201 Ethics in Nursing: Definition of Concepts

Ethical Use of Social Media

1. Do not post anything about your patients that may violate their rights to privacy and confidentiality. 2. Never post images of patients. 3. Online contact with patients blurs professional and personal boundaries. 4.You are ethically obligated to report any breach inconfidentiality or privacy that you encounter online. 5. Remember that posting any thing leaves a digital foot print forever.

Codes of Ethics for Nursing

A code of ethics is a social contract through which the profession informs society of the principles and rules by which it functions. Shapes professional self-regulation Serves as guidelines to the members of the profession 1893: Nightingale Pledge ANA Code of Ethics for Nurses (latest: 2015) www.nursingworld.org ICN Code of Ethics for Nurses www.icn.ch/ethics.htm Student Nurses' Association Code of Academic and Clinical Conduct

Dilemmas Created by Patient Data Access Issues

Access to health care information comes with a great responsibility to protect information from unauthorized use. •Computer ethics have been in existence since the 1970s, now a standard in healthcare institutions

Dilemmas Regarding Patients' Rights

Advocate Groups for Patients' Rights: 1971: United Nations and Declaration of the Rights of Mentally Retarded Persons 1990: Americans with Disabilities Act (amended in 2008) Less Formal Interest Groups: Dying Person's Bill of Rights, Pregnant Patient's Bill of Rights, and Rights of Senior Citizens 2003: American Hospital Association and "The Patient Care Partnership"Patient Self-Determination Act: • Patient's right to choose how vigorously they want to be treated in life or in death Ethical Issues Related to Immigration and Migration: • Communication/language challenges between patients and healthcare providers • Migration of nurses

Deontology

An act was moral if its motives or intentions were good, regardless of the outcome.

Deontologic

An action is right or wrong independent of its consequences

Ethical Decision-Making

Assess the situation (gather data). Diagnose (identify) the ethical problem. • Plan: - Identify options. - Think ethical problem through. - Make a decision. • Implement your decision. • Evaluate your decision.

Ethical Principles

Classified as Principle-Based or Care-Based Principle-Based • Ethicalprinciplesareacombinationofbothutilitariananddeontologictheoriesandoffers specific guides for practice. Care-Based Looks to care as the foundation for nursing's ethical obligation • Feministethics • Critiquesexistingpatternsofoppressionanddominationinsocietyespeciallyaffecting women and the poor

Ethical Principles

Code of Ethics for Nurses: "The nurse practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (ANA, 2015). "

Gilligan's

Orientation to individual survival A focus on goodness with recognition of self-sacrifice The morality of caring and being responsible for others, as well as self

Beneficence

Defined as "the doing of good."

Nonmaleficence

Duty to do no harm. Double effect considers the intended foreseen effects of actions by the professional nurse

Virtue Ethics

Emphasizes the character of the decision-maker

Justice

Equals should be treated the same and that unequals should be treated differently, act fairly.

Theories that are important for nurses

Ethical theories that are useful to nurses include deontology, utilitarianism, virtue ethics, and principalism

Fidelity

Faithfulness or honoring one's commitments or promises (keep promise

Ethical Principles Matching

Fidelity Veracity Nonmaleficence Autonomy Justice Beneficence

Nursing ethics - subset of bioethics

Formal study of ethical issues that arise in the practice of nursing

Dillemmas Resulting for Personal Value Systems

Values are learned beliefs that help people choose among difficult alternatives, even when there may not be a good choice. Professional ethics outweigh personal ethics in a professional setting

Stages of Moral Reasoning

Kohberg's & Gilligan's

Ethics in Nursing: Definition of Concepts

Moral distress is typically described as a response to a situation when nurses are faced with ethical dilemmas but also encounter institutional constraints that limit their actions (Pendry, 2007).

Utilitarianism

Moral rightness of an action is determined solely by its consequence

Ethical Dilemmas in Nursing

Personal Value Systems Peers' and Other Professionals' Behavior Social Media and Substance Abuse Patients' Rights Institutional and Social Issues Patient Data Access Issues

Kohberg's

Pre-conventional level Conventional level Post-conventional level

Socioultural Influences Posing Ethical Challenges: Social Media and Substance Abuse

Problems with social media The transmission of potentially identifiable patient information The blurring of professional and personal boundaries ANA and Social Networking Principles Toolkit NCSBN and A Nurse's Guide to the Use of Social Media

Autonomy

Respect rights of patients to make health care decisions.

