Follow ethical guidelines in decision-making in all work undertaken the health setting with awareness of potential ethical complexity in own work role
Roles and responsibilities of members of the team
Reflect understanding and compliance with the principles of duty of care and legal responsibilities in all work undertaken
Refer any breach or non adherence to standard procedures or adverse event to appropriate personnel
Maintain confidentiality of any client matter in line with organisation policy and procedure
Show respect for rights and responsibilities of others through considered application of work practices
Reflect current working knowledge and understanding of employee and employer rights and responsibilities in all work undertaken
Recognise, avoid and/or address any conflict of interest
Working in a SSD you might find yourself in situations where you’re not sure what to do, what’s right and what’s wrong. This topic, shows you that there are laws covering what is right and what is wrong, as well as guidance from various professional bodies. Laws governing discrimination and privacy (people’s right to control what happens to their personal information) also impact on the SSD industry, and we show you how to avoid breaking these regulations.
As someone working in the health industry, you need to be aware of the potential ethical complexity in your work role.
Ethical principles suggest that all members of the sterilising team have certain obligations and responsibilities to their clients and to each other. This means that we should be able to work together harmoniously and be willing to help each other whenever needed.
The principal pf a hospital or health care centre has the ultimate responsibility for the well-being of clients and the actions of employees/ Having said this, there are situations within the heal care facility white each member of the team, including the sterilising technician, will be considered directly liable for his or her own actions. If you are working in a small rural or remote centre, the director or owner of the centre would be the principal.
A code of ethics is a set of moral principles and practice standards which a profession uses to guide practice.
Codes of ethics are usually voluntary controls and not laws that serve as a means of regulation within a profession.
For the team, ethics means that all members have certain obligations, and responsibilities, to their clients. We should be able to work together in close harmony and be willing to help each other whenever needed.
How will the code of ethics affect health care workers as they go about their work every day in the surgery, office or laboratory? This is an important and interesting question. Go to the website below to find out more.
Visit the Code of conduct – NSW Health for further information www.health.nsw.gov.au/policies/pd/2005/pdf/PD2005_626.pdf
Here is a brief outline of sections of the code:
Ethical dilemmas are recognisable by the fact that there are at least two sets of values involved, and you are being asked to decide which is most important. Being faced with conflicting values usually gives us a sense of confusion and makes us feel unsure. You need to ask yourself: what is the most important point (ie obligation, value, need, issue, etc) here?
As a worker your primary responsibility is to safeguard the client’s rights, but sometimes the best way to do this is not always clear. Other workers, carers or family members may see the situation differently. The situation may not be clear-cut.
Ethical dilemmas can be roughly categorised in the following ways:
What are competing or conflicting values?
It is about being faced with a choice between two conflicting moral principles and it is not clear-cut which choice will be the right one.
Sue is an Educator in a sterilising department who has been carrying out workshop training for some new employee’s in her own facility, and also for some outside visitors whom also work in the industry. She smells alcohol on the breath of one of the employee’s being trained and she has good reason to suspect that she might also be taking illegal substances.
Sue wonders whether she should report this to the department manager of the other hospital where this one particular visitor works. She acknowledges the employee’s right to self-determination (the case for not intervening) versus the value of protecting human life (the case for intervening). However, although Sue is a strong advocate of the individual’s rights, she cannot defend the right of the individual to inflict harm on themselves and others and to break the law.
In a SSD you may have clients who:
This is where your own personal values may conflict with the action you need to take. For example, Maria is a community health nurse who lives next door to a family consisting of a mother and three children under the age of six. Maria notices that the children are always grubby and often sick. She thinks that they eat a lot of junk food. She sometimes thinks that the mother is neglectful.
Human experience is very complex, isn’t it? The question really is whether the children are at risk from harm.
Remember that you know you must always consider your legal responsibility under the NSW Children and Young Persons (Care and Protection) Act 1998, to notify the department when you suspect child abuse or risk of harm.
Find out more about protecting children at the NSW Department of Community Services website:
Unethical conduct is when you can see that another person is not adhering to professional ethics and is behaving in a way that puts clients at risk.
