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PROFESSIONAL NURSING BOUNDARIES (PP0613)

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PROFESSIONAL NURSING BOUNDARIES (PP0613)




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TABLE OF CONTENT

1.0    INTRODUCTION                                                                          2

2.0    ADHERING TO PROFESSIONAL ETHICAL STANDARDS IN MALAYSIA                                                                                             5

3.0    A CASE STUDY                                                                           7

4.0    CONCLUSION                                                                               9
                  







1.0       INTRODUCTION
Acknowledgement of the commence that nursing lawful and moral guidelines are developing and advancing in the worldwide group, structures the premise for this investigation of Malaysian nursing law and morals. Late changes in the procurement of medicinal services in Malaysia have helped the developing significance of nursing law and morals. The part of Malaysian attendants has been influenced by case identified with carelessness, educated assent, privacy, and killing. Malaysian nursing enactment does not address numerous legitimate and moral issues that oblige a far reaching set of laws that perceive the impressive union between lawful and moral judgments. Mechanical developments in health awareness have likewise made difficulties for the Malaysian nursing calling. Attendants must prevail over these difficulties by getting more educated about legitimate and moral choice making. The instruction of Malaysian attendants about the requests of law and moral measures would advertise more amazing responsibility, learning, and individual duty in giving human services to people all around their life compass.
Medical attendants give a consoling human interface between patients and the doctor's facility, and between groups and the health awareness framework hence framing the "heart" of medicinal and social insurance administration procurement in Malaysia. The quickly changing Malaysian wellbeing environment has obliged medical caretakers to give mind through stretched out parts so as to supplement the administrations rendered by other wellbeing experts. These augmented parts have constrained Malaysian medical attendants to get more included in practices that may have significant individual legitimate outcomes. Subsequently, Malaysian medical caretakers have gotten to be progressively mindful of lawful and moral issues that have affected on their practices and have likewise perceived the vitality of a strong establishment in legitimate and moral standards along these lines pushing competency in autonomous complex choice making.
In Malaysia, medical caretakers speak to the biggest workforce in the human services area. 1 They are the fundamental suppliers of medicinal services, especially in rustic and remote regions. The nursing workforce has now expanded to around 60,000, or more or less 2.25 medical caretakers for every 1,000 populace. 2 There are 18 nursing universities under the Malaysian Ministry of Health, 6 college programs, and 32 private segment certificate programs. Graduates of Nursing and Midwifery programs, right hand attendants, and rustic medical caretakers must succeed in the separate enlistment examinations set by the Nursing Board and the Midwifery Board of Malaysia to meet all requirements for enrollment and practice. 3 The necessities are stipulated under the Nurses Act 1950 [act 14] and the Midwives Act 1966 [act 436]. 4 However, these Acts don't have particular procurements with respect to the risk of attendants emerging in therapeutic negligence. Legitimate guidelines and standards with respect to issues of misbehavior influencing Malaysian medical attendants are found in the English Common Law. Area 3 of the Malaysian Civil Law Act 1956 [act 67] gives that unless there is any composed law in energy in Malaysia, the courts in Malaysia should apply the Common Law of England and the Rules of Equity as controlled in England on April 7, 1956. In any case, the said Common Law and the Rules of Equity should just be connected insofar as the circumstances of the States of Malaysia and their individual occupants allow, and subject to such capabilities as neighborhood circumstances render necessary.
Customarily, the specialist attendant relationship in Malaysia is likened to that of an expert and servant. Attendants have been described as being unequipped for free or agreeable choice making in therapeutic medication. Attendants had never been endowed with formal obligations that may have had real lawful outcomes and have taken a noticeably uninvolved part in such choice making. Notwithstanding, the late changes in the procurement of health awareness in Malaysia have united specialists and attendants as accomplices. Cutting edge social insurance settings have set more terrific attention on the attendants' part in arranging, actualizing, and assessing nursing forethought. The part of attendants has subsequently been influenced by suit identified with carelessness, educated assent, privacy, and willful extermination. Subsequently, it would just appear to be simply that attendants' augmented parts make them lawfully answerable for the results of their movements responsible to their companions, businesses, patients, and eventually, the courts.




