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values

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Enduring beliefs or attitudes about the worth of a person, object, idea, or action. People have a small number of these.

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value system

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Are basic to a way of life, give direction to life, and form the basis of behavior- especially behavior that is based on decisions or choices. Are the way by which people organize their values internally along a continuum from most important to least important.

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beliefs (or opinions)

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Interpretations or conclusions that people accept as true, They are based nore on faith than on fact. May last briefly. Often judged as correct or incorrect.

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attitude

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Mental positions or feelings towards a person, object, or idea (e.g., acceptance, compassion, openness). Lasts over time. Jusged as good or bad, positive or negative.

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values transmission

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Influenced by social traditions; cultural, ethnic, and religious groups; and by family and peer groups.

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professional values

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Acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers.

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5 values essential for the professional nurse are:

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altruism, autonomy, human dignity, integrity, and social justice

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values clarification

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Process by which people identify, examine, and develop their own individual values. A main principle is that no one set of values is right for everyone. Promotes personal growth by fostering awareness, empathy, and insight. An important step to take in dealing with ethical problems.

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Which fundamental professional nursing values have not varied over time or across groups?

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Human dignity, equality, and prevention of suffering.

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True or Fale The nurse should never assume that the client has any particular values.

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True

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What are the steps that may help clients clarify their values?

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Listing alternatives Examining possible consequences of choices Choosing freely Feeling about the choice Affirming the choice Acting with a pattern

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ethics

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-a method of inquiry that helps people understand the morality of human behavior -the practices or beliefs of a certain group (ie, medical ethics, nursing ethics) -the expected standards of moral behavior of a particular group as described in the group's formal code of professional ethics.

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bioethics

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ethics applied to human life or health (ie, decisions about abortion or euthanasia).

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nursing ethics

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refers to ethical issues that occur in nursing practice.

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Scope and Standards of Practice

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A publication by the ANA (2010) which holds nurses accountable for their ethical conduct.

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Professional Performance Standard 7

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-Of the ANA Scope and Standards of Practice publication relates to ethics. -The current edition of this standard was significantly expanded to include greater emphasis on nurse advocacy and professional responsibility.

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morality (or morals)

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-similar to ethics, many use the terms interchangeably -refers to private, personal standards of what is right and wrong in conduct, character, and attitude.

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It is important for a nurse to distinguish between....

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morality and law -laws reflect moral values of a society, however, an action can be legal but not moral. -action can be moral but illegal. morality and religion (as they relate to health practices)

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moral development

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The process of learning to tell the difference between right and wrong and of learning what should and should not be done. Is a complex process that begins in childhood and continues throughout life.

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Lawrence Kohlberg (1969) and Carol Gilligan (1982)

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Two well-known theorists of moral development.

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What is the difference between Kohlberg and Gilligan's theory?

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Kohlberg's theory emphasizes rights and formal reasoning; Gilligan's emphasizes care and responsibility, although it points out that people use the concepts of both theorists in their moral reasoning.

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What factors differentiate the three main types of moral theories?

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Their emphasis on: a)consequences, b) principles and duties, c)relationships

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What are the three moral frameworks?

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-Consequence-based (teleological) theories -Principle-based (deontological) theories -Relationships-based (caring) theories

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Consequence-based (teleological) theories

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Look to the outcomes (consequences) of an action in judging whether that action is right or wrong. Ex, utilitariansim

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utilitarianism

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A consequentialist theory. Views a good act as one that is the most useful-that is, brings the most good and the least harm for the greatest number of people.

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utility

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Most good and the least harm for the greatest number of people

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Principles-based (deontological) theories

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Involves logical and formal processes and emphasize individual rights, duties, and obligations. Morality is determined by whether it is done according to an impartial, objective principle.

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Relationships-based (caring) theories

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Stress courage, generosity, commitment, and the need to nurture and maintain relationships. Judges actions according to a perspective of caring and responsibility. Stress individual rights, promotes the common good or the welfare of the group.

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moral principles

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Statements about broad, general, philosophical concepts such as autonomy and justice. Provide the foundation for moral rules.

