Module 2: ethics

• morals and ethnics 
  • morals: private, personal, or group standards of right and wrong 
    • moral behavior reflects personal moral beliefs 
    • "in general, is it wrong to steal?"
      
  • ethics: study of right and wrong conduct 
    • formal process for making consistent and logical moral decisions 
    • uses specific rules, theories, principles, and perspectives to inquire into the justification of an individual's actions in a particular situation 
    • "what should i do in a given situation?" (is it wrong to steal if you have to do it to feed your children?)
• nursing ethics 
  • ethical questions that arise of nursing practice 
    • what will your level of participation be in a given ethnically challenging situation? 
    • can you support clients' decisions based on their ethnical beliefs? 
    • what are your feelings about the results of decisions made by others? 
  • you are responsible for deciding the nature and extent of your own involvement in each situation 
  • must support pts who are making ethnical decisions or perhaps coping with the results of decisions made by others 
• moral or ethical agency 
  • moral distress can occur when nurses are unable to act as moral agents 
  • nurses experience moral outrage when they perceive that others are behaving immorally
  • sources of ethical problems: societal factors, the nature of nursing work 
    • societal factors: increased consumer awareness, technological advances, multicultural population, and cost containment
      
  • moral or ethical agency for nurses: ability to base their practice on professional standards of ethical conduct and to participate in ethical decision making 
    • nurses have choices and are responsible for their actions 
  • ethnical agent must be able to do the following:
    • perceive the difference between right and wrong 
    • understand abstract ethical principles 
    • reason and apply ethical principles to make decisions  weigh alternatives, and plan sound ways to achieve goals  
    • decide and choose freely 
    • act according to choice (this assumes both the power and capability to act) 
  • nurses' ethical problems are immediate, serious, and frequent 
  • nurses have multiple obligations and relationships that can create conflicting loyalties 
    • employees with a relationship with the agency 
    • professionals with a special relationship with clients and inter-professional team members 
  • nurses expected to follow the provider's presciptions for client care, although the provider is not the nurse's employer 
  • most orgs providers are higher on the power and status hierarchy than are nurses 
  • ethnical dilemmas arise when nurses experience conflicts in their loyalties to clients, families, providers, and other nurses 
• nurses as ethnical agents 
  • know the diff b/w right and wrong 
  • understand abstract ethnical principles 
  • apply ethnical principles in decision making 
  • weigh alternative principles in decision making 
  • decide and choose freely 
  • act acccording to choice 
  • consider value neutrality
    • attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgemental when providing care 
    • it requires significant insight to recognize how your value-laden perspective impacts your perceptions and thus conclusion abt a situation 
• values 
  • belief about the worth of something
  • highly prized ideals, customs, goals
  • freely chosen 
  • learned through observation and experience 
  • vary from person to person 
  • can change 
  • expressed through behaviors, feelings, knowledge, and decisions 
• factors in moral decision making 
  • attitudes
    • feelings toward person, idea, object
    • includes thinking (cognitive), feeling (affective), & doing (behavioral) component 
    • what a person thinks
  • beliefs 
    • something that one accepts as true 
    • not always based on fact, sometimes based on facts 
    • may or may not involve values 
• ethnical principles 
  • autonomy: person's right to choose and ability to act on that choice 
    • based on respect for human dignity 
    • demonstrated when you:
      • treat pt w/ considersation 
      • believe pt stories abt course & symptoms of their illnesses 
      • protect those who are unable to decide for themselves 
      • protect privacy and confidentiality 
  • nonmaleficence: duty to do no harm and to prevent harm
    • refers to: 
      • actual harm
      • risk of harm 
      • intentional harm 
      • unintentional harm: can occur bc lack of knowledge, skill, or ability 
  • beneficence: duty to do or promote good 
    • do no harm, prevent harm, remove harm, bring abt positive good 
    • paternalism: treating others like children 
      • can have neg outcome even though you think you are acting in their best interest 
  • fidelity (faithfulness): duty to keep promises 
    • basic part of every pt care situation 
  • veracity: duty to tell the truth
  • justice: obligation to be fair 
    • equal treatment of all pts 
• professional guidelines for ethnical decision making
  • code of ethnics for nurses purposes:
    • inform the public abt the profession's minimum standards
    • demonstrate nursing's commitment to the public it serves 
    • outline major ethnical considerations of nursing 
    • provide general guidelines for professional behavior 
    • guide the profession's self-regulating functions 
    • remind us of the special responsibility we assume in caring for the sick 
  • international council of nurses (ICN) 
    • first adopted its code of ethics for nurses in 1953 
    • has since served as the standard for nurses worldwide 
    • stresses respect for human rights, including cultural rights, the right to life and choice, the right to dignity, and right to be treated with respect 
  • american nurses association (ANA)
    • revised code of ethnics in 2015 
    • relevant in many practice settings and reflects current ethnical situations 
  • standards of care 
  • patient care partnership
    • american hospital association (AHA) published a document: patient care partnership (2003)
    • instead of using "rights," it is written in terms of pt expectations and responsibilities
    • encourages healthcare providers to be more aware of the need to treat pts in an ethnical manner and to protect their rights  
  • the joint commission: contains sections on org ethics and individual rights 
    • requires ethnical behavior in care, treatment, services, and business practices 
    • pts values, preferences, need for information, & other factors that promote autonomy must be considered in their plan of care 
    • includes statement abt the need for meeting pt needs in the event care must be denied in the institution while you must also consider the org legal responsibility 
• processes for ethnical practice 
  • clarify your values: the process of becoming conscious of and naming ones values 
    • if you clear abt ur values, u will be more able to make good decisions & to avoid imposing your values on others 
    • important to appreciate how other's values influence their decisions 
  • identify moral dilemmas: only problems that pose a question between competing & equally valuable interests are true dilemmas 
  • use a decision making model 
  • M O R A L 
    • Massage the dilemma 
    • Outline the options 
    • Resolve the dilemma 
    • Act by applying the chosen option 
    • Look back and evaluate 
  • look for a compromise
    • a good compromise: one that preserves the integrity of all parties 
      • discussions are carried out in a spirit of mutual respect - all view points are respected and considered 
      • compromise solution itself is ethnically sound 
  • participate on an ethnics committee
    • develop guidelines ad policies, provide education and counseling, and in the case of ethnical dilemmas, review the case and provide a forum for the expression of the diverse perspectives of those involved
    • usually follow one of three models when discussing a dilemma 
      • autonomy model
      • patient benefit model 
      • social justice model 
  • improve your ethnical decision making 
    • nurses tend to use conventions as criteria for decision making rather than pt personal needs and well-being 
    • full-spectrum nurse must move from conventional (rules-bound) to the post-conventional (reasoning) stage of moral development 
      • use theoretical knowledge 
        • review nursing & other literature for discussion of cases and experiences of other nurses 
      • use self knowledge 
        • examine your personal value system 
        • explore the influences of your religion, cultural beliefs, and personal experiences 
      • use practical knowledge 
        • ask to attend either ethnical rounds or an ethnics committee meeting 
      • consult reliable sources 
        • attend ethnics education programs & discuss issues w healthcare providers, attorneys, ethicists, and clergy to obtain perspective of others
      • share 
        • regularly engage in discussions w the staff on ur unit to determine differences in value systems & to collaborate proactively to identify methods to effectively resolves ethnical dilemmas 
      • evaluate