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COURSE GUIDE
Introduction
Welcome to OAN3167 Sociology and Medicolegal Aspects of Nursing
This subject provides students with a general overview of the basic concepts, perspectives, and findings of sociology, particularly those relating to socialization, social structure, social institutions, and culture. It also looks at the medicolegal and ethical issues in Nursing.
In this course guide, I will share the course learning outcomes, the overview of the plan of the course and the assessments. I will also share the expectations of being a student in this course. It is intent to make this learning experience both convenient and fun while achieving the intended outcomes.
Course Learning OutcomesA course learning outcome (CLO) is the expectation of what you should be able to do by the end of the course. It provides a guide to both the educator as well as the student to focus on achieving the intended outcomes. For this course, we have three course learning outcomes (CLO) that can be categorized into two domains; cognitive and affective. The CLOs are as follows:
CLO1 Explain the various sociological perspectives, concepts and social issues. (C2, PLO1) CLO2 Discuss the legal and ethical aspects that govern nursing practice.(C5, PLO2) CLO3 Demonstrate social responsibility, respect for the social norms and the different cultures while working collaboratively in a group. (A3, PLO4) Overview of the Teaching and Learning Plan
As an online course, we will use the Learning Management System (LMS) for all our communication, materials and assessments. We will have synchronous meeting via the LMS as well as Self Instructional Materials (SIM) to facilitate your learning and progress through the course. As an ODL learner, you are expected to be self directed. The SIM will provide you with a complete guide of the course materials and resources. Each topic will have topic learning outcomes followed by the lesson notes. Links to videos and other resources will be provided to support your learning process. You will also be given reading materials out of the SIM. At the end of each topic, there will be self check questions. Here you can test yourself. Review the notes and resources should you need to. We will also have scheduled online meetings. Here we will have discussions and tutorials. For this course we will also have group work which will be included in our online meetings. We will have the total of 7 synchronized meeting over the semester.Assessment
The assessments are planned as coursework and well as a summative project. the breakdown of the weightage is as follows:
A. Continuous Assessment Weightage (%) 1 Test I 10% 2 Test II 10% 3 Group work 20% B. Summative Assessment Weightage (%)
Assignment
60%
Total A+B
100%
Test
A test will be given at a set time within the semester to test your knowledge of the content covered as well as your ability to apply the knowledge into scenarios. The test will be given online 2 times , that is the 4th and the 7th week
Assignment
An assignment which consists of an academic essay of 1500 words on the Perspectives of Psychology is required. The essay will need to be submitted to Turnitin and a similarity index of 20% or less is required. You will be required to submit a draft of the essay by Week 8 of the semester. I will read your work and provide you with constructive feedback for improvement by Week 9. Final submission will be by Week 12.
Project
For the summative assessment, you will need to do a group project with your peers. Each group should consist of not more than 5 persons. The project can be a community project, a health promotion project, a Webinar or any feasible project. This can be done virtually. You will need to brainstorm for ideas of the project and share your proposal during the online meeting. The purpose is for you to work in a team and during the process use your knowledge from the course to understand and respect each other. You will be graded using a rubrics on Interpersonal Skills.
Your Responsibility as an ODL Student
The concept of ODL is to be flexible and facilitate learning even while working. As an ODL student, you are expected to be self directed. Utilise the SIM provided and make full use of the resources (recorded lectures, videos, readings) provided. Attend synchronous meetings to facilitate discussion, clarification and guidance. You are expected to attend at least 85% of synchronous meeting. Should you miss the meeting, do refer to the recordings that will be uploaded after the meeting.
Academic Honesty
Cheating, in any form, is a very serious offence which could lead to severe disciplinary action. Cheating includes:
- using unauthorized materials in tests and examinations;
- letting another person take tests or examinations on one’s behalf OR taking tests or examinations on another person’s behalf;
- working jointly, copying or sharing another student’s work and presenting it as one’s own piece of work;
- inventing, copying or altering data, quotations or references;
- plagiarizing, i.e. taking or using another person’s work without attributing the source and thus, giving the impression that it is one’s own work.
Any student caught and found guilty in the disciplinary hearing will be deemed to have FAILED in the subject and will be required to REPEAT the said subject. Any repeated offence may result in EXPULSION FROM THE UNIVERSITY
Closing Note
We are glad to have you with us 😃. Let's look forward to a fun, challenging and fruitful semester.
Do contact me should you need any help. I will be gladly assist you.
Ah Zimah Omar
📩 ahzimah@nilai.edu.my
TOPIC 1: INTRODUCTION TO THE SOCIOLOGICAL PROCESS
INTRODUCTION TO THE SOCIOLOGICAL PROCESS
The study of sociology in nursing is important to all nurses because it involved the study of human social relationships that involved individual behaviours, family, status, religion, cultures, and social structures.
What do we understand socialization process is all about? As we understand based on our working experience as a nurse caring for all categories of patients from different status and background. Thus the following outcomes stated below, will explain and help us to understand in depth the importance of socialization in nursing care. Understand better
LEARNING OUTCOMES
At the end of the lectures, student will be able to:
1. define socialization process
2. describe the development of sociology.
3. explain the relevant of social science knowledge in understanding health care needs.
4. Describe the research method in sociological questions.
5. describe the theoretical perspectives of Sociology
1.1 SOCIALIZATION PROCESS
Firstly, socialization is the process refers to the development of the individual from childhood to social daily life through formal education in schools, through non-formal programs that will help the society to be managed and run smoothly. The socialization process covers the primary socialization, secondary socialization, development socialization, anticipatory socialization, and resocialization.
An example of the primary socialization takes place when a child learnt the different attitudes, values and actions that being carried out by each individual culture. The secondary socialization refers to the process of learning that involve the behaviours practice smaller groups of people within the larger society. This normally involved the teenagers and adults and involves smaller changes than those occurring in primary socialization. This happen when a person entering a new profession, relocating to a new environment or society.
The third socialization process involve the development in which the process of learning behaviour in a social institution to develop the social skills. While the anticipatory socialization explains the processes of socialization in which a person will practice or tag with senior personal for the future positions, occupations, and social relationships.
Consequently, rresocialization can be an intense experience, with the individual experiencing a sharp break with their past, and needing to learn and be exposed to radically different norms and values. An example might be the experience of a young man or woman leaving home to join the military
The common terms used in sociology subject and understanding the terms you will be able to understand the implications of sociology apply in our profession as a nurse during the bedside nursing care.
The term used are:
• Sociology - the systematic study of human societies and human behavior in social settings.
• Social structure – how people, groups, and organization are arranged with respect to each other.
• Symbolic interactionism – a branch of sociology concerned with the communication between people that occurs by means of symbols such as words, gestures, facial expressions, and sound.
• Culture – all the learned customs, beliefs, values, knowledge, artifacts and symbols that are constantly communicated among set of people who share a common way of life.
• Values – general idea that people share about what is good or bad, desirable or undesirable.
• Norms – a specific guideline for action, a rule that says how people should behave situations.
What are the agents involved in socializing? As regards to the people around us, agents of socialization are the people and groups that influence our self-concept, emotions, attitudes, and behavior.As an example, the Family is responsible for, among other things, determining one's attitudes toward religion and establishing career goals.
Education is the agency responsible for socializing groups of young people in particular skills and values in society.
Peer groups refer to people who are roughly the same age and/or who share other social characteristics (e.g., students in a college class), the Mass Media and other agents such as religion, workplace, the country etc. Thus the agents of socialization teach people what society expects of them, what is right and wrong, and they give them the skills they need to function as members of their culture.
1.2. THE DEVELOPMENT SOCIOLOGY
The field of Sociology emerged in the 19th century when European philosophers began to use scientific methods. The social philosophers who were not sociologists such as Plato and Socrates did thought and argued about social behavior. They did not test their speculations against reality.
At least 2 factors combined to convert some philosophers into sociologists: the social upheavals of the 19th century Europe and the advancement of the natural sciences. The western world was radically altered during the 19th century as the Industrial Revolution (IR) brought new industries, technologies and the ways of living.
Almost overnight, societies that had long been rural and stable became industrialized, urbanized, and chaotic. They confronted problems as such the exploitation of factory workers, the migration of people from farms to the cities, congestion and poverty in the cities, crowded and squalid housing, broken families and rising crime.
Questions related to economic class, social status, urbanization, and the dangers of factory work raised new issues about society and social interaction, meanwhile the European political order had been shaken. Many people began to question the legitimacy of their monarchies and the authority of the church, demanding greater freedom of the individual. This led to social philosophers feeling the need to find solutions to their societies’ new problems and to understand how and why such radical change could occur.
At the same time the natural science were highly respected as they were providing ways to both explain and control aspects of the physical environment. Social philosophers looked at the natural science to learn from them. As sociology developed, these 2 urges – to improve the world and to apply scientific methods to the study of society – continued to motivate the sociologists.
The early thinker responsible for the development of SOCIOLOGY was – AUGUSTE COMTE 1978 – 1857.He was a French philosopher was one of the founders of sociology and coined the term sociology. Comte believed sociology could unite all sciences and improve society and argued that sociology must have a scientific base and be objective. He was then regarded as the “father of sociology”
The second was HARRIET MARTINEAU – 1802 – 1876. He studied social behavior in Britain & United States who emphasized more to social problems. While HERBERT SPENCER 1820 – 1903, he introduced the applied concept of evolution to explain how societies “evolve” overtime.
EMILE DURKHEIM 1858 – 1917 introduced and was pioneered work on suicide. He insisted that behavior must be understood within larger social context and developed fundamental thesis to help explain all society. Subsequently he pioneered the systematic application of scientific principles and was the first to use statistical methods to test a hypothesis.
Later, modern development introduced by MAX WEBER 1864 – 1920. He was German Sociologist who fully comprehend behaviour, whom you must learn the subjective meaning people attach to their actions. In order to do this –you have to adopt a method called Verstehen (fair- SHTAY-in) – empathetic understanding of their subjects. They put themselves mentally in their subject’s position, could obtain “interpretive understandings” – the meanings of behavior. Then follow with careful observation.
1.3. THE SOCIOLOGY AS A SCIENCE
Social Sciences are defined as the fields of human knowledge that deal with all aspects of the group life of human beings. They are closely related to humanities (deals with literature, music, art, and philosophy) because both deal with humans and their culture. Sociology is a science as indicated by to Auguste Comte and Durkheim because it adopts and applies the scientific methods. It makes proper use of scientific methods in the study of its subject matter. Hence sociology is considered as science. However, Social Sciences are most concerned with those basic elements of culture that determine the general patterns of human behaviour.
There are several components of Social Sciences. Firstly, the Anthropology is the study of relationship between biological traits and socially acquired characteristics. Sometimes called the study of huma which divided into physical anthropology and cultural anthropology. There are major steps in Scientific Inquiry as such as observation: All scientific knowledge relates to the natural environment and all knowledge begins with facts gathered through careful observation, formulation of problem, collection and classification of more facts, generalization, formulation of the hypothesis, testing the hypothesis and retesting and reformulating the theory.
Approaches in Social Sciences we need to define the problem, review the literature review, develop a theoretical framework, and formulate hypothesis. Then we are requiring choosing the research design, collect the necessary data, analyse the results, and draw conclusion.
Sociologists test and modify their understanding of how the world works through scientific analysis. Sociologists gather data on the ground and formulate theories about what they find. These theories are then tested by using the scientific method to assess the theory’s validity. It focuses on the group not the individual. Is to understand social institutions and look for repeating patterns in society children abduction in Asia as sexual predators in the internet.Sociology is the systematic study of society and social interaction. To carry out their studies, sociologists identify cultural patterns and social forces and determine how they affect individuals and groups. They also develop ways to apply their findings to the real world.
Mankind need to understand and observe the importance of social sciences with knowledge based society will be better equipped to socializing process as well as balanced knowledge about social sciences will ensure the humans existence
1.4. THE SOCIOLOGICAL IMAGINATION
The Sociological Imagination is the concept of being able to "think ourselves away" from the familiar routines of our daily lives in order to look at them anew. Mills defined Sociological Imagination as "the vivid awareness of the relationship between experience and the wider society." It is the ability to see things socially and how they interact and influence each other. To have a Sociological Imagination, a person must be able to pull away from the situation and think from an alternative point of view.
The Sociological Imagination is stimulated by a willingness to view the social world from the perspective of others. It involves moving away from thinking in terms of the individual and their problems, focusing rather on the social circumstances that produce social problems.
As for the Private Issues & Public Issues, there is a strong tendency in liberal democracies towards seeing human behaviour in terms of individual characteristics, abilities, choices and preferences. We tend to experience whatever happens in our own lives as unique and private, and also to interpret what happens to other people as unique and private to them. These are seen as ‘private troubles. Sociologists, on the other hand, are more interested in the relationship between what happens to individuals in their lives and the larges processes of social, economic and political change that might be said to lie underneath or behind those happenings. The discipline of Sociology encourages you to look for the social processes and structures that give a generalised pattern to those private troubles and thus turn them into ‘public issues.
The thinking of the sociological Imagination ‘Neither the life of an individual nor the history of a society can be understood without understanding both, yet men do not usually define the troubles they endure in terms of historical change. Seldom aware of the intricate connection between the patterns of their own lives and the course of world history, ordinary men do not usually know what this connection means for the kind of men they are becoming and for the kinds of history making in which they might take part. What they need, is a quality of mind that will help them to see what is going on in the world and what may be happening within themselves.
1.5. SOCIOLOGICAL RESEARCH METHODS
Before we proceed further, let's look at this video:
The purpose of sociological research is to answer questions about social life and the social world. To do this, sociologists develop theories, which is a general explanation of how or why social life follows the pattern it does. Sociologists try to ensure that their theories are based on sound evidence. Sociologists have a variety of different methods that they use to gather information about society.
