AUTONOMY, ACCOUNTABILITY,

ASSERTIVENESS, VISIBILITY OF
NURSES AND LEGAL
CONSIDERATIONS IN NURSING
PRESENTED BY :
CHARU
MSc 1st year
CON AIIMS RISHIKESH
20-09-2019 1
AUTONOMY:
• According to Lewis & Batey(1982):
It’s the freedom to make discretionary and
binding decisions consistent with one’s
scope of practice and freedom to act on
those decisions.
20-09-2019 2
 BENEFITS OF AUTONOMY
• Job satisfaction
• Freedom to act on binding decisions
• contribution to the wellbeing of patients
• Independency
• Quality service and care to patients
20-09-2019 3
 CHALLENGES WITHOUT
AUTONOMY
• Lack of recognition and valuing of nursing
knowledge
• Inability to raise and resolve concerns
• Interruptions to the nurse’s ability
• No Relationship with colleagues
20-09-2019 4
ACCOUNTABILITY
• According to Sullivan and Deekan,
Accountability is being responsible for one’s actions and
accepting the consequences of one’s behavior.
Accountability is not a vague feeling or an obscure concept.
It is a clear obligation which must be manifested as a
structured component of nursing practice, based on
responsibility, authority and autonomy.
20-09-2019 5
20-09-2019 6
 LINES OF ACCOUNTABILITY
• UPWARD : looking up the line and doing what managers and
supervisors require and accountable to them.
• LATERAL : Accountabilty as a self regulation in which nurses
are accountable to and judged by, criteria set by their peers.
• DOWNWARD OR PUBLIC : Where staff is accountable for
patients.

20-09-2019 7
UPWARD ACCOUNTABILITY

20-09-2019 8
20-09-2019 9
LATERAL ACCOUNTABILITY

20-09-2019 10
DOWNWARD ACCOUNTABILITY

20-09-2019 11
 TYPES OF NURSING
ACCOUNTABILITY
• FISCAL ACCOUNTABILITY: concerned with
financial probity and ability to adequately explain
expenditure.
• PROCESS ACCOUNTABILITY: This accountability
is concerned with the use of proper procedures.
• •PROGRAMME ACCOUNTABILITY: It is concerned
with the activities undertaken and their quality.
20-09-2019 12
 Contd…
• PRIORITIES ACCOUNTABILITY: This deals with
the relevance or appropriateness of chosen
activities.

20-09-2019 13
ELEMENTS OF ACCOUNTABILITY
• CLARITY: Goals are clear and specific
• COMMITMENT : listen , understand, agree and
commit to achieve the objectives .
• CONSEQUENCES : the result or effect, typically
one that is unwelcome or unpleasant. Nurses will
keep this in mind and work accordingly.
20-09-2019 14
LACK OF ACCOUNTABILITY

20-09-2019 15
 REASONS FOR LACK OF
ACCOUNTABILITY
• Job description not available.
• Lack of guidelines, standards and controls.
• Authority not specified.
• Overburdened staff due to shortage of staff.
• Lack of adequate training and efficient experience.
• Lack of up to date knowledge , skills and competence.
20-09-2019 16
CONTD…
• Unwilling.
• Inadequate supervision by ward managers.
• Out dated policies, protocols and
procedures.
• Lack of decision making.
20-09-2019 17
 WAYS OF ENHANCING
ACCOUNTABILITY
• Well defined duties and jop descriptions.
• Written policies protocols and procedures.
• Nursing audit and standard of practices.
• Proper delegation of responsibilities.
• Proper training and education of the self.
• Periodical evaluation of each individual’s nursing
practice. 20-09-2019 18
CONTD…
• Refine and modify outdate policies and
procedures.
• Availability of adequate number of
personnel and resources for patient care.
• Conducive working environment.
20-09-2019 19
 ASSERTIVENESS
• Assertiveness is a particular form of control. It is not
about power. It is better described as the art of confident,
clear honest and direct communication, while at all times
retaining respect for other people.

20-09-2019 20
 CHARACTERISTICS OF
ASSERTIVENESS
• Self-presentable
• Ability to share
• Good attitude towards work
• Fearless expression
• Straight forwardness
• Self control
20-09-2019 21
20-09-2019 22
 ASSERTIVE COMMUNICATION
• It is a way of communication that allows people to
express themselves in a direct, honest and
appropriate ways that don’t interfere on another
persons right. A person position is expressed
clearly and firmly using “I” statements.

20-09-2019 23
TYPES OF BEHAVIOUR

20-09-2019 24
 VISIBILITY OF NURSES
• Visibility is the way a person appears to others in
the case of profession, the way that profession
appears to other disciplines and to the general
public.
• It is the degree of exposure to public notice.

20-09-2019 25
VISIBILITY OF NURSES

20-09-2019 26
 IMPORTANCE OF VISIBILITY
• Recruitment of students
• Enhance public view
• Funding for nurses
• Relationship with administrations
• Relationship with government
• Profession self identity
20-09-2019 27
 STEPS TO INCREASE VISIBILITY
1. Advertising nursing 2. Role of media

20-09-2019 28
3.Nurse for health care tomorrow 4.Raise the voice campaign

20-09-2019 29
 Nursing Now’ Campaign
• ‘Nursing Now’, a three-year global campaign (2018-
2020),run in collaboration with the WHO and ICN
aims to improve health by raising the profile and
status of nursing professionals worldwide.
• In India ‘Nursing Now’ campaign was launched
during International Conference on “Nurses and
Midwives for Universal Health Coverage” hosted by
INC and endorsed by ICN from 29th Nov,2018 to 1st
December, 2018
20-09-2019 30
CONTD…
5.Power and empowerment
6.Assertiveness
7.Advocacy

