Concept of Accountability – This book covers the entire syllabus of “Leadership & Management” prescribed by the BNMC for Diploma in Nursing Science & Midwifery Students.
We tried to accommodate latest information and topics. This book is an examination setup according to the teachers’ lectures and examination questions. At the end of the book previous university questions are given. We hope in touch with the pook students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.
Concept of Accountability
Nurses are expected to be accountable to the profession, to the client and public, to the employing agency and more importantly to one own self.
Nurses are no longer to expected to live on the premises in which they work, they are no longer expected to work most of their working hours without time away from duties, and they are considered a piece of property belonging to agency in which they work. They should see as free and independent persons with other aspects of life beside the professional life.
However, it seems inevitable that nurses live their life bear professional work become highly stressful and burnout. In this regards Nurse must accountable for self. They must be responsible for their mental, physical health, for ensuring that they keep all aspects of life in a balanced perspective.
Definition of Accountability:
Accountability is about taking responsibility for nurses actions, always ensuring nurse is competent to do the activity they’ve been asked to perform, and always putting patients’/clients’ interests first.
Accountability is an essential component of professional nursing practice; accountability also is an essential component of patient safety. The American Nurses Association Code of Ethics states that the definition of accountability is “To be answerable to oneself and others for one’s own actions.”
Or,
Accountability is the condition of being answerable and responsible to someone for specific behavior that is part of the nurse professional role.
(Ref by- BT Basavanthappa/2/249+Lecture)
Types of Accountability:
In addition of the different aspects of accountability identified above, some analyzed have identified different kinds of accountability. Leat (1988), for example, suggest that accountability has different dimensions in the health care context. These includes four types:
A. Fiscal accountability (concerning financial probity and ability to trace and adequately expenditure
B. Process accountability: (concerning the use of proper procedure: for example, demonstrating that locally derived standard and those set out by national service frame works are being adhered to)
C. Program accountability: (concerning the activities under taken and there quality) and
D. Priorities accountability: (concerning the relevance or appropriateness of chosen activities)
Of these, she suggests that process and program accountability are the most relevant to clinical governess.
Self-Management:
Self-management in it most simple form is the thing that people do between medical visits-in fact most people are self-managing 99% of the time. The Institute of Medicine has a formal definition–the skills and confidence that one needs to manage the medical, role and emotional consequences of chronic illness.
Functions of Self-Management:
Self-management support involves the support that a general practice provide to patient to carry out the above three main tasks. Self-management is not patient education which is sample knowledge based instruction for a specific disease.
The traditional focus of health care has been around illness and the relief or cure of symptoms. Patients with chronic disease, however, are more suited to a wellness perspective where they are encouraged to remain well for as long as possible. To maintain wellness, patient need to concentrate on three tasks.
1. Medical management such as taking medication, monitoring symptoms and or adhering to a healthy diet.
2. Maintaining, changing and creating new meaningful behavior or life roles, for e.g. people with back pain many to change the way the participate in their favouirate sports.
3. Dealing with the emotional impact of having a chronic illness, which alters ones view of the future emotion such as anger, fear, frustration and depression are common.
Factors Affecting the Effectiveness Of Self-Management:
a) Communication skills
b) Time
c) Available support in a crisis
d) Access and understanding of rescue medication
e) Involvement of carriers
f) Understanding of the condition
g) Inhaler technique
Significance of Self-Management and Accountability in Nursing Practice:
If patients understand how to recognize and act on symptoms, how to make effective use of medication and how to access appropriate service at the right time they should experience gains in the health status and reduced dependents on the health services.
Self-management is also about helping people management work and leisure activities and developed strategies to deal with the psychological consequence of illness. These includes findings way to –
1. Provide comprehensive information, support and educations to help people understand there condition, what they can do to maintain health and how to recognize and respond to symptoms
2. Monitor symptoms and provide early intervention with follow up, including plans for responding to exacerbations
3. Provide advice on and access to physical activities, pulmonary rehabilitation and psychological therapy.
4. Provide information, tools and technique that allow patients to better management their own condition.
Nurses Responsibilities to Self:
A. Refusing to work in situations that she she/he considered unsafe.
a) This may be lack of knowledge and experiences of the area.
b) Insufficient staffing or some other problem inherent in the situation itself.
B. Acknowledging one’s own limitations and knowing when further education is needed to more fully and safely to perform one’s role.
