Ethical Foundations of Professional Nursing – Flashcards

The duty to do good. Nurses are obligated to act in the best interests of clients and their support.

The duty to do no harm. The basis for most nursing codes of ethics.

When the legal requirement does not appear compatible with the ethical approach

Highly personal, freely chosen, enduring beliefs or attitudes about the worth of a person, object, idea, or action. Derive from a persons culture, ethnic group, and religious background; societal tradition; and from those held by peer group and family. They motivate behavior and guide choices and decisions. Can be: Non-moral in nature (Effect personal preferences) Moral in nature (Exemplified by honesty and doing good). Values of both a moral and non moral nature can come into conflict.

Values are learned within the context of a person's sociocultural environment through observation and experience. Start with family--> community. Cultural influences. People need societal values to feel accepted and they need personal values to produce a sense of individuality. Professional values often reflect and expand on personal values.

Process in which people identify, examine, and develop their own individual values. Principle: no one set of values is is right for everyone. Promotes personal growth by fostering awareness, empathy, and insight.

Helps nurses understand why certain situations bother them and helps nurses decide whether they can accept differences in values when providing care. Nurses must be aware of their own values and attitudes in order to recognize when a situation might affect the care they are able to provide (self awareness).

1. List Alternatives. 2. Examine possible consequences of choice. 3. Choose freely. 4. Feel good about the choice. 5. Affirm the choice. 6. Act on the choice. 7. Act with a pattern. (When implementing the nurse assists the client to think each question through, never imposing personal values. The nurse can provide information in a non judgmental way.)

Personal ethics guiding the individual's behavior and choices

Referring to the beliefs of a particular group, such as religion or a profession, as members of the group consider what is right or wrong or good or bad

Requirements necessary for people to live together in a society

Way a person perceives those requirements necessary for people to live together in a society and the way the person responds to them.

A pattern of change in moral behavior over time

Lawrence Kohlberg and Carol Gilligan

Theory focuses on the structure of thought about moral issues rather than specific content of moral values. Phases of the theory move from concrete to abstract. Range from egocentric actions to behaviors that show concern for society and rightness. Progression through the stages is determined by one's exposure to social complexity and the opportunity to question and discuss ethical decisions. Developed his theory by conducting interviews using hypothetical dilemmas. All subjects were male which led to serious criticism of his theory. Theory of moral development emphasizes fairness, rights and autonomy in a justice framework.

Focuses on care perspective, which is organized around the notions of responsibility, compassion and relationships. For women moral maturity is less a matter of abstract, impersonal justice and more and ethic of caring relationships. A blend of ethics of justice and care is necessary for a person to reach maturity. Two interesting dimensions characterize human relationships: equality and attachment. Stages as in developing an ethic of care. Each stage ends with a transitional period (a time when the individual recognizes a conflict or discomfort with some present behavior and considers new approaches).

Fairness; based on the idea of equality that everyone should receive the same treatment.

Based on a premise of non violence that no one should be harmed or abandoned, typically followed by women.

The ends justify the means; applying this rule requires that the person be able to predict outcomes of actions when making decisions. Example: saving the mother's life (the end, or consequence) justifies the abortion (the means or act).

Non-consequential theories claim that certain acts are right or wrong based upon rules or laws or ideas. Deontology focuses on adherence to the right action regardless of consequences. Example: consider any termination of life as a violation of the rule "do not kill" and therefore would not abort the fetus, regardless of the consequences of the mother.

Focuses on developing and maintaining good character traits, so the decision is not what to do but how to be. If the intent is good, the act is moral regardless of the outcome. Brenner and Wrubel proposed caring as the central goal of nursing as well as a basis for nursing ethics.

Are are the center of theories of ethics and guide ethical decision making. Ex: Sanctity of life, Utility, Autonomy, Respect for person, Beneficence, Nonmaleficence, Justice, Veracity, Fidelity.

Directs us to preserve and protect life

Directs us to perform those actions likely to have the best consequences for all who are affected

Refers to self determination and the right to make one's own decisions

Treating others with consideration. The principle is violated when when a nurse disregards client's subjective accounts of their symptoms

Fairness and treating people equally. Nurse provides the same level of care regardless of their socioeconomic background

To be faithful to an agreement and responsibilities one has undertaken. Maintaining confidentiality. If a nurse tells a patient she will be back in one hour she should remain faithful to that promise

Telling the truth.

