PROFESSIONALISM IN NURSING

MODULE CODE:NMT 04102

9: PROFESSIONAL, LEGAL AND ETHICAL
PRINCIPLES RELATED TO NURSING AND
MIDWIFERY PRACTICE
 Objectives

At the end of these session students should

be able to:
1. Define the terms nursing, patient and
care
2. Explain functions and roles of a nurse
3. Explain qualities of professional nurse
4. Explain historical background of nursing
in Tanzania
 Cont…

5. Explain four elements of code of ethics

for nurses
 Overview

• The concepts of nursing practice derived

from various aspects of care and its
application to the professional.
• The practice of nursing is conducted by
skilled personnel trained with special
knowledge on how to perform various
nursing practice.
 Cont…

• Principle of nursing practice is bind by the

ethical code of conduct which enables an
individual to value the life of each other
within the professionals and clients in the
health care setting.
 Common Terms in Nursing

 Profession - Is a group (vocational or

occupational) that required specialized
education and intellectual knowledge
 A nurse - Is a registered person with
specialized education program capable of
working independently in solving patient’s
care problems and is able to teach and work
successfully with others in the medical care
team
 Cont…

 Nurse - Is a person with good character,

experienced a sense of calling and who is
well trained to meet the physical needs
of patients (Nightingale definition)
 Cont…

 Nursing - Is an art and a science where

by a professional nurses learns and
acquires competencies to deliver
compassion care and respect to
patients.
 Cont…

 Nursing - Is the protection, promotion,

and optimization of health and abilities,
prevention of illness and injury,
alleviation of suffering through the
diagnosis and treatment of human
response, and advocacy in the care of
individuals, families, communities and
populations ( ANA, 2003)
 Cont…

 Patient – Is a person receiving or

registered to receive a medical treatment
 Client - Is a person using the services of a
professional person or organization
 Care -
 Cont…

 Practice - Is the art of doing something in

accordance to set standards
 Cont…

 Nursing profession - Is a field of practice

whereby individual nurses has acquired
all competencies and demonstrate
ongoing criteria of a profession.
 A professional nurse has the following
criteria:
Provide unique service to society
 Cont…

Work as intellectual and distinguished

person with body of knowledge
Expand body of knowledge in nursing to
meet the demands of the health care
deliveries
Responsible and accountable to public
services
 Cont…

Undergoing a period of education

including both theory and practice
Autonomy and ability to develop policy
about the discipline and control of the
related activity
 o Adhere to code of ethics and conduct
 Cont…

Motivate other member for carrier

choice and development
Share common attitude, identity and
values
 Cont…

 Caring - Is a universal phenomenon that

influences the ways in which people think,
feel and behave in relation to one another.
 In nursing, caring is an inherent features of
nursing practice that creates possibility,
determination and involvement to others
events, things or matters to a person.
 Cont…
 Health - Is the state of complete physical,
mental and social well-being and not merely
the absence of disease or infirmity (WHO)
 Hospital - Is an institution where sick or
injured are given medical or surgical care.
These institutions are categorized according to
the types and levels of health care services
provided
 Cont…

 Environment - Is the complex of physical,

social and cultural conditions that affects
the nature of individual or community
 Ethics - Is a system of moral principles or
standards governing conduct. It is
concerned with judgments about what is
right or wrong conduct in relation to moral
conflicts.
 Cont…

 Etiquette - Is the code of behavior that

delineates expectation for social behavior
according to the contemporary conversion
nouns within a society and social group.
 Code - Is an authoritative system of written
rules, which are similar to Law and are
binding and formulated to regulate
behavior
 Cont…

 Principle - Is an accepted role of action

for conducts which guide the standards
of performance
 Ethical Principle - Ethical Principle is the
process in decision making and problem
solving undertaken by a person with a
sound moral principle.
 Cont…

