Common law system

Australia and New Zealand are referred to as common law countries. The common law system has its origins in the legal system and principles developed in England around the fourteenth century which became the basis for the legal systems of it colonies. The English common law system forms the basis for the complex and sophisticated legal system that exists in Australia and New Zealand today (Forrester & Griffiths 2010; Staunton & Chiarella 2008).

In common law countries the source of law and legal system is based on a combination of:

Acts of Parliament

The parliament has the power to make or unmake laws and laws made by the parliament are referred to as parliamentary or statutory laws and known as Acts of Parliament (Staunton & Chiarella 2008). Acts of Parliament are the other major source of law and are commonly referred to as legislation. Acts are accompanied by Regulations that give directions for the administration of the Act (Forrester & Griffiths 2010).

The Australian Health Practitioners Regulation National Act 2009 arising from the National Registration and Accreditation Scheme for health professions is an example of an Act of Parliament. The Regulations accompanying this Act are administered by the Australian Health Practitioner Regulation Agency (AHPRA) which is responsible for ensuring that the intentions of this Act are followed in terms of regulating health professionals under the national accreditation scheme (see AHPRA website).

Nurses practising in Australia need to be aware that Acts may differ from state to state or territory and many health laws in relation to regulation of hospitals and healthcare services are within the jurisdiction of state and territory law. Some examples of Acts relevant to nursing practice are outlined in Clinical Interest Box 2.2.

The employer

The healthcare institutions as employers are legally responsible for the acts committed by all employees during the course of their employment. This is referred to as the principle of vicarious liability and is relevant to all nurses. It renders an employer vicariously liable for an employee’s actions committed during the course of employment (Crisp & Taylor 2009; Mair 2010) (see Clinical Scenario Box 2.1). For example, a hospital may be held liable due to negligence in duty of care for the client by the act or omission of care by a nurse causing harm. However the legal liability of the employer does not absolve a nurse from individual responsibility, and legal action can be taken against a hospital and a nurse or against a nurse as an individual if harm is caused by the actions of the nurse (Crisp & Taylor 2009). In the situation of nurses who are self-employed they are solely responsible and liable for the harm caused by their actions (Mair 2010).

It is the responsibility of healthcare employers to ensure that:

Nursing regulation

The primary function of the nursing regulatory authority is to protect the health and safety of members of the public by ensuring that nurses are competent and fit to practise. The nursing profession in Australia is regulated by AHPRA under the National Registration and Accreditation Scheme for health professions. The registration and accreditation of nurses is implemented through the national Nursing and Midwifery Board of Australia. In New Zealand, the Nursing Council of New Zealand is responsible for the registration of nurses. (See Online Resources at the end of this chapter for internet links to nursing regulatory authorities.)

Note that the midwifery classification is separate to that of nursing. Under nursing there are three classifications:

By defining the terms under which a nurse may practise in each of the classifications of registration, the law protects the community by deeming the qualified nurse to be safe and competent to practise nursing. Nurses who do not fulfil the requirements of the standards, codes and guidelines for the nursing and midwifery profession may not practise as nurses or midwives. (See online resources for AHPRA and Nursing Council of New Zealand codes, guidelines and scope of practice for nurses.)

As health professionals an annual practising certificate or renewal of registration must be obtained from the nursing regulatory authority. The responsibility for ensuring that registration or enrolment fees are paid each year and demonstrating competence fit for practice rests with the individual nurse. Nurses have to meet the standards and requirements for registration or enrolment that govern professional practice. (See Online Resources and Clinical Interest Box 2.3.)

The nursing regulatory authority is empowered to deregister nurses in certain circumstances; for example, a nurse’s registration or enrolment may be cancelled if they unlawfully use a registration number or if they are found to be unfit for practice, guilty of misconduct or negligence in a professional respect.

From 2011 in Australia it is a requirement that nursing students enrolled in an accredited program of study are also noted on the Australian Nursing and Midwifery Board student register. It is the responsibility of the education provider to ensure relevant details of students are provided to the regulatory authority on commencement of study. The primary purpose of the student register is to protect the health and safety of members of the public. There are greater numbers of nursing students in the clinical practice environment today and it is important to consider legal and ethical implications for clinical practice and safety of the students and the clients/clients. (See Online Resources.)