Definition for sociological research method is the statement about a group of people or things that is based on only a few people or things in that group with the goal as test common sense & people’s assumptions then replace with fact & evidence
There are two types of sociological research methods. Quantitative: research that relies on
numerical data and the Qualitative: research which uses observation and relies upon descriptive data.
The methods that need to be carried out are:
- Experiment: research that takes place in a lab setting (limited use in social research) Ø Field Research: research that takes place in a natural (non-lab) setting (primarily used in social research)
- Questionnaire: asking a sample population to respond to a to a series of closed-ended questions Ø Interview: asking of open-ended questions in order to gain required information Ø Survey: research method in which people respond to questions (most common method used in research)
- Secondary/Historical Analysis: reading and analysing another person’s data and r research on a topic Ø Case Study: in depth examination of a single group, problem, or community Longitudinal Study: type of case study that is conducted over a period of time. Cross-sectional Study: focus on data collected at a specific period.
- 4. Participant Observation: research in which the researcher becomes involved with the group being studied Ø Natural Observation: research based on observation of people in any given environment (place)
TOPIC 2. THEORETICAL PERSPECTIVES OF SOCIOLOGY
INTRODUCTION TO THEORETICAL PERSPECTIVES
It is a set of statements that seeks to explain problems, actions or behavior which is effective theories that explain and predict. Sociologists develop theories to explain how individual behaviour can be understood within a social context.
Learning Outcomes:
By the end of the lecture, students should be able to:
1. Briefly describe the 3 theories/perspectives of Sociology
1.1. MAJOR THEORETICAL PERSPECTIVES
The Sociologists approach the study of human society in different ways. Either at the big picture; the macro view – large social phenomena of society such as social institutions and inequality. Or zero in on immediate social situations in which people interact with each other; micro view.
Three Major Sociological Theories were the Functionalist, Conflict and Symbolic Interactionist.
a. FUNCTIONALIST PERSPECTIVE
The Functionalist perspectives focused on social order. Each part of society – the family, the school,
the economy, the state – performs certain functions for the society as a whole. All parts are interdependent
E.g. The family – depends on school to educate children. School – depends on family and state for financial support- the state- depends on family and school to help children grow up to become law abiding tax paying citizens. Resulting in a stable social order
Dysfunction: Element or process of society that may be disrupt a social system or reduce its stability
If something disrupts this social order, its parts will adjust in a way that produces stability.
E.g. If economy is in bad shape- the family would adjust – maybe spend less, save more. Schools- maybe offer fewer programs, emphasize on vocational programs – for students to get jobs. The state might cut its budget. This will result in a new social order.
According to functionalists – social consensus is what holds the society together.
Social consensus – a condition in which most members of the society agree on what would be good for everybody and cooperate to achieve it.
Social consensus according to Durkheim can come about in 2 ways, mechanical and organic solidarity.
Mechanical solidarity - Is a type of social cohesion that develops when people do similar work and have similar beliefs and values.
Usually in small scale traditional societies e.g. everyone works at farming and believe in the same gods.
Organic solidarity - Arises when people in a society perform a wide variety of specialized jobs and therefore must depend on one another. Characteristic of complex industrialized societies
E.g. – bankers, teachers, engineers, plumbers, other businesses, professions and occupations. All of different religions. Not bound by same beliefs or conformity. Bound together by the need for each other. This perspective has been criticized for focusing on the positive functions of social events and ignoring the negative ones. It justifies status quo
E.g.- By emphasizing what every current aspect of society does for its citizens, functionalism encourages people to dismiss social change as dysfunctional (harmful) even though change may in fact produce a better society.
b. CONFLICT PERSPECTIVE
Sees social change as beneficial and to assume that the social order is forcibly imposed by the
powerful on the weak. They criticize the status quo. Karl Marx believed that conflict between economic classes was the key force in society, conflict theorist today defines social conflict between any unequal groups or societies.
The Marxist View : Conflict not merely a class phenomenon but part of everyday life in all
societies. Emphasis on social change and redistribution of resources makes conflict theorists more “radical” and “activist” than functionalists.
c. CONFLICT PERSPECTIVE
Assumes social behavior is the best understood in terms of conflict or tension
between competing groups. Conflict not necessarily violent. Which can take the form of labor negotiation, party, politics, competition between religion for new members or disputes over federal budget. Emphasize that groups or societies have conflicting interests and values and compete with each other for scarce resources.
The more powerful gain more than the less powerful, the former continues to seek more wealth and power while the latter continue to struggle for more resources. This perpetual competition results in a society that is always changing.
d. SYMBOLIC INTERACTIONIST PERSPECTIVE
Focuses on the details of a specific situation and the interaction between individuals in that situation. The combinations of these countless interactions in various situations is seen to constitute society. People assign meanings to each other’s words and actions. Our response to a person’s action is determined not by that person’s action but by our subjective interpretation of the action.
e. INTERACTIONIST PERSPECTIVE
Generalizes about everyday forms of social interaction to explain society as a whole. Sociological framework for viewing human beings as living in a world of meaningful objects.
f. SYMBOLIC INTRACTIVE INTERACTIONIST PERSPECTIVE
Suggest 2 things: people do not respond directly to physical things. Rather they respond to their own interpretations of them. because people constantly impose interpretations; on the world in general, on other people, themselves, and even their own interpretations – and then act accordingly, human behavior is fluid, always changing.
How we act is constantly being altered by how we interpret other people’s actions to our own behavior. This perspective has been criticized for ignoring the larger issues of national and international order and change, and the influence of social forces and social institutions on individual interactions.
g. FEMINIST PERSPECTIVE
Views inequality in gender as central to all behavior and organization. Sometimes allied with conflict theory, the feminist perspective also focus on micro-level relationships of everyday life, just as interactionist do.
https://www.youtube.com/watch?v=DbTt_ySTjaY
TOPIC 3. SOCIAL INSTITUTION
INTRODUCTION OF SOCIAL INSTITUTIONSocial institutions comprise norms, values and attitudes. Visible in traditions and cultural practices that are performed by the members of a society. Can be reflected in the formal institutional framework of a society (e.g. constitutions, laws, legal mechanisms)LEARNING OUTCOMES
At the end of the lecture, the students will be able to:
1. Define institution.
2. State the characteristics and function of institution.
3. List types of institutions
3.1. WHAT IS SOCIAL INSTITUTION?
It is a group of social positions, connected by social relations, performing a social role, e.g. universities, government, families. It can also be defined in a narrow sense as any institution in a society that works to socialize the group of people in it. Thus, the characteristic of social institution is a set of relationship that develop gradually with a system of behaviour certified by a group.
3.2. CHARACTERISTIC AND FUNCTIONS OF AN INSTITUTIONS
There are several characteristics and functions that be pointed by philosophers and sociologist but in 1996 Palistic indicated that the institutions are purposive with their own needs and goals or objectives which relatively confirmed with that content. The pattern roles and relations that people ratify in a particular culture become traditional enduring. Even though institutions are subject to change which takes place gradually.
Institutions are structured. It tends to reinform with one another because their behaviour patterns of social roles and social relations were structured by themselves. While institutions are unified structure which function as a unit i.e value laden. Their repeated uniformities, patters and trends become codes of conduct. Most of these codes causes pressures. While others developed in the form of rules and laws.
a. VARIOUS FUNCTIONS OF INSTITUTION.
Institutions simplify social behaviour for the individual’s person. Ways of thinking and acting has become largely regularized and prearranged for the individual before he enters the society.
E.g., social institutions provide every child with all the needed social and cultural mechanisms through which he can grow socially.
Institutions therefore provide ready-made forms of social relations and social roles for the individual. The principal roles are not invented by the individuals, they are provided by the institutions. Institutions also act as agencies of coordination and stability for the total culture. The way of thinking and behaving can be accepted by the society. Whatso ever institution tend to control behaviour and contain the systematic expectations of the society. Group behaviour is often subconsciously fixed through constant repetition with the need of planning. The group can easily ascertain from its institutions the normal modes, trends and procedures.
3.3.. FIVE MAJORS SOCIAL INSTITUTIONS
They are family, religion, educations, economics, and government.
Family can be defined as group of people who are related by marriage, blood, or adoption and often who leave together and share economic resources. The family is the most universal social institution, but what constitutes a “family” varies across cultures.
a. WHAT IS THE FUNCTION OF FAMILY?
Regulation of Sexuality activity – all societies regulate sexual activity to some extent. Incest taboo is found in every society, but categories of restricted differs across cultures.
Socialization – family is the first agent of socialization, so societies rely on the family to teach the norm of the society. Parent siblings and other relatives serve as the earliest role model s. Reproduction – family is the approved social unit for producing members to replace those who die or move away. Rules are set in place about who can raise children and how children should be raised.
Economic and Emotional Security – it is the basic economic unit which is expected to guid the psychological development of its member and provide a loving environment.
b. FAMILY SYSTEMS
Nuclear family – one or both parents and their children.
Family of orientation – it is the nuclear family into which the person is born or adopted.
When a person marries, a new nuclear family is formed called a family procreation.
Extended family - two or more generations
Kinship – Network of people who are related by marriage, birth or adoption
c.. FAMILY ORGANIZATION
It depends on to the answer to the four questions below.
How many marriages partner? – Marriage pattern
Who live with whom? – Residential Patterns
How is family membership determinant? – Descendent Patterns
Who made the decision in the family? – Authority patterns
d. MARRIAGE PATTERN
· Monogamy – the marriage of one man to one woman
· Polygamy: multiple marriage partners.
· Polygyny – one man & multiple women (most common form of polygamy)
· Polyandry – one woman & multiple men (less common)
e. RESIDENTIAL PATTERNS
· Patrilocality – couple lives with or near husband’s family.
· Matrilocality – couple lives with or near wife’s family.
· Bilocality – couple decides which parents to live with or near.
· Neolocality – couple lives apart from both sets of parents.
f. DESCENDENT PATTERNS
Patrilineal descent – kindship traced through the father’s family; and the property passed from father to son.
Matrilineal descent; kinship traced through mother’s family whereabout the property passed from mother to daughter.
Bilateral descend; kinship traced through both parents and the property inherited from either side of the family.
g. AUTHORITY PATTERNS
Patriarchy – father holds most of the authority
Matriarchy – mother holds most of the authority
Egalitarian – mother and father share authority
h. CHANGING PATTERNS
Dual-earner families – families in which both husband & wife have job which become the norm during the late 1900s. Today day-care centre for children and father are more likely to help with household chores.
The sandwich generation are couples who have babies and elderly parent to care for at the same time.
Voluntary childlessness is the conscious choice to remain childless.
3.4. DIVOICE IN MALAYSIA
There are several reasons why in Malaysia divorce among marriage takes place.
Infidelity: Sadly, extra-marital affair (or adultery) took the main spot of problem to a married couple as a man (or even woman) often started with an emotional affair and which later turned into a physical affair. As a matter of fact, adultery is often cited as a ground for divorce in Malaysia.
Money (Financial dispute): It is common that financial issue becomes a real
problem to a married couple when the husband (who is supposed to be supporting the family financially) is not providing to the family sufficiently. More often than not, this will turn into an argument if money is involved.
Domestic Abuse: This can be either physical or mental abuse in Malaysian. As a matter of fact, there is a strong correlation between domestic abuse and financial problems.
Lack of communication: Often couples will complain that they are not communicating enough (or at all) even though they are staying under one roof. Sooner or later, this will cause the marriage to breakdown.
Lack of intimacy: This can be either emotional intimacy or physical intimacy (sexual intercourse).
3.5. EDUCATION
The definition of education means that it is a system consisting of the roles and norms that ensure the transmission of knowledge, values and patterns of behaviour from one generation to the next. While schooling is defined as a formal education which involves instruction by special trained teachers who follow official recognized policies. But in some preindustrial societies, education is largely informal and occurs mainly within the family.
The intellectual purposes of schooling include the teaching of basic cognitive skills such as reading, writing and mathematics that transmit specific knowledge and to help students acquire higher -order thinking skills such as analysis, evaluation, and synthesis.
While the political purposes of schooling are to inculcate allegiance to the existing political order. At the same time to prepare citizens who will participate in political order and to help assimilate diverse cultural group into a common political order and to teach children basic laws of society.
The social purpose of schooling is to socialize children into various roles, behaviour and values of society in order to help solve social problems. But the economic purposes of schooling are to prepare students for their occupational roles. This is to select the trained and allocate individuals into the division of labour.
a. EDUCATION; CONFLICT PERPECTIVE
Education serves to sort students into social ranks and to limit the potential of certain individuals and group to gain power and social rewards. Thus, whether the students achieved or failed that will reflect the existing inequalities.
Tracking of education means it involves the assignment of students to different types of educational programs. While the classroom instructions will use in the different tracks to serve and to reproduce the status quo.
In education and socioeconomic status – opportunities for educational success are distributed unequally. The higher status college students outnumber lower-status college students. The social control school produce unquestioning citizens who except the basic inequalities of the social system. As for the hidden curriculum, schools’ transmission of cultural goals that are not openly acknowledge.
b. EDUCATION; INTERACTIONIST PERSPECTIVE
Students labelled as fast learners or slow learners without any data eventually took on the characteristics of the label. A self-fulfilling prophecy is prediction that leads to behaviour that makes the prediction come true. When the teachers treat students as if they are bright and capable the students begin to think of themselves in this way and vice versa. The Coleman reports found that the socioeconomic status of fellow students was the most significant factor in explaining students success. Consequently, peer pressure may be a factor in this dynamic.
