CODE OF ETHICS & STANDARDS OF PSYCHIATRIC NURSING PRACTICE
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Approved by the College of Registered Psychiatric Nurses of Alberta (CRPNA) Provincial Council October 2022.
Contents of this publication may not be reproduced in whole or in part without the express permission of the College of Registered Psychiatric Nurses of Alberta.
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Chief Executive Officer (CEO)
College of Registered Psychiatric Nurses of Alberta (CRPNA)
Suite 201, 9711 – 45 Avenue
Edmonton, AB. T6E 5V8
Phone: (780) 434-7666 Toll Free 1 (877) 234-7666
Fax: (780) 436-4165
Email: [email protected]
Website: www.crpna.ab.ca
The College of Registered Psychiatric Nurses of Alberta (CRPNA) is the professional regulatory body for Registered Psychiatric Nurses (RPN) in Alberta. In accordance with the Health Professions Act (HPA), the CRPNA is accountable for public protection by ensuring that Registered Psychiatric Nurses in Alberta provide safe, competent, and ethical practice. This is achieved through the development, monitoring, and enforcement of the CRPNA Code of Ethics and Standards of Psychiatric Nursing Practice. This document articulates the legal and professional obligations of the Registered Psychiatric Nurse. These are the minimum requirements that must be met and failure to do so may constitute unprofessional conduct. The CRPNA Code of Ethics and Standards of Psychiatric Nursing Practice apply to all practice settings, domains of practice and roles regardless of an individual RPN’s educational preparation or professional experience. All CRPNA Standards are authoritative statements in which the psychiatric nursing profession describes the responsibilities for which its registrants are accountable. (Appendix 1). Standards define the psychiatric nursing profession’s accountability to the public and the outcomes for which registered psychiatric nurses are responsible. All registrants must be knowledgeable about and abide by the CRPNA Code of Ethics and Standards of Psychiatric Nursing Practice.
Psychiatric Nursing, as a distinct profession, provides services to individuals whose care needs relate to physiological, psychological, sociocultural, spiritual, and developmental health. The core knowledge and skills of psychiatric nursing are derived from the biological, physiological, psychological, sociological, philosophical, and anthropological sciences. The competencies acquired from this body of knowledge guide the application of critical thinking, clinical reasoning, and professional judgment. The core of psychiatric nursing practice is the therapeutic relationship. Psychiatric Nursing is committed to the prevention of illness and to the promotion and maintenance of optimal health, rehabilitation, and recovery. Registered Psychiatric Nurses engage in various roles providing health services to individuals, families, groups, and communities. The practice of psychiatric nursing occurs within the domains of direct practice, education, administration, and research.
The Code of Ethics are the minimum requirements that articulate clear expectations and ethical principles to guide practice, promote professional integrity and inspire professional excellence. The Code provides a framework for professional responsibility and accountability while promoting high ethical standards; they apply to all practice settings, domains of practice, and roles regardless of an individual RPN’s educational preparation or professional experience. All regulated members must be knowledgeable about and abide by the Code of Ethics. Failure to adhere to the Code of Ethics constitutes unprofessional conduct as defined in the HPA. (See Appendix 1)
Through the Code of Ethics, Registered Psychiatric Nurses uphold the principles of:
- Beneficence
- Non-maleficence
- Fidelity
- Integrity
- Respect for Autonomy
- Justice
Principles
- Beneficence – Duty to do good
A Registered Psychiatric Nurse:
a. Considers the well being of the individual(s) receiving care
b. Provides compassionate holistic care in the best interests of the individual
c. Recognizes the requirement to care for and protect vulnerable persons including those with diminished capacity and those at the end of their life
- Non-maleficence – Duty to do no harm and protect others from harm
A Registered Psychiatric Nurse:
a. Refrains from initiating or participating in any practice that is considered harmful to the welfare of individuals in their care and/or others
b. Reports, in good faith, any incompetent or unethical behaviour of health care providers and/or others to the appropriate authorities
c. Accepts responsibility and accountability for one’s own actions taking all necessary steps to prevent or minimize harm; and should harm occur, ensure appropriate disclosure
