Mais conteúdo relacionado



  2. HISTORY  Concept of accountability is not new.  Public expectations of the need for auditing of official expenditure (one form of accountability) was evident in Athens as long as 400 B.C.  Although nurses were legally accountable from 1919 with passing of Nurses Registration Act.
  3. HISTORY (contd.)  With time, obedience & importance of following orders was stressed in nursing.
  4. HISTORY (contd.)  Concept of accountability has evolved over the years i.e.  Regular reporting to explanation of actions & outcomes.  Justification of values informing actions & outcomes
  5. ACCOUNTABILITY  Being free to act.  Being obliged to give an account of one’s actions.  Being capable of giving an account.  Being responsible for one’s own actions.  Being capable of accepting the consequences of one’s own actions.
  6. NURSING ACCOUNTABILITY  ACCOUNTABILITY is an obligation to accept responsibility or to account for one’s actions to achieve desired outcomes. Accountability resides in role & can never be delegated away. Accountability is always about the outcomes, not process, which are simply the means through which outcomes are achieved.  Porter O’Grady & Wilson.
  7. DEFINITION (contd.)  According to Black’s Law Dictionary, Accountability is defined as the state of being responsible & answerable.
  8. Definition ( contd.)  Mc Farlane in 1987, developed her argument by saying that accountability implies “decision making about nursing care based on sound knowledge & the standards & criteria”.
  9. LINES OF NURSING ACCOUNTABILITY  According to Hunt, there are Upward accountability: it implies “looking up the line & doing what the managers & administrators require”.
  10. LINES OF NURSING ACCOUNTABILITY (contd.)  Lateral accountability: it implies to self regulation, in which practitioners are accountable to & judged by the criteria set by the peers.  Downward accountability: it implies to public accountability in which staff is accountable to the patients.
  11. LINES OF NURSING ACCOUNTABILITY ( contd.)  According to Dewar (1999);  Administrative line:  Organizations are accountable to the government.
  12. LINES OF NURSING ACCOUNTABILITY (contd.)  Professional line: Clinicians are accountable to the organizations that regulate their profession.  Inspection line: Between government & independent inspectors
  13. THE GROUNDWORK FOR ACCOUNTABILITY  It is the growth of theoretical and concept base for nursing practice that allows the to truly accountable in this technological and scientific field.  Programmes are urgentaly to help the practicing nurse understand available research report and apply the findings to work situtions.  Research & Establishment Of Theoretical Base For Nursing
  14. TYPES OF NURSING ACCOUNTABILITY According to Leat,  Fiscal accountability: deals with financial probity & the ability to trace & adequately explain expenditure.  Process accountability: Concerned with the use of proper procedures.
  15. TYPES OF NURSING ACCOUNTABILITY (contd.)  Programme accountability: concerned with the activities undertaken & their quality.  Priorities accountability: deals with the relevance or appropriateness of chosen activities.
  16. TYPES OF NURSING ACCOUNTABILITY(contd.) Nursing accoun tability Social accounta bility Ethical accounta bility Professio nal accounta bility Legal accounta bility Employ ment account ability
  17. TYPES OF NURSING ACCOUNTABILITY  SOCIAL ACCOUNTABILITY ◦ Sets the norms for acceptable behavior within the society
  18. SOCIAL ACCOUNTABILITY (contd.)  According to WHO, Four values are: ◦ Relevance ◦ Quality ◦ Cost-effectiveness ◦ Equity in service
  19. TYPES OF NURSING ACCOUNTABILITY (contd.)  ETHICAL ACCOUNTABILITY:  Ethical structure are important in health.  Ethical rules form part of accountability in nursing.  Ethical accountability may be set by rules decided by society that cover everyone.  Society may allow conscientious objections to some activities in health
  20. ETHICAL ACCOUNTABILITY (contd.) Relates to moral obligations. Stresses values & principles identified with various ethical approaches such as:
  21. LEGAL ACCOUNTABILITY  Law is a major area of accountability.  Law is a set of rules, regulations & cases that provide interpretation of the rules & regulations which apply to society.  Two systems of law:  Civil law  Criminal law Each system has its own rules & its own court system.
  22. LEGAL ACCOUNTABILITY (contd.)  Civil law: ◦ Includes arrangement in area such as family law, employment law & in areas such as negligence & consent. ◦ Includes disputes between staff & the employer ◦ Involves paying compensation.
  23. LEGAL ACCOUNTABILITY (contd.)  Criminal law: ◦ Includes rules set by the Parliament to be followed every member of the society. ◦ Deals with the issues such as  Medication  Fertility treatment  Suicide,  Organ & tissue donation,  Mental health &  Decision about health care
  24. LEGAL ACCOUNTABILITY (contd.)  Criminal accountability(contd.) ◦ Criminal law sanctions may involves fines & imprisonment.
