Introduction to Compassionate, Respectful and Caring Health Work Force

Compassion: Is a feeling of deep sympathy and sorrow for the suffering of others accompanied by
a strong desire to alleviate the suffering?
 Therefore, we can say it is being sensitive to the pain or suffering of others and a deep desire to
alleviate the suffering.
Respectful: Is the kind of care, in any setting, which supports and promotes, and does not
undermine a person’s self-respect, regardless of any differences

The action meanings of the word respect are:-

 Pay attention to
 Avoiding damage e.g. insulting, injuring
 Not interfering with or interrupting
 Treating with consideration
 Not offending

Caring: Caring is an intensification of the affective dimension of empathy in the context of

significant suffering. It is coupled with effective interventions to alleviate that suffering.

Compassionate, respectful and caring (CRC) - means serving patients, being ethical, living the
professional oath, and being a model for young professionals and students. It’s a movement that requires
champions who identify with their profession and take pride by helping people.

Characteristics of CRC Health Professionals

CRC health professionals have the following four essential characteristics:
1) Consider patients as human beings with complex psychological, social and economic needs and
provide person-centered care with empathy;
2) Effective communication with health care teams, interactions with patients and other health
professionals over time and across settings;
3) Respect for and facilitation of patients’ and families,’ participation in decisions and care.
4) Take pride in the health profession they are in and get satisfaction by serving the people and the
country.

Over view of Pharmaceutical ethics

 Definition of profession and Vocations

A profession:
  Is an occupation that requires extensive training and the study and mastery of a
specialized knowledge and usually has a professional associations, ethical code and
process of certification and licensing
A profession is generally distinguished from other kinds of occupation by:

 Its requirement of prolonged specialized training acquiring a body of knowledge

pertinent to the role to be performed and
 An orientation of the individual to ward service, ether to community or organization.

Criteria of a profession

 Professional status is achieved when an occupation involves practice

 A profession carries great individual responsibility and based up on theoretical
knowledge
 The privilege to practice is granted only after the individual was completed a
standardized program of highly specialized education and has demonstrated an
ability to meet the standards for practice.

Elements of profession

 An intellectual discipline and standard of knowledge

 A representative boy of practitioners.
 Standard of conduct
 Service and advice, in the interest of the patient or client

Is Pharmacy is a profession? Yes!!

B/c:
A. Has intellectual discipline and standard of knowledge
B. Has university degree/College diploma and a practical training
C. Has a representative body of practitioners
 EPA (Ethiopian Pharmaceutical Association)
D. Standard of conduct
 There are standard of conducts known throughout the profession.
E. Service and advice:
 Province service and advice in the interest of the patients

A profession generally refers a Pharmacist, doctor, lawyer, nurse or other skilled worker

who was required to obtain college/university training.

 Definition of professional ethics

Vocation

 Is an occupation that requires usually skills and education program range from short
units (ten weeks or less) to long term program up to two years length

What is the difference between Vocation and Profession?

 Though both vocation, as well as profession, indicates the career or the occupation
through which an individual makes a livelihood, vocation is a broader term than
profession.

 Profession refers to the career that one opts for, getting extensive training and acquiring
special skills to become eligible for a job in it.
 Vocation refers to an occupation for which god gives a calling to the individual.
 Profession requires training and qualification whereas vocation is the innate ability in an
individual towards a particular occupation.
Note:

 A vocation is generally a job that requires a particular set of skills acquired through
experience or through training but not necessarily dependent on a college degree. These
would include plumbing, electrician, mechanic, etc.

Ethics, ethical principles and professional ethics

Ethics: is the science of moral value. It is composed of moral beliefs and rules about right
and wrong.

 Can be defined as the branch of philosophy dealing with standards of conduct and moral
judgment.
 It refers to the practices or beliefs of a certain group (i.e. nursing ethics, Physicians'
ethics).

Ethics is concerned what ought to be, what is right, or wrong, good or bad. It is the base on
moral reasoning and reflects set of values. It is a formal reasoning process used to
determine right conduct

Ethical principles

There are four common ethical principles:

Autonomy- self determination

Beneficence- does god things to patients

Non-malficence- avail doing bad things to patients

Justice- fair treatment to all patients.