Examples of unethical conduct could include situations when:
A code of ethics helps us to identify unethical situations, and is therefore important to think about regularly. It should never be a dead piece of paper stuck at the back of the filing cabinet.
It is important to work to build an atmosphere of trust, respect and candour in the workplace by:
If we have a trusting atmosphere, hopefully we can confront potentially unethical behaviour and support each other to act professionally at all times.
There are also some standards that apply to all businesses. These include:
It is important to keep your clients’ business as just that – their business. You should only discuss matters relating to your clients’ business with co-workers, and then only what needs to be discussed. Discussions should take place in the workplace and not be audible to other members of staff or the general public. You should never discuss clients’ business with family or friends.
It is important to be discreet about many matters in the workplace. Think before you make comments or express personal viewpoints and be tactful when responding to someone else’s critical or negative comments; even if you agree with them, your comments will often be repeated to other people.
Punctuality is very important in the business world. While ‘time is money’ is a cliché, keeping people waiting implies that your time is more valuable than their time. If you are running late for an appointment you should always try to contact the client (or your supervisor) and you should always apologise.
Treat your clients and co-workers as you would like to be treated. Use polite language and consider their needs.
It is important that you develop a reputation as a dependable staff member. Being dependable means that you finish jobs you start, you follow through on jobs and you do what you say you are going to do.
Honesty isn’t only to do with money but affects how you relate to other people. Honest people tell the truth, admit their mistakes and are willing to say what they do and don’t know. Honesty will earn you respect from both your clients and co-workers.
Loyalty to your organisation is important. You are often the first and main representative of your company to your client. You should never criticise other staff members or the organisation to your clients. If mistakes have been made you should apologise in a way that represents the company positively and professionally.
Being loyal does not mean that you have to make exaggerated claims about how great your organisation and its services are. Avoid claims that put your organisation in a good light but that are misleading, inaccurate and untrue.
Your responsibilities involve client care, loyalty to your employer, and being a team member.
The following points outline your ethical responsibilities in the workplace:
If, in your employment, you find that you are unable to accept any of the above mentioned points, then you probably need to re-consider what you want in a career.
As a member of a team you are expected to work effectively with fellow staff members.
The work-based relationships you form are founded on the same principles as any other relationship in your life: co-operation, mutual respect, trust and loyalty, reciprocal effort, such as the following:
It is so important to have a pleasant personality, a sincere interest in your clients, a genuine interest in sterilising and, above all, an acceptable work attitude.
Read through the responsibilities listed above once again, this time reflecting on how they will affect how you carry out your duties, eg, providing sterile products for your clients.
Complaints may be directed to the following bodies:
Legislation and common law steer the way in which we as workers perform our professional duties in the workplace.
Legislation refers to rules and regulations that have been passed in Parliament (either State or Federal) and have become law. Legislations clearly define what is legal or illegal and as a consequence there are serious sanctions applied if the guidelines or legislations are not adhered to. An example of a legislation which you may have heard about is the Occupational Health and Safety Act.
Common law, by contrast, refers to judge-made laws. These are laws whereby a decision about guilt is not bound by Acts of Parliament but rather by looking at legal precedence (what decisions have been made previously by a judge), and looking at community attitudes and expectations. An example of common law in Australia is the Mabo case.
In the health services, common law is framed around duty of care requirements. This means that a worker has a responsibility to provide appropriate standards of care to clients, and a responsibility to assist in maintaining a safe working environment for colleagues and clients. Decisions about worker negligence are related to community standards of what is fair and reasonable care. This is of course far more open to interpretation than an Act of Parliament (legislation).
A set of principles adopted by an individual, group, or government. For example, an aged care facility will have a Policy of Occupational Health and Safety
The correct method of doing something. For example, hand washing procedure or needle safety protocol.
Standards are guidelines or principles, which dictate and describe how specific legislation should be applied. They are a statement about how services should be delivered in the community and a statement about what clients should expect from service delivery. They are a level of quality or excellence attained and accepted as the norm.
Guidelines are often official recommendation on how something should be done and what action should be taken in a particular situation. For example, the Infection Control Guidelines.
