Professional practice in a health and well-being setting refers to the standards, guidelines, and protocols that are followed by healthcare professionals to provide safe, effective, and ethical care to patients or clients.
It encompasses the knowledge, skills, attitudes, and behaviours that are required to deliver quality care and promote positive health outcomes. These areas include:
- clinical knowledge and needed skills
- ethical and legal considerations and requirements
- communication and interpersonal skills
- cultural competence and awareness
- professional development and training
Impact on aims
The term "impact on aims" refers to how a specific action, intervention, or event may influence the goals or objectives of the health and well-being sector. Evaluating this impact is crucial for resource allocation and programme improvement. When assessing the impact on aims, consider whether the action is likely to contribute to or hinder the intended outcomes or objectives.
Reflection
Consider how these priorities will impact your role as a support worker and your commitment to professional and ethical practice.
- Equity and whānau: How can you ensure equitable care and positive outcomes for those you support?
- Example: Implementing culturally sensitive care plans for individuals from diverse backgrounds.
- Te Tiriti o Waitangi: How will you align your practice with the Treaty principles of partnership, protection, and participation?
- Example: Collaborating with Māori community leaders to incorporate traditional healing practices into healthcare.
- Inclusivity: What steps can you take to create an inclusive healthcare environment that values diversity?
- Example: Organizing training sessions on LGBTQ+ health issues for your team to enhance inclusivity.
- Community well-being: How can you contribute to keeping people healthy within their communities?
- Example: Organising community health workshops to educate locals on preventive care.
- Digital services: Are you prepared to embrace digital tools for improved care delivery in homes and communities?
- Example: Using telehealth platforms for regular check-ins and consultations with remote clients.
- Sustainability: How can you support the establishment of initiatives like Te Whatu Ora and Te Aka Whai Ora for a financially sustainable system?
- Example: Advocating for the allocation of resources to preventive health programmes that reduce long-term costs.
Ethics are moral principles or values that influence how a person behaves or the way they perform an activity.
Behaving ethically means doing the right thing. Ethical standards include such things as honesty, responsibility and loyalty, and upholding the right to life and the right to privacy. Because everyone has their own culture, beliefs and morals, there can sometimes be variation in what people view as ethical and unethical, which can lead to differences in our actions.
All people who work in a health or wellbeing setting are required to work in an ethical and professional way within the codes of practice relevant to their place of work and the type of work that they are doing.
Ethical care includes establishing the tangata's priorities, values and choices to meet their taha tinana (physical health), taha wairua (spiritual health), taha whānau (family health) and taha hinengaro (mental health) needs. This may include their whakapapa, tīpuna and the wider whānau, hapū and iwi’.
Values
A source of ethical guidance is the worker's own values. These personal values will inevitably influence the workers’ everyday practice. Therefore, it is important for workers to embrace and learn the overall values of effective practice, such as respect for the client, being non-judgemental, and the promotion of client-worker autonomy.
Ethical issues may arise if the worker’s personal values conflict significantly with other sources of ethical guidance. It is important for support workers to develop an understanding of their own values and how these have the potential to impact their work with clients.
Unethical behaviour in the workplace
People behaving unethically in the workplace fail to follow moral principles. They may also contravene organisational policies and procedures. Examples may include:
- covering up a mistake such as forgetting to give a client medication
- fabricating health records
- giving a client a new medication without disclosing it to them or their whānau
- accepting gifts from a client
- carrying out care tasks that you are not qualified to perform
- passing on confidential information
If you see a co-worker behaving unethically, you need to report it following organisational procedures. This protects you and the client.
Where unethical practice is detected, the organisation will have a range of responses available. This may range from warnings and retraining to loss of employment.
Ethical dilemmas
Support workers can be faced with a range of ethical issues throughout their practice. The ‘right’ course of action may not always be clear because there can be conflicts between different ethical principles and practices.
Some potential ethical dilemmas a support worker might encounter include issues surrounding:
- confidentiality
- autonomy
- professional boundaries
- conflict of interest
- dual relationships
8-step process for ethical decision-making
Cory, G., Corey, M., Corey, M. and Callanan P. (2015) suggest an 8-step ethical decision-making process.
Click on the headings below to display details about the 8 steps.
Gather all relevant information, clarify the nature of the issue, and look at it from multiple perspectives.
Fully consider the context, including the rights, responsibilities, and welfare of all involved.
Consult the codes and standards of the organisation and the profession to determine whether they offer guidance and what that guidance is.