- Fidelity – Duty to care
A Registered Psychiatric Nurse:
a. Provides care to individuals for whom they are responsible
b. Provides safe, competent and ethical care
c. Recognizes one’s own limitations and uses professional judgment when accepting responsibilities
- Integrity – Duty to act with honesty and integrity
A Registered Psychiatric Nurse:
a. Conducts one’s self in a manner that reflects honesty, trustworthiness, reliability, impartiality, and diligence
b. Takes responsibility, is accountable for decisions and provides rationale for actions
c. Refrains from permitting one’s professional designation to be used for personal gain in connection with the endorsement of products or services that are not directly related to their psychiatric nursing independent practice
- Respect for Autonomy – Duty to respect persons and promote individuals’ choices
A Registered Psychiatric Nurse:
a. Respects the unique, inherent worth and dignity of all persons and strives to ensure that the rights of individuals are upheld
b. Respects individual’s autonomy and their right to choose by recognizing them as full partners in decision-making
c. Recognizes limitations to autonomy and the need to protect individuals with diminished autonomy
d. Respects and values the knowledge and contributions of other health care providers and works collaboratively with others
- Justice – Duty to treat all people fairly and equitably
A Registered Psychiatric Nurse:
a. Does not discriminate on the basis of a person’s race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, sexual orientation, age, health or mental health status, place of origin, lifestyle, mental or physical ability/disability or socio-economic status or any other similar attribute
b. Provides fair and equitable access to services and resources within their control and equal treatment and protection for those in their care
c. Recognizes the importance of identifying insufficient human and/or material resources required in their area of practice, and advocates for same
The Standards of Psychiatric Nursing Practice are the minimum acceptable level of performance required of the Registered Psychiatric Nurse. The Standards of Psychiatric Nursing Practice articulate the legal and professional obligations of the Registered Psychiatric Nurse; they apply to all practice settings, domains of practice, and roles regardless of an individual RPN’s educational preparation or professional experience. The standards of practice describe a competent level of psychiatric nursing care as demonstrated by the critical thinking model also known as the nursing process, and includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation and represents the problem-solving process that the registered psychiatric nursing follows in daily interactions with client’s, groups, families, and communities. It is the professional responsibility of the Registered Psychiatric Nurse to know, understand and adhere to the Standards of Psychiatric Nursing Practice. Failure to meet the Standards constitutes unprofessional conduct as defined in the Health Professions Act. (See Appendix 1 & 2)
Indicators illustrate how to meet each Standard of Psychiatric Nursing Practice. The indicators are representative but not comprehensive for each Standard. Specific indicators vary with the situation and context within the psychiatric nurses’ role. It is the professional responsibility of the Registered Psychiatric Nurse to articulate how they meet the Standards.
The Registered Psychiatric Nurses establishes collaborative professional, interpersonal, and therapeutic relationships with clients that are safe, informed, confidential, accountable and maintains professional therapeutic boundaries, and prevents sexual abuse/misconduct in the therapeutic registered psychiatric nurse-client relationship.
A Registered Psychiatric Nurse:
- Continually applies the therapeutic use of self within professional practice. The therapeutic use of self is the foundational instrument that Registered Psychiatric Nurses use to establish therapeutic relationships with clients to deliver care and psychosocial interventions.
- Applies knowledge and understanding of therapeutic relationships within their practice.
- Recognizes and addresses power imbalances in therapeutic relationships.
- Uses effective communication strategies and interpersonal skills to establish, maintain, re-establish, and terminate the therapeutic relationship.
- Recognizes transference/countertransference and its impact on the therapeutic relationship and deals with them appropriately.
- Consistently applies and reflects on processes of self-awareness and self-knowledge within professional practice.
- Applies the psychiatric nursing process to therapeutic relationships.
