutional level
 Professional level
 Societal level

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

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

17. ELEMENTS OF ACCOUNTABILITY
 Clarity:- expectations and goals are clear and
specific. if staff members know about reason
behind the expectations, they are more likely to
commit themselves to meeting it.
 Commitment:- the accountable person must
listen, understand, agree, and commit to achieving
the objectives.
 Consequence:- consequence are the after of the
negligence to commitments. a person should bear
the consequences of being accountable.

18. ACCOUNTABLE FOR WHAT
 For providing safe and therapeutic environment.
 Maintaining adequate supplies material
equipment for smooth function of working unit.
 Protecting client’s legal rights and privacy
 Maintaining accurate records and reports

19.  Working within ethical boundaries .
 Delegating responsibility appropriately.
 Maintaining good interpersonal relationship.
 Delivering the care as per standards lay down by
profession, statutory body and institution.
 Delegating responsibility appropriately.
 Contributing to development of the profession.

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

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

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

23. ►Assertiveness
 Do you have trouble
saying "NO", even
when you really
should?

24. DEFINITION
 “Assertiveness is a tool for expressing
ourselves confidently and a way of
saying yes or no in an appropriate
way. “
 It is considered as healthy behaviour for all
people against personal powerlessness and
results in personal empowerment.

25. STYLES OF COMMUNICATION

27.  Example: Say: 'I feel upset when you
interrupt me because I can't finish what I am
saying.‘ ◦ Instead of: 'You're always
interrupting me!'
 Example . Say: "I won't be able to . . . ."
instead of 'I'm not sure if I can . . .
 Example . Say: "I've decided not to . . ."
instead of 'I don't think I can . . . . "

28. BENEFITS
 Creating health, meaningful relationship.
 Less friction and Conflicts
 Increase self respect s well as respect from other
 Our self esteem is enhanced and always feel in
control
 Less stress at work and overall sense of well being.
 Emotional and Physical health improves.

29. AIMS OF ASSERTIVENESS
 The aim of assertiveness is to find the best
possible solution for all the people. It is about
finding win- win solutions.
 Assertiveness sees everyone as equal with equal
rights and responsibility.
 Assertiveness increases the chances of our needs
being met.
 Assertiveness allows us to remain in control

30.  Assertiveness brings greater self confidence.
 Assertiveness lets us have greater confidence on
others
 Assertiveness people have more friends.
 Reduced stress.

31. ASSERTIVENESS , A-S-E-R-T
MODEL
 A- Ask for god’s help: pray to god to guide you
through scripture and his spirit.
 S- State the problem: think over and state the facts of
the problem.
 E- Express yourself: state your feeling. Do not judge.
 R- Request change and feedback: specify one
behaviour change. Then listen to other person’s thoughts
and opinions.
 T- Talk it out: paraphrase their ideas. Discuss the
consequences, consideration and options.

32. STRATEGIES FOR IMPROVING
ASSERTION AT WORK
 Ask
 Bring energy to the job
 Get your emotions under control
 Good place to talk if possible
 Effective assertion requires a listener.
 Ideal time and place to communicate

33. TECHNIQUE FOR BEING
ASSERTIVE
 Identify your personal rights, wants and needs.
 Identify how you feel about a particular
situation.
 Be direct
 Own your message
 Avoid assumptions

34.  Avoid statement that begins with “why” “you”.
 Ask for feedback
 Stop apologizing all the time
 Act confident even if you don’t feel confident
 Feel free to say NO, I don’t know, I don’t
understand etc.

35. ASSERTIVENESS AND NURSING
 Assertiveness is an important issue in nursing
practice.
 Education program in assertiveness knowledge and
skills have been vague for sometime in nursing
because nurses have recognized need for
assertiveness in quality nursing care.
 Nurses has more on their minds than just helping
patients every day they are confronted with
challenges such as communication issues and
high stress levels.

36.  Nursing students will need assertiveness and it will
be up to the individual to adjust his behavior in
order to obtain a job or promotion, to develop a
carrier to increase her confidence.
 Use entries in your diary to role playing in your
situations that cause your problems. You can role
play with your family and friends and alone. To
make exercise effectively, you should choose a
situation you may have to deal with.
 As nurse works in different situations, they
have to be assertive in order to meet the
challenges and to win the cooperation from
others.

37. SUMMARY
 Autonomy is the state of being independent of
having responsibility, authority and
accountability for one’s work and personal time.
 Accountability means being answerable for
work decisions about answerable for work,
decisions about work and being professionally
responsible for the standard of practice.
 Assertiveness is the ability to, “say yes or no”,
when you want freedom to be yourself in all
circumstances.