20-09-2019 31
 RESPONSIBILITIES OF NURSE
FOR PROFESSIONAL VISIBILITY
• Identify professional base activity in practice.
• Take a stand if someone saying wrong about
NURSING .
• Nursing profession and communication are
the important aspects of nursing.
20-09-2019 32
 LEGAL CONSIDERATIONS IN
NURSING
• Laws and regulations related to nurses in india are
controlled by state legislation as state registration acts
and central acts: INDIAN NURSING COUNCIL.
• The INC is an autonomous body under the government of
India ,Ministry of health and welfare which establishes a
uniform standard of training for nurses, midwives and
health visitors.
20-09-2019 33
 LEGAL COMPLICATIONS
• TORTS
• ASSAULT
• BATTERY
• NEGLIGENCE
• MALPRACTICE
• FALSE IMPRISONMENT
20-09-2019 34
CONTD…

• INVASION OF PRIVACY
• LEGAL DOCUMENTS :
• Advance directives
• Do not resuscitate
• Informed Consent
20-09-2019 35
 NURSING LIABILITIES
• All nursing observations should be noted carefully and
described accurately .
• Patient’s complain should be recorded accurately.
• Nurse must report through the proper channels.
• Authorities must be informed regarding any kind of
equipment, material and supplies which are for any
reason less than safe for used in clients care. 20-09-2019 36
 NURSES ROLE TO PREVENT
COMPLICATION
• Review nursing practice periodically, update knowledge and
improve skills by in service education , and continuing education
programme.
• They should have complete knowledge of all rules and regulations
of hospital and they should be aware about their duties and
responsibilities.
• They should follow standard practice protocols .
• Be a clean observer.
• Always follow 10 R’s of medication.
• Maintain records and reports accurately.
20-09-2019 37
 CONCLUSION
So today we have discussed about topic ‘AUTONOMY
,ACCOUNTABILITY,ASSERTIVENESS,VISIBILITY OF
NURSES AND LEGAL CONSIDERATIONS IN NURSING. I
hope you all have gained knowledge from this topic and will
apply it in your future nursing practice.

20-09-2019 38
 RESEARCH ARTICLE 1
• ( International journal of health sciences and research )
• Topic : Relationship of Assertiveness and Self Esteem among
Nurses
• Published by : S .K . Maheshwari et al.
• Published on : 19/05/2015
• Place : Punjab

20-09-2019 39
• PURPOSE : To examine the relationship of
assertive behaviour and self esteem among
nurses

• METHODS: In a exploratory, co-relational, cross sectional survey,

220 eligible nurses working in selected hospitals of Punjab were
identified conveniently and assessed using Socio demographic
Data Sheet, Rathus Assertiveness Schedule and Rosenberg Self
Esteem Scale. Data were analyzed using descriptive statistics and
Independent t-test.

20-09-2019 40
• RESULTS: Assertive behavior has moderate positive
correlation with self esteem. Older nurses who are on
regular job, studied from Govt. nursing institutions and
working in Govt. hospitals were more assertive. Nurses
those are older, Christian, belongs to nuclear family and
working as PHN had more self esteem as compared to
others.

20-09-2019 41
• CONCLUSION: The findings of the present investigation
suggested that assertive behavior and Self Esteem are positively
and significantly correlated. Nurses should regular assess their
assertive behavior as it affects the Self Esteem of self and
communication with in health care system. Assertiveness training
or other intervention may be initiated for nurses who are non
assertive and have low self esteem.

20-09-2019 42
 RESEARCH ARTICLE 2 :
• Topic : Is modified brief assertiveness training for
nurses effective? A single‐group study with
long‐term follow‐up
• Published by : Naoki Yoshinaga RN, PhD et al.
• Pubished on : 25 july 2017
20-09-2019 43
• Aim :
To evaluate the long‐term effectiveness of modified brief
assertiveness training (with cognitive techniques) for
nurses.
• Background :
Most assertiveness training takes a long time to conduct
thus, briefer training is required for universal on‐the‐job
training in the workplace.
20-09-2019 44
• Methods :
In this single‐group study, nurses received two 90‐min
training sessions with a 1‐month interval between
sessions. The degree of assertiveness was assessed by
using the Rathus Assertiveness Schedule as the primary
outcome, at four time points: pre‐ and post‐training,
3‐month follow‐up and 6‐month follow‐up.

20-09-2019 45
• Results :
A total of 33 nurses received the training, and the mean
Rathus Assertiveness Schedule score improved. These
improvements were maintained until the 6‐month
follow‐up. The pre–post effect size of 0.22 (indicating small
effect) was larger than the effect sizes ranging from −0.56
to 0.17 (no effect) reported in previous studies that used
brief training.

20-09-2019 46
• Conclusions :
Modified brief assertiveness training seems feasible
and may achieve long‐term favourable outcomes in
improving assertiveness among nurses.

20-09-2019 47
 REFERENCES
• Basavanthappa B. T .Essentials of medical surgical nursing, Second south Asia
edition, Jaypee brothers medical publications .2009.p.67,71,101.
• Potter P. A .Fundamentals of nursing. Ninth edition.Mosby Elsevier.2017.p.105,106.
• Christensen B. L. Foundations of nursing .Sixth edition. St. Louis Mosby Year Book
.p.24,26.
• https://www.nmsupport.org.au/students-and-graduates/assertive-communication
• http://uchsindia.com/college/images/autonomy-accountablity-assertiveness.pdf
• https://www.omicsonline.org/open-access/how-we-can-enhance-nurses-
assertiveness-2167-1168-3-194.pdf

20-09-2019 48