A substantial part of your job is based on policies and procedures of the practice where you work. The organisation's management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines.
These policies and procedures are based on current legislation and all staff are expected to comply with this legislation. If a staff member does not comply with policies of the practice, it may be considered as a breach and disciplinary action may be taken in line with legislation that applies. When there are any changes to legislation, standards, regulations or guidelines, management will reflect these changes by also implementing changes to policies, processes and practices as necessary.
What is the purpose of legislation and law and why is it important for workers to be clear about this?
Laws tell us how we must work. In the health services there are a number of rules and regulations that relate to client care, and how services are provided in the community and in health settings. These are in place to ensure that the rights and safety of clients and workers are upheld, and so that a consistently high quality of service is provided at all times. Community service organisations, including community-based and government services, have to comply with a minimum set of legal requirements. These vary according to the target group, but some legislation operates across all service types, such as Occupational Health and Safety and the Anti-Discrimination Act.
The following terms describe the process of applying legislation and law to service delivery:
Statutory Requirements relate to legislation and Acts that have been passed through Parliament. If a legal obligation is statutory it means that there is an Act which outlines what we should do in given situations. One can be legally punished if the Act is not followed. For example, in NSW it is a statutory obligation for community service workers to report situations where a child is at risk of harm.
Regulatory Requirements refer to standards or rules on how a service should be run in order to meet the needs of clients safely and effectively whilst ensuring at all times that clients are able to have control over their own lives.
Regulations are the details of how to make the broader directions of a particular Act work in practice.
The statutory and regulatory requirements contained in Acts and regulations shape community service organisations’ policies and procedures. They guide your decisions about what is “right” in regard to your clients in the same way that road rules provide clear instructions about how we should drive safely so that others are not put in danger.
To summarise, key statutory and legislative requirements are your legal obligations to your clients. They are:
Duty of care is a difficult term to define as there isn’t a legal definition of the concept (except in occupational health and safety legislation). Duty of care comes under the legal concept of negligence, and negligence belongs to the domain of common law. There hasn’t been an Act of Parliament passed defining what is legal or illegal but rather the decision is based on what is considered appropriate or not appropriate at a particular time in history.
Duty of care refers to the obligation to take responsible care to avoid injury to a person whom, it can be reasonably foreseen, might be injured by an act or omission. A duty of care exists when someone’s actions could reasonably be expected to affect other people. Part of duty of care for sterilisng departments is that they have a responsibility to ensure all items are processed correctly and that the finished product will guard the sterility of the item until it is required for use. This means that each person working in the sterilising department must have sufficient knowledge and skills to ensure their actions will not impact adversely on patient care, the organisation, environment and fellow team members. If someone is relying on you to be careful, and that reliance is, in the circumstances, reasonable, then it will generally be the case that you owe them a duty of care. You need to be clear about exactly what the nature of the care or support is that you are providing, and on which the person is relying. Failure to exercise care in that situation may lead to foreseeable injury (in other words it could have been avoided with due care taken).
Standard of care refers to what is expected of any other reasonable person/worker who performs the same duties. This is not about having to be the perfect worker but about being good enough and doing your job as well as any other worker. Judges when making their decisions regarding whether or not a worker has failed to provide a reasonable standard of care looks at many factors such as:
Duty of care can arise in all aspects of life, not just in community support services.
The following scenario illustrates the application of duty of care in a broader sense.
Mike works in a sterilising department He notices that part of the laparoscopic instrument (the handle) is not fitting properly together with the rest of the instrument. Rather than return it to the manufacturer for rectification, he packs it in the tray along with the other instruments.
When this particular instrument is used in the theatres it falls apart and onto the patient. There is a delay in the operation as they need to get hold of or open up another tray containing same instrument causing delay in operation and risk to a patient.
When you recognise another worker as behaving unethically, it is appropriate to discuss this with the worker directly. If that is not successful you may need to report the unethical conduct to someone in higher authority, such as a supervisor, coordinator, or director. This can be a very difficult situation, especially if it involves another team member or a colleague who you respect.
