Conform to the legislative and ethical framework informing Professional Conduct in Nursing in South Africa..pdf

Unit 1: Legislative and Ethical framework
Conform to the legislative and ethical framework
informing Professional Conduct in Nursing in South
Africa.
ETHOS AND PROFESSIONAL PRACTICE 2
1/30/2025 BY C SETTLEY 1

By the end of this lesson, students will be able to:
Demonstrate proficiency in navigating the Nursing Act and other relevant Acts.
Understand the ethical foundations and universal ethical principles that guide healthcare
practice.
Apply ethical decision-making skills to resolve ethical dilemmas commonly encountered in
nursing.
Discuss the responsibility areas that are typically included in a nursing job description.
Analyze the process of including new activities in an existing job description.

Introduction & Potential dilemmas
Discussion on the importance of law and ethics in nursing practice. How does rules and ethical
principles guide your clinical experiences?
1. Patient Rights and Dignity
Scenario: A nurse encounters a situation where a patient refuses life-saving treatment.
Discussion: In South Africa, the Patients’ Rights Charter and the Constitution protect patients'
autonomy. How should nurses balance respecting the patient’s choice with their duty to
preserve life? What ethical principles (e.g., autonomy, beneficence) guide this decision?
2. Confidentiality and Privacy
Scenario: A nurse overhears a colleague sharing a patient’s HIV status in a public setting.
Discussion: The National Health Act emphasizes patient confidentiality. What legal and ethical
steps should the nurse take to address this breach, and how does it impact trust in healthcare?

Introduction
3. Informed Consent
Scenario: A nurse is asked to assist with a minor surgical procedure, but the patient doesn’t seem to understand the risks
involved.
Discussion: In South Africa, informed consent is a legal requirement under the Health Professions Act. How can nurses
ensure that patients fully comprehend medical information, especially in communities with language barriers?
4. Workplace Ethical Dilemmas
Scenario: A nurse is asked by their employer to dispose of expired medication improperly to save costs.
Discussion: The Nursing Act No. 33 of 2005 and Environmental Legislation mandate proper disposal of medical waste.
What should the nurse do in this situation, and what are the potential consequences of ignoring ethical and legal
standards?
5. Equitable Access to Care
Scenario: A rural clinic runs out of essential medication, and the nurse must prioritize who receives treatment.
Discussion: The Constitution of South Africa guarantees access to healthcare. How should nurses apply ethical principles
of justice and fairness in resource allocation?

Key Concepts:
Define professional conduct in nursing and its role in
protecting patients, healthcare providers, and institutions.
Professional conduct in nursing refers to the behavior, attitudes, and practices that align with the ethical and legal
standards governing the nursing profession.
Role of Professional Conduct
1. Protecting Patients
- safety, ethical care, high quality care
2. Protecting Healthcare Providers
- framework for ethical decision making, reduces distress, burnout
3. Protecting Institutions
- reputation of facilities, ethical practices
Professional conduct in nursing serves as the cornerstone of safe and effective
healthcare delivery, creating a protective framework that benefits patients,
practitioners, and institutions alike.

Sources of Law Influencing Nursing Practice
a) Legislation
Legislation in nursing refers to the body of laws and regulations enacted by governing
authorities to define, regulate, and guide the nursing profession.
These laws outline the scope of practice, establish standards of care, and ensure
accountability, patient safety, and ethical conduct in healthcare delivery.
Impact of Legislation on Nursing
1. Defining Scope of Practice
Legislation, such as the Nursing Act No. 33 of 2005 in South Africa, clearly outlines the roles and
responsibilities of nurses at various levels (e.g., professional nurses, enrolled nurses, and
auxiliary nurses).
It ensures that nurses perform only tasks for which they are trained and qualified, safeguarding
patient safety.

a) Legislation
2. Protecting Patient Rights
Laws like the National Health Act ensure patient rights, including informed consent,
confidentiality, and equitable access to care.
Nurses must comply with these legal standards to maintain trust and uphold patient autonomy.
3. Promoting Ethical Practice
Legislation provides a framework for ethical decision-making, supporting nurses in addressing
complex dilemmas (e.g., end-of-life care, resource allocation).
It reinforces adherence to professional codes of ethics and institutional policies

a) Legislation
4. Ensuring Accountability and Competence
Licensing requirements and professional regulations, enforced by the South African Nursing
Council (SANC), ensure that nurses are competent and accountable for their practice.
Disciplinary measures for misconduct protect the profession’s integrity and public confidence.
5. Improving Workplace Safety
Occupational health and safety laws ensure a safe environment for nurses, reducing risks of
workplace injuries and exposure to infectious diseases.
This fosters better morale and efficiency within healthcare teams.