 Code of ethics - Is the rule that governing

and regulates the conduct of members
 Code of conduct - Provides a framework
that defines the core value and standards
which professional must follow.
 Cont…

 Values - Refers to something that is

perceived as desirable or „‟the way
things ought to be”.
 Physician - Is a person who has
successfully completed a course of
medical studies and is licensed to
practice medicine in a particular
jurisdiction.
 Cont…

 Dentist - Is a person who trained and

licensed to diagnose, treat and prevent
dental problem.
 Physiotherapist - Is a person who trained
and licensed to assist client with
musculoskeletal problems by means of
heat, water, exercise, massaging and the
use of electrical current
 Cont…
 Laboratory technician - Is a person who
is trained and licensed to examine
specimens from the client/patient such
as blood, urine, feaces and discharges
from wound to provide exactly
information that facilitate the medical
diagnosis and prescription of proper
therapeutics.
 Cont…

 Pharmacist - Is a person who is trained

and licensed to prepare and dispensing
pharmaceuticals in hospitals and
community settings.
 Cont…

 Radiologist - Is a person who is trained

and licensed to assist with a variety of x-
ray film procedures from simple chest
radiography to more complex
fluoroscope
 Dietitian or Nutritionist - Is a person
who has special knowledge about
nutrition and food.
 Cont…

 Social worker - Is a person with

knowledge and skills on counseling
clients and support person about social
problems at all settings.
 Functions and Roles of a Nurse

Individual assignment
 Qualities of a Professional Nurse

 Nursing is considered as a holy

profession, serving the human being.
This profession demands skill,
hardworking and devotion.
 To become a good nurse, a person should
have the following qualities that portray
professional criteria:
 i. Should have a sound knowledge of the nursing
profession, obtained from a reputed institute.

 Should always be ready to learn more.

 As a nurse is more frequently in contact
with the patients should have excellent
communication skills.
 These include speaking as well as
listening skills.
 ii. A good nurse should be emotionally
stable
 Nursing is a very stressful job. Every day
the nurses witness severe traumatic
situations, surgeries and deaths.
 The nurse should be mentally strong and
should not get disturbed by such
incidences. Good presence of mind is
crucial in the nursing profession.
 Cont…

 In any critical condition or medical

emergency, if the doctor is not there,
then the nurse should not get confused.
Should be confident enough to take the
correct decisions.
iii. The nurse should be able to openly talk with the patients and
their family members in order to understand their needs and
expectations

 Should be able to explain the treatment given

to the patient.
 Should be alert every moment about the
condition of a patient.
 Should be able to notice a minor change in
the patient’s health status.
 iv. Kindness and empathy are the qualities that
every nurse should possess
 The nurse should be calm and kind to the
patients, even if they are aggressive.
 v. A good nurse should be highly qualified
and trained.
 Good professional skills are a must for
the nurse
 Watchfulness is an important quality of a
good nurse
 The nurse should understand the pains
and suffering of patients
 Cont…

 A good nurse should be flexible about

his/her working hours and
responsibilities
 Should provide comfort and sympathy to
the patients, instead of getting angry
with them.
 Cont…

 Medical emergencies can occur at any

time. Nurses often have to extend their
duty hours, work in overnight shifts, or
work on weekends too.
 vi. A good nurse should have a strong
physical endurance
 Should be able to perform a number of
taxing maneuvers, stand up for a long
period of time or lift heavy
objects/people on a daily basis.
 vii. A nurse should have a respect for
people and rules
 Should be devoted to the profession.
 Should be aware of different cultures and
traditions and confidentiality
requirements of the patients. He/she
should respect the wishes of the
patients.
viii. A nurse should be active and cheerful