C. Being able to prevent transmission of the disease to their patients with the use of appropriate precaution technique.
D. Doing their own personal best.
Ways or Implication for Self in Accountability:
Nurses are great when it comes to patient care through patient education but usually they have difficulty applying this information to themselves. The nursing profession is both mentally and physically challenging. Therefore, nurses must be accountable to themselves by:-
1. Maintaining physical health.
2. Being aware of one’s feeling and able to maintain emotionally healthy.
3. Engaging in recreational activities.
4. Maintaining spiritual health practicing daily prayer or medication.
Nursing Care Delivery within Health Care System:
There are 5 (five) patterns of nursing care delivery within health care system. These are:
1. Functional nursing.
2. Team nursing
3. Total patient care.
4. Primary care nursing.
5. Nursing management
| Functional Nursing: | Functional nursing divides the nursing work into nursing units that are then assigned to one of the team members. In this method, each has specific duty of tasks, they are responsible for. For example, one is assigned to give all the medication, another performs all the treatments and another works at the desk transcribing physician’s order and communicating with other nursing departments about patient care issues. This pattern is been used less often becomes its focus tends to be more on completing the task rather than caring for individual patients. |
| Team Nursing: | Team nursing is a care delivery model that assigns nurses to teams that then are responsible for a group of patient. Team nursing is organized and directed by a nurse called the team leader. The team leader and supervisors, co-ordinates all the care provided by those on his team. The team is most commonly made up of various level of nursing staff and personnel. All team members report the outcomes of their care to the team leader, the outcomes of their care to the team leader. The team leader is responsible for evaluating whether the goals of patient care are met. Conferences are important part of team nursing. They may cover a variety of subjects but are planned with certain goals in mind, such as determining the best approaches to each patient’s health problems, increasing the team member’s knowledge and promoting a cooperative spirit among nursing personnel. |
| Total patient care | Total patient care is a system of comprehensive patient care that considers the physical, emotional, social, economical and spiritual of an individual. The nurse is responsible for the total care for the patient assignment for the shift she/he is working |
| Primary Care Nursing: | Primary Nursing is the care delivery system that best supports professional nursing practice. The focus is on the nurse-patient relationship, strengthens accountability for care, and facilitates patient and family involvement in the planning of care. Our care delivery system allows the Primary Nurse to establish a therapeutic relationship with each patient and family. High quality nursing care that is individualized to a particular patient and administered compassionately, competently, and with continuity is achieved through Primary Nursing. |
| Nursing/Case Management: | Nursing/Case management is a strategy to improve patient care and reduce hospital cost through co-ordination of care. A nurse/case manager is responsible for co-coordinating care and establishing goals from preadmission through discharge. In this model a nurse is assigned to a specific high risk patient, such as cardiac surgery patients. The case manager has the responsibility to work with all disciplines to work with all disciplines to facilitate care. The advantage is that it ensures the higher quality compared to other models. The disadvantage is that it requires enough nurse time allocated for this activity |
Total Patient Care:
Total patient care is a system of comprehensive patient care that considers the physical, emotional, social, economical and spiritual of an individual. The nurse is responsible for the total care for the patient assignment for the shift she/he is working.
| Advantage of Total Patient Care |
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| Disadvantage of Total Patient Care |
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Primary Care Nursing:
Primary nursing is a care delivery model that clearly describes the responsibility and accountability of the registered nurse and designates her as the primary provider of care to patients. It consists of four elements. These are-
a) Allocation and acceptance of individual responsibility for the decision making to one individual.
b) Assignment of daily care by the case method.
c) Direct person to person communication.
d) One person is operationally responsible for the quality of care administered to patient on a unit for care 24 hours a day, 7days a week. It is a method of providing comprehensive, individualized and consistent care.
The nurse has accountability and responsibility to develop a plan of care with the patient and family. There is a holistic approach to care, which facilitates continuity of care rather a shift to shift focus.
Disadvantages include a high cost, a requirement of knowledgeable nurses to ensure the appropriate matching of nurse to patient etc.
Nursing/Case Management:
Nursing/Case management is a strategy to improve patient care and reduce hospital cost through co-ordination of care. A nurse/case manager is responsible for co-coordinating care and establishing goals from preadmission through discharge. In this model a nurse is assigned to a specific high risk patient, such as cardiac surgery patients.
The case manager has the responsibility to work with all disciplines to work with all disciplines to facilitate care. The advantage is that it ensures the higher quality compared to other models. The disadvantage is that it requires enough nurse time allocated for this activity.
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