Nursing 104- Chapter 9

altruism

concern for the welfare of others. -caring, commitment, compassion, generosity, perseverance -gives full attention to the client when giving care; assists other personnel in providing care when they are unable to do so. -expresses concern about social trends and issues that have implications for health care.

trust

difficult questions surface, but at the heart of the principle veracity is _______. health care consumers today expect accurate and precise information that is revealed in and honest and respectable manner. today, for trust to develop between providers and patients, there must be truthful interaction and meaningful communication.

beneficence

is to promote goodness, kindness, and charity. to provide benefits to others by promoting their good.

ethics

science or study of moral values.

nursing code of ethics

was first introduced in the late nineteenth century and has evolved through the years as the profession itself has evolved and changes in society and health have come about.

international council of nurses code of ethics for nurses

-the fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health, and to alleviate suffering. -the need for nursing is universal. inherent in nursing is respect for life, dignity, and rights of humans. it is unrestricted by considerations of nationality, race, creed, color, age, sex, politics, or social status. -nurses render health services to the individual, the family, and the community and coordinate their services with those of related groups.

american nurses association code of ethics for nurses

-the nurse in all professional relationships, 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. -the nurses's primary commitment is to the patient, whether an individual, family, group, or community. -the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

american nurses association code of ethics for nurses

-the nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. -the nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. -the nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conductive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

american nurses association code of ethics for nurses

-the nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. -the nurse collaborates with other professionals and the public in promoting community, national, and international efforts to meet health needs. -the profession of nursing , as represented by associations and their members, is responsible for articulating nursing values, maintaining the integrity of the profession and its practice, and shaping social policy.

situation assessment procedure

1. identify the ethical issues and problems 2. identify and analyze available alternatives for action 3. select one alternative 4. justify the selection

bioethical dilemmas

_______ are situations that pose a choice between perplexing alternatives in the delivery of health care because of the lack of a clear sense of right and wrong. it is imperative that every nursing student consider the potential dilemmas that might arise in a given practice setting. concepts of life and death are central to the nursing's body of knowledge, but a discussion of these concepts is incomplete unless the threats of conflict also are explored. conflict must be addressed as the concepts of life and its origins, birth, death, and dying are addressed. conflict must also be addressed in the many varied situations that come up day after day in the practice of professional nursing.

justice

________ becomes a bioethical issue at the point that it will affect whether, when, where, and how a patient will receive health care.

informed consent

________ dilemmas evolve from questions about whether patients are competent to make informed decisions and whether there are family members or surrogates to make these decisions by proxy. difficult questions are posed for health care providers by the need for this from minors, confused older adults, persons in emergency situations, and persons who are mentally compromised, imprisoned, inebriated, or unconscious. the burden of this lies with the physician in most circumstances, although the nurse frequently is responsible for aspects of informing and obtaining consent.

euthanasia and assisted suicide

_________ and __________ present the newest ethical questions surrounding the dying process. because death is universal and part of human existence, every health care provider serving in every delivery setting must address the difficult end of life questions.

(1)refined value system and (2)worldview

a ___1___ and ____2___ can serve professionals as they deal with the meaning of life and its many choices. a __2___ provides a cohesive model for life; it encourages personal responsibility for the living of that life, and prepares one for making ethical choices encountered throughout life.

values clarification

a clear understanding of what is right and wrong is necessary first step to a process sometimes referred to as ________, a process by which people attempt to examine the values they hold and how each of those values functions as part of a whole. nurses must acknowledge their own values by considering how they would act in a particular situation. it is an important learning tool as nurses prepare themselves to become competent professionals.

injustice

a person has been treated justly when he or she has been given what is due or owed. an denial of something to which a person has a right or entitlement is an act of ________.

value

a personal belief about worth that acts as a standard to guide behavior; a value system is an entire framework on which actions are based and is the backbone to how one thinks, feels, and takes actions.

nonmalficence

a principle that implies a duty not to inflict harm. in ethical terms, it is to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats.

