Chapter 6 review (fundamentals of nursing)

Characteristics of the Care-Based Approach to Bioethics

*Centrality of the caring relationship *Promotion off dignity and respect for patients as people *Attention to the particulars of individual patients *Cultivation of responsiveness to others *Redefinition of fundamental moral skills to include virtues ex Which of the following theories of ethics most highly prioritizes the nurse's relationship with patients and the nurse's character in the practice of ethical nursing? Care-based ethics Which of the following nursing situations is an example of the care-based approach to ethics? Select all that apply • Providing a back rub to a client on bed rest • Holding the hand of a dying client • Involving the parent in the bed bath of a child Correct

Purposes of the Code of Ethics of 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

ICN Guideline 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 examples 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 standard in practice, education, management,, and research

Using the Nursing Process to Make Ethical Decisions

1. Assess the situation (gather data) 2. Diagnose (identify) the ethical problem 3.Plan identify think ethical problem through make a decision 4.Implement your decision 5.Evaluate your decision

Professional Values

Altruism Autonomy Human dignity Integrity Social justice EX Which nursing actions best describe the use of the professional value of human dignity? (Select all that apply.) • A nurse provides privacy for an elderly patient. • A nurse plans individualized nursing care for his or her patients. • A nurse refuses to discuss a patient with a curious friend.

Promoting Self-Determination

An act linked to advocacy, with the belief that making choices about health is a fundamental human right that promotes the individual's dignity and well-being. Nursing roles: -facilitates patient's decision making -interprets findings for their patients -informs patients of various aspects to be considered -helps patients verbalize or organize their feelings -calls in those people who should be involved in the decision making (family, primary nurse, physician, clergy) -helps patients assess all of their options in relation to their beliefs Overall patients advocate for the right of patients to make their own decisions concerning their health, with careful consideration to clarify what being an advocate to the patient entails. However, supporting all of the patient's preferences may pose an ethical problem, such as assisting in termination of life, in which case the nurse would have strong ethical grounds to refuse to advocate for this request.

value system

An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person's values influence beliefs about human needs, health, and illness, the practice of health behaviors, and human response to illness

Beauchamp and Childress's Principle-Based Approach to Bioethics

Autonomy Nonmaleficence Beneficence Justice Fidelity Veracity

beneficence

Benefit the patient and balance benefits against risks and harms; active promotion of the patient's benefit, being sensitive to the fact that individuals identify benefits and harms differently

Valuing Process

I. Choosing 1. freely 2. from alternatives 3. after consideration of the consequences II. Prizing 4. with pride and happiness 5. with public affirmation III. Acting 6. with incorporation of the choice into one's behavior 7. with consistency and regularity on the value

Ethical Conduct

Practice based on professional standards of ethical conduct as well as professional values Nurses should *Cultivate the virtues of nursing *Understand ethical theories that dictate and justify professional conduct *Be familiar with codes of ethics for nurses and standards for professional nursing conducts ex A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches which of the following? Ethical conduct

Autonomy Bioethics

Respect rights of patients to make health care decisions

Veracity

accountability, privacy, confidentiality

Integrity

acting in accordance with an appropriate code of ethics and accepted standards of practice. reflected in the professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession ex In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? Integrity

utilitarian

action-guiding theory of ethics that states that the rightness or wrongness of an action depends on the consequences of the action

Principle-based approach

an approach to bioethics that offers specific action guides

Common modes of value transmission: Laissez-faire

children are left to explore values on their own and to develop a personal value system. This approach often involves little or no guidance and can lead to confusion or conflict.

Common modes of value transmission: Rewarding and punishing

children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values.

Common modes of value transmission: Moralizing

children are taught a complete value system by parents or an institution that allows little opportunity for them to weigh different values

Common modes of value transmission: Responsible choice

encouraging children to explore competing values and to weigh their consequences. Support and guidance are offered as children develop a personal value system

deontologic

ethical system in which actions are right or wrong independent of the consequences they produce

Justice

giving each patient his or her due; act fairly process that distributes benefits, risks, and costs fairly ex A nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute patient still receives a reasonable amount of time, attention, and care during the course of the shift. Which of the following is the nurse attempting to enact? Justice

Fidelity

keeping promises; being faithful to the promise you made to the public to be competent and to be willing to use your competence to benefit the patient entrusted to your care. ex A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? Fidelity

Human dignity

respect for the inherent worth and uniqueness of individuals and populations. reflected when the nurse values and respects all patients and colleagues EX Which nursing actions best describe the use of the professional value of human dignity? (Select all that apply.) • A nurse provides privacy for an elderly patient. • A nurse plans individualized nursing care for his or her patients. • A nurse refuses to discuss a patient with a curious friend.

ethical dilemma

situation that arises when attempted adherence to basic ethical principles results in two conflicting courses of action

Social Justice

upholding moral, legal, and humanistic principles. reflected when the nurse works to assure equal treatment under the law and equal access to quality healthcare. ex Which of the following actions most clearly demonstrates a nurse's commitment to social justice? Lobbying for an expansion of Medicare eligibility and benefits

Altruism

a concern for the welfare and well-being of others. Reflected by the nurse's concern for the welfare of patients, other nurses, and other healthcare providers EX A nurse demonstrates the professional value known as altruism when caring for patients in a long-term care facility. What is an example of a nursing action based on this value? A nurse researches the culture of a Muslim patient when planning nursing care.

values clarification

a process by which people come to understand their own values and value system

nursing ethics

a subset of bioethics, formal study of thical issues that arises in the practice of nursing and of the analysis used by nurses to make ethical judgements

Nonmaleficence

avoidance of causing harm; seek to prevent harm or risk of harm whenever possible. ex An emergency department nurse and health care team are caring for a semiconscious child age 2 years with numerous fractures and evidence of cigarette burns. They suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle? Nonmaleficence

ethical distress

occurrence 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

bioethics

scope encompasses a number of fields and disciplines grouped broadly under the rubric "the life sciences" Issues in bioethics include responsible research conduct, genetic enhancement, environment ethics, and sustainable healthcare exWhich of the following is a characteristic of the care-based approach to bioethics? The promotion of the dignity and respect of clients as people

ethical agency

the ability to behave in an ethical way; to do the ethically right thing because it is the right thing to do ex A nurse instructor is teaching students about the use of ethical agency in nursing practice. Which statements accurately represent the basic principles of ethics? (Select all that apply.) • The ability to be ethical begins in childhood and develops gradually. • Ethics is a systematic inquiry into the principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. • A commitment to developing one's ability to act ethically is known as one's ethical agency.

Autonomy

the right to self-determination. Reflected in a nurse's respect for patients' rights to make decisions about their healthcare. EX A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This patient is utilizing which ethical principle in making his decision? Autonomy

Common modes of value transmission: Modeling

children learn what is high or low value by observing parents, peers, and significant others---> may lead to socially acceptable of unacceptable behaviors