Professional boundaries

Professional nursing practice requires nurses to be aware of and understand the legal and professional boundaries within which they must function. Professional boundaries in nursing are the parameters within which nurses practise, to ensure that the limits of professional and therapeutic relationships with clients/clients in their care are not crossed. When a nurse crosses professional boundaries then that action is deemed as unprofessional conduct or behaviour. It is considered a misuse of the power vested in the professional over a vulnerable person in their care (Crisp & Taylor 2009; Kerridge et al 2005).

Regardless of the healthcare setting, nurses in daily professional practice are faced with difficult decisions linked to rofessional boundaries. It is critical that nurses as healthcare professionals recognise the lines of separation from the person in their care and apply sound judgment in managing issues around professional boundaries. Common examples of professional boundary concerns in nursing practice are accepting gifts and services, entering into sexual relationships, entering into financial arrangements, access to health information, disclosing health information (Crisp & Taylor 2009).

The professional boundaries for nursing practice in Australia and New Zealand are defined by guidelines and principles of safe practice jointly prescribed by Australian Nursing and Midwifery Council and the Nursing Council of New Zealand. These are set out in the framework for professional practice guidelines, A nurse’s guide to professional boundaries (2010). The guidelines provide a framework of what constitutes the limits of professional behaviour in nurse–client relationships and the decision-making tool is designed to assist with concerns relating to these situations. (See Clinical Interest Box 2.4 and Clinical Scenario Box 2.2.)

Contracts

A contract is an agreement between parties that is legally enforceable because of mutuality of agreement and obligation. A contract gives rise to rights and obligations that are protected and enforced by the law (Staunton & Chiarella 2008). The terms and conditions of the contract are binding on parties to the contract (Kerridge et al 2005).

A contract may be in writing or it may arise by implication, such as an agreement that is reached between a client and a healthcare agency to which they are admitted. Although in this case the client is not required to sign a document, they will have entered into a contract as to the nature and extent of their proposed treatment with the healthcare agency or the medical officer. The expectation is that safe and appropriate care is provided.

An important form of contract for nurses is the contract of employment that nurses as employees enter into with their employer. Arising out of this contractual relationship are certain rights and obligations relevant to both the employee and the employer that are defined in a written contract of employment (Crisp & Taylor 2009). Employment contracts are covered under the area of industrial law, and industrial awards impose specific provisions on employers relating to the health and safety of employees, the payment of wages and the provision of certain conditions. An industrial award is a document that sets out the wages and conditions of a particular group of employees and represents the contract of employment between the employer and the employee. A copy of each award can be obtained from the Department of Industrial Relations. Employers are required to have copies of the relevant awards available so that they are accessible to employees. Nurses have a responsibility to themselves to understand their contract of employment and their industrial award.

When starting each work shift, nurses engaged through nursing agencies are under contract to the health agency to which they have agreed to be allocated. A nursing agency is only an employment agency even though the nurse’s pay may be processed through it.

Standards of care

Standards of care are the guidelines or criteria for the standard of care that a nurse is expected to deliver (Crisp & Taylor 2009; Kerridge et al 2005). Nurses have a responsibility to be familiar with the standard of care which includes the degree of care, skill and judgment they are expected to exercise and to understand the importance of not undertaking tasks outside their defined role and function. There are a number of documents that help nurses to know the standard of care that is expected of them. Some are more binding and important than others, some documents set the minimum standards for practice and others clearly identify the standards to which nurses ought to aspire in daily practice (Crisp & Taylor 2009). (See Online Resources for the range of documents including competency standards, codes and guidelines that identify standards of care.)

In Australia the National Competency Standards for the Enrolled Nurse (ANMC 2002) and in New Zealand the Competencies for the Enrolled Nurse Scope of Practice (Nursing Council of New Zealand 2010) provide a regulatory and assessment framework to guide the scope of practice of enrolled nurses. These documents are binding. For enrolled nursing students these documents set the minimum criteria for competencies to be demonstrated to be eligible for entry into practice. Other sources of information to help nurses know the standard of care expected are healthcare agency policy and procedure manuals, government policy documents, professional organisations, nursing literature and specific regulations relevant to area of practice (Crisp & Taylor 2009).