When reporting unethical conduct you need to be clear about:
You need to document details of the unethical behaviour clearly and professionally. You also need to clearly document the course of action you have taken and the reasons for that course of action.
If you are not sure what to do, always speak to your supervisor or another appropriate staff member. Remember that it is important to look after yourself and keep yourself safe in all situations. If you need support, ask for it!
If the person you reported the incident to does not take action or support you, you should report the incident to another manager, an external complaints service such as Health Care Complaints Commission (HCCC) or an advocacy service.
There are many ways unethical behaviour can be reported, including;
It is important to build an atmosphere of trust and respect in the workplace by:
Remember the discussion about confidentiality in the section on ethics at the beginning of this topic. Have a think about your daily work in the SSD. Part of your job might require you to have a look at the day’s theatre list in order to prepare instrumentation needed. When looking at the theatre list you notice a name of a patient whom you know. Do you think that disclosing this information to your friends outside your workplace is ethical or unethical?
Over 20% of the Australian population were born overseas. It is important to remember that in 1788, 100% of the people who lived in Australia were indigenous people. Indigenous people now make up around 1.8% of the population. It is easy to see from these statistics that a very large proportion of Australians come from a migrant heritage.
A multicultural society is one that not only recognises but actively encourages people from a variety of backgrounds to retain their language and culture. However, culture is not just related to immigration. It is about the knowledge, values and beliefs of a society.
When working with people from a similar background, there is a shared language, similar gestures, and a shared understanding of the dominant cultural values. People are more likely to be familiar with culturally appropriate boundaries such as knowing when to shake hands or touch or not touch.
Different cultures have evolved differently, based on different political, social and religious histories, adaptation to different climatic and environmental conditions and types of food available, as well as availability of resources for economic development. Different cultures also have different ways that people relate to each other, ways of expressing feelings, using gestures, and protocols for communication, for example people from Mediterranean cultures kiss once on each cheek when they meet but Asian culture are more inclined to nod or bow.
Working with people from different cultural backgrounds can mean that you need to be aware of possible cultural differences, and respond in a culturally appropriate manner whenever possible. If you are not sure of the meaning of certain actions or gestures you might need to clarify with your colleague or supervisor.
Think about how cultural diversity is promoted in an organisation you belong to, eg a TAFE college, community group or workplace. Do you think this could be improved? What suggestions would you make if you could?
Two general types of discrimination are direct and indirect discrimination. Direct discrimination is easy to see since it is clearly unfair (eg refusing to serve a person be cause of the colour of their skin).
Indirect discrimination is harder to see. It results form having a rule or situation that is the same for everyone, but this makes it unfair for some groups of people (eg to require everyone doing a certain job to be above a certain height, even though this is not necessary to perform the job role).
It is also important to understand that some discrimination, while it is unfair, is reasonable. This may be for reasons of public or personal safety.
Decide if the following are examples of reasonable or unreasonable discrimination.
Discrimination is against the law in Australia. It is illegal to discriminate in relation to a person’s sex, marital status, race, religion, age, sexual orientation, transgender or disability.
As a worker you must ensure that you demonstrate a non-discriminatory approach to your work—in relation to both clients and other workers. If you practise discrimination then a complaint may be filed against you with organisations such as the NSW Anti Discrimination Board, or at a Federal level The Human Rights and Equal Opportunity Commission, who have the authority to hear and deal with these matters. Both these organisations have websites that can provide you with additional information about these issues:
Human Rights and Equal Opportunity Commission at: www.hreoc.gov.au
NSW Anti Discrimination Board at: www.lawlink.nsw.gov.au/adb.nst
The video Working on Rights (produced by the Redfern Legal Centre) gives an excellent summary of discrimination and what can be done to counter it. This video is available through the TAFE library system or through the State Library of NSW. To borrow material form the State Library you will need to go to your local library and ask them to apply for it on inter-library loan. Your library may charge you a small fee for this service.
The relationship between employer and employee is affected by laws that control conditions of employment such as rates of pay, working conditions, and other matters.
It is important for you, as a member of a team, to be aware of the role each professional and industrial association plays.