3.6. RELIGION
It is defined as a system of beliefs and rituals that serves to bind people together through shared worship, in order to creating the social group. The set of beliefs and practices that pertain to a sacred or supernatural realm that guides human behaviours and gives meaning to life among a community of believers.
a. CHARACTERISTIC OF RELIGION
It is the belief in a power beyond the individual in which a doctrine accepted teaching of salvation. A code of conduct, the use of sacred stories with religious rituals based on action and ceremonies.
b. FUNCTIONS OF RELIGION
The religion serves as a means of social control. It exerts a great influence upon personality development. The religion always fears of the unknown. The religion explains events or situations which are beyond the comprehension of man. It gives man comfort, strength and hope in times of crisis and despair. It also preserves and transmits knowledge, skills, spiritual and cultural values and practices. It serves as an instrument of change. To promotes closes, love, cooperation, friendliness, and helpfulness. Religion alleviates suffering from major tragedies. Thus, it provides hope for a wonderful life after death.
c. TYPES OF BELIEF SYSTEMS
There are three types of belief systems which are animism, theism and ethnicism.
Animism belief that spirits actively influence human life. The spirit are contained though out mother nature. Spirits are not worshiped as gods but are instead seen as supernatural forces that may issues assistance, example Shamanism and Totemism.
Theism is a belief in a god or gods. It is either called Monotheism and Polytheism.
Monotheism is belief of one god who is usually the creator and moral authority. Example Judaism, Christianity, and Islam
Polytheism is a belief in a number of gods who usually centres one powerful god with lesser gods. Example – Hinduism or Greek or Roman Gods.
Ethnicism are based on the idea that moral principles have a sacred quality. A set of principles such as truth, honor and tolerance serve as a guide to living to living. Example – Buddhism, Confucianism and Shinto.
3.7. POLITICAL & ECONOMICAL INSTITUTIONS
This institution is developed when in need was felt for an orderly and dependable way of obtaining resource controlled by other groups. Example - election
POLITICS – is a major social institution involving the organization of power in society. Political systems attempt to foster the perception that their power is; legitimate, derived from tradition and rationally passed rules and regulations. It is an organized way in which power is distributed and decision are made with society.
Examples – democracy, authoritarianism, and monarchy.
3.8.ECONOMICS
The social institution that organizes the production, distribution and consumption of goods and services. There are two types of economic models, Capitalism and Socialism.
The difference between Capitalism and Socialism are:
Capitalism is an economic system when the means of production are owned by private individuals. Companies lives by the profit motives. The companies have owners and managers that exist to make money. It is also the government jobs by enforcing laws and regulations to make sure there is level playing fields for private companies
While socialism the making of profits are run by the state or public. But under a socialize system everyone works for wealth and the profit made will be equally shared to everyone. The government decides how wealth is distributed for and among the people
3.10. CHARACTERISTICS AND SOCIAL FUNCTIONS OF MEDICINE.
Hospitals is an organized system of social relationship with certain common values to meet health need of the society. Its assigns status and roles to individuals within the institution.
The medical teams involve taking care for the sick society are the:
Physicians/Doctors who are institutionalize their authority through a system of medical education and standardized educational licensing following the code of conduct of the MMA
Nurses to undergo training with apprenticeship in school of nursing
Patients or hospital clients will treat the patients as according to the types of disease and complications
Physical illnesses are thought to originate primarily from physical sources, and doctors use biomedical or surgical cures to treat them - Other cultures consider illnesses punishment for certain deeds.
Mental Illness is when patient’s hearing voices or hallucinating are generally viewed as symptoms of a mental illness while other societies, these symptoms might instead indicate a religious experience
Scientific Medicine - herbalists, druggists, midwives, even barbers while now seek medical treatment from trained, certified medical doctors
Holistic Medicine is - medical approach that involves learning about a patient’s physical environment and mental status
https://www.khanacademy.org/test-prep/mcat/society-and-culture/social-
structures/v/institutions-government-economy-and-health-and-medicine
a. SOCIAL STRUCTIURE TOWARDS ILLNESS
The way that people, group, and institutions are organization with respect to one another. This structure organization is believed to influence behaviour or at least to limit the choices open to people. According to structural perspective, a person’s choices can be explanation by social forces that arise from the ways in which society is organized. (Social forces such as influence of education and social background on choice of healthy lifestyle)
Predominantly social structure approach would draw upon quantitative data derived from social survey, epidemiological studies and comparative studies in order to point to and processes in determining health outcome for social group.
b. HEALTHCARE AND MEDICINE
The pathophysiology of the diseases medical diagnosed. The Sociology distinguish it from illness when the sense that one feels unwell. The society’s acceptance that one is not well, as in allotted number of ‘sick days’ /sickness.
TOPIC 4. THE RELATIONSHIP BETWEEN INDIVIDUALS AND SOCIETY.
INTRODUCTION
The term society is derived from the Latin word ‘socius’, which means companionship or friendship. ▪ Two primary components of a society are its culture and its social structure. ▪ Society is one of the basic sociological terms. In simple sense, society is a large grouping that shares the same geographical territory, shares a common culture and social structure, and expected to abide by the some laws.
LEARNING OUTCOMES
1. Discuss the relationship between individual and varies society
4. THE RELATIONSHIPS BETWEEN INDIVIDUALS AND SOCIETY
A society consists of people who share a territory, who interact with each other, and who share a culture. Society is defined a web of social relationships. A society is a collection of individuals united by a certain relation or mode of behaviour which marks them off from others who do not enter theses relations or who defer from them in behaviour.
The characteristics of society consists of people, mutual interaction, and mutual awareness. There is likeness, which refers to similarities but differences in their social relationships that involved co-operation and division of labour.
The interdependence and dynamics causing change is always present in society. Thus, social control, has its own means and ways of controlling the behaviour of its members. While culture and gregarious nature, it refers to the tendency of men to live in groups.
4.1. THE INFLUENT OF BIOLOGY
a. Community Rural & Urban
Rural society - The villager’s satisfaction all the needs in the village. They have a sense of
unity and feeling of friendliness towards each other. The development of village is influenced considerable by the life of the village. Major occupation is agriculture which involves dependence on nature.
Rural sociology-->scientific study of rural society; involve study on the on the society,
institutions, activities, interaction, and social change. Takes urban surrounding into consideration for a comparative study.
Urban society- There’s division of labour into specialized occupation. Social organization are based on occupation are based on occupation and social class. Practice trade and commerce. There is formal government institution. Practices good communication, record keeping with technology update.
Urban sociology - Urban derived from Latin ‘urb’ referring to a city. Urban sociology is a study of urban living; the people in the society, the relationship, interaction and social changes.
Urbanization is when the Movement of people from communities concerned chiefly or sorely with agriculture to other communities generally larger whose activities are primarily centred in government, trade, manufacture or allied interest.
b. involve 2 ways process:
• Movement from village to cities; change from agricultural occupation to business, service, profession.
• Changes in migrants’ attitude, belief, values and behavioural pattern. What attract people to migrate to urban area?
• Better wages & technology
• Employment / business opportunity
• Better community for education
• Poverty and unemployment, long working hours, low income in rural compared to urban.
• Developing countries are placing more and more reliance on industrialization.
It is also involved social process and affect not only environment physically but also socio-culturally.
c. Industrialization
The process of converting to a socioeconomic order in which industry is dominant.
Along with its technological components. Industrialization & urbanization completely transform family interaction. Many factors fuelled industrial growth in the late 19th century. Abundant resources, new technology, cheap energy, fast transport and available of capital and labour.
d. Advantages of urbanization & industrialization
Business leaders how to operate and coordinate many different economic activities across
broad georaphic area. Business become larger and the modern corporation become an important from of business organization.
e. Disadvantages of urbanization / industrialization
Family → from extended. Multigenerational family system into a nuclear family (parent/ children). Urban families significantly smaller. Live in unhealthy housing; overcrowded, polluted. Social → increase crimes, independent neighborhood.
Environment → pollution, disaster, global warming. Health →communicable diseases
4.2. POPULATION DISTRIBUTION
The definition is Population distribution is the pattern of where people live, population density with measurement of the number of people in an area. It is an average number which is calculated by dividing the number of people by area. And usually shown as the number of people per square kilometre
a. What factors affecting population density are physiological factors, high density, and low density.
Physiological factors – see to the shape and height of the land, resources, and climate
Resources - High density - shape and height of the land, Low land which is flab, areas rich of resource (coal, oil, fishing area, gold) and area with few resources tend to be sparsely populated.
Climate - Low density. Areas with temperate climates tend to be densely populated as there is enough rain and heat to grow crops and areas with extreme climates of hot and cold tend to be sparsely populated. Eg : Sahara dessert
b. What factors affecting population density are human factors, high density, and low density.
Population density consist of Human factors, political, social, and economic.
Human factors - Political – High density, Country with stable government tend to have a high population density Eg : Singapore and Low density, Unstable countries tend to have lower population densities as people migrate. Eg. Afghanistan
Human factors – social - High density - Group of people want to live close to each other for security. Eg. USA Low density other group of people prefer to be isolated. Eg : Scandinavans
Human factors -economic – high density with good job opportunities encourage high population densities. Low density - Limited job opportunity cause some areas to be sparsely populated Eg : Amazon Rainforest
c. Population distribution
This rapid growth in population has been called a population explosion. Birth rate -> number of live babies born in a year for every 1000 people in the total population. Death rates-> number of people dying per 1000 people. When birth rates are higher than death rates the population of an area will increase. Over the past 150 years improvements in health care and sanitation around the world have led to a drop in the death rate.
d. Population structure
The population structure for an area shows the number of males and females within different age group in the population. This information is displayed as an age-sex or population pyramid. Population pyramid of Less Economic Developed Countries typical have a wide base and a narrow top. This representation a high birth rate and high death rate. Population pyramid of More Economically Developed Countries typically have a roughly equal distribution of population throughout the age group. The top obviously gets narrower as a result of death.
4.3. THE INFLUENCE OF THE CULTURE
Culture is an organization of phenomenon of acts (patterns of behavior) objects (tool) idea (belief, knowledge, sentiments) attitudes values the use of symbols. The values, beliefs, standards, languages, thinking patterns, behavioral norms, communications styles etc. shared by a group of people. We have an obligation to be respectful and sensitive to another’s belief system. Healthcare workers must be culturally competent and comfortable with those they serve. Healthcare workers should understand how their own personal biases and values influence communication with parents, families, and co-workers.
Culture is derived from the English word ‘kulthra’ and Sanskrit word ‘ samskar ’ which denotes social channel and intellectual excellence. Culture is a way of life. Culture is a complex whole, which includes knowledge, belief, art, morals, customs and any other capabilities and habit acquired by the man as a member of society. Culture is symbolic, (representative) continuous, cumulative (collective) and progressive process.
a. CHARACTERISTICS OF CULTURE
Culture is an acquired quality or learned way of behavior. Learn through experience, imitation, communication, concept, thinking and socialization process. Culture is transmitted by vertically and horizontally and thus it is communicative. vertical transmission from generation to generation
Horizontal transmission from one group to another group. Culture is social but not individual. Culture can be shared by members of group (thinking, feeling, acting). It is
idealistic. (unrealistic/impractical) that fulfills some needs and desires of individual to fulfill group function. Culture is adoptive and integrative. It evolves into more complex forms through division
of labor, which develops special skills, the interdependence of members within the society continuously and cumulatively.
Culture is dynamic and gratifying which varies from society to society. Every culture has a culture of its own/unique. (Customs, tradition, moral, ideals, belief, practice). It is super organic, and independent of physical and physiological properties and characteristics
b. TYPES OF CULTURES
Culture is unique, every culture has its own varied and diverse, culture is base on society and the content is culture is of two types:
Material culture - Manmade objects, which may be experienced with senses e.g. pen, table, it is concerned with external, mechanical, and utilitarian objects.
Non-material culture- Include the concepts, values and ideas, e.g. Monogamy, polygamy, democracy.
c. FUNCTION OF CULTURE
As a social being – it requires us to regulate the conduct and prepares the human being, understand the meaning of situation. To provides solutions to complicated situations as it provides traditional interpretation to certain situations. You should be able to defines value, attitudes, and goals in order to broaden the vision of individuals. It also keeps the individual behavior intact. Creating new needs and interests by moldings national character and able to defines myths, legends, supernatural believes in providing behavior pattern and relationship with others.
4.4. HOW SOCIETIES ATTEMPT TO CONTROL DEVIENCE.
Mores (MOR-AYZ) are norms deemed highly necessary to the welfare of a society. Each society demands obedience to its mores when violations can lead to severe penalties. e.g. most countries have strong mores against murder, child abuse, use of illegal drugs.
Folkways are norms governing everyday behaviour that plays an important role in shaping the daily behaviour of members of a culture. It is relatively weak norms in which violation does not cause concern. They are the conventions and habits learned from childhood., are correct behaviour, correct manners proper dress and eating food with the proper utensils. The breaking or questioning a folkway does not cause severe punishment, but may cause the person to be laughed at, frowned upon or scolded
Sanctions are rewards and punishments given out to those who follow or violate social norms.
Formal norms – positive – staff given Bonos, testimonial dinner or given medal or certificates whereas the negative norms when the staff is demoted, fired or expulsion from work.
The informal norms – positive – smiling to staff, complimented and cheers whereas negative norms the characteristic of frowning, humiliation and be littering the staff.
4.5. ATTITUTES TOWARDS CULTURAL VARIATIONS
Ethnocentrism - Refer to the tendency to assume that one’s own culture and way of life’s represent the norm or are superior to all others.
Cultural Relativism - The evaluation or looking at people’s behaviour from the perspectives/point of view of their own culture.
TOPIC 5.STRACTIFICATION & MORBIDIITY
INTRODUCTION STRATIFICATION AND MOBILITY
Stratification is the division of society into classes that have unequal amounts of wealth, power, and prestige. Karl Marx and Max Weber studied these dimensions in great detail.
Murray,2011 emphazised that social stratification is a horizontal division of society into higher and lower social units. It is a system by which society ranks categories of people in a hierarchy in which society is divided based on economic, social, political, religious and other aspects.
LEARNING OUTCOMES
At the end of the discussion, the learners shall:
- Define social stratification.
- Describe the three main types of social stratification.
- Explain social mobility.
- Enumerate the types of social mobility.