Consider all relevant legislation and organisational policies; determine whether they guide actions to be taken in such a situation.
Consult with colleagues and supervisors to gain the benefit of their perspectives, experience, and expertise, and to extend your understanding of relevant factors.
Brainstorm as many potentially viable solutions to the dilemma as you can.
Consider the probable outcomes, risks, and benefits of the various solutions. It is important to consider your legal and ethical responsibilities as you do so.
Carefully review everything, select a course of action (in consultation with your supervisor), and enact it.
Policies and procedures set out clear expectations for each employee in that organisation. They outline what's expected from your job role, complementing your individual employment agreement. Policies and procedures support employment agreements by providing details on matters that might not have been originally discussed in person.
Definition of policy and procedure
A policy is a set of rules or principles to be followed in a particular area, e.g., a leave policy might explain the expectations for requesting holiday leave.
A procedure is the way something is done, e.g., the forms that need to be filled out for requesting holiday leave.
A policy will often be supported by multiple procedure documents. For example, an organisation's health and safety policy might be linked to accident reporting procedures, evacuation procedures, hazard reporting procedures, etc.
Policies are general whereas procedures are specific. The following is an example of an accident reporting procedure:
- Check immediate safety.
- Help injured people or call a doctor.
- Secure the area.
- Inform emergency services if required.
- Fill in any required reports including accident forms.
- Inform your supervisor.
Procedures will vary depending on where you are and what has happened. It is important to follow your organisation's specific procedures.
Organisations typically develop a wide range of policies and procedures to assist workers in their roles. Policy and procedure documents are often compiled in a manual or are available on an organisation’s intranet for easy staff access.
Reflection
Click on this link to view the range of staff policies and procedures from HomeCare+.
Select one policy or procedure and read through it, then head to the forum and discuss the following in the 3.3.3 Policy/procedure thread:
- Which policy or procedure did you read?
- What are some of the points that were included?
- How could this document support your role?
Case study
Read the following case study and reflect on how you would respond.
Imagine you are working at a small community services organisation. As you walk into the waiting room to greet your next client, you realise that your client, Chloe, has brought along her 4-year-old son Tyler and 8-year-old daughter Hannah. Chloe tells you that she initially arranged for her mother to look after the children, but her mother is unwell today. Chloe tells you that she will just leave the children in the waiting room and that Hannah can look after Tyler, but you note that Tyler is restless and crying. You also notice that other clients in the waiting room are obviously distracted by Tyler.
According to your organisation's policies and procedures, for safety reasons, children must be supervised at all times and are generally not allowed to be present in appointments except when they are the client.
Support workers are required to comply with all relevant laws, standards, ethical guidelines, and organisational policies and procedures that apply to their role. There are a large number of laws and standards that you need to be aware of which will be relevant to your everyday practice.
Legislation relevant to your support worker role includes:
- Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996 (the Code of Rights)
- Health and Disability Services (Safety) Act 2001
- Health and Safety at Work Act 2015
- Human Rights Act 1993
- New Zealand Bill of Rights Act 1990
- Official Information Act 1982
- Privacy Act 2020
Each Act provides guidance on different aspects of client care. For example, the Human Rights Act protects people from certain kinds of discrimination in public life and from breaches of their human rights.
Privacy Act
The Privacy Act is the legislation designed to protect the privacy of an individual. It defines such things as:
- What personal information is.
- When personal information can lawfully be collected and from whom.
- How personal information should be stored.
- Who has access to personal information.
- How personal information can be used or disclosed.
In a healthcare setting, there will be a legitimate need to collect and store personal information. This will include contact details and medical data. Because of the deeply private nature of this information, the Privacy Act must be adhered to rigorously. It is important to note that the Act defines personal information very broadly: anything that identifies someone is personal.
As a support worker, you will frequently be called upon to share information about your client with team members or external health suppliers. Therefore, you must understand who you are authorised to share information with. The Privacy Act dictates that, as a rule, personal information must not be shared. However, there are circumstances under which it can be shared with certain people or institutions. For example, a subject may authorise their information to be shared with medical staff. Or if the sharing of information will lessen a serious threat, it can be disclosed. For example, in an emergency, you could share medical details with ambulance or hospital staff.
Your organisation should have policies related to minor breaches of privacy and what rectification will be made. The Act defines a notifiable privacy breach as one that causes significant harm. If a significant privacy breach is identified, the Act dictates that the Privacy Commissioner is notified.