code of ethics

a set of statements encompassing rules that apply to people in professional roles.

ethical theory

a system of principles by which a person can determine what should and should not be done. although there are others, utilitarianism and deontology are western world theories that many health care professionals studying bioethics have embraced as a guide for answering the question regarding what is right to do in a given ethical dilemma.

integrity

acting in accordance with an appropriate code of ethics. -moral, ethical, and legal professional behavior. -the nurse is honest and provides care based on an ethical framework that is accepted in the profession.

social justice

acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation. -courage, integrity, morality, objectivity. -acts as a health care advocate. -allocates resources fairly. -reports incompetent, unethical, and illegal practices objectively and factually.

advance directives

advanced technology and the potential to keep people alive for extended periods have brought about legislation aimed at giving people choices about end of life decisions while they are still healthy and well enough to make informed decisions. the opportunity to make ________ is now common and even a requirement for admission to hospitals and other health care agencies that receive federal dollars. people are not required to decide, but must be given an opportunity to do so. ideally the health care community will provide such an opportunity while the patient is well, perhaps in a community setting, such as a public library or community center.

the demands of the beneficence and those acts and decisions within the health care delivery system that might pose threats.

although it may seem natural to promote good at all times, the most common bioethical conflicts results from an imbalance between?

paternalism

an action and an attitude wherein the provider tries to act on behalf of the patient and believes that his or her actions are justified because of a commitment to act in the best interest of the patient. it is a reflection of the "father knows best" way of thinking. the phenomenon presumes in the name of beneficence, to overlook the patient's right to autonomy. thus, in the process of attempting to act in the best interest of the patient, it involves actions not based on the patient's choices, wishes, and desires. it interferes with a patient's right to self-determination and occurs when the provider believes that he or she can make a better decision than the patient.

utilitarianism

an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or the to the least possible balance of bad consequences. these ethics are noted to be the strongest approach used in bioethical decision making. an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma.

deontology

an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and compel them to do what is right. ethics are based on a sense of universal principle to consistently act one way. in bioethical decision making, moral rightness is the act that is determined not only by the consequences it produces, but the moral qualities intrinsic to the act itself.

acountability

an ethical duty stating that one should be answerable legally, morally, ethically, or socially for one's activities.

veracity

an ethical duty to tell the truth.

nonmaleficence

an ethical principle stating the duty not to inflict harm.

deontology

an ethical theory stating that moral rule is binding.

utilitarianism

an ethical theory stating that the best decision is one that brings about the greatest good for the most people.

component nurse

an ethically sensitive nurse who can deal with the human dimensions of care that include a search for what is good and right for what is accurate and efficient.

bioethics

an interdisciplinary field within the health care organization that has developed only in the past four decades. it has developed with the age of modern medicine, specifically with the development with hemodialysis and organ transplantation. think of questions from stem cell research, sexual reassignment, and reproductive-assisting technologies. it is in response to these and other contemporary advances and challenges in health care.

preconventional

at first, morality is all about rules imposed by some source of authority. moral decisions made at this level (________) are simply in response to some threat of punishment. the good-bad, right-wrong labels have meaning but they are defined only in reference to a self-centered reward-and-punishment system. a person who is in the _________ level has no concept of the underlying moral code informing the decision of good or bad or right or wrong.

autonomy

based on the principle of _______, the consent process must be voluntary and without coercion; the fully informed patient must clearly understand the choices being offered.

situation assessment procedure

can be a useful procedure to guide the thinking of a group that has been asked to provide counsel. it can be applied to the decision-making process when procedures and policies are being developed to address conflicting variables. the procedure is applicable to the daily practice level of ethical decision making as patients and providers make choices between right and wrong actions. the procedure is equally applicable to the policymaking level where professionals come together to consider right and wrong choices that affect society as a whole. it can be applied to difficult questions that arise in any setting in which the nurse is responsible for or contributes to ethical decision making.