Negligence

Negligence is a tort and means a civil wrong that relates to incidents where a person who suffers injury through a negligent act or omission can seek compensation from the person responsible for the negligence (Mair 2010). If a nurse gives care that does not meet accepted standards, the nurse may be held liable for negligence; for example, if the nurse’s actions result in harm to a client. Like other health professionals, nurses have a duty of care to their clients and, generally, negligence means failure by a nurse to take appropriate actions to protect the safety of a client. This may involve failing to do something that should have been done, or doing something that should not have been done. Examples of negligence in nursing include incorrect administration of medications, failure to communicate important information about a client’s condition, failing to take appropriate measures so that a client consequently sustains an injury and even failure to exercise reasonable care in giving advice to the client.

In the event of alleged negligence against a nurse the responsibility or the onus for proving negligence is with the plaintiff or the person alleging negligence (Mair 2010). A plaintiff must prove three elements to succeed in an action for negligence:

(Mair 2010; Staunton & Chiarella 2008)

The likelihood of injury to a client, and the risk of liability, is reduced when the nurse adheres to the principles of sound nursing practice and follows the established policies relating to standards of care. Clinical Interest Box 2.5 lists categories of negligence that may result in malpractice.

Defamation

The term ‘defamation of character’ refers to any communication, spoken or written, about an individual that injures their reputation. The term ‘libel’ is used when the communication is written, whereas the term ‘slander’ is used when the communication is spoken. With regard to nursing practice, all clients have a right to expect their privacy and confidentiality to be respected, and colleagues have a right to expect that their personal and professional reputations will not be harmed.

Nurses should therefore exercise extreme caution when discussing or documenting information relating to clients and when discussing members of staff. For example, a nurse may not be openly critical of the standard of care provided by another nurse. A nurse who is genuinely concerned about standards of nursing care should direct their concern through the proper channels and do so confidentially when making a complaint or report to senior administration (Mair 2010). Nurses should refrain from gossiping about colleagues, as this practice may lead to irreparable damage of an individual’s personal or professional reputation. Nurses should avoid making statements in writing in a client’s documents that may be interpreted as being of a defamatory nature. Nurses must ensure that all statements relating to a client are written in an objective rather than a subjective manner.

False imprisonment

False imprisonment refers to the wrongful deprivation of a person’s freedom of movement, such as restraining or detaining a person against their will. With regard to nursing practice, there are certain situations in which a client may need to be restrained, for example, to protect them from injury, protect others from being injured or prevent damage of property. Nurses must be aware that the application of any restraint is only performed in consultation with the client’s medical officer, and then only after very careful consideration. Written authorisation by a medical officer is generally required for the application of a restraint. Nurses need to know state laws and their organisations’ policies regarding restraint of clients. Apart from very specific instances, there are no powers to detain a person in a healthcare agency against their wishes, except when they are an involuntary client under mental health legislation. The Department of Health and Ageing has guidelines for the use of restraints in health and aged care organisations. There must be a medical officer’s order for the restraint which states the reason and time period. The order must be reviewed daily. Restraints can only be used after every other possible way of ensuring the safety of the client has been tried unsuccessfully. (See Ch 13 for further discussion on the use of restraints.) All healthcare agencies have a document that a client is asked to sign if they decide to leave the agency against medical advice.

Assault and battery

Assault and battery are considered criminal offences as well as breaches of civil law (Mair 2010). Although the term ‘assault’ is used to describe both actions, there is a distinction between the two. Assault occurs when a threat to carry out unwanted and unlawful contact on another person is made, thereby causing that person to be in fear of their safety. Battery involves the direct, intentional and uninvited application of physical contact to another person’s body (Crisp & Taylor 2009) (see Clinical Scenario Box 2.3).

In nursing practice, a nurse could intentionally or unintentionally commit an act of assault if they did anything in terms of touching the client without consent. As many nursing activities involve direct physical contact with a client there is the possibility of committing assault and battery which could result in an offence of trespass to the person if unwanted and unlawful contact is made (Mair 2010). The important factor in situations in which physical contact is involved is to make sure you have the client’s consent.

Consent

Consent by a client can be provided in a number of ways (Crisp & Taylor 2009; Mair 2010). Implied consent is frequently given in the performance of nursing activities. For example, if a nurse requests a client to hold out their arm so that they can measure their blood pressure, and the client does so, then they have implied their consent to that procedure. Clients frequently give consent verbally, for example, by agreeing to have a procedure performed. Written consent provides documentary evidence that consent was given. Before any invasive procedure or surgical intervention is performed a client is requested to sign a consent form.

