Ethics (6Q)

New revisions to the ANA Ethics Code emphasizing obligation of nurse managers/leaders to

○ Provide an ethical practice environment in which nurses feel safe to speak up ○Leaders called to provide continuing ethics education, coping skills and other resources like ethics consultation and moral distress interventions

Paternalism

Allowing a person to make a decision for another Examples - Mandatory flu vaccine - Nurse does not inform pt of ↑BP when pt questions nurse b/c RN believes this information will upset the pt.

Ethical Principles

Autonomy Beneficence Non-maleficence Veracity Justice Paternalism Fidelity

• States values, beliefs of our profession and standard of professional action • Guides our actions • Start point for ethical issues • ANA publishes position papers on ethical issues

Code of Ethics for Nurses (ANA 2015)

A problem is an ethical dilemma if

○ It cannot be solved solely by a review of scientific data. ○ It involves a conflict between two moral imperatives. ○ The answer will have profound effect on the situation/client

Ethical Decision-Making Framework

Guide to discuss the ethical issue: • Gather data & identify conflicting moral claims • Identify key participants, who should make the choice • Determine moral perspective and phase of moral development of key participants • Identify available options & consequences of options • Rules, obligations, and values that should direct choices • Determine desired outcomes • Act on the choice • Evaluate outcomes of the action

Veracity

Truth Examples: - Informing family of sentinel event, error - Completing incident report, near miss - Reporting RN friend who arrives at work impaired

Is paternalism ever justified?

Yes § Supports beneficence § Assisting staff in professional decisions § If patient indecisive, fearful

Autonomy

- Personal freedom, right to choose Examples: 1. Informed Consent 2. Progressive discipline with employees 3. HN decision about unit operations 4. Staff decisions regarding patient care

Moral Residue

-Describes the lingering feelings that exist after a morally distressing situation has passed.

Moral Distress

-Describes the negative emotional response that occurs when a health care provider knows the morally correct action to take but is prevented from doing so -Threatens core values and moral integrity

Non-maleficence

-Do no harm - Trying To Prevent Harm -Maximizes patient safety and minimizes errors -Principle most helpful when balanced against beneficence. Examples: - Stopping medication , treatment harmful to the patient or viewed as an ineffective/inappropriate/futile treatment -Refusing to provide a treatment that has not be shown to be effective -Emphasizing employees positive traits; not destroying their self-esteem and self-worth. - Withdrawing life sustaining treatment - medical futility

Patient Rights

-Informs patients what to expect during hospital stay -Their right to: § High-quality care § Clean, safe environment § Involvement in their care § Privacy protection § Help leaving hospital § Help with billing claims

Ethical Dilemma

-Problems when more than one choice can be made - Choice is influenced by the values and beliefs of the decision-makers.

Beneficence

-Promote good, doing good to others. -Consists of mercy, kindness, & charity deeds -Taking actions to benefit & promote the welfare of people -Help prevent or remove harms or improve situation Examples: 1. Hep B series, flu shots given to employees 2. Encouraging pt to stop smoking 3. CPR 4. Educating community about STD prevention 5. Knowing organ donation laws

Fidelity

-Requires loyalty, fairness, truthfulness, advocacy, and dedication in relationships. -Keeping one's promise, fulfilling one's commitments Example § Maintaining staff vacation request § Keeping promise made to patient/family § Respect for Persons, Others

2 Ethical Theories

1. Deontology: Study of duty, Focuses on duties and rules, Actions based on moral rules and unchanging principles. 2. Utilitarianism: Consequences are important, Actions are judged by their utility; evaluated according to the usefulness of their consequences, Greatest good with least harm.

• Branch of philosophy in which one reflects on morality • Concerns the individual within society, ultimate "good' of individual, "why" of ones actions • Law concerns society as a whole • 'Northern star' that guides professional behavior but does not give specific solutions to dilemmas.

Ethics Ethical dilemmas

Justice

Fairness, treating people equally and without prejudice regardless of social or economic background

Ethical Committees Provide

• Education • Policy development and guideline recommendations • Case review, consultation

Leadership Role in Ethics

• Ethical leadership is an essential part of organizational leadership • Self-awareness of your values, beliefs • Trust essential • Role model confidence in decision making • Promote moral courage • Situational awareness of staff, possible ethical concerns • Provide mutual support of staff • Ethical succession planning • Educate staff, read articles, brown bag discussions • Encourage membership on ethical committee • Ethics "rounds"

Steps in ethical decision-making

• Identify whether the issue is an ethical dilemma. • State the ethical dilemma, including all surrounding issues and individuals involved. • List and analyze all possible options for resolving the dilemma, and review implications of each option. • Select the option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care. • Justify why one option was selected. Apply this decision to the dilemma and evaluate the outcomes.

Moral Distress Issues

• Inadequate staffing • Ineffective communication • Perceived incompetent coworkers • Carrying out MD orders for unnecessary tests and treatments for terminally ill patients • Lack of respect for patient wishes by physicians. • Fear of physician backlash End of life issues

Ethical Committees

• Inter-professional membership • Provide guidance, structure that assists with decisions involving ethical dilemmas •Use guidelines, framework to assist with the resolution

Ethical Climate

• Organizational conditions & practices in which problems with ethical implications are identified, discussed, and decided.

An exemplary ethical organization must

• Possess, state, and act on values emphasizing care of the sick & promotion of health • Involve key stakeholders in identifying & managing its values • Disseminate understanding of values to staff • Recognize all its activities influence ethical quality of care • Cultivate skill at identifying threats to and conflicts among its values • Partner only with others who live by compatible values

Ethical Decision-Making

• Process by which a decision is made about an ethical issue. Frequently, requires a balance between science and morality

Ethical Issues Encountered in Practice

• Technology • Cost containment • Patient's rights • Staffing issues, inadequate staffing • Impaired nurses, perceived incompetent coworkers • Confidentiality • Refusal of treatment