1. Autonomy (respect for persons)

 Is the promotion of independent choice, self-determination and freedom of action

 It means clients are entitled to make decision about what will happen to their body

The term autonomy implies the following basic elements

 The autonomous person is respected

 The autonomous person must be able to determine personal goals.
 The autonomous person has the freedom to act upon the choices

2. Beneficence (doing good)

 This principle is the basis for all health care providers.

The principle of beneficence has three components:

 Promote health
 Prevent harm
 Remove evil or harm

3. Non-malficence (avoiding harm)

 It is the converse of beneficence. It means to avoid doing harm. When working with
clients, health care workers must not cause injury or suffering to clients.
 It is to avoid causing deliberate harm, risk of harm and harm that occurs during the
performance of beneficial acts.
E.g. Experimental research that have negative consequences on the client.

 No malficence also means avoiding harm as a consequence of good. In that case the
harm must be weighed against the expected benefit.
4. Justice (fairness)

 Is fair, equitable and appropriate treatment.

 It is the basis for the obligation to treat all clients in an equal and fair way.
 Professional ethics
 Is the moral principle which should guide members of the professions in their dealings
with each other and their patients, the patrons, the state, etc…
 Is a field of applied ethics whose purpose is to define, clarify, and criticize professional
work and its typical values
 Is a set of standards that describe the professional behavior that is expected in all fields
of work

Self-Check -1 Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Write true if the statement is correct or write false if the statement is incorrect
1. Pharmacists/Druggist are legally allowed to practice the profession of pharmacy if
she/he is not registered?
2. Ethics is the science of moral value?
Multiple Choose
3. Which one of the following ethical principle is the promotion of independent choice,
self-determination and freedom of action?
A. Autonomy
B. Beneficence
C. Non-malficence
D. Justice
4. Why Pharmacy is a profession?
A. Has intellectual discipline and standard of knowledge
B. Has university degree/College diploma and a practical training
C. Has a representative body of practitioners
D. Standard of conduct as well as Service and advice:
E. All of the above

Rights and obligations of pharmacy profession

Getting the right medication is the right of a patient. But unlike other rights, patients may fail
to understand this particular right. The fact is that pharmacy is known only to the practitioner
and hence it is up to the practitioner and the existing regulations whether patients are
satisfied with the service or not.

Humanity and justice

Humanity:

 Refers to the human race or mankind as a whole, to that which is characteristically

human, or to that which distinguishes human beings from other animals or from other
animal species primal nature.

 it is to mean the tenderness to reach out for those who are suffering

Justice:

Justice is fair, equitable and appropriate treatment. Justice refers to fair handling and
similar standard of care for similar cases; and fair and equitable resource distribution among
citizens.

Example:
 Resource scarcity is the common issue in healthcare settings. For example, there may be
only one or two neurosurgeons and many patients on the waitlist who need the expertise
of these neurosurgeons. In this case we need to serve patients while promoting the
principle of justice in transparent way. Example, the rule of first come first serve could be
an appropriate rule.
 Justice requires the treatment of all patients equally, irrespective of their sex, education,
income or other personal backgrounds.
Confidentiality

 Confidentiality in healthcare ethics underlines the importance of respecting the

privacy of information revealed by a patient to his or her health care provider.
 The healthcare provider must obtain permission from the patient to make such a
disclosure.
The high value that is placed on confidentiality has three sources:
Autonomy: personal information should be confidential, and be revealed after getting a
consent from the person

Respect for others: human beings deserve respect; one important way of showing
respect is by preserving their privacy.
 Trust: confidentiality promotes trust between patients and health workers

The right of patient to confidentiality

 All identifiable information about a patient's health status, medical condition, diagnosis,
prognosis and treatment and all other information of a personal kind, must be kept
confidential, even after death. Exceptionally, family may have a right of access to
information that would inform them of their health risks.

 Confidential information can only be disclosed if the patient gives explicit consent or if
expressly provided for in the law. Information can be disclosed to other healthcare
providers only on a strictly "need to know" basis unless the patient has given explicit
consent.

 All identifiable patient data must be protected. The protection of the data must be
appropriate to the manner of its storage.