 Her/his presence should make the

patient relaxed and comfortable.
 The nurse’s pleasant appearance can
reduce the patient’s stress and pains.
 His/her voice should be soft and gentle.
HISTORICAL BACKGROUND OF
NURSING IN TANZANIA
 Historical Background of Nursing
Worldwide
i. Nursing in the Ancient Times
 Nursing did not exist as a unique discipline
before the birth of the Christian Era
 The nursing which existed was that of a
mother caring for her sick child or relative
 During those days illnesses were believed to
be the result of the anger of gods or the work
of evil spirits
 ii. The Ancient Egypt, 4000 B.C

 During this time the priests were the

healers
iii. The Babylonia, 2000 B.C
 The people looked at diseases as being
the result of sin
iv. The Indians, 1000 to 800 B.C
 The Indians had a highly developed
culture and good sanitation
 v. The Jews

 The Jewish race had the finest record in

hygiene and sanitation
 They had also a good knowledge of
Anatomy and Physiology
vi. The Greeks, 1200 B.C
 Many “Temple–hospitals” were built in
memory of the god Aesculapius
 Cont…

The usual method of deciding any

particular treatment was that the patient,
on entering the hospital, prayed to the god
Aesculapius
 vii. The Romans, 800 B.C.

 They were influenced by the Greek

medicine
 The “Valetudinarians” were building in
which the soldiers and slaves were
treated and cared for in order to increase
manpower
 viii. The Christian Era, 50 A.D.

 The early Christians were inspired by the

teaching of Christ
 Christ taught to help each other like
brothers and sisters
 Service to the sick and the poor was
service to God
 The bishops formed the religious orders
of DEACONS AND DEACONESSES
 ix. The Dark Period of the Nursing, (18th
Century.)
 Despite of new discoveries and great
scientific development in medicine, the
religious life of the community was
shallow
 Only a few people were ready to join
religious Congregations and those who
joined were illiterate
 x. Development of Modern Nursing,
(19thCentury)
Four types of organization developed
gradually in order to improve the
deteriorated care for the sick
i. The Catholic Religious Congregations
ii. Lutheran Deaconesses
iii. Civil Orders Especially the Red Cross
 Cont…

iv. Civil Nursing 1820 – 1910 Florence

Nightingale
 Is the pioneer in Nursing Education
 In 1860 she founded the first nursing
school at St. Thomas Hospital, London
 Cont…

 By the middle of 18th century and the

beginning of 19th century, nursing
services started to be delivered by civil
nurses – women who did not belong to
religious congregations
 The Historical Background of Nursing in
Tanzania
 In Tanzania traditional, the care of
patients and women in child birth was
carried out by elder, married women in
the community
 Western medicine was brought to
Tanzania by then Tanganyika by the
missionaries of the different churches
 Cont…

 At the beginning the Africans preferred

to trust their traditional midwives
 Therefore the missionaries sought for
cooperation with these traditional
midwives
 They taught them personal hygiene by
using soap and water and also simple
midwifery techniques
 Nursing Training in Tanzania

 In 1925-African District Sanitary

Inspectors were trained in Dar es Salaam,
Tanga and Tabora
 The students were taught Anatomy,
Physiology, Elementary Medicine, Minor
Surgery and Dental Practice
 In 1936 the course for Dispenser (later
called Medical Assistants)
 Cont…

 As young men and women had some

education at the mission primary
schools, were trained to become nurses
 It was not difficult to obtain young men
for the training, but there was strong
opposition to the idea of young women
being allowed to attend child birth or to
nurse male patient
 Cont…

 From 1930 to 1939 Several missions in

Tanganyika took up the training of nurses
 At this time, a Matron in Chief was
appointed
 The progress in Nursing Education
continued as follows
 In 1947 the first group of girls were
trained as nurses by the government at
Sewa Haji Hospital in Dar es Salaam
 From 1950 – 1960 Thirteen school for
nursing training were existing
 Cont…

 The nursing schools run by the missions

as well as government were: Mweka,
Tanga Princess Margareth in Dar es
Salaam, Mvumi, Peramiho, Kiomboi,
Magila, Ndolage, Kolandoto, Mnero,
Sumve and Kongwa
 Cont…