deontology theory

claims that a decision is right only if it conforms to an overriding moral duty. all decisions must be made in such a way that the decision could become universal law. persons are to be treated as ends in themselves and never as means to be ends of others.

reproduction

closely akin to the abortion question are newer questions about ________. genetic screening, genetic engineering, stem cell therapy, and cloning are newer, highly advanced, and sophisticated techniques that bring with them the most ethically entangled questions ever encountered; the entire human genome project with its rapidly developing advances represents the greatest challenge to date. definitions of family, surrogacy, and other related issues also bring ethically entangled questions.

ethical climate in the workplace

current dynamics, such as the emerging genetic interventions associated with therapeutic and reproductive cloning, debates about securing stem cells for research and treatment, evolving legal definitions of family, ongoing questions about euthanasia and assisted suicide, and escalating threats to the effective delivery of health care as a result of significant nursing shortages, now being called ________________, bring nursing's code of ethics into the forefront.

integrity

every person bearing the title of nurse must aspire to maintain himself or herself as a professional of ________ who is willing to blow the whistle on those whose actions are irresponsible and harmful. if this is not the case, the wrong will continue and the harm to others will escalate. in the end, the profession as a whole will suffer, and the well being of society will be diminished.

veracity

everyday issues that test the concept of _______ are the concepts of alternative treatment and acknowledging uncertainty. it is the nature of health science that new knowledge must come forth to abolish less effective dogma. new ignorance comes along with these new discoveries.

ethical dilemmas

failure to be accountable for one's own actions places a tremendous burden on the relationship with the patient and poses __________ for fellow nurse professionals. in health professions in which the safety and health of society are at stake, the obligation of professionals to police the practice of their colleagues is important.

moral development

forming a worldview and a value system is an evolving, continuous, dynamic process that moves along a continuum of development often referred to as _________. just as there is an orderly sequence of physical and psychologic development, there is an orderly sequence of right and wrong conduct development.

scientific or technologic approach

health care professionals who adhere to an exclusively __________ or __________ to care will be seen as insensitive and will fail to meet the genuine needs of the patient, needs that include assistance with more subjective concerns, such as how to think about the many advanced care choices laid before them.

values

ideas of life, customs, and ways of behaving that society regards as desirable.

first step

in the _______ of assessment, there is an attempt to find out the technical and scientific facts and the human dimension of the situation- the feelings, emotions, attitudes, and opinions. a nurse must make and attempt to understand what values are inherent in the situation. finally, the nurse must deliberately state the nature of the ethical dilemma. this step is important because the issues and problems to be addressed are often complex. -what is the issue here? -what are the hidden issues? -what exactly are the complexities of this situation? -is anything being overlooked?

second step

in the ________, a set of alternatives for action is established. it is important to follow. because action are based most commonly on a nurse's personal value system, it is important to list all possible actions for a given situation, even actions that seem highly unlikely. without deliberately listing possible alternatives, it is doubtful that the full consideration of all possible actions will take place. -what are the reasonable possibilities for action, and how to do the different affected parties want to resolve the problem? -what ethical principles are required for each alternative? -what assumptions are required for each alternative, and what are their implications for future action? -what, if any, are the additional ethical problems that the alternatives raise?

autonomy

institutional review boards are established within research institutions for the purpose of overseeing that the degree of risk to the subject is minimized, if not eliminated. human experimentation tests the principle of ________ and respect for personhood.

nuremberg code

is a set of provisions for research that must be followed for the federal government to approve research.

beneficence-nonmalficence principle

is largely a balance of risk and benefit. at times, the risk for harm must be weighed against the possible benefits. the risks should never be greater than the importance of the problem to be solved.

veracity

most contemporary professionals believe that telling the truth in personal communication is a moral and ethical requirement. if there is a belief in health care that truth telling is always right, then the principle of _______ can itself pose some interesting challenges. in the past, truth telling was sometimes viewed as inconvenient, distressing, or even harmful to patients and families.