Formal statement of a group's ideals and values. Set of ethical principle that is shared by members of the group, reflects their moral judgments over time and serves as a standard for their professional actions

*4 principle elements* = 1. Nurses and people. 2. Nurses and practice. 3. Nurses and the profession. 4. Nurses and coworkers. *4 responsibilities* = 1. promote health. 2. Prevent illness. 3. Restore health. 4. Alleviate suffering

1. Inform the public about the minimum standards of the profession and to help them understand professional nursing conduct. 2. To provide a sign of the profession's commitment to the public it serves. 3. To outline the major ethical considerations of the profession. 4. To provide general guidelines for professional behavior. 5. To guide the profession in self regulation. 6. To remind nurses of the special responsibility they assume when caring for clients.

1. The nurse is all professional relationships, practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems 2. The nurse's primary commitment is to the patient 3. The nurse promotes, advocates for and strives to protect the health and safety of the pt. 4. The nurse is responsible and accountable for the individual 5. The nurse must preserve integrity, and safety, to maintain competence, and to continue personal and professional growth 6. The nurse participates in establishing, maintaining and improving healthcare environments and conditions 7. The nurse participates in the advance,net of the profession though contributions to practice, education and administration 8. The nurse collaborates with other health professionals and the public in promoting community, national and international efforts to meet health needs 9. The profession of nursing as represented by association and their members, is responsible for articulating nursing values, for maintaining integrity of the profession and its practice, and for shaping social policy

The ethical difficulty is related to deciding what to do. Question to ask = "What should I do?" These scenarios are usually "ethical dilemmas" (meaning there is no easy solution).

The ethical difficulty is related to implementing the decision. Questions to ask are: "What can I do?" Or "What risks am I willing to take to do what is right? These types of scenarios may lead to "moral distress."

1. Facts of the specific situation. 2. Ethical theories and principles. 3. Nursing codes of ethics. 4. The client's rights. 5. Personal values. 6. Factors that contribute to or hinder one's ability to make or enact a choice (cultural values, societal expectations, degree of commitment, lack of time, lack of experience, ignorance or fear of the law, and conflicting loyalties, etc.)

1. Maximizing the client's well-being. 2. Balancing the client's need for autonomy with family member's responsibilities for the client's well-being. 3. Supporting each family member and enhancing the family support system. 4. Carrying out hospital policies. 5. Protecting other clients' well-being. 6. Protecting the nurse's own standards of care.

May be hard to understand and to deal with, but solvable in principle.

A specific situation involving a choice between undesirable alternatives, where there are no precedents or rules to follow.

A perplexed state with uncertainty over alternatives.

The nurse may ask these questions -- 1. For whom is the decision being made? 2. Who should be involved in making the decision, and why? 3. What criteria (social, economic, psychological, physiological, or legal) should be used in deciding who makes the decision? 4. What degree of consent is needed by the subject of the decision?

The preservation of each person's integrity, with no one forced to give up values, principles, or moral integrity.

1. Some basic moral language must be shared (i.e. Focus on client rights and autonomy). 2. A context of mutual respect must exist. 3. The moral perplexity of the situation must be honestly acknowledged. 4. Legitimate limits to compromise must be admitted (when a person is so certain about a particular course of action that to compromise would be to compromise the sense of self, limits of compromise are reached. Compromise may not be possible).

Highly publicized issue that people feel very strongly about on both sides. Principle of sanctity of life vs principle of autonomy. Some states have "conscience clauses" that allow nurses/doctors/institutions to refuse to assist with an abortion if it goes against their religious or moral principles. However, nurses have no right to impose their value on a client and clients MUST be provided with information and counseling regarding abortion if they so desire.

