Ch.6 values, ethics, and advocacy Exam 1

The 4 A's to rise above moral distress

-Ask -Affirm -Assess -Act

5 step process for resolving ethical conflict

-Assess -identify ethical problem -plan -implement -evaluate

Purpose of code of ethics

-It is a succient statement of the ethical obligations and duties of every individual who enters the nursing profession. -profession's nonnegotiable ethical standard -expression of nursings own understanding of it's commitment to society

Nurses have four fundamental responsibilities in the code of ethics

1. to promote health 2. to prevent illness 3. to restore health 4. alleviate suffering

Fidelity

Keep promises

5 common modes of value transmission

Modeling, moralizing, laissez-fair, rewarding and punishing, responsible choice

Bioethics

Number of fields and disciplines grouped broadly under the rubric "life sciences"

Ethical distress

Nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action

Value system

Organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct.

The American Association of Colleges of Nursing identified five values that epitomize the caring, professional nurse. 5 Nursing professional values:

1. Altruism 2. Autonomy 3. Human Dignity 4. Integrity 5. Social Justice

Modeling

Children learn what is of high or low value by observing parents, peers, and significant others. This may lead to socially acceptable or unacceptable behaviors.

Moralizing

Children taught a complete system by parents or an institution that allows little opportunity to weigh different values

Principle based approach to bio-ethics

Combines elements of both utilitarian and deontologic theories and offers specific action guides for practice. AUTONOMY, NONMALEFICENCE, BENEFICIENCE, JUSTICE, FIDELITY

Altruism

Concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of patients, other nurses, and other health care providers. Sample professional behaviors include: demonstrates understanding of cultures, beliefs, and perspectives of others. Advocates for patients, particularly the most vulnerable. Takes risks on behalf of patients and colleagues. Mentors other professional.

Feminist ethics

Critiques existing patterns of oppression and domination in society. Nurses working in a feminist framework promote social policy that reflects a fundamental trust in women and those in the margins. This trust is recognition that all persons deserve the opportunity to make legitimate choices about conditions that affect their lives and are deserving of respect whenever they exercise such agency.

A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accordance with which of the principles of bioethics?

E is correct a. autonomy b. beneficence c. justice d. fidelity e. nonmaleficence

Human dignity

Respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is reflected when the nurse values and respects all patients and colleagues. Sample behaviors include: Provides culturally competent and sensitive care. Protects the patients privacy. Preserves the confidentiality of patients and health care. Designs care with sensitivity to individual patient needs.

Autonomy

Respect rights of patients or their surrogates to make health care decisions

Utilitarian

Rightness or wrongness of an action depends on the consequences of thd action

Code of ethics

Set of principles that reflect the primary goals, values, and obligation of the profession

Common ethical issues encountered by nurses in daily practice include:

cost-containment issues that jeopardize patient welfare. end of life decisions. breaches of patient confidentiality. incompetent, unethical, or illegal practices of colleagues.

Ethical delimmas

Attempted adhereance to basic ethical principles results in two conflicting courses of action

Advocacy

Protection and support of anothers rights

Bill of rights for nurses

1. practice in a manner that fulfills their obligations to society 2. practice in environments that allow them to act in accordance with professional standards 3. work in an environment that supports and facilitates ethical practice 4. freely and openly advocate for themselves and pt's w/o fear of retribution 5. fair compensation for their work 6. environment that is safe 7. negotiate the conditions of their employment

Advocacy in nursing practice

1. representing patients- much nursing time is spent representing patients interest or guiding in protecting their own rights. 2. promoting self determination- nurse advocates do not make ethical decisions for their patients. Instead, they facilitate their patients' own decision making. Nurses interpret findings for their patients, provide information to be considered, help them verbalize and organize their feelings, call in those people who should be involved in the decision making, and help patients assess all of their options. 3. whistle-blowing- every nurse who witnesses unsafe care has a duty to patients to report it. 4. being politically active- As the government becomes more involved in the delivery and funding of health care services, and as those designing rationing plans speak seriously of age and other variables as criteria for limiting care, nurses must continue to advocate for the health care needs of those least empowered to do so for themselves.

A professional nurse committed to the principle of autonomy would be careful to:

A is correct a. provide the information and support a patient needed to make decisions to advance one's own interest. b. treat each patient fairly, trying to give everyone his or her due. c. keep any promises made to a patient or another professional caregiver. d. avoid causing harm to the patient.

When an older nurse complains to a younger nurse that nurse's just aren't ethical anymore, which reply reflects the best understanding of moral development?

A is correct. a. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." b. "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" c. "Ethics is genetically determined...it's like having clue or brown eyes. Maybe we are evolving out of the ethical sense your generation had." d. "I agree! It's impossible to be ethical in a practice setting like this."

A student nurse begins a clinical rotation in a long term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements reflect a correct understanding of advocacy? select all that apply.

A,C,F are correct a. advocacy is the protection and support of another's rights b. patient advocacy is primarily done by nurses. c. patients with special advocacy needs include the very young and the elderly, those who are seriously ill, and those with disabilities. d. nurse advocates make good health care decisions for patients and residents. e. nurse advocates do whatever patients and residents want. f. effective advocacy may entail becoming politically active.