Regardless of the form in which consent is given it must be valid and for consent to be valid it must be voluntarily and freely given. It should also cover the treatment to be carried out, and be given by a legally competent person who has sufficient information about the treatment or intervention to be performed (Crisp & Taylor 2009). (See Clinical Scenario Box 2.4.)

Legal capacity to give consent is determined by age and the person’s mental and intellectual function. Legal consent can only be given by a competent adult and if the person is unable to give consent specific legislation enables others to give consent on the behalf of that person (Crisp & Taylor 2009; Mair 2010). Parents and guardians can provide consent for children and minors. Under guardianship legislation a guardian or appointed authority may give consent for treating a mentally incompetent person. The mental health legislation allows non-consensual treatment of mentally ill persons. In circumstances when it is difficult to obtain consent, for example if the client is unconscious, consent can be obtained from someone legally authorised to give consent on behalf of the client. If the situation arises that the client requires emergency treatment and it is impossible to obtain consent from the client an authorised person may give consent. In the event of life-threatening situations the overriding duty of care negates the need for consent and legislation enables medical intervention without consent. An example would be an unconscious person who has serious life-threatening injuries from a motor vehicle accident.

Informed consent is given when the client is provided with adequate information about, and understands, the procedure to which they are consenting. The client giving consent understands the risks and benefits involved as well as the actual procedure (Mair 2010). When a nurse provides information to a client about the nursing procedure to be performed it is the responsibility of the nurse to ensure that the person consenting is competent to determine what treatment or care they will be subjected to. In the case of medical and surgical procedures it is the responsibility of the medical officer to provide the client with an adequate explanation of any proposed treatment. Informed consent for medical and surgical treatment is documented on a consent form which is a legal record. This form is signed by the client giving consent to the treatment and the medical officer providing the information. In some healthcare facilities a general medical treatment consent form is signed by the client on admission, for the treatment and care provided during the course of that admission. However, this does not include specific medical interventions that may be required to diagnose or treat the client. Additional informed consent is required for diagnostics tests or procedures.

An important consideration with regard to consent is that the client has the right to withhold or revoke their consent at any time provided they are competent to do so. In this event they must be informed about any detrimental consequences of refusal (Mair 2010). If either situation arises, the event must be reported immediately to the nurse in charge, the medical officer and be documented.

Confidentiality and privacy

‘Confidentiality’ refers specifically to restrictions upon private information revealed in confidence, with an understanding that the information will not be disclosed to others; ‘privacy’ refers to ownership of one’s own body or information about one’s self (Kerridge et al 2005). Nurses have a legal and ethical obligation not to disclose confidential information acquired about clients in their care, except when such disclosure occurs during the course of their professional duties (Johnstone 2009). Information that may be classified as confidential and private may be anything related to a client’s condition, treatment being given, the prognosis, or anything relevant to a client’s private life. Disclosure of such information may lead to legal action against the healthcare agency. The requirement for nurses to observe a duty of confidentiality is spelt out in the Codes of Conduct and Code of Ethics for Nurses. (See Online Resources.)

Information communicated in a client’s nursing and medical records must be kept confidential and, therefore, nurses are responsible for protecting records from unauthorised readers. Information provided to other treating healthcare professionals should be kept to a need-to-know basis, and consent from the client must be obtained if a third party requires access to records (Mair 2010). A client’s right to privacy must be respected and their affairs must not be discussed with other clients, with non-professional staff or with members of the general public. Discretion should be used by nurses during their off-duty hours and they should avoid careless chatter about the healthcare agency, any of the clients or staff members. If approached at any time by a representative of an organisation, press, radio or television, a nurse should refrain from giving information but should refer the enquiry to the administrative section or other appropriate department of the healthcare agency.

Documentation

Client records are important legal documents and it is therefore important that nurses keep accurate and complete records of all treatment and care administered to the client (Mair 2010). In the course of work a nurse is required to document information about clients on nursing care plans, progress notes, flow charts and any other care specific documents used in the healthcare facility. These client health records are legal evidence of the interventions and care provided. A client’s records may be required in legal proceedings, for example, as evidence in a case when treatment and care is disputed or where negligence has been alleged. Therefore, in addition to ensuring that any information is recorded accurately and concisely for the purpose of communication between members of the health team, accurate detailing of all relevant information is necessary to provide adequate explanation to a court of law. If a client’s records are required in legal proceedings they will be subject to very close scrutiny by lawyers. Good quality documentation in such situations will provide a clear account and help nurses defend their case (Crisp & Taylor 2009).