2.0       Adhering To Professional Ethical Standards In Malaysia
In satisfying their obligations, medical attendants are regularly tested with clinical circumstances that have moral clashes. These uncertain clashes may cause emotions of dissatisfaction and feebleness that can prompt bargains in patient forethought, work disappointment, or contradictions among those on the social insurance group. 6 Nurses need aptitudes and direction to help resolve moral clashes. 7 Through Malaysian nursing training, attendants are taught to hold fast to the qualities of the nursing calling. 8 Ethical codes of expert practice plot standards that exhibit the obligation of the calling's parts to Malaysian culture. The Code of Professional Conduct for Nurses (CPCN) created by the Nursing Board of Malaysia 9 frameworks the qualities and obligations to which medical caretakers are required to stick, to settle on sound moral choices and give amazing nursing forethought. The CPCN portrays what enlisted attendants 10 must think about their moral obligations, briefs other medicinal services experts and parts of the general population about the moral responsibilities of medical caretakers, and maintains the obligations of being an automatic calling. 11 It comprises of six procurements separated into three significant substance zones that address the major qualities and responsibilities of medical caretakers, the limits of obligation and faithfulness, and the obligations to patients.
Universally, the moral standards and decides that normally guide nursing practice and patient forethought incorporate non-maleficence, beneficence, independence, constancy, veracity, and equity. 12 In Malaysia, the standards of non-maleficence and beneficence are frequently examined together and as with beneficence, the commitment is to positive activity in forestalling and pushing great. With non-maleficence, the commitment is expressed as negative terms. Case in point, there is an obligation to do no mischief, in this manner it is a commitment not to incur hurt deliberately. 13 In Malaysia, self-rule implies an exceptional manifestation of individual freedom, wherein people are allowed to pick and execute their own particular choices as indicated by their own particular individual qualities and convictions, free from trickery, coercion, requirement, and compulsion. 14 In Malaysian law, regard for patients incorporates treating patients paying little respect to ethnic birthplace, nature of wellbeing issues, religious convictions, and societal position. 15 Respect likewise reaches out to medical attendants' partners. Procurement 1.5 of the CPCN gives that "the attendant ought to work collectively and co-operatively with different parts of the medicinal services group and ought not waver to counsel suitable expert partners when required." Fidelity alludes to devotion, especially the obligation to respect duties made to others, especially in staying away from lead that is viewed as slanderous to the nursing calling. 16 Veracity includes activities and convictions that are focused around the qualities of truth, exactness, and trustworthiness. 17 Finally, as indicated by the guideline of equity as defined in Malaysian law, all individuals ought to be dealt with decently and accessible assets ought to be utilized fairly.
Clashes may happen between two or more moral standards, which may prompt moral difficulties in choosing what is the right or best game plan. Clashes, especially in appreciation to Malaysian society, may happen in regards to educated assent. For example, the medical caretaker might over depend on patient independence when, as a general rule, the data might just cause the patient to make an improperly unequal judgment because of inclination and preference from the patient. 19 Other such clashes may incorporate issues identifying with contradictions over patients' revival status, pointlessness of medication, and proportioning of rare assets. 20 In an alternate sample, a medical attendant who exceedingly values non-maleficence, or tries to minimize damage, may feel uncomfortable when offering chemotherapy to a more established grown-up patient when she feels that the dangers to the patient exceed the potential profits. Interestingly, a medical caretaker who is guided by the standards of admiration and self-governance may not be harried, feeling that the most imperative obligation is to satisfy the patient's solicitation, notwithstanding the degree of profit to hazard. 21 Nurses might additionally get included in differences between patients and patients' families about the best courses of medicine and the needs of the patients. Medical caretakers should consequently be urged to bring issues to light among associates and energetically talk about the lawful and moral issues in their practice settings. This will help Malaysian medical caretakers start to reduction sentiments of vulnerability and discover the best answers for determination these moral