Dillemmas Involving Peers' and Other Professionals' Behavior

Sociocultural Influences Posing Ethical Challenges: Social Media: Posting on social Media (Facebook, twitter, blogs), creates two distinct problems • Transmission of potentially identifiable patient information • Blurring of professional and personal boundaries • See: ANA'sGuidelinesforSocialNetworkingPrinciplesatwww.nursingworld.org • NCSBN'sNurses'GuidetouseofSocialMediaatwww.ncsbn.org

Dillemas Involving Peers' and Other Professionals' Behavior

Sociocultural Influences Posing Ethical Challenges: Substance Abuse Nurses and other health care professionals impaired by drug dependence, alcohol abuse, or other addictions Deciding how and when to confront a colleague Deciding to report Signs and Symptoms of being "under the influence" include: slurred speech, unsteady gait, combativeness, and smell of alcohol on breath

Veracity

Telling the truth, or not lying, accountability, privacy, and confidentiality

Ethics in Nursing

The ability to be ethical, to make decisions and act in an ethical manner, begins in childhood and develops gradually.

Utilitarian

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

Principalism

Uses key ethical principles of beneficence, non-maleficence, autonomy, and justice in resolution of ethical conflicts or dilemmas

Bioethics

the application of ethical theories and principles to moral issues or problems in health care. Determining what should be done in a specific situation by applying ethical principles

Ethics:

• A term used to reflect what actions an individual should take and may be "codified," as in the ethical code of a profession • A systemic study of principles of right and wrong conduct, virtues and vice, and good and evil as they relate to human flourishing • DerivedfromGreekwork"ethos"whichmeanshabitsorcustoms • Process oriented • Involve critical analysis of actions

Dilemmas Created by Institutional and Social Issues

• Centers for Medicare & Medicaid Services (CMS) • Ethical dilemmas between nurses and the organizations that employ them may develop over policies dictated by the organizations or mandated by governmental agencies. • Ethics committees

Codes of Ethics for Nursing

• Code of Ethics with Interpretive Statements is the nursing professional's expression of its ethical values and duties to the public (ANA, 2015a) • ANA published the latest version of the Code of Ethics for Nurses with Interpretive Statements in 2015 • ANA responsible for periodic review of the code to ensure the reflection of contemporary issues and is consistent with ethical standards of society

Ethical Experience and Decision Making/Ethical Problems

• Ethical Dilemma: Conflict between patients, their families, healthcare professionals, and institutions. • Ethical Distress: Occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action

Purposes of the Code of Ethics for Nurses

• It is a succinct statement of the ethical obligations and duties of every nurse. • It is the profession's nonnegotiable ethical standard. • It is an expression of nursing's own understanding of its commitment to society.

Measurement Criteria for Standard 7 (ANA Standards)/The Registered Nurse

• Maintains a therapeutic and professional health care consumer-nurse relationship within boundaries. • Contributes to resolving ethical issues involving health care consumers, colleagues, community groups, systems, and other stakeholders. • Takes action regarding illegal, unethical, or inappropriate behavior that can endanger or jeopardize the best interests of the health care consumer or situation. • Speaks up when appropriate to question practice when necessary for safety and quality improvement. • Advocates for equitable health care consumer care.

Examples of Ethical Problems

• Paternalism • Deception • Privacy • Confidentiality • Allocation of scarce nursing resources • Valid consent or refusal • Conflicts concerning new technologies • Unprofessional, incompetent, unethical, or illegal physician practice •Unprofessional, incompetent, unethical, or illegal nurse practice • Shortstaffingandwhistle-blowing • Beginning-of-lifeissues • End-of-lifeissues

Ethical Conduct

• Practice based on professional standards of ethical conduct as well as professional values • Nurses should: • Cultivatethevirtuesofnursing • Understandethicaltheoriesthatdictateandjustifyprofessionalconduct • Be familiar with codes of ethics for nurses and standards for professional nursing conduct

7 Basic Tenets of Bill of Rights for RNs/Registered Nurses

• Practice in a manner that fulfills obligations to society and to those who receive nursing care • Practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice • Work in an environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses • Freely and openly advocate for themselves and their patients, without fear of retribution

7 Basic Tenets of Bill of Rights for RNs/Registered Nurses

• Receive fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities • Practice in a work environment that is safe for themselves and their patients • Negotiate the conditions of their employment, either as individuals or collectively, in all practice settings

ICN Guidelines to Achieve Purposes of Code of Ethics

• Study the standards under each element of the code. • Reflect on what each standard means to you. • Discuss the code with coworkers and others. • Use a specific example from experience to identify ethical dilemmas and standards of conduct in the code. • Work in groups to clarify ethical decision making, and reach consensus on standards or ethical conduct. • Collaborate with other professionals to apply standards in practice, education, management, and research.

Measurerement Criteria for Standard 7 (ANA Standards)/The Registered Nurse

• Uses Code of Ethics for Nurses with Interpretive Statements to guide practice • Delivers care in a manner that preserves and protects health care consumer autonomy, dignity, rights, values, and beliefs • Recognizes the centrality of the health care consumer and family as core members of the health care team • Upholds health care consumer confidentiality within legal and regulatory parameters • Assists health care consumers in self-determination and informed decision making