ethics acculturation

moving toward the level of moral maturity required for sound ethical decision making is, for most, a learning endeavor that requires a strong commitment in the task. nurses must commit themselves to such learning, to a process called _______ across the span of their career. the issues will only get more complex and confounding as new advances are introduced; the commitment to lifelong moral and ethical reasoning development is imperative. the desired outcomes as a result of this across the years are integrity, personal growth, practical wisdom, and effective problem solving on behalf of patients and their families. these are qualities that are characteristics of an ethically sensitive and morally mature person.

third step

multiple factors come together in the ______. after identifying the issues and analyzing all possible alternatives, the skillfull decision maker steps back to consider the situation again. there is an attempt to reflect on ethical theory and to mesh that thinking with the identified ethical principles for each alternative. the decision maker's value system is applied, along with appraisal of the profession's values for the care of others. a reasoned and purposeful decision results from the blending of each of these factors.

postconventional level

not all people develop beyond the conventional level of moral development. a morally mature individual (___________), one of the few to reach moral completeness, is an autonomous thinker who strives for a moral code beyond issues of authority and reverence. integrative thinking is required to move toward having the critical components necessary to make moral judgments. the morally mature individual's actions are based on principles of justice and respect for the dignity of all humankind and not just on principles of responsibility, duty, or self-edification.

international council of nurses code of ethics for nurses

nurses and coworkers -the nurse sustains a cooperative relationship with coworkers in nursing and other fields. -the nurse takes appropriate action to safeguard the patient when his or her care is endangered by a coworker or any other person.

international council of nurses code of ethics for nurses

nurses and people -the nurse's primary responsibility is to those people who require nursing care. -the nurse, in providing care, promotes and environment in which the values, customs, and spiritual beliefs of the patient are respected. -the nurse holds in confidence personal information and uses judgement in sharing this information.

international council of nurses code of ethics for nurses

nurses and practice -the nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning. the nurse maintains the highest standards of nursing care possible within the reality of a specific situation. -the nurse uses judgement in relation to individual competence when accepting and delegation responsibilities. -the nurse, when acting in a professional capacity, should at all times maintain standards of personal conduct that reflect credit on the profession.

international council of nurses code of ethics for nurses

nurses and society -the nurse shares with other citizens the responsibility for initiating and supporting action to meet the health and social needs of the public.

international council of nurses code of ethics for nurses

nurses and the profession -the nurse plays a major role in determining and implementing desirable standards of nursing practice and nursing education. -the nurse is active in developing a core of professional knowledge. -the nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing.

common ground

perhaps the most useful tool for the morally mature professional nurse is a set of principles, standards, or truths on which to base ethical actions. ________ must be established between the nurse and the patient and family, between fellow nurses, between the nurse and other health care providers, and between the nurse and other members of society. this can be established by adhering to a set of principles that can move everyone involved toward understanding and agreement.

autonomy

personal freedom and the right to make choices.

code of ethics

provide implicit standards and values for the professions.

human dignity

respect for inherent worth and uniqueness of individuals and populations. -consideration, empathy, humaneness, kindness, respectfulness. -values and respects all patients and colleagues, regardless of background.

autonomy

right to self-determination. -respectfulness, trust, objectivity. -provides nursing care based on respect of patients' rights to make decisions about their health care. -honors individual's right to refuse treatment.

nursing ethics

system of principles concerning the actions of the nurse in his or her relationship with patients, patients' family members, other health care providers, policymakers, and society as a whole.

distributive justice

taking into consideration the needs, interests, and wishes of each patient.

umbrella concept

the ______ says that humans have incalculable worth or moral dignity not possessed by other objects or creatures. there is unconditional intrinsic value for everyone. people are free to form their own judgements and whatever actions they choose. they are self-determining agents, entitled to determine their own destiny.