b) Regulations
1. Licensing Requirements
Purpose: Regulations outline the criteria nurses must meet to be licensed and legally practice.
Example (South Africa):
◦ The Nursing Act No. 33 of 2005 empowers the South African Nursing Council (SANC) to regulate
licensing.
◦ Details in Regulations:
◦ Completion of accredited nursing education programs.
◦ Successful passing of examinations administered by SANC.
◦ Ongoing registration renewal contingent on meeting continuing professional development (CPD) requirements.
Impact: Licensing regulations ensure that nurses are competent, maintain high standards, and
are accountable for their actions.

b) Regulations
2. Scope of Practice
Purpose: Regulations define the specific tasks and responsibilities nurses can perform based on
their qualifications and levels of training.
Example (South Africa):
◦ Regulations under the Nursing Act classify the scope of practice for:
◦ Professional Nurses: Advanced clinical care, leadership, and decision-making.
◦ Enrolled Nurses: Supportive clinical roles under supervision.
◦ Auxiliary Nurses: Basic patient care and assistance.
Impact: These detailed rules prevent unauthorized practices, reduce risks to patients, and
enhance role clarity within healthcare teams.

b) Regulations
3. Standardizing Care
Purpose: Regulations establish standards for ethical and clinical nursing practices.
Example: Infection control protocols, medication administration guidelines, and procedures for
documentation.
Impact: Ensures consistency in care delivery, minimizes errors, and promotes patient safety.
4. Guidelines for Disciplinary Action
Purpose: Regulations provide procedures for investigating and addressing professional misconduct.
Example (South Africa): The Code of Ethics for Nursing Practitioners in South Africa guides disciplinary
action in cases of negligence, abuse, or breach of patient confidentiality.
Impact: Protects patients, maintains public trust, and holds nurses accountable.

c) Case law
Case law, also known as judicial precedent, refers to legal principles established through the decisions of courts in
individual cases.
These rulings serve as authoritative interpretations of legislation and provide guidance on how laws should be
applied in specific situations.
Over time, case law becomes a critical source of legal standards alongside statutory law.
Importance of Case Law in Shaping Nursing Practices
1. Clarifies Legal and Ethical Responsibilities
2. Sets Precedents for Professional Conduct
3. Guides Responses to Ethical Dilemmas
4. Protects Patients and Healthcare Workers
5. Influences Policy Development
Read the Landmark case (SDL) For discussion next week.

More interesting cases
1. Castell v De Greef (1994) – South Africa
Key Issue: Informed consent in medical treatment.
Summary: This case established that healthcare providers must provide patients with sufficient
information about risks, benefits, and alternatives to treatment. It set the standard for informed
consent in South Africa, which is crucial for nurses when administering treatment or assisting in
medical procedures.
2. Bolam v Friern Hospital Management Committee (1957) – UK
Key Issue: Professional negligence.
Summary: The case established the "Bolam test," which assesses whether a healthcare
professional acted in accordance with a standard practice accepted by a responsible body of
medical opinion. Nurses must meet the standard of care expected in their profession to avoid
negligence.

More interesting cases
3. SANC v Magagula (2007) – South Africa
Key Issue: Professional misconduct by nurses.
Summary: A nurse was found guilty of professional misconduct after neglecting her duties,
resulting in harm to a patient. This case emphasized the importance of adherence to
professional codes of conduct and standards set by the South African Nursing Council (SANC).
4. McFarlane v Tayside Health Board (1999) – UK
Key Issue: Ethical implications in family planning.
Summary: A case where a failed sterilization procedure led to an unplanned pregnancy. It
highlighted the ethical duty of healthcare providers, including nurses, to counsel and inform
patients about the risks and effectiveness of medical procedures.

Case Scenario: The Ripple Effect of Negligence
Background
Lerato is a newly licensed professional nurse working in a busy hospital in South
Africa. Overwhelmed by her workload and pressured by time constraints, she
takes shortcuts in her duties. One morning, Lerato administers medication to a
patient, Mr. Dlamini, without cross-checking his allergy history. As a result, Mr.
Dlamini suffers a severe allergic reaction and falls into a coma.