Informed Consent

Informed consent is legal document whereby a patient signs written information with
complete information about the purpose, benefits, risks and other alternatives before he/she
receives the care intended. It is a body of shared decision making process, not just an
agreement. Patient must obtain and being empowered with adequate information and ensure
that he/she participated in their care process.
For consent to be valid, it must be voluntary and informed, and the person consenting must
have the capacity to make the decision. These terms are explained below:

Voluntary: the decision to either consent or not to consent to treatment must be made by the person
him or herself, and must not be influenced by pressure from medical staff, friends or family. This is to
promote the autonomy of the patient.

Informed: the person must be given all of the information in terms of what the treatment
involves, including the benefits and risks, whether there are reasonable alternative
treatments and the consequences of not doing the treatment.

Capacity: the person must be capable of giving consent, which means they understand the
information given to them, and they can use it to make an informed decision.

Decision making for incompetent patients

Many patients may be incompetent to make a decision for themselves. Example, include
young children, individuals affected by certain psychiatric or neurological conditions which
potentially impair their decision making ability, and those who are temporarily unconscious or
comatose. These patients require substitute decision-makers. Ethical issues arise in the
determination of the appropriate substitute decision-makers and in the choice of criteria for
decisions on behalf of incompetent patients.

Refusal of treatment
Every adult with power to decide is entitled to refuse medical treatment. The healthcare
provider must respect a patient’s decision to refuse treatment, even if he or she disagrees
with the patient’s decision. In these circumstances, the care provider should clearly explain
to the patient the possible consequences of refusing treatment and offer the patient the
opportunity to receive a second medical opinion if possible.

Adaptability

 Able to change or to be changed so as to be suitable for new needs, different conditions,

etc…
 Is the ability to adjust oneself to new or changed circumstances/conditions
Cooperation

 It refers to the practice of people or greater entities working in common with commonly
agreed upon goals and possibly methods, instead of working separately in competition.
 Is a co-working system; the work of pharmacy vocational is insignificant unless it is
augmented by other health practitioners. Therefore health practice must be team work
Kindness and firmness

 Kindness – is the act or state of charitable behavior to other people.

 Firmness – is the faculty which stands for determination and persistence for the
connection between principles and acts or preservance, determinants and resolution.
Honesty

Being loyal: Health practice is wide in nature involving many people and many activities. For the
people to be beneficiary and activities to be accomplished successfully being an honest is the primary
asset to achieve

Responsibility, accountability and transparency

Responsibility: Is the condition or the fact that one can shoulder obligations.
 Accountability: Is the condition or fact that one can be called to answer for his wrong
doings.
Transparency: This is a case in which things must run by the book (based on rules,
regulations etc) rather than by what is comfortable and beneficial to one self.
.

Self-Check -2 Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Write true if the statement is correct or write false if the statement is incorrect
1. Confidentiality promotes trust between patients and health workers?
2. Kindness is the act or state of charitable behavior to other people?
3. Accountability is the condition or the fact that one can shoulder obligations?

Short Answer Question

4. What are rights of patient confidentiality?

Components of unethical behavior

Smuggling or Trafficking
  Illegal transport of goods, in particular across a border OR
 Taking from one country to another country unlawfully, especially goods without
paying necessary tax.
1.3.2. Corruption

 It is a general concept describing any organized and interdependent system in

which part of the system in either not performing duty.
 It was originally intended to, or performing them in an improper way to the
determinant of the system’s original purpose.

1.3.3. Mistreating the patient

 with drug(theft)
 behavioral

1.3.3. Drug dependence /addiction

1.4. The comprehensive use of psychoactive drugs, to that point where the user has no
effective choice but to continue use.

Self-Check –3 Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Multiple choose
1. _____ is illegal transport of goods across a border unlawfully without paying
necessary tax.
a. Corruption
b. Mistreating the patient
c. Trafficking
d. Drug dependence
2. All of the following is Components of unethical behavior except.
A. Alcohol-dependence
B. Drug dependence
C. Autonomy
D. aggressive
Short Answer Questions
3. What is Drug dependence?

Ethiopian pharmaceutical code of ethics

 They are intended to guide and direct pharmacists, qualified persons and pharmacy
technicians in their relationships with patients, colleagues, regulatory and
administrative authorities and society

 Objectives

 To promote high standard of conduct and practice among pharmacy professionals and
patients and pharmacy professionals and other health professionals.
 To state publicly the principles that forms the fundamental basis of the duties and
responsibilities of the Pharmacists/Druggists.
 To safeguard the public from unethical and substandard professional practice.
 To foster the good relationship that would prevail among Pharmacists/Druggists, other
health professionals and patient or the society.