bioethical abortion conflict

the ________ has been debated using ethical theories, ethical principles, value systems, rights issues, choice questions, and so on. answers acceptable to society as a whole have not materialized; thus the right or wrong of abortion continues to rest with each person. despite clear, generalizable answers to the abortion question, nurses serving in health settings for women and children must be prepared to face this morally laden issue.

accountability factor

the ________ in the practice of nursing is such that a keen sense of responsibility and personal integrity are necessary qualities for every practicing nurse. it is the nurse's ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. failure to meet such obligations places the patient-nurse relationship at risk.

ethical sensitivity

the capacity to decide with intelligence and compassion, given uncertainty in a care situation, with an additional ability to anticipate consequences and the courage to act.

protect

the challenge today is to mesh the need for truthful communication with the need to _______. health care providers must lay aside fears that the truth will be harmful to patients and come to the realization that more often then not, the truth can alleviate anxiety, increase pain tolerance, facilitate recovery, and enhance cooperation with treatment. with a pledge toward human decency, health care providers must commit themselves to truth telling in all interactions and relationships.

rights of conscience

the civil rights that protect conscientious health care providers against discrimination, allowing them the right to act according to the dictates of their conscience.

ethics acculturation

the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional preparation.

patient-provider relationship

the healthy _______ is based on the open communication described previously, wherein patient choice and respect for personhood are deemed just as important as scientific knowledge and sound health care advice. this is built on trust when the right to confidentiality and privacy became ethical and legal obligations. it makes way for the crucial legal concept of informed consent, which stipulates that the patient has the right to know and make decisions about his or her health. these decisions take the form of consent or refusal of treatment.

classic theory

the most widely accepted theory on moral development is the now ______ developed by lawrence kohlberg. he theorizes a cognitive development process that is sequential in nature with progression through levels and stages that vary dramatically within society.

autonomy

the principle of respect for a person, is sometimes labeled as the primary moral principle. if an autonomous person's actions do not infringe on the autonomous action of others, that person should be free to decide whatever he or she wishes. this freedom should be applied even if the decision creates risk to his or her health and even if the decision seems unwise to others. concepts of freedom and informed consent are grounded in the principle of this.

step 4

the rational discourse on which the decision is based must be shared in an effort to justify the decision. the decision maker must be prepared to communicate his or her thoughts through an explanation of the reasoning process used. the justification for a resolution to an ethical issue is an argument wherein relevant and sufficient reasons for the correctness of that resolution are presented. defending an argument is not an easy task, but it is a necessary step to communicate the reasons or premises on which the decision is based. this step is important to advance ethical thought and to express sound judgement. the justification process: 1. specify reasons for action 2. clearly present the ethical basis for these reasons 3. understand the shortcomings of the justification 4. anticipate objections to the justification

moral development

the rightness or wrongness of the complex and confounding health care decisions that are being made totally depends on the level of ________ of those professionals entrusted with the tough decisions.

death and dying

the second most debated conflict in health care involves the issue of ________. since the development of lifesaving procedures and mechanical ventilation, questions about quality of life and the definition of death have escalated. with the advances in health care, it has become unclear what is usual care and what is heroic care. the purpose and quality of life of a person in a vegetative state continue to be debated.

whistle- blowing

there are countless situations in which the official policing body will never be involved, and the obligation to denounce a harmful action or potentially threatening situation falls to a fellow member of the profession. sometimes known as __________, the obligation to denounce is based on the fact that to remain silent is to consent to the action or threatening situation. whether denouncing a chemical impairment, negligence, abusiveness, incompetence, or cruelty, the obligation is a moral one based at least in part on the principle of beneficence.

1. autonomy 2 beneficence, nonmaleficence 3. veractiy

three principles have proven to be highly relevant in bioethics: _________, ____________, and ____________. these principles are not related in such a way that they jointly form a complete moral framework. one may be relevant to a situation, where the others are not. yet these principles are sufficiently comprehensive to provide an analytic framework by which moral problems can be evaluated.