Staunton and Chiarella (2008) list a number of important points for quality documentation:

To reduce the risk of an incorrect entry being made:

Reporting of adverse events and clinical incidents

Nurses have an ethical and legal responsibility to report any accidents or incidents that occur within a healthcare agency. A written report must be made immediately after an accident or incident occurs in which a client, a visitor or a member of staff was involved, even when no injuries appear to have been sustained or the incident seems trivial. Most healthcare agencies have special forms, often electronic, for this purpose. Reporting of adverse events and clinical incidents provide a source of information to improve the quality of care and to evaluate the effectiveness of policies.

There is always a possibility that the ‘aggrieved person’ may take legal action, in which case the written report becomes a very important document. The information included in the report must be factual, clear, concise and objective. Personal opinions must not be included, and care must be taken to avoid using terms that could be misinterpreted. For further details on documentation and reporting skills, refer to Chapter 16. Examples of adverse events that may be reported are listed in Clinical Interest Box 2.6.

Coroner’s court

A coroner’s court is presided over by a magistrate, called a coroner, whose main function is to detect unlawful homicide. A coroner is required to investigate any death that was unexpected, or if the person died in unusual or violent circumstances. An inquest into a death may be conducted as long as several years after the event occurred and, in the case of an inquest arising out of a client’s death in a healthcare agency, a nurse may be called upon to give evidence. If this situation arises, nurses are advised to seek legal advice before giving a statement to the police or appearing in court. The healthcare agency through which the nurse is employed will generally ensure that they are represented by the agency’s legal representatives. Alternatively, a nurse can be represented by the professional nursing organisation of which they are a member.

Legal responsibilities of nursing students

Nursing is a practice-based profession and this requires students to touch clients and to be exposed to the professional environment in order to learn nursing skills properly. Therefore those involved in the education and supervision of students, and the students themselves, all carry the responsibility for ensuring that students are properly supervised and are never put into a situation where the client’s safety and wellbeing might be at risk in any way (Crisp & Taylor 2009; Kerridge et al 2005). Supervisors should ensure that students are adequately prepared to undertake new skills in the clinical environment and also that they have had previous practice in nursing skills laboratories. Students must be supervised by an experienced and competent nurse either from their tertiary education institution or from the clinical environment in which the student is placed. If students are uncertain about procedures in the clinical environment it is their responsibility to inform their supervisor and seek clarification (Crisp & Taylor 2009).

During the course of their nursing studies many students often find work as assistants in nursing. Crisp & Taylor (2009:354) point out that it important to recognise that, while such employment will undoubtedly provide valuable experience, the student is employed as an unqualified member of staff and should not take on responsibilities outside the scope of that role or their education.

In Australia, under national legislation nursing students enrolled in an approved program of study at a tertiary institution are registered with the Nursing and Midwifery Board of Australia for the duration of their education and clinical training as a student. The core role of this Board is to protect the public: clients are entitled to expect to receive a safe standard of care, regardless of whether the care is delivered by a registered or student nurse.

Ethics

Ethics may be defined as a set of moral principles that imply a commitment unrelated to monetary reward or prestige and which are derived from a system of values and beliefs concerned with rights and obligations. Ethics is concerned with ascribing moral values to, or passing moral judgment on, such things as people, situations or actions. Ethics is also concerned with the justification of such moral ascriptions (Johnstone 2009; Freckelton & Peterson 2006; Fry et al 2011; Kerridge et al 2005).

Ethics involves different moral and philosophical positions regarding what is good and what may not be right. A number of different theoretical perspectives may be applied to guide ethical behaviour. The well-known ethical theories are deontological ethics, teleological ethics, moral rights theory, virtue ethics and ethical principlism. In nursing practice and healthcare ‘ethical principlism’ is a commonly applied framework for analysing ethical issues and moral decision making (Johnstone 2009). (See Clinical Interest Box 2.7.)

Nursing ethics

In Australia and New Zealand nursing ethics are strongly influenced by the bioethics movement. The term bioethics originates from the ancient Greek: bios meaning ‘life’ and ethikos, ithiki meaning ‘ethics’. The bioethics movement originated in the United States and its main focus is the rights and duties of clients and healthcare professionals; the rights and duties of research subjects and researchers; and the formulation of public policy guidelines for clinical care and biomedical research (Reich 1995, cited in Crisp & Taylor 2009:332). (See Clinical Interest Box 2.8.)