Definitions
 Code – is a set of rules about how people should behave or about how something must be
done.

 Code of practice – is a set of written rules which explains how people working in a
particular profession should behave.

Code of ethics of Pharmacy

 Is the moral principle which should guide members of the pharmacy profession in their
dealing with their job, patients, fellow professionals, public and other profession
management of pharmaceuticals?
 It is a governing conduct of all Pharmacy personnel both within and outside the
practice of pharmacy.

1.5. Ethical standards of practice in Ethiopia

1.5.1. Ethical standard during dispensing and Prescription handling of medication in

pharmacy

1.5.1.1. The pharmacist/Druggists should

 Personally fill all prescriptions or ensure appropriate filling of orders.

 Accept prescriptions only in written form except under emergency or compelling
conditions.
 Sell only products approved by DACA/FMACA
 Do not dispense prescription only drugs without prescriptions.
 Immediately inform the prescriber due correction or clarification if the prescription has
been found to be illegible or appears to be wrong.
 Do not dispense any drug to patients who do not appear in right mental state.
 Dispense medications as original packs whenever possible; if not repack materials
should be labeled appropriately.
Labels should contain:

 Name of medicine
 Batch number
 Expiry date
 Strength
 Dose
 Frequency of dosing
 Duration of treatment
 It is free to make generic substitution.
 Do not alter prescriptions in any way
 Do not fill prescriptions of drugs written by a prescriber for his own use.
 Do not dispense for prescribers self-use.

1.5.1.2. Instructing, educating and counseling patients

The Pharmacist/Druggists should

 Have appropriate knowledge and skills for patient education and counseling.
 Adapt messages to fit patients.
 Give ample verbal and written information on dispensed drugs.
 Conduct counseling or education in a conductive environment.

1.5.1.3. Premises

The pharmacist/Druggists should maintain the premises that fulfill the

following.

 The external and internal appearances of the pharmacy should be inspiring

and attractive.
 Premises should permitflow of work, communication and supervision,
cleaning and maintenance.
 Minimization and avoidance of cross contamination and adverse effect on
the quality of the product, service and health of the public.

1.5.1.4. Special segments of public

  Premises should allow ease access and service and to disabled persons.
 Do not supply any medicinal products to children unless satisfied that the product
will be used safely.

1.5.2. Ethical standard during compounding and manufacturing of pharmaceutical

1.5.2.1. Compounding

 Only authorized personnel should be involved in compounding.

 Only healthy, mentally and physically fit personnel should be involved in
compounding.
 Have procedures for compounding.
 Have working procedures for every technical operation, cleaning (SOP).
 Label products properly.
 Product identity
  Strength
 Route of administration/application
 Instruction of use

1.5.2.1. Manufacturing of drugs and medical supplies in Ethiopia

The Pharmacist/Druggists should

 Give due consideration to safety, efficacy and quality.

 Make sure every operation is in accordance to the national current GMP
standards.
 Maintain records and keep track of all key processes (from concept to all
the way delivery).
 Ensure that products carry unique batch number, manufacturing date and
expiry date.
 Look after the needs of his employees, Space, Safety and comfort
 Professional respect and independence
 Only engage in fair, transparent and free competition.
 Have working procedures for every technical operation, cleaning (SOP).
 Proactively, protect and support the environment in accordance with the
national guideline.
 Correct or expose any malpractice through the appropriate channel.

1.5.2.2. Pharmaceutical supply management and rational drug use

What is drug supply management?