Social stratification is defined as a characteristic of society that affects the lives of the people. There are four principles of social stratification.
The first principles is a trait of society, not simply a reflection of individual differences; secondly social stratification carries over from generation to generation; thirdly social stratification is universal but variable; and lastly social stratification involves not just inequality but beliefs as well.
Stratification is universal in that all societies maintain some form of social inequality. Social scientists have found that inequality exists in all societies.
5.1.THE STRUCTURING OF SOCIETY IN TO DIFFERING LEVELS OF CLASS.
Social stratification assumes of three types. It is the class system involved the economic, the caste system that is the social well being and race that explain the heredity of the society.
The five class models are upper class, upper middle class, lower middle class, working class and lower class
In social-economic class system, the lower class represent 1/5 of population and category falls below poverty line. Worker class include 1/3 of population with below average income have less financial security than middle class.
a.Middle class include 40% - 45% of population. Upper Middle class distinguished by higher income, higher prestige occupations and more education. Upper class involves small elite population of the riches and powerful people consists of old rich whose wealth is transmitted over several generation
Caste System as indicated by William (2008) is a system in which an individual’s rank and its accompanying rights and obligations is ascribed on the basis of birth into a particular group. It is originated from the Spanish word means “breed, race, strain or a complex of hereditary qualities”.
Race as stated Biesanz,(2009) is a large group of people distinguished by inherited physical difference”. The criteria of racial classical As an example the Negroes: with their black skin, projecting jaws, broad nose and curly hair include the Melanesians, who have a lighter skin and slightly different nose from the Negro group. While the Mongoloid: they may be called as yellow race has lighter skin, prominent cheek bones, olive shaped eyes and straights black hair but the Caucasians: overlap with other races.
5.2. WHAT IS SOCIAL MOBILITY?
Social mobility is the movement of an individual or group from one social position to another over time. Common in society having a class system. Changes take place in the social position, for better or worse as a result to personal achievements
For example: A person becomes a manager from an ordinary shopkeeper, his status is also enhanced. On the other hand, if the manager losses his job and comes to his old shop, the status enjoyed by him as a manager is lost. Thus, it is seen that people in society continue to move up and down the status or the scale. This status or class movement is called Social Mobility.
Factors Influencing Social Mobility are It democratic political system and the industrial economy of class system encourages migration from rural to urban cities. Industrialization will attracts immigration to a society
The types of social morbidity are vertical morbidity are movement in any or all the three areas of living; class, occupation and power involving status changes. And Horizontal Mobility, are changes of residence or job without status change, such as teacher’s leaving one school to work in another school.
Open system mobility: It refers to the free movement in status changes In such a system,
status can be achieved, mobility is motivated and encouraged.
Closed Model of Mobility: It refers status is based on birth or caste. When a society ascribes
to its members, deferent degrees of status on the basis of sex, religion and caste.
5.3. INTER-GENERATIONAL MOBILITY
Mobility between generations. Movement between a father’s generation and a son’s generation. The son of a farmer father is now a Civil servant or a business executive. The present-day industrial society is marked by inter-generational mobility.
https://slideplayer.com/slide/12742782/
TOPIC 6. SOCIALIZATION PROCESS
INTRODUCTION OF SOCIALIZATION PROCESS
In the organized social relationship of human groups, social processes take place. Social processes are repetitive forms of actions, patterns of social behaviors.
Social processes manifest themselves through various modes such as competition, conflict, cooperation, accommodation, and assimilation. These processes take place on continuous basis at micro and macro levels. These modes of social processes are interrelated, and each may yield the other, and they take place in cyclic manner.
At the end of the lecture, students will be able to:
- Define socialization process
- Describe the agents of socialization.
- Identify the factors affecting the process of socialization.
- Explain the problems and failures in the process of socialization.
6.1. DEFINATION OF SOCIALIZATION PROCESS
Socialization is a process that introduces people to social norms and customs. This process helps individuals function well in society, and, in turn, helps society run smoothly. Family members, teachers, religious leaders, and peers all play roles in a person's socialization.
This process typically occurs in two stages: Primary socialization takes place from birth through adolescence, and secondary socialization continues throughout one's life. Adult socialization may occur whenever people find themselves in new circumstances, especially those in which they interact with individuals whose norms or customs differ from theirs.
6.2. AGENTS OF SOCIALIZATION
They are the people and groups that influence our self-concept, emotions, attitudes, and behavior
The Family is responsible for, among other things, determining one's attitudes toward religion and establishing career goals. Education is the agency responsible for socializing groups of young people in particular skills and values in society. Peer groups refer to people who are roughly the same age and/or who share other social characteristics (e.g., students in a college class).The Mass Media and other Agents: Religion, Work Place, The State.
a. SOCIAL CHANGE
In sociology it is the alteration of mechanisms within the social structure characterized by changes in cultural symbols, rules of behaviour, social organizations, or value systems.
b. FACTORS RESPONSIBLE FOR SOCIAL CHANGE.
Geographical factors like climatic conditions that influence the climatic conditions. Sociological factors like social conflicts, social oppressions, modernization etc.. There is explosion of population and the environmental factors like newly built cities, industrialized and urbanized natural environment. The scientific and technological factors like technical advancements, new interventions, modern machineries, tools etc.
The ideological factors like social philosophy, pollical philosophy and religious philosophy. The legislative factors like legislation on temple entry, banning child marriages etc. which lead to the impact of western civilization and cultural diffusion. Thus, the level of education and literacy attained by the society and modernization of society
A population change – a social also change and become a casual factors in further and cultural changes. Migration encourage further changers for it and brings a group into new environment subject to new social contacts and confronts it with new problem.
c. PROCESS OF SOCIAL CHANGE
Parsons (1996) indicated that there are three processes of social change. Firstly, differentiation – increasing complexity of social organization. e.g., transition from “medicine man” to Physician, nurse, and pharmacist. Secondly, adaptive upgrading – social institutions become most specialized in their purposes, e.g., Specialization of doctors – pulmonologist, haematologist, oncologist, paediatrician. Third, is the inclusion – including groups that were excluded because of race, gender, ethnicity, and social class are not included., e.g., male nurses, female engineers, female pilot…
d. TYPES OF SOCIAL CHANGE
Consist of three that are, civilization change e.g., dress, foods habits, technologies. Cultural change consists of religion, rituals, literature and change in social relationship like father and son, teacher and students, husband and wife. Source of social change are major sources of social change include population growth and composition, culture and technology, the natural environment, and social conflict.Factors influence change are Physical environment - Population growth, Economic factor, Ideology And leadership
e. FACTORS OF SOCIAL CHANGE
Collective behaviour and social movements are just two of the forces driving social change, which is the change in society created through social movements as well as external factors like environment shifts or technological innovations. Essentially, any disruptive shift in the status quo, be it international or random, human-caused, or natural, can lead to social change.
Subsequently there are numerous and varied causes of social change which consists of four common causes as recognised by social scientists are technology, social institutions, population, and the environment. These four of these areas can impact when and how society changes. And they are all interrelated a change in one area can lead to change throughout. Modernization is a typical result of social change, which refers to the process of increased differentiation and specialization within a society, particularly around its industry and infrastructure.
https://courses.lumenlearning.com/wmopen -introtosociology/chapter/social-change/
TOPIC 7.SOCIAL INTERACTION & SOCIAL STRUCTURE
INTRODUCTION SOCIAL INTERACTION AND SOCIAL STRUCTURE
The concepts of social interaction and social structure are closely linked to groups and organizations. Both are defined as Social Interaction is the process by which people act and react in relation to others and Social Structure is the way in which a society is organized into predictable relationships.LEARNING OUTCOMES
At the end of the lecture, the students will be able to:
1. Definition social interaction and social structure.
2. Describe the Elements of Social Structure
3. State the characteristics of groups
4. Discuss the leadership style
5. Explain the group dynamic
6. Explain group interaction
7.1. DEFINITION
Social structure: The way in which a society is organized into predictable relationships. Human beings interpret or define each other’s actions.These interpretations are based on the individuals’ socialization. Meanings given to the actions and situations affect the outcome of the social situation.
7.2. ELEMENTS OF SOCIAL STRUCTURE.
There are five elements of social structures we can examine in predictable social relationships. The elements involved the statuses, social roles, Groups, Social networks, social institutions. These elements of social structure are developed through the lifelong process of socialization.
Statuses - refer to any of the full range of socially defined positions within a large group or society, from the lowest to the highest where about a person can have many statuses at the same time. As for example - President of Malaysia, fruit picker, son, daughter
Status has two types:
a. Ascribed status – assigned to a person by society without regard for the person’s unique talents or characteristics or as assignment takes place at birth
As for example - race, ethnicity, gender, age
b. Achieve status – comes to us through our own efforts
As for example - bank manager, lawyer, doctor, nurse, convict, pianist, student
Each person in a society occupies many positions each of which involves distinct statuses.
Social Roles – a set of expectations for people who occupy a given social position or status.
As for example - roles of a nurse, driver, secretary
• Role conflict – ex: Mother and teacher to her son; male nurse to a female patient
• Role strain: difficulty arising from conflicting demands and expectations
• Role exit: exiting from a role to assume new role
As for example - adolescent changing into mature ways
7.3. CHARACTERISTIC OF GROUPS
a. Groups - any number of people with similar norms, values, and expectations who interact with one another on a regular basis.
As for example- ex: basketball team, offices, church, mosques, symphony orchestra, church choir
Each society is composed of many groups in which daily social interaction takes place.
Subsequently the groups play a vital part in society’s social structure and much of our interaction takes place within groups and is influenced by their norms and sanctions that serve as links to social networks
b. Social Networks and Technology are series of social relationships that links a person directly to others and through them indirectly link to still more people while Social Institutions are organized patterns of beliefs and behavior centered on basic social needs.
In other words, social interaction is the foundation of society and without interaction there would be no group life. As for instance, interaction is the major processes for the socialization of an individual from birth to death, which exists in every culture.
There are different forms of social interacts Its either between individual and individual, between individual and group/s, between individual and culture last but noy least between group/s and group/s
The example between individual and individual – nurses and patients or shopkeeper and customers buying the goods or teacher coaching a student. The example of an individual and group/s are the teachers and group of students, a performer and the audiences, a girl with her peers group. Example of individual and cultures that involve customers are the common practice where there is no definite binding laws which being used daily in the social life.
Other example of social interaction that involved the individual and cultures are the traditions that emphasized a way of thinking, behaving, or doing something that has been used by the people in a particular group, family, society, etc., for a long time. The handing down of information, beliefs, and customs by word of mouth or by example from one generation to another without written instruction
Group characteristics indicated that everyone participates in a social group. It compromises 2 or more people who are of common experiences and interest. Members share the same needs and goals, take each other into account in their life.
Likewise, the group are divided into two types that is the primary and the secondary group.
c. Primary group is just small group and the relationship are both personal and enduring; face to face association and cooperation They are always having strong and lasting personal loyalties due to close relationship. They always display genuine concern for each other’s welfare.
As for example - street gang, family members, sorority
d. Secondary groups is define as a typically large and interpersonal social group based on some special interest or activity which involves little personal knowledge and have weak emotional ties. The relationship is short term whereabout the member have little chance to develop deep concerns for one another’s welfare
7.4. LEADERSHIP STYLES.
https://pressbooks.howardcc.edu/soci101/chapter/5-3-social-interaction-in-everyday-life/
Leadership is a process by which a person influences others to accomplish an objective and directs the organization in a way that makes it more cohesive and coherent” “A process whereby an individual influences a group of individuals to achieve a common goal” Northouse (2013). As a leader you can never say thank you enough, but even more important is the idea of serving the people you are leading.
The attributes of leadership Respected leaders concentrate on Be, Know, and Do as indicate by U.S. Army, 1983. They emphasized on belief and character of people around them, the knowing of the job, tasks and human nature and how the tasks being implemented, ways motivating and providing the correct methods of doing.