  25. EMPLOYMENT ACCOUNTABILITY  Another source of accountability  Contract of employment sets out the responsibilities & rights for the nurse & the employer.  Job description may give more detail & set out the extent of the nurse’s role.
  26. EMPLOYMENT ACCOUNTABILITY (contd.)  Protocols & policies may set out specific activities in employment relationship.  Disciplinary measures can be taken by each party in employment relationship.  Range from warning through
  27. PROFESSIONAL ACCOUNTABILITY  At heart of nursing practice.  Creates principles of conduct.  Allows the nurses to work within the framework of practice.  Regulatory body for nurses & midwives.  Currently known as Nursing & Midwifery Council (NMC).
  28. PROFESSIONAL ACCOUNTABILITY (contd.)  Function of NMC: To create the limits on professional accountability in nursing & midwives practice.  NMC Code of Professional Conduct Clause 1.3 states that  ‘You are personally accountable for your practice. This means that you are answerable for your actions & omissions, regardless of advice or directions from another professional.’
  29. PROFESSIONAL ACCOUNTABILITY (contd.)  NMC Code of Professional Conduct is personal to every nurse & midwife.  Relationship between nurse or midwife & NMC is a personal & cannot be delegated to another nurse or midwife.
  30. PROFESSIONAL ACCOUNTABILITY (contd.)  Breach of duty is considered to occur if the nurse performs an unauthorized act, fails to act or carries out an unauthorized act improperly.  If a nurse found guilty of a breach of duty, he or she may lose his or her license or be a defendant in a malpractice law suit.
  31. ACCOUNTABILITY & NURSING’S PROFESSIONAL BODIES.  Before 2002, UKCC had been the professional regulatory body for nurses, midwives & health visitors.  First edition published in 1983 ‘the code of professional conduct’.
  32. Accountability & Nursing Professional Bodies (contd.)  Confusing clauses in the exercise of professional accountability were ◦ Work in a collaborative & co-operative manner with other health care professionals & recognize & respect their particular contributions within the health care team (Clause 5)
  33. Accountability & Nursing’s professional bodies (contd.)  Have regard to the environment of care & its physical, psychological & social effects on the patients & also to the adequacy of resources & make known to appropriate persons or authorities any circumstances which could place patients in jeopardy against safe standards of practice. (clause 10)
  34. Accountability & Nursing’s professional bodies (contd.)  Have regards to the work load of & the pressures on professional colleagues & subordinates & take appropriate action if these are seen to be such as to constitute abuse of the individual practitioner or to jeopardize the safe standards of practice. (clause 11)
  35. Accountability & Nursing’s professional bodies (contd.)  In response to this, UKCC published ‘Exercising Accountability’ which provide central focus of the Code- ◦ “accountability is an integral part of professional practice, since in the course of practice, the practitioner has to make judgments in a wide variety of circumstances & be answerable for those judgments”.
  36. The Positive Aspect Of Accountability  Greater resposibility  Health care delivery.  Maintaining safe standards for clients.  Control over their practice.  Gain self respect.
  37. SUMMARY OF THE PRINCIPLES AGAINST WHICH TO EXERCISE ACCOUNTABILITY  Interest of the patient are paramount.  Professional accountability must be exercised in such a manner as to ensure the primacy of the patient is respected.  The exercise of accountability requires the practitioner to seek to achieve & maintain high standards.
  38. SUMMARY OF THE PRINCIPLES AGAINST WHICH TO EXERCISE ACCOUNTABILITY (contd.)  Advocacy on behalf of patients .  Role of other persons in the delivery of health care to patient.  Public trust & confidence in the profession.  Each registered nurse must be able to justify any action taken in course of her professional practice.
  39. SUMMARY Accomplishing a culture of accountability, requires both individual & joint responsibility.  Leader’s role – to focus on removing barrier  Staff’s role – to embrace the concept, model behaviors & spread key learning.
  40.  A) Accountability to the client.  B) Accountability to the self.  C) Accountability to the public.  D) Accountability to the profession.  E) Accountability to the agency. A cheklist for accountability:
  41. PROVERB  Ahako a he iti, he pounamu  Though it is little it is special
  42. BIBLIOGRAPHY •Kozier Barbara “Fundamentals of Nursing” Published by Pearson Education Pvt. Ltd. 7th Edition Page No.85,516. •Trained Nurses Association of India “Fundamentals of Nursing – A Procedure Manual” Published by Secretary General (TNAI). Edition 2005 Page No.121. •BT Basvanthappa “Nursing Education” Published by Jaypee Bros. Pvt. Ltd. 1st Edition Page No.56. •BT Basvanthappa “Nursing Administration” Published By Jaypee Bros. Pvt. Ltd.2nd Edition Page No.65. •Wikipedia – the free encyclopaedia from • nursing
  43. Thank you