 Management is a process of doing activities in order to achieve desired results using
available human, materials & other resources.
 Drug supply management is practical way in which government policy-makers,
essential drugs program manager, non-governmental organizations (NGOs), donors,
and others can work to ensure that high-quality essential drugs are available,
affordable, and used rationally.
 DSM can also be defined as a process of planning, organizing, staffing, directing and
controlling the work of personnel involving towards the objectives of drug supply
system in accordance with agreed up on policy and directives using the available
resources
 Set your priority according to national need.
 Circulate only products approved by DACA/FMACA.
 Always acquire pharmaceuticals through appropriate procurement procedures.
 Inspect products up on receipt.
  Store drugs and other substances as per the current Good Storage Practice
throughout the supply system.
 Distribute pharmaceuticalsonly to authorized clients, in fair and equitable
manner.
 Distribute free sample to health professionals only.
 Maintain records and keep track of sold products.
 Promote rational drug use.
Rational use of drugs is the safe, effective, appropriate and economic use of drugs. Saying
the same thing in the other word, it is a reasonable use of or appropriate drugs. All the four
criteria's should be considered whenever drugs are used:-

Effectiveness:- a drug should produce a therapeutic effect for the disorder with the patient
Safety: - a drug should not produce intolerable side effect /adverse effect.
Appropriate: - a drug should be suitable with the individual patient condition.
Example: - drug utilization of patients with hepatic or renal problem is not exactly identical
with that of healthy liver & kidney patients for the same disease.

Economic: - unnecessary expenditure for drugs or costly use of drugs should be avoided as
much as possible.

Drugs should only be used when they are necessary, and in all cases the benefit of
administering the medicine should be considered in relation to the risks involved. It is better
not to use drugs if their benefit - to - risk ratio is smaller.

Rational Drug Use

Definition of rational drug use

 The aim of any drug management system is to deliver the correct drug to the patient who
needs that medicine

 The rational drug use requires that patients receive medications appropriate to their
clinical needs, in doses that meet their individual requirements, for an adequate period of
time and at the lowest cost to them and their community.

 The term rational drug use in a biomedical context includes the following criteria:

a. Correct drug

b. Appropriate indication

c. Appropriate dosage

d. Appropriate patient

e. Correct dispensing
 f. Patient adherence to treatment
1.5.2.4. Handling of narcotics, psychotropic and other dangerous drugs.

 Store these substances in a separate secured area.

 Only the pharmacist himself/herself should carry of the dispensing.
 Dispense through only prescription paper approved by DACA/FMACA.
 Handle properly poisonous substances to prevent any injury to the public.
 Immediately report breakage, loss or theft to DACA/FMACA.
 Store securely and separately expired and damaged products and dispose according to the procedure set by
DACA/FMACA

Self-Check –4 Written Test

Directions: Answer all the questions listed below. Use the Answer sheet provided in the
next page:
Multiple choose
1. Labeling of pharmaceutical product should contain all of the following except one?
A. Name
B. Dosage
C. Expiry date
D. None

2. Which one the following is false the rational drug use Correct drug

A. Appropriate indication

B. Appropriate dosage

C. Appropriate patient

D. incorrect dispensing
3. which of the following word is implies drug should produce a therapeutic effect for the
disorder with the patient
A. Effectiveness
B. Safety
A. Appropriate
B. Economic
Short Answer Questions
4. What are the role of pharmacist/druggist for Pharmaceutical supply management and
rational drug use?
Note: Satisfactory rating - 5 points Unsatisfactory - below 5 points

You can ask you teacher for the copy of the correct answers.

Answer Sheet
Score = ___________
1. _________
2. _________ Rating: ____________

3. _________
4. _________

Name: _________________________ Date: _______________

 Reference
1. DiMatteo, M.R. (1994). Enhancing patient adherence to medical recommendations.
2. National CRC Manual June 2017 ethiopia
3. Dispensing of Pharmaceuticals-III | ORHB december 2017
4. Beth A. Lown, Julie Rosen and John Marttila. An Agenda For Improving Compassionate Care: A
Survey Shows About Half Of Patients Say Such Care Is Missing. Health Affairs 30, no.9
(2011):1772-1778.
5. FDRE, Regulation No ,299/2013, Food, Medicine and Health Care Administration and Control,
Council of Ministers Regulation
6. J Med Ethics-2003-Macklin-275-80.pdf
7. J Med Ethics-2008-Molewijk-120-4.pdf
8. Harry Chambers, Harry E. Chambers Effective Communication Skills for Scientific and
Technical Professionals 2000
9. EMA, Code of Ethics for Doctors practicing in Ethiopia, 2009
10. Royal Pharmaceutical Society of Great Britain, Code of Ethics for Pharmacists and Pharmacy
Technicians, Aug, 2007