In our organization in order to be proficient leading the staff working in her team, she must understand the four factors of leadership. She must have the follower, being a good leader, able to communicate professionally and overseeing situation around.A leader must know her strength and weakness of herself with good knowledge and skills. Understand the human nature on how to treat human needs, emotions, and how people respond to stress. Able to be a good trainer and know who are the people in the organization that can give a helping hands to run smooth the organization. Ever ready to give support to staffs by providing direction.
a. STYLE THEORY
Style theory looks into the behavior of the leader. Leadership styles enable the leaders to look into the behavioral pattern determines the type of leader, rather than the personal characteristics of the leader which sometimes describes leaders as Autocratic (authoritarian, Democratic (participative), Bureaucratic or Laissez faire
Autocratic leadership (Authoritarian)
This styles the leader uses authority over the subordinates, Leaders normally does not trust the employees and always rely on threats and punishment which lead to high absenteeism and turnover of staff. They behave like dictators, have one way communication and employees become stressful
The situations where Autocratic leadership is needed In emergency, when employees do not know their work and need to be directed, time is limited/quick decision needed, need to produce high volumes on daily basis and when the organization poorly managed previously
The situations when Autocratic leadership is not used is when workers are tensed, fearful and angry, workers want to be heard, when there is low morale, high absenteeism and high turnovers and workers become too dependent on the leader to make all the decisions
Democratic Leadership
In this democratic leadership styles, leader work together with the subordinates and makes collective decisions/turnover less. Normally the subordinates have chance to voice out their opinions, however the manager makes the final decisions. Leader keeps workers informed of issues affecting their work and workers encourage to develop and get promoted/set their own goals
Democratic Leadership styles is applicable to workers who are knowledgeable and when leaders want to share decision making and problem solving with workers. This is the most common and popular style which encourage team building and full participation of the workers. But Democratic Leadership cannot be use if time is a constraint and decisions are needed
Urgently. This happen when workers are not fully informed about all the information in decision making thus the decision must be made by the leader him/herself.
https://pressbooks.howardcc.edu/soci101/chapter/5-3-social-interaction-in-everyday-life/
Bureaucratic Leadership
This style is when the leader does everything according to the procedures and policy. Enforcement of the rules are laid down by the leaders himself. If the leader is unable to find an answer in the rule, he will refer the problem to higher authorities
Bureaucratic Leadership style can be applied when workers doing routine tasks repeatedly or when required to understand certain standards and procedures , example working with dangerous chemicals and delicate equipment that being exposed to safety and security training or handling cash
This styles cannot be applied certain situation such as when the worker does what is required and nothing more or when the worker losses interest in the job and fellow workers and also when there are work habits that are hard to break and no longer useful
Laissez Faire Leadership
Last but not least these styles the Leader does not provide and direction to the workers and gives them absolute freedom. There is lack of leadership, and every worker is free to do as they please. Normally the leader really does not care, does not make decisions, and basically not interested in the work. The leader given the authority to workers to decide and set goals
For this Laissez Faire Leadership style it can be utilized when workers are educated, highly skilled and have several years of experience in the job, motivated and takes pride also trustworthy and has integrity in the job. But this style is not to be used when workers feel insecure specifically leader cannot provide any form of feedback and does not understand his responsibilities and hopes that the employee can cover him. Depending on the situation, the leader chooses the style. It can either be “Democratic style:if nurses in a certain ward are very committed and know their job well or bureaucratic or authoritarian Style if the nurses are new, unclear of their roles and functions
7.5 GROUP DYNAMIC
Group dynamic is relevant to the fields of psychology, sociology and communication studies as the groups are connected to each other by social relationship. It is defined as the social process by which people interact in a group environment. The forces that result from the interaction of group members.
a. PURPOSES OF GROUP DYNAMIC
To identify and analysis the social processes that impact on group development and performance. To acquire the skills necessary to improve individual and group performance. To build more successful organizations.
b. TYPES OF GROUPS DYNAMICARE:
It can be formal structure to perform specific tasks. There are two types – firstly the
Cross-functional teams which composed of members from different departments and secondly Cross-cultural teams which composed of members from different cultures or countries
c. TYPES OF GROUP AND TEAMS
The top management team is a group composed of the CEO, the president, and the heads of the most important departments.’ The research and development team are those members whose expertise and experience needed to develop new products. As for the common groups usually composed of subordinates who report to the supervisor, also called a department or unit. A committee of managers or nonmanagerial employees from various department or task forces as the name called meet to solve a specific mutual problems or also called an “ad hoc” committee.
The Self-Managed Work Teams give the team enough responsibility and autonomy to be self-managing. The team’s task should be complex enough to include many different steps.Select members carefully for their diversity, skills, and enthusiasm. Managers should guide and coach, not supervise. Determine training needs and be sure it is provided
Virtual Teams are team whose members rarely meet face-to-face. Interact by using various forms of information technology. Email, computer networks, telephone, fax, and videoconferences.
But the Friendship Groups are an informal group composed of employees who enjoy one another’s company and socialize with one another. Cases of Interest Groups indicated that an informal group of employees seeking to achieve a common goal related to their membership in an organization.
The group sizes having advantages and disadvantages. The advantage of small groups are the group Interact more with each other and easier to coordinate their efforts. They are more motivated, satisfied, and committed and easier to share information. Better able to see the importance of their personal contributions
Advantages of large groups are more resources at their disposal to achieve group goals. Disadvantages of large groups are the problem of communication and coordination Lower level of motivation. Members might not think their efforts are really needed. Group tasks impact how a group interacts. Task interdependence shows how the work of one member impacts another; as interdependence rises, members must work more closely together.
The Stages of Group Development consists of:
Forming -Group members get to know each other and reach common goals.
Storming-Group members disagree on direction and leadership. Managers need to be sure the conflict stays focused.
Norming-Close ties and consensus begin to develop between group members.
Performing -The group begins to do its real work.
Adjourning -Only for task forces that are temporary. Note that these steps take time!
7.6.GROUP DYNAMICS: INDEPENDENCE
Pooled in which members make separate, independent contributions to group such that group performance is the sum of each member’s contributions. And Sequential is when members perform tasks in a sequential order making it difficult to determine individual performance since one member depends on another. In case of Reciprocal work was performed by one group member is mutually dependent on work done by other members.
Inevitably the Group Roles are the set of behaviours and tasks that a group member is expected to perform because of his or her position in the group. In cross-functional teams, members are expected to perform roles in their specialty. Managers should clearly describe expected roles to group members when they are assigned to the group. Role-making occurs as workers take on more responsibility in their roles as group members.
TOPIC 8.LEGAL ASPECTS OF NURSING
8. INTRODUCTION TO MEDICO LEGAL ASPECTS OF NURSING.
Nurses face ethical issues daily regardless of where they practice. They are faced with ethical decisions that can impact them and their patients. Ethics is the science relating to moral action and one’s value system. Nursing ethics provides the standards for professional behavior and is the study of principles of right and wrong conduct for nurses.
Nursing ethics states the duties and obligations of nurses to their clients, other health professional, the profession, and the community. Ethics promotes the philosophical and theological study of morality, mental judgments and moral problems.
Nurses adhere to certain ethical principle when caring for patients. These principles include beneficence, which is doing no harm to the patient, maleficence which is doing harm to a patient for positive outcome, justice in allocating care based on need not status and patient autonomy which is respecting the patient’s right to make health decision.
LEARNING OUTCOMES
After completing the lectures, students will be able to:
- Discuss nurse practice act
- Discuss credentialing in nursing.
- describe standard of care in nursing.
- Describe the legal aspects in nursing
8.1. REGISTRATION AND LICENSURE
NURSE PRACTICE ACTS
To protects the public by legally defining and describing the scope of nursing practice. Legally control nursing practice through licensing requirements. E.g., license for SRN/ Nurse Midwife.3. Each state has a nurse practice act. Nurse responsibility to know the nurse practice act of the state which he/she practice.
a. CREDENTIALING IN NURSING
It is the process of determining and maintaining standard of practice and accountability for competence in nursing practice. Credentialing includes- Licensure, Certification and Accreditation.
b. NURSING LICENSURE
A Legal permit that a government agency grants to individuals to engage in the practice of profession which is mandatory in all state. To obtain the licensure, three criteria to meet obtain the right to license: The objectives is to protect the public safety or welfare while the occupation clearly delineated as separate, distinct area of work., thus, proper authority to assume obligations of the licensing process (e.g., state board of nursing)
c. NURSING CERTIFICATION
The voluntary practice of validating that individual nurse has meet minimum standards of nursing competence in specialty areas. (e.g., maternal-child health, pediatric, mental health, gerontology). And certification programs are conducted by specialty nursing organization.
8.2. ACCREDITATION/APPROVAL OF BASIC NURSING EDUCATION PROGRAMS
The state board nursing ensure school preparing nurses maintain minimum standard of education with legal requirement. The college / university must be accredited by MQA to maintaining voluntary accreditation means of informing the public and students that the nursing program has certain criteria.
a. STANDARD OF CARE IN NURSING
Standard of care are the skills and learning commonly possessed by members of a profession (Guido, 2006). Nurses must know their institution policies and procedures. Nurses need to remain competent through reading professional journals, attending CNE and in-services programs.
The purpose of standard of care: To protect the consume and to evaluate the quality-of-care nurses provide with Legal guidelines for nursing practice.
Nursing standard of care classified into categories can be divided into Internal standard and External standard.
Internal standards consist of nurse’s job description, education, and expertise as well as individual institutional policies and procedures.
And the External standard consist nurse practice acts, professional organization (e.g., ANA), nursing specialty-practice organization (e.g., Oncology nursing society/ emergency nurse association) and Federal organizations and federal guidelines (e.g., joint commission on accreditation of healthcare organizations JCAHO)
Nursing Practice Act - law that mandates the Board to set out the scope of practice and responsibilities for RNs. Standard of care - the skills and learning commonly possessed by members in the profession and used to evaluate the quality-of-care nurses provide.
b. NURSING BOARD MALAYSIA
Registration Units role is to ensure that all Registered Nurses, Community Nurses, Midwife Nurses Part 1, Midwife Nurses Part 11, Public Health nurses and mental Health Nurses who have passed the Malaysian Board Exam/Malaysian Midwifery Board Examination and BPL Final Examination from MOH Colleges of Nursing, IPTA.IPTS that are recognised and registered with the Malaysian Board Exam/Malaysian Midwifery Board in accordance with the Nurses Act 1950 and Regulations 1985 and Nurse Midwifes Act 1966 and Regulation 1990.Nursing Board Malaysia is responsible for the issuance of the certificate of Annual Practice to ensure nurses to practice nursing in Malaysia,
c. NURSING BOARD MALAYSIA MAIN FUNCTIONS
1. Maintain a register of qualified nurses through nursing licensure.
2. Set professional standards and guidelines for all levels of nursing education, nursing practices, management and research.
3. Regulate the conduct and competency of nurses.
4. Evaluate, approve and accredited all nursing programmes offered locally by both public and private educational institution.
5. The board shall approve institution as training school to provide training for admission by examination to the register. The board manages the nursing education and nursing practice according to the Nurses Act 1950 and Nurses Registration Regulation 1985.The nursing board is a regulatory body established under section 3 of the nurses Act 1950 (Act 14) and the nurses Registration Regulation 1985.
The Board shall approve institution as training schools to provide training for admission by examination to the Register ( Nurses Act 4 (1) )
i. Register (Registration Cert., Badge)
ii. Annual Nurse Practicing Certificate
iii. Disciplinary proceedings
It main objectives is to ensure that all Registered Nurses, Community Nurses, Midwife Nurses Part 1, Midwife Nurses Part 11, Public Health nurses and mental Health Nurses who passed the examination are registered with the Nursing Board Malaysia/ Midwifery Board Malaysia.
To make sure every nurses registered with the Nursing Board Malaysia (NBM) maintains his/her competency in order to practice nursing.
1.Registrations
All nurses who have passed to the Nursing Board Malaysia (NBM), Midwifery Board Malaysia IMBM) and final examination of Ministry of Health Malaysia IPTS and IPTA recognized in Malaysia and Malaysian Nurses trained outside Malaysia.
2.Annual Practicing Certificate (APC) FOR Nurses
APC is issued to all registered nurses who register to with (NBM) to practice nursing at health facilities in Malaysia.
3. Retention of Names
This procedure is done as to maintain the registered status in (NBM) for nurses who are not practicing nursing in Malaysia, further their studies or working abroad.
4 Confirmation of Registration.
This procedure is to verify and certify nurses who will future study in the field of nursing in institution of Higher Learning and to nurses who are applying to work abroad in order to register with the Nursing of the respective countries.
5. Verification Transcript Training
to verify and certify training transcript for nurses who have registered with NBM or MBM or as stipulated in the act.
6. Letter of Good Standing
To certify nurses registered within the NBM/MBM have maintained their registered status through the service and never being revoked.
7.. Approval of Notice of Intent to Midwives in the Hospital/Private Clinic
The Board shall have disciplinary jurisdiction over all persons registered under these Regulations.
Disciplinary punishments – The Board may , in the exercise of its disciplinary jurisdiction , impose any of the following punishments :-
i. Order the name of a registered person to be removed from the Register
ii. Order the name of a registered person to be suspended from the Register for such period as it may think fit
8.3. PROFESSIONAL ORGANIZATION BODY
• Malaysian Nursing Board(MNB)
• Malaysian Nursing Association(MNA)
• Malaysian Nursing Union(MNU)
• Association of Nurse Tutors(ANT)
• International Council of Nurses(ICN)
• World Health Organization(WHO)
8.4.. DICIPLINARY PROCEEDINGS
Disciplinary jurisdiction of the Board - The Board shall have disciplinary jurisdiction over all persons registered under these regulations.
Disciplinary punishment - The Board may, in the exercise of its disciplinary jurisdiction, impose any of the following punishments:
Order the name of a registered person to be removed from the register; Order the name of the registered person to be suspended from the register for some period as it may think fit; Order a registered person to be reprimanded; or Make any of the above orders but suspended its application subject to such condition as the Board may think fit for a period or periods in the aggregate not exceeding two years.
Has obtained registration by fraud or misrepresentation; Was not at the time of his registration entitled to be registered; Has been removed from the register of nurses maintained in any place outside Malaysia; Or has been certified to be a drug dependent by a government medical officer or a registered medical practitioner under the Drug Dependants (Treatment and Rehabilitation Act 1983.)
8.4. CONTINUING PROFESSIONAL DEVELOPMENT (CPD) FOR NURSES
Continuing professional development (CPD) has always been important in nursing. It helps nurses and midwives keep up to date with their training so they can deliver the best care to patients. Planned and organized proses of learning.
a. OBJECTIVE OF CPD
To enable nurses to maintain, improve and broaden their professional knowledge, expertise and competency. To meet their obligation to provide ethical, effective, safe and competent practice. Maintain professional competence in an ever-changing technological environment alongside numerous challenges.
This guideline refers to registered nurses, registered under the General Part and Supplementary Part of Nurses Act 1950 and also Midwives Registered in Part l, ll and lll of the Midwives Act 1966.Registered nurses are the largest group in healthcare providing direct care to patients/clients. They have great potential to contribute to the health of the community and to achieve the goals of the National Health policy.
Process of lifelong learning aimed at fulfilling patients’ needs and improving health outcomes by systemic improvement of knowledge, understanding and skills in the development of personal qualities which are necessary for the execution of professional duties, including the acquisition of new roles and responsibilities. Increasing public expectations and demands for greater quality.
Nurses face these challenges in embracing new methods of care delivery and integration of new knowledge into practice that will provide quality services that is truly patient/client – centered.
Nursing Board have taken serious concern regarding CPD activities by coordinating the approval and monitoring achievement of CPD points for the renewal of Annual Practicing Certificate (APC) or Temporary Practicing Certificate (TPC) of nurses practicing throughout Malaysia.
