Concept of Ethics N 170

Common to all theories of nursing

a) the patient b) the environment e) nursing f) health

A hospice nurse is caring for a patient with terminal cancer. The family would like the patient to continue aggressive therapy to treat the cancer, but the patient has voiced to the nurse that, after much thought, he does not want to pursue any further treatment. The nurse speaks to the family about the patient's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation? a) Moral values b) Nursing education principles c) Advanced practice licensure guidelines d) Legal responsibilities

a. Moral values- Moral values involve correct behavior, such as having some sense of right and wrong. Moral values help direct nurses to deal with human interactions that involve the integrity of life or health. 85 moral principles are beliefs and values (R/W)...these shows how people behave and relate. Law is the moral value of a society.

Belief

interpretation of what one accepts as true.

Belief and Values..

moral principles/standards in behaviors/relationship

Justice: fairness

"I was assigned two patients today—Mrs. Glenn was so nice that I wanted to spend most of the shift in her room, but I couldn't. Mr. Franks needed a lot of personal care." Which principle is involved in this situation? giving kidney to C with greatest need. Justice

2 Code of Ethics in Nursing. p1. Value people p2. Commitment to client p3. Autonomy in Bioethics issues,. .say patient with HIV, Abortion, end of life decision, organ transplant, genetic testing...these are Bioethics..relating to human life and health p4. Accountable and responsible p5. Growth profession ( back to school) p6. Environment to be ethical p7. Advancement in Nursing p8&9. Health policy (eliminate oppression)

1. ANA code of ethics ......read and reread. a. ethical obligation in duties b.ethical standards are not negotiable c. Commitment to society. 1) respect for individual 2) primary commitment is to the patient 3) advocates for and protects patient 4) accountable for individual nursing actions 5) owes self the same duties as others (health, well-being, knowledge) 6)participates in improving healthcare 7) contributions to practice, education, administration, and knowledge 8) promotes efforts to meet health needs 9) responsible for articulating nursing values and maintaining integrity of profession 2. ICN code of ethics (pg 2568 box 44-2)

The order to progress in developing ethical foundation personal values and belief shapes personal Ethical foundation

1. Be aware/clarify one's personal V/B, 2. identify your personal Ethics foundation 3. compare and integrate your personal ethic foundation and it into the ANA code of ethics 4. Identify ethic issues why working and 5.Apply the ANA code of Ethics and work continuously to improve ethical decision making abilities.

State board of Nursing American Nursing Ass. (ANA) National League for Nursing Nurse Practice Act

1. Registered Nurses have minimal qualification to practice 2. Holds list of Nurses legally practicing in the state Code of Ethics. High standard/ scope/nature/ of nursing practice, and responsibility for which nurses are accountable for. Improving nursing education and service determines minimum requirement / criteria for licensure. Each state enacts its own nursing practice act , which describes and defines the legal boundaries of nursing practice within the state.

To enhance decision making and practice

1.To overcome constraints that can impact on ethics, the Nurse; a. aware of her values b. know the N C.O.E c. seek educational growth d. respect other HC profs. e. participate/establish in ethic rounds f.serve in ethics committees g. encourage collaboration in practice. 2. Obtain the evidence-based ethical practice from the national Guidelines clearinghouse (National Guidelines Clearinghouse website holds numerous medical treatment plans.) 3. JC ( Joint Commission)..requires all HC institutes to have a writing guidelines and policies.

Evidence based Practice

A problem-solving approach to clinical practice based on best practices through available research.

Code of Ethics

A set of guiding principles that all members (PROFESSIONAL MEMBERSHIP--Nurses)of a profession accept and is a collective statement about the group's expectations and standards of behavior. please, look for your

Patients responsibility

American Hospital ass. pg 2580 box 44-8

Value clarification

As part of clients centered care, 1. Nurse identifies clients values. and relate to their specific health problems. 2. Nurse distinguishes own values from client's. ethical problems arise for differing values. It is important to clarify values, not just the nurses', but the patients' and co-workers, you learn to tolerate ethical differences

Retrieving the evidence

Collect the most relevant and best evidence. (literature search of databases ) AHRQ....for free resource compilations of evidence review and practice guidelines on a wide range of topics Agency for Health Research and Quality. (AHRQ)

Evaluate the evidence Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when he or she reflects on the decision-making process and the role it will play in making future decisions? a) Implementing b) Planning c) Evaluating d) Diagnosing c. evaluating

Critically appraise the evidence. for its , validity...u have to critic it..to see if its measurement is true. Reliability,....the results are consistent and can be replicated or reproduce in good precision. Relevance...if values are significant by measuring its strength

Values in Nursing practice

Doing good; concern for others===Altruism Right to self-determination People have inward autonomy if they have the ability to make choices and outward autonomy if their choices are not limited or imposed by others===Autonomy Respect for the uniqueness of individuals and populations.= Human dignity Honesty acting in accordance with the code of ethics and standards of practice ==Integrity Working to ensure equal treatment under the law and equal access to quality health care==Social justice

1. Developing a Clinical question PICOT P =Population,..race, gender I=Issue of interest,..treatment, educational plan, C =Comparison intervention, ...comparison group may not always exist. O =Outcomes...Quality of Life,cost, etc. T =Time frame.