Standards
Legislative Acts tend to be very broad and apply to a whole range of industries. Standards, on the other hand, tend to be more industry-specific. Standards guide an industry or organisation on how to comply with the Acts.
The New Zealand standard relevant to support workers is NZS 8134:2021 Ngā paerewa Health and disability services standard. This can be accessed HERE.
This standard is administered by the Ministry of Health. A range of institutions, including aged-care residences and mental health and disability services, are required to comply with this standard.
It sets out what providers need to do to provide safe services for clients. It defines the rights of people receiving care, such as being treated with respect and being able to make informed choices. It defines the responsibilities of providers, e.g., staff must have appropriate levels of knowledge and skills and must provide personalised treatment in consultation with the client. Providers must provide medications in a safe and timely manner and must consider preferences and nutritional needs when providing food. The standard focuses on the safety of clients and staff.
Organisational policies and procedures are developed in accordance with legal and industry requirements. Therefore, organisational policies and procedures will instruct employees on work practices that comply with these Acts and the NZS 8134:2021 standard.
Activity
Complete the quiz below, answering questions about legislation. Use the arrow buttons to move through the questions.
Many organisations develop specific codes of conduct that relate to the behaviours that workers are expected to display. These documents provide workers within these organisations with additional guidance on expected behaviours and what to do in the presence of dilemmas. If you work for an organisation that has specific codes of conduct or other standards in place, then it will be vital for you to comply with these standards and follow any protocols or procedures within them.
Example code of conduct
The Social Workers Registration Board Kahui Whakamana Tauwhiro's Code of Conduct "sets out the minimum professional standards of integrity and conduct that apply to Registered Social Workers and to the social work profession in general. This Code also lets clients and the public know the standards of conduct they can expect from social workers.” (Ref: Code of Conduct | Social Workers Registration Board)
The code includes 11 principles.
- Act with integrity and honesty.
- Respect the status of Māori as tangata whenua.
- Respect the cultural needs and values of the client.
- Be competent and responsible for your professional development.
- Protect the rights and promote the interests of clients.
- Strive to establish and maintain the trust and confidence of clients.
- Respect the client’s privacy and confidentiality.
- Work openly and respectfully with colleagues.
- Maintain public trust and confidence in the social work profession.
- Keep accurate records and use technology effectively and safely.
- Be responsible in research and publications.
The Code of Rights was created by The Health and Disability Commissioner. The purpose of the Code was to promote and protect the rights of health and disability service users and to promote a fair, simple, speedy, and efficient resolution to any complaints that these rights were not being met. The Code outlines the rights of people using a health or disability service in New Zealand.
The Code outlines ten rights that all consumers have when receiving a health and disability service in New Zealand.
- The right to be treated with respect.
- The right to freedom from discrimination, coercion, harassment, and exploitation.
- The right to dignity and independence.
- The right to services of an appropriate standard.
- The right to effective communication.
- The right to be fully informed.
- The right to make an informed choice and give informed consent.
- The right to support.
- Rights in respect of teaching or research.
- The right to complain.
Reflection
Before continuing, take a few minutes to reflect upon everything you have learned so far about codes and ethics. Identify why it is so important for support workers to be fully aware of the ethical and code requirements of the supporting role.
Human needs are the basic things that people need in order to survive, for example: shelter, food, and healthcare.
Human rights extend beyond these needs to include what individuals require to thrive. For example, The Human Rights Act 1993 is designed to protect New Zealanders from unlawful discrimination. Freedom from discrimination is not an absolute physical need, but being afforded this protection enhances both individuals and society.
The New Zealand government is tasked with protecting the human rights of its citizens. The Bill of Rights Act 1990 defines fundamental rights that New Zealanders are owed. This includes basic physical rights such as the right not to be deprived of life, along with human rights such as the right to free expression.
International treaties and conventions often influence New Zealand law. One example of this is the United Nations’ Universal Declaration of Human Rights (UDHR). This declaration was adopted by the United Nations General Assembly in 1948 and outlines fundamental human rights to be protected.
Activity
Read the information in the following links from the Human Rights Commission and then complete the activity that follows.
Overall, a company's policies and procedures should reflect a genuine commitment to respecting patients' rights, delivering quality healthcare services, and maintaining a patient-centred approach that aligns with New Zealand legislation as well as applicable codes and standards.
Let’s look at an example of how a client’s rights can be misunderstood or even violated in a supporting context. Read the following case study and consider the questions that follow.
