1. Working to Full Scope of Practice in unison with PN Ethics: Wound Care, Tracheostomy's, and Drains Presented By: Chandra Campbell, Lisa Gillespie, Danil Zaytsev, Navjot Saini

2. OVERVIEW 1.What is PN ethics 2.The Code of ethics 3.Spheres of the scope of practice 4.Ethical Principles 5.Ethical Principles and Nursing Practice 6.Accepting Accountability 7.Tracheostomys 8.Wound Care 9.When things go beyond scope 10.Drains 11.Consultation for Assistance 3. What is PN Ethics? Protects Clients Code of ethics Guide what is right and wrong Motives behind determining outcomes through those actions and their consequences of those actions on clients Support guiding actions nursing related 4. The Code of Ethics The "Code of Ethics and Standards of Practice" for licensed practical nurses of Alberta is a foundation of our profession (CLPNA: Code of Ethics and Standards of Practice, 2008, p.2). It serves us as a reference guide for building ethical relationships with our colleagues and patients, it explains our responsibilities on workplace, and directs our practice towards standards of law and existing regulations. This ethical foundation also underlines the role of philosophical values in our profession such as personal obligations, individual commitments, and believes by establishing ethical standards in order to match expectations of general public and community. The code also serves us as a tool for self reflective evaluation and it is essential for maintaining safe, companionate, and ethical environment in our workplace (CLPNA: Code of Ethics and Standards of Practice, 2008, p.2). 5. The Code of Ethics is based on several assumptions such as promotion of health and well-being to all patients, preserving their dignity, maintaining privacy and confidentiality, promotion of justice, and accountability that should never be compromised by any means (Cassells & Gaul, 1998, p.10) 6. Spheres of the Scope of Practice CLPNA Institutional Policies Students Scope 7. Ethical Principles Through guiding principles as professionals we are able to : make informed decisions Deliver more competent care Are in place to PROTECT THE RIGHTS of the individuals we care for These principles are the rights for clients: 1.Autonomy 2.Nonmaleficence 3.Justice 4.Fidelity 5.Veracity 6.Accountability 8. What these Principles mean in current nursing practice Autonomy-Right to make decisions that impact oneself and take action from those decisions, Nonmalificence-Do no harm Beneficence-act in the best interest of others, includes client advocacy, 3 parts: Promote good, prevent harm or evil, Remove Harm or evil Fedelity-Faithful to ethical principles, and code of ethics for nursing, keeping commitments and promises made to clients Justice-Fair, equitable, and appropriate treatment, equal distribution of resources Veracity-To tell the truth Accountability-Being answerable to self and others based on action, includes responsibility for ones actions for procedures performed as a nurse 9. Accepting Accountability Ethical Principles Scope of practice Common Drains Tracheostomy tubes 10. Tracheostomy tubes Cuffed tube with disposable and reusable inner cannula 11. Tracheostomy Tubes Cuff less Tube with disposable and reusable inner cannula 12. Types of Tracheostomy tubes Fenestrated cuffed and cuffless tracheostomy tubes 13. Wound Care beyond the dermis beyond beyond the point in the nasal passages where they normally narrow the external ear canal beyond the pharynx beyond the opening of the urethra beyond the labia majora beyond the anal verge into an artificial opening into the body. http://peltons.com/ When to stop: Anatomical levels of reference http://www.health.gov.bc.ca/professional-regulation/hpc/review/part-i/scope- 14. When Things Go Beyond Scope of practice When it is considered that the needs of the patient go beyond the scope of practice of LPN, the RN would take accountability for the clients care, in open discussion with RN practical nurse should decide which of the following options would be the most appropriate: RN and LPN work together to provide the required care LPN works under the supervision or guidance of RN (direct/indirect) LPN delegate the care for the client to RN https://www.youtube.com/watch?v=uXBssToP4g 15. Drains: Working within the LPN Scope . Within Scope of Practise Outside Scope of Practise Jackson Pratt Drain Nasogastric Tubes (NG Tubes) Hemovac Drain Blake Drain Davol Drain Flex-I Seal Rectal Tube & Collecting System Penrose Drain Percutaneous Drain/ Stent: Cook drain/ Pigtail drain/ CT drain Malecot Drain T-Tube Drain 16. Purpose: Seek clarification, assistance and exterior knowledge to assist in decision making pertaining to critical thinking and administration of care. Resource's available: Fellow Staff Members Alberta Health Services Policy & Procedures Manual Unit In-Service/ Education Days Charge Nurse Specialized Nursing Staff (Wound Care) **Unit Educator** Priority: Patient Safety! 17. From Us to You Nursing comes with a price we all must pay and the path is not always laid with gold. Work hard to learn what you can as students knowledge is something we strive for to make us not just better nurses but people as well. It is the people we care for that teach us about life, values, and form the experiences that help us grow as individuals in our practice. Its our responsibility to ensure their safety in our care as we grow, learn, laugh, and cry with them through their experiences to apply it so that the gold we weave can make a lasting impact on the lives we will touch throughout our careers. 18. Reference Bow Valley College, BVC. (2014). Practical nursing program diploma curriculum. Calgary, AB: BVC Canadian Council for Practical Nurse Regulation, CCPNR. (2013). Code of ethics for licensed practical nurses in Canada. Retrieved from: http://www.clpna.com/wp- content/uploads/2013/02/doc_CCPNR_CLPNA_Code_of_Ethics.pdf College of Licenced Practical Nurses of Alberta. (2013). Pp. 04, 05. Retrieved from http://www.clpna.com/wpcontent/uploads/2013/02/doc_CCPNR_CLPNA_Standards_of_ Practice.pds College of Licensed Practical Nurses of Alberta, CLPNA. (2008). Code of ethics and standards of practice. Retrieved from: http://www.clpna.com/wp- content/uploads/2013 /02/doc_CLPNAEthics-Standards.pdf Cassells, J., & Gaul, A. (1998). An ethical assessment framework for nursing practice. Maryland Nurse, 17(1), 9- 12. Hogan A. (2012). Comprehensive review for NCLEX-PN Reviews & Rationales (2nd ed.), Amherst: Pearson Education Inc. Kozier, B., Erb, G., Berman, A., Snyder, S., Bouchal, D. S. R., Hirst, S., et al. (2010). Fundamentals of Canadian nursing: Concepts, process, and practice (2nd Canadian ed.). Toronto: Pearson Education Linton A. (2012). Introduction to medical-surgical nursing. (5th ed.), Philadelphia: Saunders Elsevier