Legal Issues Raised
Professional Conduct Violation
◦ Lerato failed to follow proper protocols, including verifying patient information and adhering to safe
medication practices, which breached professional standards of care.
Legislation Breach
◦ Under the Nursing Act No. 33 of 2005, nurses are required to practice within their scope and follow regulatory
guidelines. Lerato's actions violated her legal duty to ensure patient safety.
Impact of Regulations
◦ The hospital's medication administration policy, developed under healthcare regulations, was ignored. This
policy is meant to prevent exactly such errors.
Role of Case Law
◦ A similar case, XYZ v Provincial Hospital (2015), resulted in a ruling where a nurse was held liable for
negligence, leading to a significant financial penalty and loss of licensure. This precedent will likely influence
the court's decision if Mr. Dlamini's family sues.

Consequences for Lerato
Professional Consequences:
Lerato faces a disciplinary hearing by the South African Nursing Council (SANC). If found guilty of
professional misconduct, her license could be suspended or revoked.
Legal Consequences:
The family of Mr. Dlamini files a lawsuit, citing negligence and emotional distress. The court may
order Lerato to pay damages and could even impose criminal charges if gross negligence is proven.
Institutional Impact:
The hospital, as Lerato’s employer, faces reputational damage and may be fined or sued for failing to
adequately train and supervise staff.
Personal Impact:
Lerato’s career and mental well-being are severely affected. She struggles with guilt and the financial
burden of legal fees.

d) Policies
Definitionof HealthPolicies
Health policies refer to principles, decisions, and guidelines formulated by governments or healthcare institutions to achieve
specific healthcare objectives. These policies aim to promote the health of populations, ensure quality care, and address
inequalities within healthcare systems.
1. Institutional Health Policies
These policies are developed and implemented at the organizational level (e.g., hospitals, clinics,
or health systems) to guide healthcare practices within a specific institution.
Establishing Standards of Care
Ensuring Compliance with Laws and Regulations
Resource Allocation and Management
Protecting Staff and Patients
Promoting Accountability and Transparency
◦ .

d) Policies
◦ .
2. National Health Policies
National health policies are broad strategies formulated by governments to address the health needs
of the population. In South Africa, the National Department of Health (NDoH) oversees the
development of these policies.
Guiding the Healthcare System
Addressing Public Health Priorities
Promoting Equity in Healthcare
Regulating the Health Sector
Improving Healthcare Access and Quality
Responding to Emergencies

Interplay Between Institutional and National
Policies
Institutional policies operationalize national health policies by adapting them to the local
context. For example:
A national policy on infection control is implemented in hospitals through specific cleaning, PPE,
and hand hygiene protocols.
National maternal health strategies are translated into hospital guidelines for prenatal care and
delivery.

e) Codes, Charters, and Guidelines
Eg, SANC Code of Ethics for Nurses
- The South African Nursing Council (SANC)
Code of Ethics is a foundational document
that outlines the ethical principles and
standards of professional behavior expected
from nurses in South Africa. It serves as a
guide for ethical decision-making and
upholding the integrity of the nursing
profession.
Significance:
Guiding Professional
Behavior
Ensuring Patient Safety
and Dignity
Supporting Continuous
Professional
Development
Strengthening
Professional
Relationships
Promoting
Accountability and
Trust
Legal and Disciplinary
Framework

WHO Guidelines for the Management of Hypertension
NICE Guidelines on Diabetes Management
South African HIV Management Guidelines
Clinical Guidelines for the Management of Sepsis (Surviving Sepsis Campaign)

Broader Legislative Framework for Nurses and
Midwives
The interconnectedness of employment laws, public health laws, and other relevant acts
shapes the legal and ethical landscape in which nursing professionals operate.
1. Employment Laws: Basic Conditions of Employment Act (BCEA) & Labour Relations Act (LRA)
◦ Basic Conditions of Employment Act (BCEA)
◦ Labour Relations Act (LRA)
◦ Interconnection:
The BCEA and LRA ensure that nurses are treated fairly in the workplace, which directly impacts their
morale, job satisfaction, and ability to provide quality patient care. Fair treatment and clear workplace
regulations reduce the likelihood of workplace conflicts that can impact healthcare services. A
harmonious work environment, guaranteed by these laws, contributes to the overall healthcare
system's efficiency.

Broader Legislative Framework for Nurses and
Midwives
2. Public Health Laws: National Health Act
◦ National Health Act (NHA)
3. Protection of Personal Information Act (POPIA)
4. Other Relevant Acts
◦ Health Professions Act (HPA)

References
South African Nursing Council (SANC) Code of Ethics for Nursing.
Nursing Act 33 of 2005.
National Health Act 61 of 2003.
Relevant South African case law and policies.
Batho Pele Principles.

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