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moral rules

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Specific prescriptions for actions.

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List the moral principles that a nurse must have

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autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, accountability, responsibility

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autonomy

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Refers to the right to make one's own decisions. Respecting the client's right to make decisions even when those choices seem to the not to be in the client's best interest.

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nonmaleficence

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The duty to "do not harm." A complex principle to follow as harm can be intentional as well as unintentional. Unintentional harm occurs when the risk could not have been anticipated. • Duty to cause no harm to others or remove harm • Physiological, social psychological, spiritual • Helps guide decisions about treatment approaches

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beneficence

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"Doing good." Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons.

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justice

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Frequently referred to as fairness.

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fidelity

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To be faithful to agreements and promises. Nurses often make promises and should keep them.

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veracity

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Refers to telling the truth. In practice, choices are not always clear. The loss of trust in the nurse and the anxiety caused by not knowing the truth, for example, usually outweigh any benefits derived from lying.

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accountability

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According to the Code of Ethics for Nurses, this means to be "answerable to oneself and others for one's own actions."

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responsibility

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According to the Code of Ethics for Nurses, this refers to "the specific accountability or liability associated with the performance of duties of a particular role."

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What should the ethical nurse be able to do?

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Explain the rationale behind every action and recognize the standards to which he or she will be held.

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What do the Ethical standards of the Joint Commission mandate?

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That health care institutions provide ethics committees or a similar structure to write guidelines and policies and to provide education, counseling, and support on ethical issues.

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code of ethics

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A formal statement of a group's ideals and values. Is a set of ethical principles that a) is shared by members of the group, b) reflects their moral judgments over time, and c) serves as a standard for their professional actions.

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What are the purposes of the Nursing codes of ethics?

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1) Inform the public about the minimum standards of the profession and help them understand professional nursing conduct 2) Provide a sign of the profession's commitment to the public it serves. 3)Outline the major ethical considerations of the profession. 4)Provide ethical standards for professional behavior. 5) Guide the profession in self-regulation 6) Remind nurses of the special responsibilty they assume when caring for the sick.

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Nurses' growing awareness of ethical problems has occurred largely because of.....

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a) social and technological changes and b) nurses' conflicting loyalties and obligations.

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Responsible ethical reasoning is....

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Rational, systematic, and based on ethical principles and codes rather than emotions, intuition, fixed policies, or precedent.

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moral stress

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Occurs when what is in the clients best interest may be contrary to the nurse's personal belief system. This is considered a serious issue in the workplace. One step to coping with this is using the 4A's.

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What are the 4A's to Rise Above Moral Distress?

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Ask, affirm, assess, act. In addition nurses may establish team conferences and use of counseling professionals to express their feelings.

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What is an important first step in ethical decision making?

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To determine whether a moral situation exists. Criteria is used to determine this.

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List the major ethical issues that nurses frequently encounter.

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-Responsibility and risk of caring for an AIDS client: Testing for HIV/AIDS in health professionals and clients -Abortion. Principle of sanctity of life use principle of autonomy and a woman's right to control her own body. -Organ and tissue transplantation: allocation of organs, selling of body parts, involvement of children as potential donors, consent, clear definition of death, and conflicts of interest between donors and recipients. -End-of-Life Issues: Euthanasia, assisted suicide, termination of life-sustaining treatment, withdrawing or withholding of foods and fluids. -Allocation of scare health resources -Management of personal health information.

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advocate

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One who expresses and defends the cause of another.

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What is the overall goal of the client advocate?

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To protect the clients' rights. Inform client of their rights and provide them with the info they need to make an informed decision.

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What are the three functions of the advocacy role?

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To inform, support, and mediate

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What does client advocacy involve?

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Concern for and actions on behalf of another person or organization in order to bring about change.

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Natural Law (Objectivism) St. Thomas Aquinas

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Actions are morally right in accord with our nature and end as human beings. Good should be promoted, evil avoided

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Deontology (Formalistic) Immanuel Kant

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Decision is right if it conforms to an overriding moral duty and wrong if it violates moral duty.