Performing CPD activities will be beneficial for improvement career development, job satisfaction and provision of services among nurses and midwives.
b. GUIDELINES TO APPLY FOR THE YEARLY ANNUAL PRACTICING CERTIFICATE
This logbook is designed to guide nursing professionals in recording and updating all CPD activities they have been involved in and to allocate credit points in each of the CPD activities as listed in CPD Credit Points System, respectively.
There is a requirement for annual minimum Credit Points achievement for each professional group to enable them to renew their APC.
The numbers of CPD to be collected yearly will be recommended by the Malaysia Nursing Board
However, there is no upper limit in acquiring points for CPD especially when there is growing evidence of the need to link CPD with organizational/institutional goals.
As outlined in the CPD Credit Points System, a health care professional may be involved in or attend many CPD activities of the same category, but only the maximum credit points of that category would be taken into consideration for the annual minimum.
Each CPD activity undertaken must be recorded in the logbook and be verified by the immediate supervisor with documented proof.
For renewing the APC, the collection of CPD points must be made from 1 st September of the previous year to 31st August of the current year. This applies to the renewal of APC for the coming year. However, once a 3 nurse has achieved the required CPD points, she/he is allowed to renew her/his APC earlier.
The request for renewal of the APC should be submitted to Malaysian Nursing Board by 1st September of the current year.
All completed logbook should be verified and signed by the immediate supervisor.
The logbook and summary shall be kept for future reference.
The CPD Committee at organizational level will be responsible for ensuring the implementation of this system.
The CPD committees will also be responsible to deal with any appeals from officers regarding disagreement on points awarded and the local verification process.
c. INSTRUCTIONS FOR NURSES
• Nurses are encouraged to plan their CPD activities at the beginning of each year.
• All personal profile and Healthcare provider information should be updated regularly.
• Please show your logbook to your immediate supervisor, appointed by the Head of Unit or Department/Discipline, at least 4-monthly to verify your CPD activities.
• The certificates of attendance and relevant verification documents must be produced for the purpose of verification by the immediate supervisor.
• Any appeal regarding disagreement on points awarded or the verification process should be made to the local CPD committee.
• Complete CPD-LB Pind.1/2018 form at the end of the year to determine the summary of CPD points achieved. Submit the completed CPD-LB Pind.1/2018 form to the supervisor.
VERIFICATION OF CPD POINTS BY SUPERVISOR/WARD SISTER/WARD MANAGERS
8.5 INTRODUCTION LEGAL RISKS IN PROFESSIONAL NURSING
Laws are set of enforceable principles and rules established to protect society. Legal principles form a framework within which nurse will practice the art of nursing. Of all the health personnel's, nursing personnel's have most frequent and prolonged contact with the patient. As such, are most often in a position to intervene protecting on the patient's behalf.
With the increased emphasis on clients/ patients' rights, nurses today must understand the legal obligations and responsibilities to clients. Nurses who give competent care based on their education will seldom need to worry about malpractice lawsuit. Many clients are knowledgeable about their rights related to their health and illness. Therefore, nurses should take it as a challenge to become patients advocates.
LEARNING OUTCOMES:
At the end of the lectures, students will be able to:
- discuss Malaysia legal system and law
- discuss the nurse's role as witness.
- Discuss unprofessional conduct.
- Discuss the professional liability insurance.
- Discuss nurse's role in legal issues related to nursing practices.
a. LEGAL SYSTEM
Law is, generally a system of rules which are enforced through social institutions to govern behavior (Robertson, 2006), although the term ‘law’ has no universally accepted definition (Lord Lloyd of Hampstead, 1975).Laws can be made by legislatures through legislation (resulting in statutes), the executive through decrees and regulations, or judges through binding precedents (normally in common law jurisdiction)
In general, legal systems can be split between civil law and common law systems. Historically, religious laws played a significant role in setting of peculiar matters in some religious communities. Islamic Sharia law is the world’s most widely used religious law.
Law is generally divided into two main areas.
Criminal law deals with conduct that is considered harmful to social order and in which the guilty party may be imprisoned or fined.
Civil law deals with the resolutions of lawsuits (disputes) between individuals or organizations. These resolutions seek to provide a legal remedy (often monetary damages)
b. LAW OF MALAYSIA
The law of Malaysia is mainly on the common law system. This was a direct result of the colonization by Britain. The supreme law in Malaysia –the Constitution of Malaysia sets on the legal framework and rights of Malaysian citizen.
Federal laws enacted by the Parliament of Malaysia applies throughout the country. There are also state laws enacted by the State Legislative assemblies which applies in the particular state.
The constitution of Malaysia also provides for a unique dual justice system- the secular laws (criminal and civil) and shariah laws. Shariah or Islamic law is a state law matter with the exception of the Federal Territories of Malaysia. Law also raises important and complex issues, concerning equality, fairness and justice
There is an old saying that “all are equal before the law”.
c. COMMON LAW
The laws of Malaysia can be divided into two types of laws- written law and unwritten law. Written laws are laws which have been enacted in the constitution or in legislations. Unwritten laws are laws which are contained in any statutes and can be found in case decisions.
c. CRIMINAL LAW
Criminal law, also known as penal law pertains to crimes and punishments. It regulates the definitions of and penalties for offences. Examples of crimes includes murder, assault, fraud and theft.
d.LABOUR LAW
Labour law (also labor law or employment law) mediates the relationship between workers(employees), employers, trade unions and the government.
Individual labour law concerns employees right at work and through the contract for work.
The basic feature of labour law in almost every country is that the rights and obligations of the worker and employer through a contract of employment between the two.
Many contract terms and conditions are covered by legislations or common law. One example of employment terms in many countries is the duty to provide written particulars of employment with the essential terms to an employee.
This aims to allow the employee to know what to expect and what is expected. It covers compensation, holiday, sick leave rights, notice in the event of dismissed and job description.
8.6. MEDICO LEGAL ASPECTS IN NURSING
When nurses embark on to practice their profession, they are considered responsible and accountable for the quality of nursing care in line with their duties and responsibilities. Nurses should be directly conscious of their immediate supervisors and self-regulating. Nurses are bound to a standard of conduct that is expected of a reasonably prudent nurse. The practicing license is proof that they are able to give holistic and quality care to their client as a professional nurse.
a.LEGAL PRACTICE OF NURSING
To practice nursing legally, a nurse must possess a valid and current license from the appropriate agency. i.e Nursing Board/ Council. The primary purpose of a licensure law is to protect public from injury by unqualified practitioners through informant of minimum practice standards.
b. LICENSURE IS MANDATORY
The law governing nursing licensure include the sections that specify licensing board or council, compositions and responsibilities, definition of professional, educational and evaluation requirements for licensure procedures for determining proficiency, penalties for practicing without license.
c. DEFINITION OF PROFESSIONAL NURSING PRACTICE
Professional nursing practice encompass the full scope of nursing practice and consists of application of nursing theory to the planning development, implementation and evaluation of nursing care plans for individuals, families and communities.
d. STANDARDS OF PRACTICE
Clinical guidelines, standards of professional performance, standards of practice and standards of care are often used interchangeably. The legal definition of standard of care looks to what a reasonable and prudent nurse would be in the same or similar situation. Nurse practice act: Standards of practice may have their basis in the nurse practice act (from Nursing Board/ Council)
e. NURSE AND LAW
Legal responsibility in nursing practice means the way in which nurses are obligated to obey the law in professional activities.
A professional nurse needs to update with the fast changing and advancing professional knowledge to provide safe nursing to their clients/patients.
Nursing professionals should be aware of their limitations and shall be familiar with the law and nursing practice of their own country.
Nurses should not give any room for ‘tort’ i.e negligence for malpractice in their practice.
f. NEGLIGENCE
The failure of an individual to do something that a reasonable person would in a particular circumstance in standard of care to which a nurse is legally bound.
Negligence is conduct that falls below the standard of care. If nurses give care that does not meet appropriate standards, they may be held liable for negligence.
g. THE PROBLEMS FOR WHICH NURSES ARE OFTEN FOUND NEGLIGENCE IN DURIES:
- Failure to use aseptic techniques where required.
- Leaving a foreign object in a patient's body during the surgery, eg, errors in sponge, instruments or needle count in surgical cases
- Failing to respond promptly to patient symptoms impending disaster.
- Medication and treatment errors
- Administering wrong medicine, wrong dose to a patient
- Failing to protect patient from falling, falls resulting injuries to patient.
- Administering medication inappropriately, i.e intravenous therapy, errors resulting in infiltration or phlebitis.
- Administering a care in such a manner that a patient suffers injury e.g improper handling of hot water bags, burns to clients.
- Failure to document
- Failure to assess and monitor.
Nurses are responsible for performing all procedures, correctly and exercising professional judgment for which they have autonomy to do so or in carrying out doctors' orders.Any nurse who does not meet accepted standards or practice or care or who performs duties in a careless manner, runs a risk of being found negligent.
h. MALPRACTICE
Malpractice is a negligence or carelessness by a professional person. It concerns professionals' actions and in the failure of a person with professional education, skills and knowledge to act in a reasonable and prudent manner.
Issues of malpractice have become increasingly prominent to the nurses as nursing's authority, accountability and autonomy have increased.
i.TIPS TO AVOID LAWSUITS
Follow standards of care
- Give competent health care
- Develop empathetic interpersonal relationship with client
- Complete and objective documentations
- Keep updated with current practice
- Follow SOP of the institution
j. ACCOUNTABILITY
Professional accountability applies to everyone involved in health care. Accountability is a legal obligation; in health care it is also an ethical and moral obligations. Within the realm of professional accountability-Assuming responsibility for one's own nursing practice is the most important.
A professional nurse has the responsibility to practice within her scope of care, using appropriate knowledge and skills to make decisions in the best interest of the patient. The level of responsibility and accountability depends on professional levels. Professionals nursing is based on altruism, integrity, accountability and social justice. Altruism refers to the ethical obligation to serve others without self interest.
k. ASSAULT AND BATTERY
As an attempt or threat to touch another person unjustifiably. For example: - The person who threatens someone by making a menacing gesture with a club or a closed fist is guilty of assault. A nurse who threatens a client with an injection after the client refuses to take the medication orally would be committing assault.
It is the situation where touching of a person (or person’s clothes or even something the person is carrying) that may or may not cause harm or consent required before procedures are performed.
Example: Nurse gave injection without the client’s consent. Nurse would be committing battery even physician ordered the medication.
l. PROFESSIONAL LIABILITY INSURANCE
Increase number of malpractice lawsuits against health professionals. Pphysicians, or doctor can be sued because of the negligent conduct of a nurse. Nurse can be also sued and held liable for negligence or malpractices and nurses are advised to carry their own liability insurance.
The nurses are advised to provide their own insurance coverage and not rely on hospital-provided insurance. Liability insurance coverage usually defrays all costs of defending a nurse including the costs of retaining an attorney.
m. CARRYING OUT PHYSICIAN ORDERS
Nurses are expected to analyze procedures and medications ordered by the physician. Seek clarification if seemingly erroneous orders from the prescribing doctor.
There are several categories of orders that nurses must question to protect themselves legally such as question any order a client questions, question any order if the client condition has changed,
question and record verbal orders to avoid miscommunication and question any order that is illegible, unclear or incomplete.
Competent practice is a major legal safeguard for nurses. Nurses need to provide their care within the legal boundaries. Competency also involved care that protects clients from harm. Application of nursing process – provide care and effective client care. Effective communication – protect nurse from negligence claims.
n. LEGAL PROTECTION FOR NURSES
Function within the scope of your education, job description and nurse practice act.
Follow the procedures and policies of the employing agency. To build and maintain good rapports with clients. Always check the identity of the client to make sure it is the right client. Observed and monitor the client accurately. Communicate and record significantly in the client’s condition to the physician. Be alert when implementing nursing interventions and give each task full attention and skills.
Perform procedure correctly and appropriately. Make sure given correct medication to the patient.
Delegating correctly to the right person. Protects clients from injury. Reports all incidences involving clients.
Always check any order that a client question. Know your strengths and weakness. Maintain your clinical competent.
8.7. DOCUMENTATION IN NURSING PRACTICES
Objective of documentation is to develop a better understanding of the different aspects of documentation to motivate nurses to become better documenter. To standardize the nursing documentation and ensure accurate record keeping. The effectiveness of documentation are Use of Common Vocabulary the legibility of hand writing , the proper of abbreviations and symbols in nursing reports, organization, accuracy and confidentiality of the patients reports
Use of Common Vocabulary - Enhances the quality of documentation. Supports the efforts of research and improves communication and lessens the chance of misunderstanding between members of the health team.
Legibility of the hand writing - Print if necessary, do not erase or obliterate writing, draw one line through an erroneous entry, state the reason for the error, and ssSign and date the correction.
Abbreviations and Symbols - always refer to the facility’s approved listing and avoid abbreviations that can be misunderstood.
Organization of the nursing reports - Start every entry with the date and time. Chart in chronological order. Chart in a timely fashion to avoid omissions. Chart medications immediately after administration. Sign your name after each entry.
Accuracy - Use factual, descriptive terms to chart exactly what was observed or done. Use correct spelling and grammar. Write complete sentences. Maintain continuity of care by recording with respect to notes made on previous shifts.
Documenting a Medication Error - Chart the medication on the MAR. Document in the nurses’ progress notes: Name and dosage of the medication Name of the practitioner who was notified of the error Time of the notification Nursing interventions or medical treatment and client’s response to treatment
Confidentiality - The nurse is responsible for protecting the privacy and confidentiality of client interactions, assessments, and care. The client’s significant others, insurance companies, or other parties not directly involved in care provided by the health team may not have access to clients’ records.
8.8. INCIDENT REPORTS
Used to document any unusual occurrence or accident in the delivery of client care. The incident report is not part of the medical record, but it may be used later in litigation. When an accident occurs, the nurse should first assess the client and intervene to prevent injury.