- Practices according to the principles of free and ongoing informed consent and confidentiality.
- Uses professional judgment and practices with personal integrity to initiate, maintain, re-establish, and terminate therapeutic relationships.
- Collaborates and advocates with individuals, families, groups, and communities.
- Ensures that their own personal needs are not being met within the therapeutic relationship.
- Ensures client needs remain the focus of the therapeutic relationship.
- Does not exploit the vulnerability of persons who are or who have been in their care.
- Acknowledges that any sexual behaviour is not permitted in a therapeutic relationship with or without consent. Will not engage in any sexual behavior when any psychotherapeutic interventions have been performed in the registered psychiatric nurse-client relationship even if the psychiatric nurse-client relationship has ended.
- Applies critical thinking and professional judgement in therapeutic relationships.
- Will treat family member/spouse or friends only when suitable alternatives cannot be found and will maintain appropriate boundaries between professional and personal relationships if one must treat a family member/spouse or friends in an emergent situation.
A Registered Psychiatric Nurse consistently applies, integrates, and remains current in evidence informed knowledge relevant to professional psychiatric nursing practice building on psychiatric nursing education and continued life-long learning.
A Registered Psychiatric Nurse:
1. Applies theory/evidence-informed knowledge, skill, critical inquiry, and critical clinical judgment to assess, plan, implement, and evaluate the practice of psychiatric nursing.
2. Synthesizes and applies recognized theories or frameworks to engage in innovative problem solving.
3. Applies critical thinking and critical clinical reasoning in the problem-solving process.
4. Incorporates knowledge of therapeutic modalities and conceptual models of psychiatric nursing.
5. Establishes, maintains, and coordinates a plan of care based on a comprehensive psychiatric nursing assessment.
6. Incorporates communication techniques effectively.
7. Respects diversity and promotes a culturally safe environment for clients and members of the health care team.
8. Documents the application of the clinical decision-making process in a responsible, accountable, timely and ethical manner.
9. Documents the psychiatric nursing care they provide accurately and in a timely, factual, complete, and confidential manner in whatever documentation system is used.
10. Remains current in knowledge relevant to the professional practice setting.
11. Meets continuing competence requirements.
12. Acknowledges limitations in knowledge, judgement and or skills and seeks out appropriate resources.
13. Provides leadership and consultation relevant to professional practice.
14. Supports, facilitates, or participates in research relevant to psychiatric nursing.
15. Applies appropriate infection prevention and control practices when providing psychiatric nursing care in accordance with applicable standards, best practices, and organizational requirements.
This includes:
a) employing routine practices and additional precautions when required;
b) practising aseptic technique;
c) following applicable standards for the use of single-use medical devices and for the cleaning, disinfection and sterilization of reusable medical devices;
d) following guidelines for management of blood borne fluid exposures and needle stick injuries.
16. Cannot procure or perform female genital mutilation and must intervene and report where the regulated member believes another health professional has performed or procured female genital mutilation.
17. Recognizes potential risks and hazards and implements interventions to promote a safe environment.
A Registered Psychiatric Nurse is accountable for safe, competent, and ethical psychiatric nursing practice that meets the standards of the profession and legislated requirements; a Registered Psychiatric Nurse is responsible for her/his practice.
A Registered Psychiatric Nurse:
- Maintains current registration/licensure.
- Practices in accordance with provincial and federal statutes / acts / regulations / by-laws and with the Code of Ethics, CRPNA Standards (Appendix 1), relevant legislation and any agency or employer requirements.
- Assumes responsibility and accountability for own practice and exercises professional judgment (culmination of education, experience, and insight that allows registered psychiatric nurses to execute the best action possible on behalf of patients) when utilizing agency requirements or when practising in the absence of agency requirements and seeks advice when agency requirements are unclear.
- Recognizes personal and professional limitations and competencies and discloses them when accepting assigned responsibilities and refers clients to alternative health care providers when scope of care exceeds the professional limitations.