Integrity

Acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on a, ethical framework that is accepted within the profession. Sample behaviors include: Provides honest information to patients and the public. Documents care accurately and honestly. Seeks to remedy errors made by self or others. Demonstrates accountability for own actions.

Deontologic

Action is right or wrong based on a rule independent of its consequences

Nonmaleficence

Avoid causing harm

Janie wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. She believes his dying is being prolonged painfully. She is troubled when the patient's doctor tells her that she'll be fired if she raises questions about his care or calls the consult. This is a good example of:

B is correct a. ethical uncertainty b. ethical distress c. ethical dilemma d. ethical residue

A professional nurse with a commitment to social justice is most apt to:

B is correct a. provide honest information to patients and the public. b. promote universal access to healthcare c. plan care in partnership with patients. d. document care accurately and honestly.

A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statement best describe a characteristic of the development of a personal value system? Select all that apply.

B,C,D are correct a. people are born with values b. values act as standards to guide behavior. c. values are ranked on a continuum of importance. d. values influence beliefs about health and illness. e. value systems are not related to personal codes of conduct. f. nurses should not their values influence their patient care.

A nurse who is working in a hospital setting after graduation from a local college uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply.

B,F are correct a. a patient decides to quit smoking following a diagnosis of lung cancer. b. a patient shows off a new outfit that she is wearing after losing 20 pounds. c. a patient chooses to work fewer hours following a stress related myocardial infarction. d. a patient incorporates a new low cholesterol diet into his daily routine. e. a patient joins a gym and schedules classes throughout the year. f. a patient proudly displays his certificate for completing a marathon.

Value

Belief about the worth of something, about what matters, that acts as a standard to guide one's behavior.

Beneficence

Benefit the patient, balance benefits against risks and harms

Process of valuing

CHOOSING- choose freely, choose from alternatives, careful consideration of consequences of alternatives PRIZING- Pride and happiness, Public affirmation ACTING- Acts by combining choice into ones behavior, with consistency and regularity on the value

Rewards and punishment

Children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values

Five year old bobby has dietary modifications related to his diabetes. His parents want him to value good nutritional habits and they decide to deprive him of a favorite T.V. program when he becomes angry after they deny him food not on his diet. This is an example of what mode of value transmission.

D is correct a. modeling b. moralizing c. laissez-fair d. rewarding and punishing

The American association of colleges of nursing identified five values that epitomize the caring professional nurse. Which of these is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice?

D. is correct a. altruism b. autonomy c. human dignity d. integrity

Care based approach

Directs attention to specific situations of individual patients viewed within the context of their life narrative. The care perspective directs that how you chose to be and act each time you encounter a patient or colleague is a matter of ethical significance.

Responsible choice

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

Justice

Give each his of her due, act fairly

Ethical agency

Just because we want to be nurses doesn't mean that we automatically have some natural ability to always do the ethically right thing because we know it's the right thing to do. This ability, ethical agency or ethical capacity, must be cultivated in the same way nurses cultivate the ability to do the scientifically right thing when providing care.

Laissez-fair

Leave children to explore values on their own and to develop a personal value system. No single set of values is presented as best for all. Often involves little or no guidance and may lead to confusion and conflict.

Value clarification

Process by which people come to understand their own values and value system. It is a process of discovery, allowing the person to discover what through feelings and analysis of behavior what choices to make when alternatives are presented.

Autonomy

Right to self determination. Professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their health care. Sample Behaviors include: Plans care in partnership with patient's. Honors the right of patients and their families to make decisions about health care. Provides information so that patients can make informed decisions.

Morals

Similar in meaning to ethics, refers to personal or communal standards of right and wrong

Nursing ethics

Subset of bioethics, formal study of ethical issues that arise in the practice of nursing and analysis used by nurses to make ethical judgments

Ethics

Systematic study of principles of right and wrong conduct, virtue and vice, and evil and good as they relate to conduct and human flourishing. The ability to be ethical and make decisions and act in an ethical manner, begins in childhood and develops gradually.

Value Neutral

To encourage health care professionals to respect and accept the individuality of patients, some educators have advised that professionals be "value neutral" or "nonjudgmental" in their professional roles. Professional nurses do not assume that their personal values are more correct than those of the patients. This encourages effective care for patients with different values from the nurse's.

Social justice

Upholding moral, legal, and humanistic principles. This value is reflected in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality health care. Sample behaviors include: Supports fairness and nondiscrimination in the delivery of care. Promotes universal access to health care. Encourages legislation and policy consistent with the advancement of nursing care and health care.

Action guiding theories

Utilitarian, deontologic

3 questions at the heart of bioethics

What kind of person should i be in order to live a moral life and make good ethical decisions? What are my duties and obligations to other individuals whose life and well being may be affected by my actions? What do i owe the common good or the public interest in my life as a member of society

Ethics committees chief functions

education policy making case review consultation in some cases research