Case study
Malik is a 38-year-old Pakistani immigrant from Taupō who is seeking help from a large government-funded community services organisation. His assigned helper, Sarah, becomes uncomfortable when Malik tells her that he is Muslim and has sought help because he is having marital difficulties. Sarah assumes that Malik is oppressing his wife and does not want to work with him even though her organisation's services are open to all. She tells Malik that he is not eligible for the organisation’s services and that she cannot help him.
In this case, Sarah is breaching a range of legislation and codes. She is breaching the Human Rights Act 1993 which prohibits discrimination on the basis of race or religion. She is also breaching Right 2 from the Code of Rights which affirms the right to freedom from discrimination. Sarah is also breaching her organisational policy which says that client eligibility is not affected by religious or cultural affiliation.
The consequences for these actions can include disciplinary action by the organisation and personal legal charges.
- Why is it important to avoid imposing your own values onto your client?
- Why is it important to be aware of the Acts, standards, codes, policies and procedures which pertain to your industry?
Te Pae Tata is the interim New Zealand health plan published in 2022. It details the upcoming transformation of the New Zealand health system. The document can be accessed from the Te Whatu Ora website. Understanding the priorities will give you the opportunity to identify any information you lack, or skills or understanding you need to develop.
Te Pae Tata contains six priority actions.
1. Place whānau at the heart of the system to improve equity and outcomes
Health consumers and their whānau will be consulted, and their feedback used to improve health services. Emphasis will be placed on listening to Māori, Pacific people and tangata whaikaha (disabled people). Input will also be sought from migrant, rural and rainbow communities. Pacific health plan priorities and tangata whaikaha health plan priorities will be implemented. Health data will be used to develop a picture of the current system and improve performance. Māori sovereignty principles will be used in data protection, with all health data treated as a taonga.
2. Embed Te Tiriti o Waitangi across the health sector
The principles of Te Tiriti will be enacted to improve health outcomes for Māori. This includes addressing bias and discrimination with a commitment to achieving equitable health outcomes. It also provides for shared decision making, working in partnership with Māori. The Māori health improvement plan will be implemented. All healthcare workers should be familiar with Te Tiriti and their obligations under the articles as part of the health system transformation.
3. Develop an inclusive health workforce
The healthcare workforce will be strengthened through improved recruitment and retention. There will be an emphasis on increasing diversity in the health workforce, with pathways for Māori, Pacific people and tangata whaikaha. Inclusive leadership will ensure an increased number of Māori, Pacific people and tangata whaikaha in decision-making and leadership roles. The Health Charter Te Mauri o Rongo will be implemented to improve workplace experiences.
4. Keep people well in their communities
The National Public Health service will be established combining skills from the 12 former public health units. A population health approach will be applied to improve health outcomes. This will include working with Iwi Māori Partnership Boards. Community care teams will be established to improve access to healthcare for remote communities. The Reset and Restore Planned Care Plan will be implemented to maximise health service delivery.
5. Develop greater use of digital services to provide more care in homes and communities
Digital health services developed during the COVID-19 pandemic will be adapted to address current population health priorities. The interoperability of digital systems between primary, community and secondary health providers will be improved. This will allow for timely data sharing while maintaining data security. An emphasis will be placed on providing digital access to primary healthcare for rural communities with virtual after-hours and telehealth.
6. Establish Te Whatu Ora and Te Aka Whai Ora to support a financially sustainable system
A simplified national, regional and local organisational structure will be implemented. This will result in an efficient system, allowing resources to be directed where needed. Corporate costs will be reduced, increasing the amount of money available for frontline staff and services. National procurement and supply chain functions will be implemented. National consistency in data and digital capability will be enhanced by streamlining duplicate legacy systems inherited from DHBs and Shared Service Agencies, improving intra-operability and reducing costs. A climate sustainability and response plan will be implemented.
Case Study
Read the following scenario and complete the task that follows.
Hannah is a support worker providing in-home care. She has heard about the Te Pae Tata strategy and is considering how this could impact her role. She notes that priority action 1 places whānau at the heart of the healthcare system by increasing consultation and implementing the Pacific and tangata whaikaha health plan priorities. Hannah considers that she should improve her knowledge about the health plan priorities which she can do by reading the Te Pae Tata document and discussing any questions she has with her supervisor.
Consider the other priority actions of Te Pae Tata. How could they impact your role as a support worker? How could you find out more information?