 In 1951 a new course with an annual

intake of 12 students was established at
Tukuyu to train Health Nurses
 The course took two years, and included
Midwifery, Child Care Nursing, Nutrition,
Hygiene, First Aid and domestic science
 The Tanganyika Nurses and Midwives
Council

 In the year 1952 the Tanganyika Nurses and

Midwives Council was set up and enacted in
1953 by the act of Parliament as a “Statutory”
body to govern the affairs of nurses. In 1997
the profession was regulated under the
reviewed Tanzania Nurses and Midwives
Registration Act of 1997. Currently the
profession is regulated through Tanzania
Nursing and Midwifery Act of 2010
 Cont…
 In 1956 the medium of instruction in nursing
schools was changed from Swahili to English
except in the Health Nursing Training Schools
at Tukuyu
 After the independence in 1961, there were
few European nurses left
 One year up-grading course was introduced
by the Ministry of Health for registered
nurses and midwives
 Cont…

 In 1963 this course was discontinued

 A new nursing syllabus was introduced,
where by public health, midwifery and
general nursing were integrated for the
purpose to prepare an “all-purpose
nurse” who could work in a general
hospital, maternity ward or clinic
 Cont…

 In 1964 a 1-year up-grading course in a new

format was introduced, the candidates
were of 2 types; (Grade A & B)
 In 1966 a new syllabus was prepared which
reverted to the old system of separate
courses for General Nursing which lasted 3
years and Midwifery one year, designed for
primary school leavers
 Up - Grading Courses

 In 1970 the up-grading programme

changed. This time it was for grade ‘B’
nurses with a minimum working
experience of 3 – 4 years
 The course lasted for one and a half year
 After completion of the course they used
the title of “Staff Nurse
 Cont…

 With the increasing demand for public

Health Nurses, the former MCHA were
upgraded to Public Health Nurse ‘B’ for two
years
 From 1973 to 1986 Specialist schools of
nursing were established such as
Ophthalmic, Pediatric, Operating Theatre
Management, public health, mental health
and Nurse tutors
 Bachelor of Science Degree and Masters
Degree in Nursing
 In 1989 the Bachelor of Science Degree
in Nursing started at the University of Dar
es Salaam
 Cont…

 The course was under the Faculty of

Medicine, Muhimbili Medical Centre
Candidates eligible for the course are:
i. Pre-service candidates, Form VI
leavers studied for four year
ii. In–service candidates, Diploma in
Nursing studied for three years
 Cont…

 From 1998 to 2009 courses on bachelor

of Science in Nursing established at
Hubert Kairuki Memorial University,
Agha-Khan University, Tumaini University,
IMTU, Dodoma University and St John’s
University
 In 2007, Masters degree in nursing were
established at Muhimbili University,
School of Nursing
 References

1. Marquis, B. L., & Huston, C. J. (2009).

Leadership roles and management functions
in nursing theory and application (6th ed.).
USA: Lippincott Williams & Wilkins.
2. Potter, P., & Perry, A. (2005). Fundamentals of
nursing (6th ed.). USA: Mosby.
3. TNMC. (2007). Code of professional conduct
for nurses and midwives in Tanzania. Dar es
Salaam: Tanzania.
 10: LEGISLATION GUIDELINES IN
PROVIDING NURSING AND MIDWIFERY
CARE
Learning Tasks
By the end of this session, students are expected
To be able to:
1. Define the common terms related to legislation
in nursing practice
2. Explain the importance of legislation in nursing
practice
3. Describe nursing legislation guideline in Tanzania
4. Utilize legislation guideline in nursing practice
 Introduction