The management has the following responsibilities to the employee:
Areas in which you are protected are:
Your rights as a worker are directly related to your responsibilities as an employee, to the kind of behaviour which your employer, (who also has rights) is entitled to expect.
It is now possible for you to negotiate with your employer an employment agreement (contract) which meets specific needs of the profession in which you are working. This is called enterprise bargaining and it results in an enterprise agreement. This is a legal document which must be registered with the Department of Industrial Relations.
You may contact the Department of Industrial Relations for a copy of their document, Enterprise bargaining in NSW.
Before entering such an agreement it is important for you to fully understand the agreement you are entering into, therefore you should seek advice from a solicitor or, if you are a member, the Sterilising Research and Advisory Council of Australia.
It is important for you to understand the difference between working hours for a full-time employee, casual employee and a part-time employee. Full-time employment involves working 40 hours or less per week. Part-time employment involves working 20 hours or more per week, and casual work is less than 20 hours per week. Full-time employees who work more that 40 hours per week are entitled to overtime payment.
Remember, anything that reduces the award conditions is illegal. Enterprise agreements allow variations that may suit both you and your employer. The Department of Industrial Relations and a Judge of the Arbitration Court should approve enterprise agreements. This sounds threatening but is, in reality, quite a simple procedure.
Enterprise agreements must include the following:
A worker who suffers a work-related injury which results in permanent impairment or the loss of earning capacity, or who requires medical treatment after an injury can claim worker’s compensation.
Compensation is paid for:
If a person dies as a result of a work-related injury, compensation is paid to his/her dependants as well as funeral expenses.
The Workplace Injury Management Act and the Workers Compensation Act 1998 introduced a system of compensation intended to resolve disputed claims quickly and to emphasise the return to work of injured workers. Workers compensation legislation in NSW is administered by WorkCover NSW.
Injured workers and their employers have roles and responsibilities under NSW Workers Compensation legislation.
An employer’s obligation is to:
In addition, the employer has certain legal obligations to:
As an injured worker, you have an obligation to:
Find out about the workplace relations system in Australia. Begin by visiting the websites listed below.
Health Services Union of Australia: http://www.hsu.net.au/campaigns/yourrightsatwork/resources/1124853039_21377.html/
Workplace Authority (Australian federal government): http://www.workplaceauthority.gov.au
Australian Council of Trade Unions (ACTU): http://www.actu.asn.au/AboutACTU/default.aspx
Awards online: http://www.industrialrelations.nsw.gov.au/awards/index.html
The following is taken from a NSW Department of Health circular:
The NSW Health ‘Codes of Conduct’ which apply to all employees of the public health system, include:
Conflict of interest exists when it is likely that an employee could be influenced or could be perceived to be influenced, by a personal interest in carrying out their public duty . Conflicts of interest that lead to partial decision making may constitute corrupt conduct. (NSW Department of Health, December 2004)
Employees have a responsibility to:
not accept gifts, rewards, travel, meals from suppliers or individuals. (If refusal to accept a gift would offend or upset the giver, employees are expected to accept the gift, indicating that you are accepting the gift on behalf of the unit or Health Service for which you work and then follow procedures to report receiving the gift.)
treat all persons equally and fairly and not show preference to any individual or organisation.
declare a conflict of interest or potential conflict of interest to their immediate supervisor and/or the Chief Executive Officer, Director General or authorised delegate[s].
Examples of improper actions:
Going to the one supplier, who is a relative, without ensuring competitive prices are being obtained
Developing specifications that are directed at a particular suppliers product due to a personal association.
Receiving short supply of goods and paying full cost from a firm you have a financial interest in.
Rostering friends or relatives favourably to the disadvantage of other employees.
Promoting friends or relatives where other employees are more deserving.
Employing an applicant because of a personal association, where there are more deserving applicants.
Giving preferential treatment to patients/clients due to personal association at the expense of others.
NSW Department of Health File No 04/1711. Circular No 2005/4. Issued 14 January 2005. http://www.health.nsw.gov.au/policies/PD/2005/PD2005_469.html (Downloaded 21/07/07)