2.1       A CASE STUDY
As a medical assistant in a government health clinic, this topic plays the most important role in my daily work. Apart of dispensing orders from doctors, I also had to make professional decisions if they cannot rely solely on the doctor's instructions. This is due to the absence of a doctor who caused the shortage of doctors who are interested in working for government hospitals.
But this is not a reason for me to fail a health aides decided on my own judgment. This is where my analytic thinking of reasoning professional nursing boundaries takes parts. Providing medicines to patients, give advice and direction to another colleague has become my daily routine at work. Based on my experience over the years working in this clinic, I managed to set boundaries in my work ethic Based on my experience over the years working in this clinic; I managed to set boundaries in my work ethic. Thus making mobility work at this clinic becomes more organized and neat.    
Not to forget these boundaries taught me to be a medical practitioner more efficient and transparent when treating patients.
Another thing also applies in this topic is that when there are disagreements between doctors and medical assistant. This is not uncommon especially if the doctor may have just started working and inexperience. At times like this that a medical assistant should use his experience and knowledge to advise doctors involved. In situations such as this one can assess the medical and moral facts that should be used.
In addition to physician disagreement with fellow workers are also common in the medical world. This is because every individual has their own opinion even more so for those who are experienced. This is where the facts can be used in a comprehensive moral. Professional boundaries are important in determining the recommendations, decisions and orders of the precision and accuracy in treating patients.
"Boundaries are mutually understood, unspoken physical and emotional limits of the relationship between the patient and the nurse." (Farber, 1997)
When these limits are altered, what is allowed in the relationship becomes ambiguous and possibly unethical. The health and wellbeing of patients depends upon a collaborative effort between the nurse and the patient. Patients are extremely vulnerable to boundary violations because they trust us as their health care providers. They come to us in a time of need, presenting with physical, and often emotional, distress. Some patients demand continuous attention but are unaware of their insatiable neediness. (Muskin and Epstein, 2009)

















CONCLUSION
In Malaysia and globally, the nursing profession has developed through various phases in its role as a profession of primary caregivers in health care settings. The evolution of the nurses' roles in upholding legal and ethical standards clearly reflects society's changing perceptions about what is considered acceptable behavior in a caregiving profession. Changes in the legal and ethical frameworks have undoubtedly impacted the nursing profession as nurses are encouraged to take on more responsibility for decision making in the patient care process. It is simply imperative that nurses prepare themselves with the required knowledge so necessary to address the complex legal and ethical issues that have challenged today's professional nurses in Malaysia. Education of nurses about the demands of law and ethics is crucial to nursing practice in order to foster greater accountability, disseminate knowledge, and promote personal commitment in providing health care to individuals across their lifespan. Required course offerings in both university and private sector nursing curricula that specifically focus on the appreciation of evolving legal and ethical standards are essential for the maturation and sophistication of nursing as a profession in Malaysia.
Professional boundaries are the spaces between the nurse's power and the client's vulnerability. The power of the nurse comes from the professional position and the access to private knowledge about the client. Establishing boundaries allows the nurse to control this power differential and allows a safe connection to meet the client’s needs.
Boundary crossings are brief excursions across boundaries that may be inadvertent, thoughtless or even purposeful if done to meet a special therapeutic need. Boundary crossings result in a return to established boundaries but should be evaluated by the nurse for potential client consequences and implications. Boundary crossings should be avoided.




REFERENCES

Farber, N, Novak, D, O’Brien, M. Love, Boundaries and the Physician-Patient Relationship Arch Int Med 1997;157: 2291-2294.

Muskin, P,Epstein, L. Clinical guide to Countertransference. Current Psychiatry 2009; 8:25-32

Nemie, J. K. (2009). Challenges for the Nursing Profession in Malaysia: Evolving Legal and Ethical Standards. Journal of Nursing Law, 13(2), 54-62.

Nursing Center - CE Article. (n.d.). Nursing Center - CE Article. Retrieved June 1, 2014, from http://www.nursingcenter.com/lnc/CEArticle?an=00006247-200702000-00009&Journal_ID=54013&Issue_ID=69607

Professional boundaries. (n.d.). - Factsheets. Retrieved June 1, 2014, from http://www.medicalprotection.org/malaysia/factsheets/professional-boundaries

Wade, G. H. (1999). Professional Nurse Autonomy: Concept Analysis And Application To Nursing Education. Journal of Advanced Nursing, 30(2), 310-318.




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