It is defined as An incident report is a form that filled up in order to record the details of accidents, patient injury and other unusual events that occur in a health care facility such as a hospital or nursing home. It is also called an accident report which documents the exact details of the accident or unusual event while the information is still fresh in the minds of those who witness the event.
• Written at the first opportunity after the incident so that the details are not blurry or forgotten.
• Written with a pen (ink) not pencil. Information written using a pencil can be erased.
• Details should be complete and accurate.
a.The patient should be identified with the following details:
• Full name
• Hospital bed number
• Hospital ID
• Patients' diagnosis
• Patient’s condition before and after the incident
Other details included are: Details of ward or clinical area Date, time and place of incident
• Details of equipment's used to include the serial number or asset tag identification (if appropriate)
b. PURPOSES OF AN INCIDENT REPORT
To document the exact detail of an accident or unusual incident that occurred in a health-care institution. To be used in the future when dealing with liability issues stemming from the incident.
To protect the nursing staff against unjust accusation. To protect and safeguard the client in case of negligence on the part of the nurse. Helps in the evaluation of nursing care to ensure safe care to all patients.
8.9. REPORTING CRIMES, TORTS & UNSAFE PRACTICES
Nurses may need to report nursing colleagues or other health and safety or professionals for practices that endanger the health and safety of clients. When reporting an incident, the nurse must be careful to described observed behavior only and not make inferences as to what might be happening.
Write a clear description of the situation you believe you should report. Make sure that your statements are factual and complete. Make sure you are credible. Obtain support from at least one trustworthy person before filing the report.
Report the matter starting at the lowest possible level in the agency hierarchy. Assume responsibility for reporting the individual by being open about it. Sign your name to the letter. See the problem through once you have reported it.
Thus, the responsibilities of the students undergoing the training should be responsible for their own actions and liable for their own actions and liable for their own acts of negligence committed during clinical experiences. When they are performed duties that are within the scope of professional nursing: Example : administration of drugs – there are legally held to the same standard of skills and competence as a registered nurse.
To fulfill responsibilities to clients and to minimize chances for liability, nursing students needs to Make sure they are prepared to carry out necessary care for assigned clients. Ask for additional help or supervision in situation for which they feel inadequately prepared. Comply with the policies of the agency in which they obtain their clinical experience, and comply with the policies and definitions of responsibility supplied by the school of nursing
8.10. INTRODUCTION INFORMED CONSENT AND CONFIDENTIALITY
Informed consent and patient confidentiality are legal concepts that are usually defined by state laws. For legal purposes, it is important to obtain consent for health care. The health care provider should be the one who obtains informed consent.
LEARNING OUTCOMES
At the end of the lectures, students will be able to:
- describe consent.
- describe nurse's role in delegation, violence, abuse and neglect.
- Discuss law related controlled substances
- Discuss nurse's role in legal issues related to death and patients confidentiality.
a. DEFINITION OF INFORMED CONSENT
It is a person’s agreement to allow something to happen based on a full disclosure of facts needed to make an intelligent decision.
“Every human being of adult years and sound mind has the right to determine what shall be done with his/her body” (Schloendorff V, Society of New York Hospital, 1994, cited in Hess 1993, p.296)
. A competent client’s ability to make health care decisions based on:
- full disclosure of the benefits,
- Risks
- potentials consequences of a recommended treatment plan
- alternative treatment
b. CLIENT’S DECISION
It’s including no treatment, client’s agreement to the treatment as indicated by client signing a consent form and nurses must obtain consent form for nursing procedures.
The form is a recorded of the informed consent not the informed consent itself.
There are three major elements of informed consent in which the consent must be given voluntarily, Consent must be given by client or individual with the capacity and competence to understand and client must be given enough information to be the ultimate decision maker.
Generally, it is the physician to obtaining informed consent for specific medical and surgical treatments is the responsibility of person who is going to perform the procedure.
c. TYPES OF INFORMED CONSENT
There are two types of consent that is the Express consent and Implied consent
Express consent is either Oral or written agreement while the more invasive a procedure and/or the greater the potential for risk to the client the greeter need for written permission.
Implied consent to be taken when the individual's nonverbal behavior indicates agreement. E.g. Client who position their bodies for an injection and cooperate with taking of vital signs
It is EXCEPTION for Group people cannot provide consent.
There are 3 groups namely.
- the Minors (children, adult with mental capacity)
- (Parent or guardian must give consent before obtain treatment.
- Unconscious or injured that they unable to give consent
- Consent usually obtain from closest adult relative
- Consent implied in life-threatening emergency
- Mentally ill patients
d. WHAT ARE THE NURSES ROLES IN TAKING THE INFORMED CONSENT
- Nurse is not responsible for explaining the procedure but for witnessing the client signature on the form.
- The nurse signature confirms three things as a witness:
The client gave consent voluntary, with the signature is authentic while the client appears competent to give consent.
8.11. DEFINITION OF CONFIDENTIALITY
It is defined as the ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.
The general rules and privacy for confidentiality are cconfidentiality must be maintained. If needed to break get consent e.g., interest of public. To remember that there can be potential harm to patient if confidentiality is not maintained.
Some health information needs to be told for treatment. Information can be personal or private.
Information can be verbal information about body and information about health or medical history with
Respect human dignity.
In honesty in the relationship there may be good news or there may be bad news is the key to establish relationships.
a. TRUST IN THE HANDS OF THE HEALTH CARE PROFESSIONAL
The patient must have significant trust and if there are abuse of trust can be a problem.
Respect in the person - a rational being i.e., capable of reasoning and capacity to communicate and be communicated with.
8.12. INTRODUCTION EVIDENCE-BASED PRACTICES
Evidence based nursing practice focuses on critical thinking and proven outcomes. Evidence based practice (EBP) is a problem – solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values (Fireout – Overholt E., 2010). Evidence – based practice helps professional nurses make informed decisions by learning from what others in the field have researched.
LEARNING OUTCOMES:
At the end of the lecture, student will be able to:
A. Understand the concept of EBP.
B. Reflect on the purpose of EBP in relation to practice
a. DEFINITION:
Nursing Research is the scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice.
Evidence – Based Nursing Practice is an integration of the best evidence available nursing practice and the values and preferences of the individuals, families and communities who are served”.
Kozier & Erbs,( 2008) stated that the EBP the nurse integrates research findings with clinical experiences and available resources in planning and implementation of care
b. PURPOSE AND OBJECTIVESEVIDENCE-BASED PRACTICE
It seeks to make practice a less subjective enterprise and to raise it to a higher level of accountability. It is associated with efforts to identify best practices in nursing and other disciplines (Bauman, S.L., 2010).
Evidence – Based nursing aims to:
- provide the highest quality and most cost-efficient nursing care possible
- advance quality of care provided by nurses.
- increase satisfaction of patients.
- focus nursing practice away from habits and traditions to evidence and research.
c. COMPONENTS OF EVIDENCE-BASED PRACTICE
Key elements of a best practice culture a EBP mentors, partnership between academic and clinical settings, EBP champions, clearly written research, time and resources and administrative support. (Fireout – Overholt, E., 2005). When delivered in a context of caring and in a supportive organizational culture, EBP can help to achieve the highest quality of care and best patient outcomes. (Bauman, S.L., 2010)
d. WAY OF ACQUISITING KNOWLEDGE IN NURSING
It acquisitor knowledge in nursing through – Traditions, Authority, Borrowing, Trial and error, Personal experience, Role modeling, Intuition, Reasoning and Research
e. PHASES OF THE RESEARCH PROCESS
The processes include the stating the study problem, defining the purpose of the research, literature reviewing to develop a Theoretical Framework, selecting Research Design, selecting the Population and Sample, conducting a Pilot Study, collecting data, analyzing the Data, communicating Findings and recommendations
f. EBN PROCESSESS FOLLOWING THE STAGES:
- Asking a clinical question.
- Searching the literature for relevant research.
- Critically appraising what has been found. It change is required, following steps occur.
- Implementing a practice change.
- Evaluating the change in practice.
g. STEPS IN EBN
- Select appropriate topic.
- Collect appropriate and accurate data to generate evidence for nursing practice.
- Analyse data from clinical practice.
- Design interventions based on evidence.
- Predict and analyse outcomes.
- Examine pattern of behaviour and outcomes.
- Identify gaps in evidence for practice.
- Evaluate project to determine and implement best practice.
h. SOURCES OF EBN INFORMATION
Systematic Reviews
-Cochrane Collaboration. (www.cochrane.org)
-Evidenced- Based Journals.
- This section
TOPIC 9. ETHICAL ASPECTS OF NURSING
9.1. INTRODUCTION NURSING CODE OF CONDUCT
A code of ethics is a formal statement of a group’s ideals and values. It is a set of ethical principles that is shared by members of the group, reflects moral judgments over time, and serves as a standard for their professional actions.
LEARNING OUTCOMES
At the end of this lecture, students will be able to :
- Define nursing codes of ethics.
- Explain purposes of nursing codes of ethics.
- Explain elements of the codes.
- Outline origins of ethical problem in nursing.
- Discuss on making ethical decision and models.
- Explain strategies to enhance ethical decision and practice.
a. DEFINITION
Ethics comes from the Greek word ethos, meaning character. “the study of what constitutes good and bad human conduct including related actions and values” .Attempts to establish norms or principles by which conduct can be judged. Concerned with what people ought to value and what behavior ought to be considered right and wrong.
b. PURPOSES OF NURSING CODES OF ETHICS
There are several purposes why nursing codes of ethics is important in nursing profession. Inform the public about the minimum standards of the profession and help them understand professional nursing conduct. It provides a sign of the profession’s commitment to the public it serves. Outline the major ethical considerations of the profession and provide ethical standards for professional behavior. It acts as a guide the profession in self-regulation. It is a reminder to nurses of the special responsibility they assume when caring for the sick.
c. WHO ESTABLISH CODES OF ETHICS ?
International, national and state nursing associations have established codes of ethics.The International Council of Nurses (ICN) first adopted a codes of ethics in 1953 – most recent revision (2005)
d. ELEMENTS OF THE CODES
What are the elements of the codes in nursing practices.
i. Nurses and People -The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgment in sharing this information. Share with the society the responsibility for initiating and supporting action to meet the health and social needs of the public. Nurse responsible to sustain and protect the natural environment from depletion, pollution, degradation, and destruction.
ii. Nurses and Practice - Carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgment regarding individual competence when accepting and delegating responsibility. Maintains standards of personal conduct all the time which reflect well on the profession and enhance public confidence. Ensures the use of technology and scientific advances are compatible with the safety, dignity, and rights of people.
iii. Nurses and the profession - Assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. Active in developing a care of research-based professional knowledge. Acting through the professional organization, participates in creating and maintaining safe, equitable social and economic conditions in nursing.
vi. Nurses and co-workers - The nurse sustains a co-operative relationship with co-workers in nursing and other fields. The nurse take appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person.
9.2. ORIGINS OF ETHICAL PROBLEMS IN NURSING
Nurses growing awareness of ethical problem has occurred largely because of :
- Social and technological changes
- Nurses' conflicting loyalties and obligations
a. SOCIAL AND TECHNOLOGICAL CHANGES
Social changes – such as the women’s movement and a growing consumerism. A large people without health insurance, the high cost of health care. Technology creates new issues that did not exist in earlier time.
b. CONFLICTING LOYALITIES AND OBLIGATIONS
Unique position in the health care system nurses experience conflicts among their loyalties and obligations to the client, families, primary care providers, employing institutions and licensing bodies. According to code of ethics – nurse’s first loyalty is to the client. It is not always easy to determine which action best serves the client’s need.
c. MAKING ETHICS DECISIONS
Should be based on ethical principles and codes rather than on emotion, intuition, fixed policies, or precedent. A good decision is one that is in the client’s best interest and at the same time preserves the integrity of all involved. An important step in decision making is to determine whether a moral situation exist.
The following criteria may be used:
- A difficult choice exists between actions that conflict with the needs of one or more persons.
- Moral principles or frameworks exist that can be used to provide some justification for the action.
- The choice is guided by a process of weighing reasons.
- The decision must be freely and consciously chosen.
- The choice is affected by personal feelings and by the particular context of the situation.
9.3. ETHICAL DECISION-MAKING MODELS
a. Thompson and Thompson (1985).
• Review the situation to determine health problems, decision needs, ethical components, and key individuals.
• Gather additional information to clarify the situation.
• Identify the ethical issues in the situation.
• Define personal and professional moral positions.
• Identify moral positions of key individuals involved.
• Determine who should make the decision.
• Identify range of actions with anticipated outcomes.
• Decide on a course of action and carry it out.
• Evaluate/review results of decision/action.
b. Cassells and Redman (1989)
• Identify the moral aspects of nursing care.
• Gather relevant facts related to moral issue.
• Clarify and apply personal values.
• Understand ethical theories and principles.
• Utilize competent interdisciplinary resources.
• Propose alternative actions.
• Apply nursing codes of ethics to help guide actions.
• Choose and implement resolutive action.
• Participate actively in resolving the issue. Apply stat and federal laws governing nursing practice.
• Evaluate the resolutive action taken.
Being involved in ethical problems and dilemmas is stressful for the nurse. A good support system should be established such as team conferences and use of counseling professionals to allow expressing of their feelings.
9.4. STRATEGIES TO ENHANCE ETHICAL DECISION AND PRACTICE
The following strategies should be taken by a nurse to overcome the moral distress on the job:
- Become aware of your own values and ethical aspects of nursing.
- Be familiar with nursing codes of ethics.
- Seek continuing education opportunities to stay knowledgeable about ethical issues in nursing.
- Respect the values, opinions, and responsibilities of other health care professional that may be different from your own.
- Serve on institutional ethics committees.
- Strive for collaborative practice in which nurses' function effectively in cooperation with other health care professionals.