Formulate a clinical question. A group of nurses are planning to investigate the effectiveness of turning immobilized stroke patients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which of the following will the "O" in the teams PICO question refer to? a) The currently-used turning schedule b) Turning patients more frequently c) Patients who have experienced a stroke d) Preventing skin breakdown d) Preventing skin breakdown Within the PICO question framework, the "O" denotes the outcome of interest. In this case, the desired outcome is the prevention of skin breakdown. Stroke patients are the "P", or population of interest, while turning patients more frequently is the "I", or intervention. The current turning schedule is the "C", referring to the comparison of interest.

patient rights

Informed consent by (federal law) Patient Bill of Right by (health care facilities) Code of Ethics(ethics standards) by (American Nurses Association) Standards Accreditation by ( Joint Commission) Important Pieces of the Patient Bill of Rights: 1) right to informed consent 2) right to concise and understandable info 3) right to know how coverage payments are made and how they can be appealed 4) right to understand cost of care 5) right to reasonable choice of providers

Apply the edivence

Integrate best evidence into clinical practice Integrate evidence with clinical expertise and patient preferences.

Clues to moral nature of situation

feeling of guilt, hope, shame, respond with words like, ought, should, right , wrong.

Morality

personal private standards about what is right and wrong. Tell the difference between right and wrong and of learning what ought and ought not to be done;

Values

right or wrong about what matters in human behavior. What is the term for the beliefs held by the individual about what matters? a) Bioethics b) Ethics c) Morals d) Values d. values

Autonomy: client in control. add patients in decisions about all aspects of care to promote patient's independence.

right to reject medication.

Beneficence : nurse promotes good. do the right thing. taking positive actions to help others. VeRacity : nurse Reports eRRoRs

scenario The nurse did not follow hospital procedure and hung a unit of blood on the wrong client. The client had an anaphylactic reaction and the team is called in for emergency treatment. During the resuscitation, the nurse does not reveal that the wrong blood was given. Which moral principles were violated? Select all that apply Nurse is guilty of Beneficence. veracity. A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? beneficent

Protection of patients right

these are options for clients who feel that their rights have been violated. 1. patients advocates at hospitals 2. state offices for clients in long term care 3. state dept of Health. Bill or rights by US advisory commission for health industry,.pg 2567. box 44-7 .

Values one personal values, 1.social traditions, 2.cultural, ethnic, religious norms in family and associated groups. values internalized from the society or culture in which one lives. people need societal values to feel accepted, and they need personal values to have a sense of individuality professional values, nurse, socialize with other nurses , internship, clinical and life experiences. values acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers

what one understand as important and uphold it as supreme. it is what matters to him/her ethical decision making, nurses evaluate personal belief about truth....also worth of behaviors, thoughts, objects. something of worth; enduring beliefs or attitudes about the worth of a person, object, idea, or action. They are important because they influence decisions, actions, even nurse's ethical decision making

Qualitative research The nurse researcher will use qualitative research methods to investigate perceptions, and the researcher will analyze words Quantitative research Researcher analyse numbers. Basic and applied research are quantitative research methods. Measurement.

A nurse researcher is studying perceptions of vocational rehabilitation for patients after a spinal cord injury. What type of research method will the researcher use to study the perceptions of this group of individuals? Qualitative R. ===Narrative. words.

A team of nurse educators are preparing to implement an evidence-based practice (EBP) change in the way that change-of-shifts reports are organized and conducted at their hospital. Place the following stages of the EBP process that the educators will follow in the correct sequence. a) Critically appraise the evidence. b) Formulate a clear clinical question. c) Integrate evidence with clinical expertise and patient preferences. d) Collect the most relevant and best evidence. e) Evaluate the practice decision or change.

b) Formulate a clear clinical question. d) Collect the most relevant and best evidence. a) Critically appraise the evidence. c) Integrate evidence with clinical expertise and patient preferences. e) Evaluate the practice decision or change

Developing Evidence Based Practice

Developing a clinical question...PICOT. Retrieving the evidence Evaluate the evidence Apply the evidence.

non maleficence: nurse goes beyond beneficence ::nurse do no harm. avoidance of harm or injury. ::weights the risk and the benefits

The nurse notes that a client has a slight red rash after taking a dose of an antibiotic. What action by the nurse would demonstrate the moral principle of non maleficence? .....Harm is insight....provide support to prevent harm Noting the reaction and getting a new medication ordered....

Ethics and standards

conduct & character. determining what is good or valuable for individuals, for groups of individuals in the nursing team, and for society (community) at large.