• Ethics is and always has been an essential

component of nursing practice.
• Ethical principles such as respect right to life,
respect for persons, consent and confidentiality
are basic to nurse-patient relationship.
• However, the application of these principles in
specific situations is often problematic, since
nurses, patients, their family members and other
healthcare personnel may disagree about what is
the right way to act in a situation.
 Definitions of terms
• Ethics: Is a system of moral principles or
standards governing conduct. It is concerned
with judgments about what is right or wrong
conduct in relation to moral conflicts
• Legislation: Means laws that in each state are
used as instruments that define the scope of
practice.
 Definitions of terms cont…
• Negligence: Is defined as a conduct which fall
below the set standards which are established
by law or regulation (failure to conform with
applicable standards of care)
• Malpractice: Means doing wrong or bad thing
resulting to harm or tort.
 Definitions of terms cont…
• Legal liability:
 Means that the perpetrator must bear the
punishment for his/her act or compensate the
aggrieved party.
 It must be proved that the conduct caused
harmful consequence, which is sometimes
problematic.
 The conduct must be Wrongful or Unlawful and
therefore unreasonable in the eyes of society,
lastly the individual must be responsible
 Importance of legislation in nursing
practice
Legislation is important for nurses as it keep
directives on professional conduct and
practice.
Having legislation provide public health
protection, promotion and preservation of the
public health, safety and welfare through
regulation and control of nursing and
midwifery education and practice
 Nursing legislation guideline in Tanzania

In Tanzania the legislation guideline which is

governing nursing and midwifery practice is
Tanzania Nursing and Midwifery Act, 2010 together
with its regulations.
There are four prepared regulations as follows;
a) The Nursing and Midwifery (training)
regulations,2010
This regulation provides guide to any individual
who wishes to establish nursing and midwifery
school. This includes the registration, licensing
and implementation of curriculum
 Nursing legislation guideline in Tanzania
cont…
b) The Nursing and Midwifery (practice)
regulation, 2010
This regulation provides guidance on the
process to be adhered by a nurse practitioners
and those wishes to establish private nursing
and midwifery practice
 Nursing legislation guideline in Tanzania
cont…
c) The Nursing and Midwifery (fitness to
practice) regulation,2010
• Regulation provides information on the
process to be carried to deal with any
reported complaints to the Council on nursing
misconduct
 Nursing legislation guideline in Tanzania
cont…
d) The Nursing and Midwifery (registration,
enrollment and licensing ) regulations,2010
• This regulation provide information on the
categories for registration parties, conditions,
requirement and procedure to be followed for
registration as well as well as the removal
from the register roll to Tanzanian and
oversees Nurses and Midwives.
 Evaluation

