Values (Module 8)
Living Will
Document that lists medical treatment person chooses to omit or refuse if unable to make decisions and is terminally ill **Next of Kin can Override Living Will**
Advance Directive -2-
Durable power of Attorney Living will
Clinical ethics
Ethical problems that relate to caring for clients
Justice
Fair and Equitable treatment *distribution of goods and services- how to decide who receives what *how are scarce resources allocated- rank according to needs *resources for preventions, research, high cost- treatment for a few? ect. *atleast univeral access to basic services
What plays a role in developing a person's values?
Family (plays a large role) Cultural and Social Community Religious influences Ethnocentrism
Ethical Issues Related to Quality of Life and Right to Life What are the concerns and questions related to:
+Futile care +Do not resuscitate Orders (DNR) +Physician- assisted suicide +Euthanasia
A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibility as being fundamental? Select all that apply. -Preventing illness -Promoting health -Alleviating suffering -Restoring health -Providing holistic care
-Preventing illness -Promoting health -Alleviating suffering -Restoring health Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering.
Responsible choice
A balance of freedom and restriction, allowed to explore within boundaries and learns to understand values
Confidentiality
A nurse asks a middle-aged woman who is crying quietly, "Would you like to share what's troubling you?" The woman tells the nurse that she has no idea how she will pay for this clinic visit because she entered the country illegally 2 months ago and is trying to earn enough money to help her family back home. She begs the nurse not to tell anyone. If the nurse believes that this anxiety is interfering with the patient's ability to obtain needed health care, would it be ethical to break the woman's confidence to obtain help for her?
Allocation of scarce nursing resources
A nurse has just been pulled from your unit, leaving it understaffed. Among your patients is a 33-year-old man recovering from a heart attack who is being discharged in the morning (he tells you that he still has many questions), an older patient who is close to death a woman with cancer who has been vomiting all day and who is in severe pain. You know that you cannot meet everyone's needs well. How do you "distribute" your nursing care? (You really like the patient who is going home in the morning.)
What are 2 examples of Autonomy
A nurse reads The Patient Care Partnership to a visually impaired client. A nurse collaborates with other health care team members to ensure the best possible
Unprofessional, incompetent, unethical, or illegal physican practice
A nurse who works in the operating room notices that a pediatric surgeon who has been on the staff for several years and has done excellent work suddenly seems not to be concentrating during surgery and to be making more mistakes than usual. Rumors have been circulating about the surgeon having a problem with cocaine abuse after his recent divorce. The parents of one pediatric patient are dissatisfied with the progress the patient is making and ask the nurse for an opinion about the surgeon. Should the nurse voice personal concerns? Is the nurse ethically obligated to report the physician to the proper hospital authority for investigation?
Privacy
A nursing student in your class shows you her recent Facebook posting that includes a photo of a patient with a large sacral pressure ulcer. She says that since the patient is lying face down, this is not an invasion of privacy. What patient information can you post ethically on social media sites? How would you respond?
Deception
A postoperative patient asks the student nurse, who is about to administer an intramuscular injection for pain, "Is this your first shot?" It does happen to be the student's first injection, and the student is anxious. Would the student's intent to decrease the patient's anxiety justify telling the patient, "No, I've given several before"?
Values Clarification
A process of self-discovery to gain insight into own values and value systems Is not an attempt to change a person's values Nurse uses process to help client clarify values
Valid consent or refusal
A resident is attempting to perform a spinal tap on an adolescent who you know dislikes the resident. After one failed attempt, the adolescent tells the resident to stop. The resident asks you to administer an antianxiety medication to the patient to enable the resident to get the spinal tap done quickly. Should you administer the medication knowing that the patient no longer consents to the procedure?
Accountability
Ability to answer for one's own actions- to self, client, profession, employer and society- ethically and legally accountable
Integrity
Act in accordance with the code of ethics and accepted standard of practice. The nurse is honest and provides care that follows ethical guidelines Documents care honestly Seeks to remedy errors Demonstrates accountability for own actions
Deontology or Katianism
Actions are morally RIGHT or WRONG based on ethical principles regardless of the outcome or consiquences
Values and Attitudes in the Nursing Profession -5-
Altruism Autonomy Human dignity* Integrity Social justice
Paternalism
An alert older resident who lives in a long-term care facility and who is now at high risk for falls refuses to call the nurse for assistance when getting out of bed. The nurse must decide whether to obtain an order to restrain the patient. Does preventing potential harm justify violating the patient's right to autonomy and make it acceptable for the nurse to act as a "parent," choosing an action the patient does not want because the nurse believes it to be in the patient's best interest?
Conflicts concerning new technologies
An infertile woman asks you what you think about in vitro fertilization. She tells you that she is "desperate to produce a child for her husband and in-laws" but also has grave reservations about the whole process. "I've read about couples who end up with seven frozen embryos, and I think that would kill me, thinking I've got seven potential kids 'on ice.'"
