Ethics Nur 111

ANA code of ethics

"The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. The nurse's primary commitment is to the patient, whether an individual, family, group, community, population."

Moral distress

A person is unable to act upon what he or she believes is the morally appropriate action to take. When a person acts in a manner contrary to his or her personal or professional values. Internal barriers: Self-doubt, lack of assertiveness, perception of powerlessness External barriers: Inadequate staffing, lack of organizational support, poor relationships with colleagues, policies that conflict with care needs of patients. Moral distress occurs in two parts: Initially results in a stress response Moral residue/reactive distress - characterized by lingering feelings that accumulate over time with each subsequent situation in which moral distress is experienced. Moral residue occurs as a consequence of unresolved moral distress.

Culturally competent care: end-of-life decisions

Acknowledgment of and respect for cultural differences Willingness to negotiate and compromise when world views differ Being aware of one's own values and biases Using communication skills that enhance empathy Knowing cultural practices of patient groups regularly seen Understanding that all patients are individuals who may not share the same views as others within their own ethnic group

Who can give informed consent or informed refusal

Adult Legal guardian or parent of child Legal guardian of someone who is mentally disabled Only exception is if the patient's life is in danger and an immediate procedure is required to save that life.

Fidelity

Agreement to keep promises Keeping one's promise or commitments. This is a core value of the nurse-patient relationship. The second provision of the ANA Code of Ethics is for the nurse to remember that his or her primary commitment is to the patient whether the patient is an individual, family, group, or community. This is part of what binds us to our patient load once we accept report. We have made a commitment to care for those patients during our shift and until we find a replacement for ourselves, we are responsible.

Accountability

Answerable for own actions Accountable for the actions of others Accountable for patient outcomes Philosophy of nursing practice Patient Health Environment Nursing

Assess to health care

As a nurse, you will certainly deal with ethical issues related to access to care

Nonmaleficence

Avoiding of harm or hurt States that one should do no harm including inflict pain and suffering. Demands that one should not impose risks of harm. An action is wrong if it inflicts harm on others Harm can be: Emotional distress Property damage Loss of liberty to pain Disability Death Rules: Keep knowledge and skills current Know your own limitations Know when to refer Know when to delegate

The case of Cassandra C.

Cassandra C. began evaluation in the summer of July, 2014 for a suspicious lump on her neck when she was 16 years old. Diagnosed in October, 2014 with Stage 3 Hodgkin's Lymphoma. She and her mother sought a second opinion on their own which confirmed the same dx - Stage 3 Hodgkin's lymphoma. One of Cassandra's physicians reported his concerns regarding Cassandra and her mother's unwillingness to receive treatment to DCF. Cassandra's mother refuses to speak to DCF. October 31, 2014 Cassandra is removed from her mother's custody by Connecticut DCF and police and placed in foster care. November 6, 2014 DCF has temporary custody of Cassandra but she is allowed to return home with the promise to accept chemotherapy. After two treatments she runs away from home. After one week, she returns. DCF removes her from her home permanently on December 9, 2014. Admitted to the hospital for chemotherapy. Remained there under secure guard until April, 2015 when she went into remission. The Connecticut Supreme Court ruled in January, 2015 that Cassandra's rights were not violated by making her receive chemotherapy that she did not want. Cassandra turned 18 years old September 30, 2015. Were Cassandra's rights violated? Was her autonomy honored? Does she have a right to autonomy as a minor? Does her mother have a right to autonomy in her place? Could you have provided Cassandra's chemo treatments in her home? In the hospital? Were the ethical principles upheld? What could have prevented this outcome? What does the ANA Code of Ethics say for nurses?

Paternalism

Doing what the professional thinks is best for the patient according to the professional's ability and judgment Requires professional to become parent to "make decisions" for patient Should never be applied to benefit professional at expense of patient Is in conflict with autonomy

Ethics of care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives Four phases of caring and four moral elements: Caring about- Attentiveness Taking care of- Responsibility Care giving - Competence Care receiving - Responsiveness

Why do I need to know about ethics

Enables self analysis Helps to identify areas of discomfort & ethical "blind spots". Assists in mediating ethical conflict

Institutional resources

Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee.