1. What is the difference legislation and ethics?

2. What are the importance of legislations
 References

• Brent, N. J. (1997). Nurses and the law: A guide to principles and

applications. USA:
• W. B. Saunders.
• TNMC. (2010). Nursing and midwifery act. Dar es Salaam: The
United Republic of Tanzania
• Act Supplement.
• TNMC. (2010). Nursing and midwifery (registration, enrollment and
licensing) regulations.
• Dar es Salaam: The United Republic of Tanzania Act Supplement.
• TNMC. (2010). The nursing and midwifery (fitness to practice)
regulations. Dar es Salaam:
• The United Republic of Tanzania Act Supplement.
• Unknown. (n.d.). Nursing legislation. Retrieved from
http://www.righthealth.com
5: PATIENT’S AND SERVICE PROVIDER’S RIGHTS
IN THE PROVISION OF CARE
Learning Tasks
By the end of this session, students are expected
To be able to:
1. Define the term Patient’s rights and service
provider’s rights.
2. Explain patient’s rights in receiving nursing care
3. Explain nurse’s rights in providing nursing care
 Introduction
• The need for clients/patient rights is the largely
the results of vulnerability of the individual
because of the existing illness and the complexity
of the relationships in the health care setting.
• When individual person is sick and unable, thus
cannot assert his rights as he would if he was
healthy.
• Asserting rights require energy and an
underlining awareness of one’s rights in the
situation as a human been.
• In Tanzania client Chatter was established to
ensure the national policy and implementation of
the related programs adhere on sufficing the
mentioned rights.
 Definition of terms
• Rights: Is a privilege or fundamental power to
which an individual is entitled unless is
revoked by law or given up voluntarily.
• Patient/Client: Is any person who receives
medical attention, care or treatment following
illness or injury.
 Definition of terms cont…
Service Provider Rights or Nurse’s Rights
• Service providers, such as yourself, are
entitled to human rights as well as rights of a
worker. As a nurse, you have the right to a safe
environment, adequate working tools and
supplies, right to risk allowance, right to
professional autonomy and the right to
opportunities for further education,
promotion and career development.
 patient’s rights in receiving nursing
care
Be treated with compassion and love.
Be respected and receive respectful care.
Be informed of his /her health conditions and
prescribed treatment and procedure.
Privacy and confidentiality of all records and
communication regarding his/her care.
Be informed about the available resources.
 patient’s rights in receiving nursing
care cont…
 Refuse services, procedures, activities such as
research and treatments which are not comply
with the required standards.
 Be involved in decision making about the
treatment and care. The Parents, guardians,
family members, or others can also be involved to
choose and speak for patient/client who cannot
make decision for himself e.g. children,
unconscious/mental ill patient, elderly.
 patient’s rights in receiving nursing
care cont…
 Access to health services, facilities and
information regarding to their needs.
 Self-expression and self-determination (consent).
 Be aware with the hospital policy, rules and
regulations which apply into his/her care
including cost of the services delivery.
 Complain, review and appeal in accordance with
the established policy, rules and procedures. This
includes complaints about waiting times,
operating hours, the actions of health care
personnel, and the adequacy of health care
facilities
 Nurse’s rights in providing nursing
care
 Nurses have the right to practice in a manner that
fulfills their obligations to society and to those
who receive nursing care.
 Nurses have the right to practice in environments
that allow them to act in accordance with
professional standards and legally authorized
scopes of practice.
 Nurses have the right to a work environment that
supports and facilitates ethical practice, in
accordance with the Code of Ethics for Nurses
and its interpretive statements.
 Nurse’s rights in providing nursing care
cont…
 Nurses have the right to fair compensation for
their work, consistent with their knowledge,
experience, and professional responsibilities.
 Nurses have the right to a work environment that
is safe for themselves and their patients.
 Nurses have the right to negotiate the conditions
of their employment, either as individuals or
collectively, in all practice settings. This can be
done through professional Associations like,
TANNA, TAMA etc.
 Nurse’s rights in providing nursing care
cont…
 Nurses have the right to freely and openly
advocate for themselves and their patients,
without fear of retribution.
 Nurses have the right not to be abused in any
form by physicians, pharmacists, administrators
or nursing directors. Any abuse that occurs
should be dealt within a professional and in
partial manner by the nurse's employer.
 Nurses have the right not to be exploited and
abused by being floated to areas of practice that
they are not familiar with.
 Nurses have the right to rest, leisure time and
family life
 Evaluation

1. Explain the importance of maintain

patient/client rights in the health care facility
2. Outline the declared patient/client’ rights
3. Outline the declared service providers
(nurses’) rights
 References

Brent, N. J. (1997). Nurses and the law: A guide to principles and

applications. USA:
W. B. Saunders.
Burkhardt, M. A., & Nathaniel, A. (2002). Ethics & issues in
contemporary nursing (2nd ed.). USA: Cengage Learning
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and
management functions in nursing theory and application (6th ed.).
USA: Lippincott.
TNMC. (2007). Code of professional conduct for nurses and midwives in
Tanzania. Dar es Salaam, Tanzania.
TNMC. (2009). Module on ethics in nursing. Dar es Salaam, Tanzania.
TNMC. (2009). Nursing ethics: A manual for nurses. Dar es Salaam,
Tanzania.