Advances in health technology make life sustainable longer than ever. Some people want everything done to preserve life, and some do not; competent adults have a legal right to refuse any medical treatment and/or to have it withdrawn. It is often difficult for family members to make these decisions when the adult is incapable, so living wills and advanced directives are created. These documents allow people to indicate their desires about end-of-life care.

the administration of a lethal agent to end life and alleviate suffering; this can result in criminal charges when it is not legal in that state.

the withdrawal of extraordinary means of life support, such as a ventilator or in withholding CPR (as in a DNR). A decision withdraw treatment is not a decision to withdraw care and nurses must keep the patient comfortable!

Generally, providing food and fluids is part of nursing practice and nurses are obliged to do so, unless providing food is more harmful than withholding it (such as a patient NPO before surgery).

Organs may come from living donors or donors who have just died. Ethical issues related to organ donation includes: allocation of organs, selling of body parts, involvement of children as potential donors/recipients, cloning for the manufacture of organs. Religious beliefs are sometimes a source of conflict. Some nurses may have strong feelings about organ donation that make it difficult to remain neutral when approaching a grieving family about potential organ donation if the person was not already a registered donor.

Allocation of resources is a pertinent issue as medical costs continue to rise and budget cuts are implemented. Decisions about # of healthcare visits annually and and length of hospital stay are being influenced by facilities, insurance companies, HMOs, and Medicare. Is health care a right or a privilege?

moral uncertainty, moral distress, moral dilemma

Uncertainty about what is right or feeling that "something is not right"

Two opposing courses of action may be justified, but the nurse cannot tell which one to choose (see also p. 10 this outline)

The nurse knows the right action to take but feels powerless to implement it due to other forces (see also p. 9 this outline).

1. Become aware of one's own values and the ethical aspects of nursing situations. 2. Be familiar with nursing codes of ethics. 3. Understand the values of other healthcare professionals. 4. Participate on ethics committees. 5. Participate in or establish a nursing ethics group. 6. Participate in or establish educational ethics rounds.

An ethical concept for nursing practice and refers to providing support for a patient's rights or best interests. The focus of the client advocacy role is to respect client decisions and enhance client autonomy.

The nurse needs self-knowledge as well as professional knowledge about nursing and health care or needs to know where to obtain such knowledge to assist clients in their decision making.

Advocacy encompasses a range of approaches, including legal, self, collective (class), and citizen advocacy.

Rights protection model, values-based model, respect for persons model

Nurse as defender of patient's rights within the healthcare system; nurse informs patient of their rights and makes sure they are understood, and protects patients from infringement of those rights.

Positions the nurse as the one who discusses patients' needs and choices with them and helps them reach decisions consistent with their values and lifestyle, without imposing personal values on patient decision-making.

Sees the patient as a fellow human entitled to respect; nurse acts to protect dignity, privacy, and choices. Consistent with various codes of ethics to protect patients from harm.

The client is a holistic, autonomous being who has the right to make choices and decisions. The client has a right to expect a nurse-client relationship that is based on shared respect, trust, collaboration in solving problems related to health and healthcare needs, and consideration of their thoughts and feelings. Clients are responsible for their health. Nurses are responsible for helping clients use their strengths to achieve the highest level of health possible. It is the nurse's responsibility to ensure the client has access to healthcare services that meet his or her health needs. The nurse and client are equally accountable and responsible for the outcomes of their care.

Securing patients' freedom and self-determination by means of a therapeutic nurse-patient relationship. Promoting and protecting patients' rights to be involved in decision-making and informed consent. Acting as an intermediary between patients and their smilies or significant others, and between them and healthcare providers. An advocate must know how to provide support in an objective manner, being careful not to impose personal values. Underlying client advocacy are beliefs that individuals have the following rights = 1. The right to select values they deem necessary to sustain their lives. 2. The right to decide which course of action will best achieve the chosen values. 3. The right to dispose of values in a way they chose without coercion by others.

Being assertive. Recognizing that the rights and values of clients and their family must take precedence when the conflict with those of healthcare providers. Ensuring that clients and families are adequately informed to make decision about their own healthcare. Being aware that potential conflicts may arise over issues that require consultation, confrontation, or negotiation between the nurses and the administrative personnel or between the nurse and the physician. Working with unfamiliar community agencies or lay practitioners. Advocacy may also require political action.