- Recognizes competencies and limitations of colleagues and / or students when assigning responsibilities.
- Integrates cultural safety and diversity into psychiatric nursing practice understanding how bio-psychosocial needs and cultural background relate to health care needs.
- Responds to and / or reports to appropriate person(s), agency or professional body, situations which may be adverse for clients and / or health care providers, including incompetence, misconduct, and incapacity of registered psychiatric nurses and / or other health care providers, knows and utilizes relevant sections of the Health Professions Act requirements of duty to report.
- Discusses, as appropriate, unsafe competence to practice or professional misconduct with an individual prior to reporting under the relevant section of the Health Professions Act.
- Assumes responsibility and accountability for continuing competence and fulfills the requirements for the Continuing Competence Program.
- Assumes responsibility for understanding and addressing the significance of fitness to practice in the context of public protection, and strives to maintain a level of personal health, mental health, and well-being in order to provide safe, competent and ethical care. Self reports to CRPNA conditions that compromise their fitness to practice.
- Establishes collaborative partnerships that facilitate and support clients in all aspects of their care.
- Acts as a leader, teacher and role model to students, beginner practitioners and colleagues, supporting, precepting and/or mentoring them in their professional development.
- Demonstrates professional leadership by:
- a) Building trust relationships
- b) Creating empowering environments
- c) Supporting knowledge development and integration within the health care team
- d) Leading and sustaining change and balancing competing values and priorities
- Uses a collaborative, integrated, holistic, approach to develop partnerships in the best interest of their clients.
- Assumes responsibility and accountability for use of social media and understands the necessity for maintaining confidentiality, privacy, professional boundaries, and the requirements of Social Media: e-Professionalism Guidance for Nurses under the “6 P’s” – professional, positive, patient/person free, protect yourself, privacy and pause before you post principles.
A Registered Psychiatric Nurse provides leadership by acting as a role model for best practice in the delivery of quality psychiatric nursing care.
A Registered Psychiatric Nurse:
1. Demonstrates appropriate prioritization, guidance, and assignment of care responsibilities to others to safely and effectively lead the psychiatric nursing care of others.
2. Plays an active and equal role in the interdisciplinary team, collaborating and communicating effectively with a range of health care disciplines.
3. Understands the principles of effective leadership, management, group organizational and cultural dynamics; and can apply these in effective decision-making.
4. Understands and applies the principles of human factors, environmental factors and strength-based approaches when working in teams.
5. Demonstrates an understanding of the roles, responsibilities, scope of practice of all members of the nursing and interdisciplinary team; and knows how to make the best use of contributions of others involved in providing care.
6. Exhibits leadership by demonstrating an ability to guide, support and motivate individuals and interact confidently with other members of the interdisciplinary team.
7. Supports and supervises nursing students in the delivery of care, promoting reflection and providing constructive feedback, evaluating, and sharing their performance with clinical instructors.
8. Effectively and responsibly uses a range of digital technologies to access, input, share and apply information and data within teams and between agencies in accordance with employer and legislative requirements.
9. Understands and recognizes the need to respond to the challenges of providing safe, effective, person-centred psychiatric nursing care for clients who have co-morbidities and complex care needs.
10. Leads and advocates for needed resources to respond to client needs while balancing priorities and competing values in a safe and ethical manner.
A Registered Psychiatric Nurse understands, upholds, and incorporates into their practice the Code of Ethics of the profession and demonstrates advocacy for clients within the health system by responding to their needs in ways that support, protect and safeguard the client’s rights and interests.
A Registered Psychiatric Nurse:
1. Practices with honesty, integrity, and respect, demonstrating the ethics, standards, principles, guidelines, and values of the profession.
2. Applies ethical principles when ethical issues are identified to address situations of ethical distress and dilemmas.
3. Identifies the effect of own values, beliefs, bias (conscious and unconscious) and experiences in relationships with clients, recognizes potential conflicts and takes action to prevent or resolve them.
