Ethical Nursing practice – Flashcards
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ethics
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-study of ideal human behavior and ideal ways of being
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as a philosophical discipline of study, ethics is
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a systematic approach to understanding right and wrong
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morals
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specific beliefs, behaviors or ways of feeing based on personal judgements derived from one's ethics
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one's morals are judged to be
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good or bad through systematic ethical analysis
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bioethics or healthcare ethics
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application of ethical theories and principles to issues in health care
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during the 1960s and 1970s, scientists and physicians are forced to ask what bioethical questions
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who should live? who should die? who should decide?
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the aim of bioethics today
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to continue to search for answers to deep philosophical questions about life, death, and the significance of human beings and to help guide and control public policy
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moral reasoning
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pertains to making decisions about how humans ought to be and act. Identifying possible actions that could be pursued and the likely consequences of each action
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ethical theories
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utilitarianism deontology
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deontology
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refers to actions that are duty based, not based on their rewards, happiness, or consequences
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quote from Kant, an influential philosopher for the deontologic way of thinking
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moral actions should be ends in themselves, not the means to ends
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deontology based on
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unchanging principles
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example of deontolgy
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-giving a liver transplant to an alcoholic -providing care to a murder suspect
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utilitarianism
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-to promote the greatest good that is possible in situations -determined solely by its consequence -end justifies the means
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utilitarianism places great emphasis on
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-what is best for groups, not individual people -most happiness with least amount of harm
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triage
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utilitarianism takes the one with best survival rate first
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what are the foundations of the ethical principles?
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respect for persons and human dignity
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the 6 ethical principles
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autonomy beneficence nonmaleficence fidelity veracity justice
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autonomy
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one's ability to self-rule and to generate personal decisions independently
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beneficence
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consists of deeds of "mercy, kindness, and charity"
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nonmaleficence
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duty to do no harm -all persons have this duty -refraining form action that might harm others -malpractice is based on this
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fidelity
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duty to keep agreements, commitments, carryout care -creates trust -must all promises be kept?
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veracity
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-duty to tell the truth -intentional deception *right or wrong? truthtelling-patients trust nurse is competent in their practice
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justice
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-duty to be fair to all people -fair distribution of burdens and benefits
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paternalism
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-unilateral decision-making -deliberate overriding of a patient's autonomy for patient "own good"/ safety
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first nurse code
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"Nightingale Pledge"
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two different code of ethics for nurses
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ANA Code of Ethics ICN Code of Ethics
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code of ethics
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-implied contract -expression of its values and duties to the public the profession's nonnegotiable ethical standard -applies to al nurses regardless of their role
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examples of themes in the code of ethics with interpretive statements
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Respect for autonomy Relationships Patients' interests Collaboration Privacy Competent practice Accountability and delegation Self-preservation Environment and moral obligation Contributions to the nursing profession Human rights Articulation of professional codes by organizations
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ANA code of ethics (1-3)
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fundamental values and commitments of the nurse
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ANA code of ethics (4-6)
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identifies the boundaries of duty and loyalty
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ANA code of ethics (7-9)
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describes nursing duties beyond individual patient encounters
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Largely serve as the basis for the code of ethics for ANA and ICN
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deontolgoy and normative ethics
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A common theme to the ANA and ICN codes
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a focus on the importance of nurses delivering compassionate patient care aimed at alleviating suffering
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it is uncomfortable and hard to deal with
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ethical dilemmas
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ethical dilemmas arise from conflicts in
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Personal value systems Professional values Peer and others' behaviors Patients' rights Institutional and societal issues
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ethical dilemmas/conflicts
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individual is compelled to make a choice between two actions that will affect the well-being of a sentient being and both actions can be reasonably justified as being good, neither action is readily justifiable as good, or the goodness of the actions is uncertain. One action must be chosen, thereby generating a quandary for the person or group who must make the choice
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factors influencing ethical decision-making
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Code for Nurses Patient's bill of rights Social and cultural attitudes/values What are our values Science/technology Legislation Judicial decisions Personal beliefs
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ethical decision-making steps
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-Clarify the ethical dilemma *What is the specific dilemma/conflict -Gather additional data -Identify options -Make a decision -Act -Evaluate
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ethical decision-making characteristics
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-rational -systematic -base on ethical principles and law
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ethical decision-making not based on
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Precedent (earlier event) Emotions Intuition Fixed policies
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questions to consider
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-What is your "conscience" telling you? -Listen to your body -How does the action align with your values? With the ANA code of ethics? -What are the likely consequences of action or inaction? Cost? Benefit? -What decision can you live with?
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right
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something owed to an individual
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privacy
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-free from intrusion -to be left alone
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self determination
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right to decide (autonomy)
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standard of best interest
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-what is best for that person -ask ourselves: are we doing it because it is the right thing to do? or are we doing it because we can? -quality vs. quantity of life
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ethical issues related to nursing
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-commitment to patient -commitment to employer -commitment to colleagues -self-evaluation
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commitment to the patient
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-respect for human dignity -cultural competence -patient's trust
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commitment to employer
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work ethic
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commitment to colleagues
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Nurses in a "community" work for the common good Protect patients Lateral or horizontal violence/Incivility: bullying that can include behaviors such as criticism, humiliation, undervalued, teasing, "Tall poppy"
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self evaluation
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improvement competence
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moral distress
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-the pain or anguish affecting the mind, body or relationships in response to a situation in which the person is aware of a moral problem, acknowledges moral responsibility, and makes a moral judgement about the correct action -yet as a result of real or perceived constraints cannot enact the desired action
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moral suffering
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Can be experienced when nurses attempt to sort out their emotions when they find themselves in situations that are morally unsatisfactory or when forces beyond their control prevent them from influencing or changing these perceived unsatisfactory moral situations
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moral courage
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when doing the right thing is not easy; our capacity to befriend our fear and stand up for our core values or principles
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The lower the fear (especially of reprisal or retaliation) the higher
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the incidence of reporting
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The higher the peer support and organizational responsiveness to reporting ethical concerns the higher
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the incidence of reporting
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impaired nurse
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-extent of the problem -concern for self and patient -identify symptoms -confront? or report?
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boundaries violations
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-addressed in the code of ethics provision 2 -professional relationship becomes a personal relationship -nurse has power and access to confidential information
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indicators of potential boundaries violation
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-spends extended time with patient -visits when not on duty -personal disclosure
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patient advocacy
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nurses work collaboratively with others to address the healthcare needs of patients
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common ethical issues
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-mandoratory flu immunization -HIV positive healthcare worker -what are issues listed in ch14 of your book
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healthcare
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Right or privilege? Should all have access to the same services regardless of ability to pay? How much health care is each person entitled to have?
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truth telling
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You are the nurse for an elderly woman who has been medicated by accident and is extremely drowsy and confused. The family arrives and is alarmed by the change in her condition. The med error has been reported to the MD who states "there is really nothing to worry about, she will be more lucid in the afternoon when the med wears off." The family approaches you and asks you to explain the patient's changed condition.
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ethical dilemma situation
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You are caring for an 86 year old woman with stage 3-4 metastatic breast cancer. She is scheduled for surgery today and then chemotherapy. She has an involved and caring family. They want her to do "everything." She states to nurse "I don't want surgery or any treatment. I am ready to die." What should nurse do?