Nursing ethics is defined as ‘the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice, which in turn rests on the core concepts of nursing’ (Johnstone 2009:16). The nursing profession has its own code of ethics, which is a statement about expected standards of behaviour and which is used to guide ethically sound professional nursing conduct and practice. The International Council of Nurses (ICN) formulated an International Code of Nursing Ethics (1973) outlining the nurse’s responsibilities to individuals, to society, to nursing practice, to co-workers and to the nursing profession.

The code of ethics is not a set of rules, but a guide for nurses to base their professional decision making upon. Society expects professional people such as nurses to behave with integrity, dignity, competence and compassion. The International Code of Nursing Ethics, The Code of Ethics for Nurses in Australia and the New Zealand Nurses Association Code of Ethics provide nurses with guidelines to assume personal responsibility for providing a standard of excellence in clinical practice. Every nurse is responsible for determining and implementing desirable standards of nursing practice and for following ethical standards in their professional conduct and in the care they deliver (Fry & Johnstone 2008). The nurse has a responsibility to participate actively in developing a body of professional knowledge and the skills necessary to promote safe and effective nursing care as an integral part of continuing competence (see Online Resources).

Ethical issues and moral dilemmas

Ethical issues arise in numerous areas of medical and nursing practice and may require nurses to be involved in resolving them. Johnstone (2010: 49) categorises the ethical issues faced by nurses into three kinds: everyday practical ethical issues; broader mainstream bioethical issues; and the broader social justice issues associated with promoting the welfare, wellbeing and significant moral interests of highly vulnerable, stigmatised and marginalised groups of people. Clinical Interest Box 2.9 lists some of the specific and common ethical issues faced in the healthcare environment.

The complex and changing nature of the healthcare environment today generates many ethical challenges. Nurses are often faced with difficult moral dilemmas. Moral or ethical dilemmas are situations that involve two competing or conflicting moral choices, neither of which is a desirable option in terms of outcomes (Dahnke & Dreher 2006). Moral dilemmas in nursing practice may arise in a number of situations when there are value conflicts. For example, a nurse who values the sanctity of life has to care for clients terminating unwanted pregnancies, or a nurse has to care for a young client who is terminally ill and refuses treatment, but the nurse also knows that the person is suffering enormously from their condition, with a poor quality of life.

In order to correctly identify and deal with the ethical issues and moral problems nurses must apply ethical reasoning and a moral decision-making process. The most important consideration is that nurses respond in the interests of the client and the client’s wellbeing and also act justly according to the expected standards of professional practice.

Ethical decision making

One of the most commonly used models for ethical decision making in nursing practice is the steps of the nursing process. This is a deliberate and systematic problem-solving approach that can be used to resolve moral problems in the healthcare environment (Crisp & Taylor 2009; Farrell & Dempsey 2011). (See Clinical Interest Box 2.10.)

Often solving an ethical dilemma may seem almost impossible in some situations, but using the standards stated in a code of ethics helps the nurse to view such problems objectively. (See Clinical Interest Box 2.11 and Clinical Scenario Box 2.7.)

When an ethical decision is to be made, the following factors must be considered:

Moral dilemmas will continue to occur in healthcare as long as choices have to be made that involve putting one set of values against another. It is therefore important that nurses keep themselves informed and are involved in discussions and debates about ethical issues and dilemmas so that they are able to make ethical decisions in an informed way rather than on a purely emotional basis.

Advocacy

In a nursing context, advocacy means that the nurse acts for and on behalf of the client. To act as an advocate for a client the nurse must ensure that the client is provided with adequate and accurate information relating to their care, and they must support the client in any informed decisions they make about their care. In this way the nurse meets the ethical requirement of honouring a client’s right to self-determination. An important consideration when advocating for the client is to know when and how to advocate to ensure that the advocacy is within the legal and ethical guidelines of professional practice (Turner & McIntyre 2006). In nursing the concept of advocacy is based in nursing ethics which involves respecting a client’s right to:

All nurses have a responsibility to ensure that, in relation to nursing practice, the client is assured of safe and competent care and that their rights will be protected. (See Clinical Scenario Box 2.8.)