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Teleology (Utilitarianism, Consequentialism) Jeremy Bentham and John Stuart Mill

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Greatest good for the most people; assumes that an action is right if it leads to greatest balance of good consequences or to fewest possible bad consequences

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Feminist Ethics Alison Jaggar, Robin N. Fiore, Hilde Lindemann Nelson, etc

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Primarily concerned with inequalities between people, especially gender inequality; value the role and stories of relationships

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Ethic of Care Carol Gilligan Nel Noddings

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Primarily concerned with relationships and that the ultimate relationship is one of caring; focuses on emotions, feelings, and attitudes

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Distributed Justice

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resources divided among all people, not just rich. Shared burdens in society

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Standard of Best Interest

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• Used when patient is unable to make an informed decision about his/her health • Decision based on what health care providers or family believe is best for the patient • Consider how patient may be harmed, how patient may benefit, as well as physical and fiscal risks • Decisions based on the patient's expressed wishes or on documents such as living wills

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Accountability

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• Answer for one's own actions • Accountable to self, client, profession, employer, and society • Continually evaluate practice; preserve nursing excellence ◦ EBP, Safe, Effective • Maintain standards of health care, ANA Scope and Standards • Facilitate personal reflection, ethical thought and personal growth

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Responsibility

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• Reliable and dependable • Distinguish between right and wrong • Perform actions well and thoughtfully • Gains trust from clients, colleagues and society

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Advocacy

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• Working to protect the rights of another • Role of nurse - Speak on patient's behalf; Defend patient's rights to make own decisions

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Values Basic to Client Advocacy

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◦ The client is a holistic, autonomous being who has the right to make choices and decisions. ◦ Clients have the right to expect a nurse-client relationship that is based on shared respect, trust, collaboration in solving problems related to health and health care needs, and consideration of their thoughts and feelings. ◦ It is the nurse's responsibility to ensure the client has access to health care services that meet health needs.

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Veracity

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• Truthfulness, neither lying nor deceiving others • Deception can take the form of intentional lying, nondisclosure of information, or partial disclosure

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Confidentiality

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• Maintaining client privacy • Respecting privileged knowledge; keeping it confidential • Respecting the "self" of others • self-determination

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Fundamental values and commitments of the nurse (1-3)

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1. Practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations or social or economic status, personal attributes, or nature of health problems. ◦ Race, religion, beliefs, diseases ◦ Value conflict: drugs during pregnancy 2. Primary commitment is to the patient, whether an individual, family, group, or community. 3. Promotes, advocates for, and strives to protect health, safety, and rights of the patient.

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Boundaries of duty and loyalty (4-6)

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4. Responsible and accountable for individual nursing practice and determines appropriate delegation of tasks consistent with nurse's obligation to provide optimum patient care. 5. Owes same duties to self as to others, including responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. ◦ Do for others what you would want for yourself ◦ Grow as nurses, educate self 6. Participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

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Duties to broader community (7-9)

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7. Participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. 8. Collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. 9. Profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining integrity of the profession and its practice, and for shaping social policy.

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ANA Social Policy Statement

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• Describes the social context of nursing • Definition of nursing • Knowledge base for nursing • Scope and standards of nursing practice, generally speaking • Regulation of nursing practice

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The Patient Care Partnership

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• Replaces A Patient's Bill of Rights 1. High quality hospital care 2. A clear and safe environment 3. Involvement in their care 4. Protection of their privacy 5. Help when leaving the hospital 6. Help with their billing claims

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• Bioethics

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• Interdisciplinary field within health care that has evolved to address questions created as science and technology produce new ways of knowing ◦ What does it mean to be ill or well? ◦ What is the proper balance between science and technology and the good of humans? ◦ Where do we find balance when science allows us to experiment with the basic origins of life? • Application of ethical principles to health care; provide structure by raising questions that ultimately lead to answers

Kozier 5- Values, Ethics, and Advocacy + ANA – Flashcards

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