4. Applies ethical and legal considerations in maintaining confidentiality in all forms of communication; written, oral and electronic.
5. Endeavours to provide culturally sensitive care.
6. Acts as an advocate to protect and promote a client’s right to self-determination, autonomy, respect, privacy, dignity, and access to information.
7. Assists clients in the expression of individual needs, values, and choices (e.g., cultural beliefs, sexual orientation, age, and gender) and ensures that the client's perspective is known to be able to provide appropriate services.
8. Promotes a practice environment that supports client advocacy and uses information to ensure that human and other resources are used efficiently to maintain client safety.
Boundaries: Boundaries are limits that protect the space between the professional’s power and the client’s vulnerability. Boundaries define and separate professional roles from other roles. Boundaries are the limits that allow a safe connection between a professional and a client and are always based on the client’s needs (Peterson, M. 1992).
Client: Client refers to the individual, groups, and communities, who are the recipient(s) of psychiatric nursing services.
Competencies: Individual, groups, families, and communities. Competencies are the knowledge, skills, judgments, attitudes, and values required for successful functioning as a Registered Psychiatric Nurse.
Continuing Competence: Continuing Competence is the ongoing ability of a Registered Psychiatric Nurse to integrate and apply the knowledge, skills, judgment, attitudes, values and interpersonal attributes required to practice safely and ethically in their current role and setting.
Culturally Sensitive Care: Communicates and practices in a way that respects and takes into account the cultural, social, political, linguistic, and spiritual realities of the people with whom one is working.
Health: Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (World Health Organization).
Mental Health: Mental Health can be conceptualized as a state of well-being in which individuals realize their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a contribution to their community (World Health Organization).
Mental Health Promotion: Mental Health Promotion is the process of developing positive mental health both for and with the community in general and individuals who experience mental illness. It is linked to relationships with others, environmental, and lifestyle factors, and the degree of power one has over one’s life (Canadian Mental Health Association).
Recovery: Recovery is a process in which people living with mental health problems and illnesses are empowered and supported to be actively engaged in their own journey of well-being (Toward Recovery and Well-Being, Mental Health Commission of Canada, 2009).
Therapeutic Relationship: An interpersonal process that is purposeful, goal directed and focused on achieving outcomes in the best interest of the client.
- Standard of Practice Maintaining Professional Boundaries and Preventing Sexual Abuse
- Standard of Practice for Registered Psychiatric Nurses in the Provision of Restricted Activities
- Registered Psychiatric Nurses Standards of Practice Prescribing Schedule 1 Drugs and Ordering Diagnostic Tests
- Decision Making Standards for Nurses in the Supervision of Health Care Aides, 2010
Health Professions Act, R.S.A.2000, c. H-7.
Interpretation
1(1) In this Act
(pp) “unprofessional conduct” means one or more of the following, whether or not it is disgraceful or dishonorable:
(i) displaying a lack of knowledge of or lack of skill or judgment in the provision of professional services;
(ii) contravention of this Act, a code of ethics or standards of practice;
(iii) contravention of another enactment that applies to the profession;
(iv) representing or holding out that a person was a regulated member and in good standing while the person’s registration or practice permit was suspended or cancelled;
(v) representing or holding out that person’s registration or practice permit is not subject to conditions when it is or misrepresenting the conditions;
(vi) failure or refusal
(A) to comply with the requirements of the continuing competence program, or
(B) to co-operate with a competence committee or a person appointed under section 11 undertaking a practice visit;
(vi.1) failure or refusal
(A) to comply with a request of or co-operate with an inspector;
(B) to comply with a direction of the registrar made under section 53.4(3);
(vii) failure or refusal
(A) to comply with an agreement that is part of a ratified settlement,
(B) to comply with a request of or co-operate with an investigator,
(C) to undergo an examination under section 118, or
(D) to comply with a notice to attend or a notice to produce under Part 4;
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