The code of ethics for nurses

Evolves with the changing social context of nursing Central ethical values, duties, and commitments of nursing remain stable. The Code includes 9 provisions and the accompanying interpretive statements: statements include ethical values, obligations, and duties of every individual who enter the nursing profession serves as the profession's nonnegotiable ethical standard expresses nursing's own understand of its commitment to society

Laissez-faire

Explore own values; develop own value system

Feminist ethics

Focuses on inequality between people

Informed consent

Has both ethical and legal implications Based on autonomy Professional must provide all relevant information needed to make a decision Allows patient to make decision based on information provided

Ethics in the healthcare

Health care providers are granted special rights and responsibilities In the corporate world, success is measured by financial gain In health care the motive of the patient's welfare is placed above profit motive When patients seek health care they expect to receive the very best care from a professional and ethical practitioner

Response patterns to moral residue

Heightened response; conscientious objection; voicing objection. Desensitization; passivity; withdrawing from ethically challenging situations. Physical and psychological stress; burnout; leaving the profession. *In all cases, the health care professional's core values, integrity, and professional identity have been undermined.

Confidentiality

It is morally right to keep promises and other commitments, both implied and explicit. Health professionals make a promise to patients to keep certain information confidential. Breaking confidence is breaking faith

Ethics vs law

Law: Rules and regulations of society What a person did or failed to do Society as a whole as opposed to the individual within society Courts, statutes, and boards of nursing Ethics: Values, beliefs, and individual interpretations Why one acted as one did Good of the individual within society as opposed to all of society Ethics committees and professional organizations

Modeling

Learn what is of high or low value by observing parents

Is it ever OK to break confidentiality?

Legal requirement to report diseases that can have an effect on the health of the public Reporting suspected child abuse

Values and concepts

Paternalism Veracity Informed Consent Confidentiality

Informed refusal

Patient has right to assess all information provided by professional Patient can choose one that is not most valued by professional

Values

Personal principles acquired from life experiences, family and peer relationships, religion, culture, and law. Personal beliefs about the worth of a given idea, attitude, custom, or object that influence behavior. Appropriate for guiding routine decisions vs. ethics are used for clinical decisions.

Rewarding and punishing

Rewarded by demonstrating parents' values and punished for demonstrating others

Categories of ethics

Societal Ethics Clinical standard of care guided by societal ethics Organizational Ethics Mission statements for organizations Professional Ethics Professional standards: lawyers, doctors, nurse, social workers Personal Ethics Change over time Bioethics/Clinical/Research Ethics

Competence

Stay current on licensure & continuing education. Follow policies and procedures Remain aware of accreditation standards Obtain specialty certifications Maintain a practice portfolio Professional Organizations

Beneficence

Taking positive actions to help others Actions should ______________________________ Balance benefits against risks and harm Beneficence may also be viewed as the promotion of health viewed from the patient's perception or how the patient determines what is good. Important to view good through the patient's eyes. Actions are moral if they enhance a person's welfare Requires existing harm be removed Interwoven with Nonmaleficence

Moralizing

Taught complete value system that allows little opportunity to assess their own values.

The nursing process in ethical decisions

The Nursing Process: Not an ethical theory in and of itself but an organizational template expected in all nursing practice. Assessment/Data Collection - What is happening? What is the problem? Assessment/Analysis - Analyze values and factual data Diagnosis - Make a clinical judgment about the care, ethos, or issues Outcomes/Planning - What would happen if? Identify a range of approaches. Implementation - What is the fitting answer? The fitting answer should also be right. What is the outcome people can live with? Evaluation - What has happened? What can be learned from the situation?

Ethics is

The branch of philosophy concerned with evaluating human action. Ethics involves the principles or assumptions determining how individuals or groups should conduct themselves. A person's ethics are individualistic and are fashioned by previous experiences, education, and their environment. Encompasses a process of determining right conduct from wrong conduct.

Veracity

The whole truth be told. Completely answer patient's questions, giving as much information as the patient and family can understand and telling the patient when information is not available or known. This enables your patient to be autonomous. The principle of veracity is also upheld by ensuring the patient understands the information being told. Patient education.

Genetic screening

What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available?

Deontologic

an action is right or wrong based on a rule, independent of its consequences.

Justice

being fair States that people should be treated fairly and equally. Giving to each person what he or she deserves or is due. Often refers to an ability to judge without reference to one's feelings or interests. The principle of justice must be applied in situations of competing resources such as when two patients are both waiting for a kidney transplant, when there is only one ICU bed available, one OR team available, etc. Justice is also used in determining compensation in malpractice suits.

Quality of life

central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNR

Autonomy

commitment to include patients in decisions Addresses personal freedom and self-determination The right to choose what will happen to one's own person. An example of how this is honored in healthcare is the act of informed consent. In healthcare we respect the right of the individual to make their own decisions regarding their health care even if the practitioner does not agree. However, because autonomy is not an absolute right, restrictions may be place on a person's right to endanger others, such as in the case of communicable disease.

Responsible-choice

encourage children to explore competing values and to weigh their consequences

Care at the end of life

interventions unlikely to produce benefit for the patient

Utilitiarian

the rightness or wrongness of an action depends on the consequences of the action.