9.5. MANAGEMENT OF PERSONAL HEALTH INFORMATION
Keeping the client’s privacy is both a legal and moral mandate. The client must be able to trust that the nurses will reveal details of their situations only as appropriate for the health care. Nurses should help develop and follow security measures and policies.
INTRODUCTION SPECIFIC ETHICAL ISSUES IN NURSING
Nurses face ethical issues daily regardless of where they practice. They are faced with ethical decisions that can impact them and their patients. Ethics is the science relating to moral action and one’s value system. Nursing ethics provides the standards for professional behavior and is the study of principles of right and wrong conduct for nurses. Nursing ethics states the duties and obligations of nurses to their clients, other health professional, the profession and the community.
Ethics promotes the philosophical and theological study of morality, mental judgments and moral problems. Nurses adhere to certain ethical principle when caring for patients. These principles include beneficence which is doing no harm to the patient, maleficence which is doing harm to a patient for positive outcome, justice in allocating care based on need not status and patient autonomy which is respecting the patient’s right to make health decision
LEARNING OUTCOMES
At the end of the lecture, student will be able to :
- Discuss specific ethical issues in nursing.
- Explain step of decision making and the need.
- Discuss society role.
- Elaborate the ethical issues in nursing implications
- Prevent conflict with the principles of ethical nursing practice.
a. SPECIFIC ETHICAL ISSUES
Several factors contribute to the frequency of nurse's ethical issues:
Societal factors - Increased consumer awareness e.g., informed consent for treatments
and technological advances
b. ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
Because of its association with sexual behavior, illicit drug use, physical decline and death.
AIDS bears a social stigma. The American Nurses Association’s position on AIDS – the moral obligation to care for HIV-infected client cannot be set aside unless the risk exceeds the responsibility.
c.i. ABORTION
The debate continues between the sanctity of life and the right for a woman to control her own body. Conscience clauses give the caregiver the right to refuse to participate in abortions, but they cannot impose their values on the client. The client has a right to be educated about all choices.
Abortion is defined as expulsion of fetus and products of conception with fetus
weight less than 500gram.
c.ii. ABORTIONS IN MALAYSIA
Abortion laws provide specific guidelines for nurses about what is legally permissible. Section 312 of the Penal Code states that a termination of pregnancy is permitted in circumstances where there is risk to the life of the pregnant woman or threat of injury to her physical or mental health.
Although terminations are permitted, the law is nevertheless limited. Under the Penal Code it is the doctor alone who makes the decision as to whether a termination should be carried out. This is especially worrying in view of the results from the 2007 survey by the Reproductive Rights Advocacy Alliance of Malaysia (RRAAM) which found that only 57 per cent of 120 doctors and nurses surveyed knew that abortion is legal in certain circumstances.
c.iii. . COMPARISONS MADE WITH OTHER COUNTRIES
Abortion laws, generally, are historically framed as criminal offences and they tend to be amended later towards providing more liberal grounds for abortions. Exceptions added later range from ‘threat to life’ and ‘threat to physical or mental health’ up to ‘economic-social reasons’, and, ultimately, to allowing abortions ‘on demand’. Sometimes, specific conditions are stated, e.g. rape, fetal malformations, contraceptive failure, etc.
Examples given were Australia, Singapore, Vietnam, China – very liberal, permitting abortions on all the above grounds. The Philippines and Sri Lanka represent the other extreme, where abortions are restricted only in order ‘to save her life’. This has resulted in high rates of unsafe abortions and frequent hospital admissions for serious complications.
Malaysian law, by comparison, lies in between; it is ‘moderately permissive’. An important point to clarify: mental health under our Penal Code does not require psychiatric assessment.
Additional requirements: Third party authorization by a medical professional is required. The legal period allowed is 120 days and the woman’s consent is required. If she is not ‘quick’ with child, they are subject to up to three years imprisonment and/or payment of a fine. A woman usually considered to be ‘quick’ with child around the fourth month of pregnancy.
If the abortion results in the death of the woman and she has consented, the person performing the abortion is subject to up to 10 years imprisonment and payment of a fine .If the woman did not consent, the person is subject to up to 20 years imprisonment.
In conclusion:
Nurse needs to be aware of their code of professional conduct in matters dealing with abortion. Their role in health promotion especially in Reproductive Health would help women to make informed, decisions.
d. ORGAN DONATIONS
d.i. ORGAN TRANSPLANT
Ethical issues related to organ transplantation include allocation of organ, selling of body parts, involvement of children as potential donor, consent, clear definition of death and conflicts of interest between potential donors and recipients.
It means that "Organ donation" refers to donation of organs upon death. If a person is brain dead, certain organs like the cornea, heart, kidneys, liver, lungs, skin, and bones can be harvested to enable a transplant to take place and used to save more than one person's life. Process: tissues or organs are removed from a live, or recently dead, person to be used in another.
The procedure goes as - Donor gives the organs, Recipient gets the organs , People of all ages can become donors and the Organs can also come from animals (xenotransplantation)
SOCIETY’S ROLE
To increased public awareness regarding organ donation in order to develop a greater efforts to dispel public concerns in such that the organ donation can help with tragedy so much so it’s clearly understood that "organs wasted are lives lost”
d.ii. TYPES OF DONORS
Can ether be - Dead donors that almost all organs can be donated by someone dead but the organs have to reach the recipient within a few hours after the donor's death.
• Brain death
• Donation after cardiac death (DCD)
• Tissue donation
Or Live donors – from related and unrelated family members
d.iii. CONSENT POLICY FROM DONOR
Cadaver donation - Relatives provide consent OR State law may allow other surrogate consent.
Generally voluntary - opt In: Donor consents in advance / opt Out: Anyone who has not refused is considered a donor
While In live donation the donor consents - Parental for children give the consent
d.vi. ORGAN DONOR CRITERIA - The standard policy to follow are as indicated below:
• Age is generally less than 80 but is based on patient’s current medical history.
- Dead by neurologic criteria - “Brain Dead”
• Dead by cardio-pulmonary criteria
• Medical history is examined at the time of death.
- Free of HIV - All serologies are examined at time of death but HIV to HIV is possible.
d.v. TISSUES DONOR CRITERIA
Normally the donation occurs after cardiac death. The criteria to follow are.
• Age < 70
• Recovered within 24 hours after death if body is cooled in the first 12 hours.
• No active, transmissible disease
• No autoimmune disorder
The common tissues being transplanted are Heart valves, Pericardium, Skin, Bone -Whole or processed grafts, Veins, Fascia, Ligaments/Tendons, Eyes: Cornea, Sclera or Whole Eyes for Research
e. EUTHANASIA - END OF LIFES
It is an advance Directives – as indicated all 40 states have enacted advance directive legislation. Having the client complete these saves many moral and ethical decisions. Euthanasia and assisted suicide. Euthanasia is a Greek word meaning ‘good death’. It is sometimes call mercy killing.
It is defined - Euthanasia is generally defined as the act of killing an incurably ill person out of concern and compassion for the person’s suffering. The term euthanasia normally implies an intentional termination of life by another at the explicit request of the person/client who wishes to die.
e.i. TYPES OF EUTHANASIA
• Voluntary euthanasia: When the person who is killed has requested to be killed.
• Non-voluntary: When the person who is killed made no request and gave no consent.
• Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary.
• Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. suicide."
• Euthanasia By Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection.
• Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.
e.ii. PASSIVE EUTHANASIA
Hastening the death of a person by altering some form of support and letting nature take its own course is known as passive euthanasia. e.g., turning off respirators, halting medication, discontinuing food and water which allows the client to dehydrate or starve to death or failure to resuscitate.
Passive euthanasia also includes giving the client large doses of morphine to control pain. The likely hood that the pain killer can suppress respiration which cause death earlier. e.g., Administering such medication is regarding as ethical in most political jurisdictions and by most medical societies.
Passive euthanasia is now more commonly known as withdrawing or withholding life sustaining., or therapy (WWLST) e.g., withholding special attempts to revive a client.
e.iii. ACTIVE EUTHANASIA
Active euthanasia involves causing the death of a person through a direct action. The religious perspective indicated that Muslims are against euthanasia. Life is sacred. Euthanasia and suicide are not included among the reason allowed for killing in Islam. The reasons for euthanasia are due to unbearable pain, right to commit suicide or willingly to die
e. vi. EUTHANASIA AND ASSISTED SUICIDE
The ANA (American Nurses Association) states that both active euthanasia and assisted suicide are in violation of the Code for Nurses.
allowing a person to die by withholding or withdrawing measures to maintain life (withdrawing or withholding life-sustaining therapy. This is both legally and ethically more acceptable to most persons than assisted suicide.f. TERMINATION OF LIFE-SUSTAINING TREATMENT
Nurses must understand that a decision to withdraw treatment is not a decision to withdraw care. As the primary caregivers, nurses must ensure that sensitive care and comfort measures are given as the client’s illness progresses.
f.i. WITHDRAWING OR WITHHOLDING FOOD AND FLUIDS
It is generally accepted that providing food and fluids are administered by a tube to a dying patient or are given over along period to an unconscious client who is not expected to improve, then some consider it to be extraordinary. A nurse is morally obligate to withhold food and fluids (or any treatment) if it is determined to be more harmful to administer them than to withhold them. The nurse must also honor competent and informed clients’ refusal of food and fluids.
f.ii. ALLOCATION OF SCARE HEALTH RESOURCES
The moral principle of autonomy cannot be applied if it is not possible to give each client what he or she chooses. In this situation, health care providers may use the principle of justice – attempting to choose what is most fair to all. Some nurses are concerned that staffing in their institutions is not adequate to give the level of care they value. California is the first state to enact legislation mandating specific nurse-to-client ratios.
It clearly explained that the increase in technological advances and the growing numbers of elderly population have expanded the ethical dilemmas faced by elders and the healthcare profession. Providing them with competent care information and professional assistance as well as the highest quality of care and caring is of almost importance. The ethical problems faced by nurse involves issues on euthanasia, assisted suicide, termination of life sustaining treatment and or withdrawing/withholding food and fluids. And the nurses have to practice based on ethics and legislation (Law)
g.DO NOT RESUSITATE
It is defined as the legal ordered by the physician who care for the patient’s.
A DNR (Do Not Resuscitate) Oder or no code is a legal order written or a doctor's order initiated at the request of the patient who wishes and has decided not to have cardiopulmonary resuscitation (CPR) attempted in the event his or her heart or breathing stops.
A DNR is written to indicate that the goal of treatment is a comfortable, dignified death and that the further life-sustaining measures are not indicated.
g.i. PRINCIPLES OF DO NOT RESUSITATE
Consensus building is the most inclusive process for determining what is the best treatment for that individual, at that time, and in that place.
Normally the instructions being carried out according to: respect the patient’s wishes. Respect of life and care in dying. The right to know and to choose. Appropriate withholding and withdrawal of life sustaining treatment. A collaborative approach to care and transparency and accountability.
g.ii. CATERGORIES OF PATIENT FOR DNR
A competent patient who has stated his/her wish not to initiate or who has stated his/her wish to have life support withdrawn, Example: Competent patient have given clear wishes before the present episode of illness or those who have given do not resuscitate orders (DNR).
Terminal condition - Patient has a progressive, unrelenting terminal disease whose death is expected and in whom resuscitation represents a violation of the right to die with dignity.
Brain death - Brain death is perfectly legitimate and legal to withdraw all forms of life support once a diagnosis is made.
Other categories - Scoring system. APACHE (Acute Physiological and Chronic Health
Evaluation) - SAPS (Severe acute Physiological Score), Quality of life.h
g.iii. TYPES OF DNR
- Maximal (Restorative) Care Before Arrest, Then DNR
In this option, one requests the full scope of restorative care before the heart stops or before breathing stops. This may include Intubation, Cardiac monitoring, IVs, Drug therapy. Or if at any time during treatment the patient's heart or breathing stops, the patient will not be resuscitated; that is, personnel will not provide CPR, cardiac pacing, defibrillation or drug therapy.
- Limited (Palliative) Care Only Before Arrest, Then DNR
In this option, treatment given by emergency medical personnel may include Opening the airway by non-invasive means, Passive oxygen, controlling external bleeding, Positioning for comfort, Splinting, if necessary or transportation to hospital or designated facility capable of providing in-patient hospice care.
g.vi. THE PALLIATIVE CARE THAT NEEDS TO BE CONSIDERED ARE ONLY BEFORE ARREST, THEN DNR
If at any time the person's heart or breathing stops, the emergency medical personnel will not provide CPR, cardiac pacing, defibrillation, or drug therapy.
g.v. STEPS IN DECISION MAKING FOR DNR
- Medical consensus - It is essential that the primary physician and the intensive care team have agreed on a consensus before any decision is taken.
- Nursing consensus -it is essential that they also are in support of the decision to withhold or withdraw therapy.
Communication / Documentation: DNR form / BHT (red pen)
g.vi. THE ANA(2003) MAKES THE FOLLOWING RECOMMENDATIONS RELATED TO DNR ORDERS
- The competent client’s values and choices should always be given highest priority.
- When the client is incompetent, an advance directive or the proxy decision makers acting for the client should make health care treatment decision.
- A DNR decision should always be the subject of explicit discussion between the client, client’s family, any designated decision maker acting on the client’s behalf, and the health care team.
- DNR orders must be clearly documented, reviewed and updated periodically to reflect changes in client’s condition.
- A DNR order is separated from other aspects of a client care and does not imply that other types of care should be withdrawn.
g.vii. STRATEGIES TO ENHANCES ETHICAL DECISION AND PRACTICE
The following strategies should be taken by a nurse to overcome the moral distress on the job:
Become aware of your own values and ethical aspects of nursing. Be familiar with nursing codes of ethics. Seek continuing education opportunities to stay knowledgeable about ethical issues in nursing. Respect the values, opinions, and responsibilities of other health care professional that may be different from your own. Serve on institutional ethics committees. Strive for collaborative practice in which nurses' function effectively in cooperation with other health care professionals
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