Chapter 22 - Ethics and Values

moral distress

- Need to take a specific action even though you believe it is wrong - ex. Nurse is making a joke about the patient, and you are afraid to speak up because of retaliation

access to health care

- justice - fairness and distribution of health care

Health Insurance Portability and Accountability of 1996 (HIPPA)

- mandates that patient information is held confidential - if you violate, the hospital can be fined - meaning that nurse will be fired - "the right to know" = if you are involved in that patients care, you have a right to their information - regulates communication in medical records

values

- need to know your own personal values - you get your values from your family and education - ethical dilemmas - result from conflicting values

what is this? = "You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the provider and your head nurse and follow agency procedure."

= Accountability

what is this? = "A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request."

= Advocacy

what is this? = "You see an open medical record on the computer and close it so that no one else can read the record without proper access."

= Confidentiality

what is this? = "You tell your patient that you will return in 30 minutes to give him his next pain medication."

= Responsibility

approaches to ethics

A nurse is caring for an older adult, Stella, who has dementia and whose son, David, does not adhere to the unit's visitation policy, namely, that he leave her bedside for half an hour during change of shift.

Step 2: Gather all relevant information

A review of Miguel's chart shows that his diabetes is poorly controlled. There is a note from the hospital's diabetes education program indicating that Miguel and his parents were given information about a diabetic diet and appeared to understand the information. There is also a note by the social worker concerned that Miguel is having trouble accepting this diagnosis.

Step 6: Create an action plan and carry it out

Ask him about his behavior but in a kind way, not punitive or threatening.

When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates that? A. Assessing the patient's pain on a numeric scale every 2 hours B. Asking the patient to establish the goal for pain control C. Using alternative measures such as distraction or repositioning to relieve the pain D. Monitoring the patient for oversedation as a side effect of his pain medication

B. Asking the patient to establish the goal for pain control

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of: A. responsibility. B. accountability. C. competency. D. moral behavior.

B. accountability.

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? A. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. B. The single focus on power imbalances does not apply to all situations in which ethical problems occur. C. In a diverse community it can be difficult to find agreement on which principles or rules are most important. D. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable

C. In a diverse community it can be difficult to find agreement on which principles or rules are most important.

What is the best response for the nurse to give if a patient asks the nurse to send a photo of an x-ray to him via a messaging tool in a social media site? A. Yes, if you remove all patient identifiers before sending B. No, because the patient's x-ray results should be discussed with a provider C. Yes, because respect for autonomy means honoring this patient's request D. No, because health information of any kind should not be shared on social media

D. No, because health information of any kind should not be shared on social media

A patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of: A. autonomy. B. fidelity. C. justice. D. nonmaleficence.

D. nonmaleficence.

autonomy: explanations

Explaining things to the patient, allows them to refuse something

beneficence

Good, positive actions to help others, you have the best in mind ex. Nursing - we are trying to do good for the patients

autonomy: informed consent

HCP (healthcare provider) tells the patient the risks and benefits of a certain procedure.

autonomy: patient dying

If a patient is dying, they want to go home but the family want everything done for the patient, need to contact healthcare provider, needs to respect the patients request not the families

fidelity: patients

If patient in pain and you tell them pain med are due in 30 mins—you must follow through with the meds in 30 mins

ethics committees

If you have a major ethical dilemma—they will be the ones to process the problem, will not have to deal with it on your own

Step 5: Consider possible courses of action

Option 1: Take a tough stance with Miguel and remove the food and avoid his room and pretend to be unaware of his behavior. Option 2: Ask him about his behavior but in a kind way, not punitive or threatening. Option 3: Call Miguel's doctor to talk to him, call his parents and asking that they intervene, or pull Miguel's friend out of the room and explain to him that he needs to leave and take the food with him because he is disrupting Miguel's care.

Step 1: Ask if this is an ethical problem

The situation is an ethical problem because two opposing actions—to try to stop Miguel from eating the snacks or to leave him alone—can both be justified.

ethical dilemma

When you are faced with a ethical dilemma and there are two courses of action—need to decide which one is right for the situation

Step 4: Name the problem

You arrive at the conclusion that you have an ethical dilemma between acting with beneficence to protect Miguel's health and respecting his autonomy.

Step 7: Evaluate the action plan

You realize that spending a few minutes to learn more about Miguel made it easier to negotiate the removal of the snacks. He came to trust you because of the interest you showed in him as a person. This is a strategy you can apply in the future.

Step 3: Identify the ethical elements in the problem and examine your values

You want to ensure that Miguel manages his diabetes because you value his health. At the same time, you recognize that as a teenager, he wants the freedom to make his own choices, unrestrained by his disease process. You value him as a person and recognize that in addition to his physical health problems, he has developmental needs.

Accountability

answering for your own actions

fidelity: yourself

attending to emotional needs, seek mentoring, continuing education

autonomy

being independent and freedom from external controls

advocacy

being the patient's voice

Bioethics

branch of ethics within healthcare ex. organ transplant - not enough organs to go to everyone, so you need to decide who gets what

Justice

fairness, being fair to all people, and distribution of resources ex. Health insurance (should everyone be given It) , location of hospitals, organ transplants

Fidelity

faithful to keep your promises

fidelity: Institution

following policies and procedures

Responsibility

following through on your professional obligations - Being responsible for the care you provide and delegation - Seek help when you are unsure about your skills and knowledge - Following policies and procedures

care at the end of life

futile = when intervention is unlikely to produce a benefit for patient ex. patient is dying within a few weeks, it would be futile to give them the flu shot

code of ethics

guiding principle of a profession

professional autonomy

if there is a conflict in their job duties due to ethic, you can reassign duties ex. Abortion—nurse does not believe in abortion, they do not have to participate

morals

judgement about behavior ex. honesty is the best policy

cauistry

look at similar situations in the past and think about how it was handled ex. Look back at a similar situation and look at if the outcome were positive or negative and act based off that

quality of life

look at the values and benefits of medical interventions ex. flu shot cons = pain pros = wont get the flue

utilitarianism

looking at the greatest good for the greatest amount of people, focuses on outcomes ex. let him stay because it might upset a bunch of people if it gets hostile

ethics of care

make decision based on our caring relationships - talking with family member and patients

values clarification

need to clarify your values, patient's values, and colleagues values

confidentiality

respecting patients privacy

ethical dilemma case study: "You are caring for Miguel, an 18-year-old with diabetes. Another nurse tells you that his parents are supportive, involved, and knowledgeable about his condition, but Miguel is mostly angry and uninterested in diabetes education. You walk into the room and find that a friend from Miguel's high school is visiting and has brought in candy and other snacks that contradict Miguel's prescribed diet."

steps: 1. ask if this is an ethical problem 2. gather all relevant information 3. identify the ethical elements in the problem and examine your values 4. name the problem 5. consider possible courses of action 6. create an action plan and carry it out 7. evaluate the action plan

deontology

the situation is either right or wrong based on the rules ex. this is the policy, you must follow it or leave

Nonmaleficence

to do no harm ex. Bone marrow transplant—lots of pain - not guarantee of a positive outcome

feminist ethics

unequal power ex. when we are working with a vulnerable population (pregnant women, children, people with disabilities) - Is the patient intimidating the patient? Abusive? Should they be asked to leave - Could be the nursing is asking the family to leave because of the leverage of power

Ethics

what is right and wrong in our conducts

social media

you cannot post pictures of or information on social media - cannot friend patient or family member of patient either