Ethical Decision Making Process
Assess the situation Define the ethical dilemma Plan- Identify the Weigh Alternatives Implement decision Evaluate & Discuss
Ethical Principles and the law -2-
Autonomy and patient self-determination Act Advanced Directive
Ethical Principles used to make ethical decisions (Principles of Bioethics)
Benefience Nonmalefience Autonomy Veracity Justice
Types of Ethics
Bioethics Nursing ethics Clinical ethics Feminist ethics
Three main activies of the valuing process
Choosing Prizing (treasuring) Acting
Choosing
Choosing freely from alternatives after careful considerations of the consequences of each alternative
Values theorists describe the process of valueing as focusing on three main activates
Choosing- freely, from alternatives- after teaching has the right to comply or refuse Prizing- treasuring Acting- with choice, with consistency
Acting
Combining choice into one's behavior with consistency and regularity on the value
Altruism
Concern for welfare of patients, including culture and beliefs- treating pt as whole not just their diagnosis Gives full attention; helps others, including staff. Shows concern about social issues and beliefs Advocates for others on behalf of patients and colleagues Acts as a mentor
Under ethical conduct 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 conduct
Bioethics
Grouped under life sciences *What do i have to do to live a moral life *What are my duties and obligations to clients for their well being who will be affected by my actions *based on nurse-patient relationship
Purposes of the Code of ethics for nurses
It is a 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
Autonomy and Patient Self-Determination Act
Legal right to make health care decisions Right to refuse treatment Have chart information Advance directive
Example of advocacy
Limiting visitors due to client complaining of pain
Durable Power of Attorney
Making someone a power of attorney over you when you can't make sound medical decisions
Ethical agency
Must be cultivated in the same way that nurse cultivate the ability to do the scientifically right thing ex: Ethical practice requires a skill set that must be consciously learned and nurtured
Ethnocentrism
Once believes their own values are superior to others values
Feminist ethics
Oppression ask how decisions will effect women
Examples of Ethical Problems
Paternalism Deception Privacy Confidentiality Allocation of scarce nursing resources Valid consent or refusal Conflicts concerning new technologies
Ethical conduct
Practice based on professional standards of ethical conduct as well as professional values
7 Basic Tenets of Bill of Rights for RN's / Registered Nurses Must be able to:
Practice in a manner that fulfills obligations to society and to those who receive nursing care Practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice Work in an environment that supports and facilitates ethical practice, in accordance with the Code of ethics for nurses Freely and openly advocate for themselves and their patients, without fear of retribution Receive fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities Practice in a work environment that is safe for themselves and their clients Negotiate the conditions of their employment, either as individuals or collectively, in all practice settings
Ethical dilemma
Presents a question of conflicting ethical principles *both sides have desirable and undesirable aspects
Ethics Committee
Process ethical dilemmas Multidisciplinary members-include nurses Education & Policies JACHO standards
Human Dignity
Respect for the inherent worth and uniqueness of the individual, right to privacy, addresses as desired, confidentiality, and respect Designs care with sensitivity to individual client needs- pt to pt basis; even if same diagnosis they are different Culturally competent and sensitive care
What are the 2 ways to Teach values?
Responsible choice Reward and Punishment
Short staffing and whistle-blowing
Restructuring has resulted in chronic understaffing on the unit where you work. You believe that patients are now at risk because there simply are not enough nurses to provide quality care. Some nurses are talking about forming a union and going on strike. Because yours is the only major hospital in a rural area, you are unsure whether striking is a morally legitimate option. Because efforts to get management to address the issues have repeatedly failed, you are also contemplating "going public" with your concerns. Your brother works for the local newspaper, and he would be willing to do a story about the situation at the hospital. What do you do?
ICN Guidlines to Achieve Purposes of Code of Ethics (international code of nursing)
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 example 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 standards in practice, education, management, and research
Nonmaleficence
do no harm or least possible harm
Autonomy
freedom of choice
Autonomy
The right to self-determination. -Professional practice reflects autonomy Reflects patients rights to make decisions about their healthcare -Need to be educated & informed Plants care in partnership with patients Honors patients right to make own decisions -even if its not what we want them to do Provides information so patient can make an informed decision
Social justice
Upholds moral, legal and humanistic principles The nurse works to assure equal treatment for all under the law. Equal access to quality care Supports non discrimination Promotes universal access to health care Encourages legislation and policy consistent with the advancement of nursing care and health care
Measurement Criteria for Standard 7 (ANA Standards) / The Registered Nurse:
Use Code of ethics for nurses with interpretive statements to guide practice Delivers care in a manner that preserves and protects health care consumer autonomy, dignity, right, values, and beliefs Recognizes the centrality of the health care consumer and family as core members of the health care team Upholds health care consumer confidentiality within legal and regulatory parameters Assists health care consumers in self-determination and informed decision making Maintains a therapeutic and professional health care consumer- nurse relationship within boundaries Contributes to resolving ethical issues involving health care consumers, colleagues, community groups, systems, and other stakeholders Takes action regarding illegal, unethical, or inappropriate behavior that endanger or jeopardize the best interests of the health care consumer or situation Speaks up when appropriate to question practice when necessary for safety and quality improvement Advocates for equitable health care consumer care
Ethical residual
When a nurse does something wrong ex: falsifying a document & feels guilty and promises to never to it again
Unprofessional, incompetence, unethical, or illegal nurse practice
When you make your morning rounds, a patient tells you that one of the nurses fondled her body and made suggestive remarks during the previous night shift. You suspect that the patient may simply be trying to cause trouble, and because you like the nurse in question, you find it hard to believe the patient. What should you do?
Ideals of conduct
guidelines for decision making in conflicts and disagreements about correct practice and behavior
Laissez Faire
without restrictions or limitations; are given no direction; parents want children to explore values and decide for themselves **may create confusion (in younger children) and conflict within the family
Ethical Issues Related to Quality of Life and Right to Life
Who defines what quality-of-life means? What are the concerns and questions related to?
Beginning-of-life issues
You are a psychiatric mental health nurse working in a Catholic hospital whose ethical and religious directives forbid abortion and abortion counseling. You are talking with a single woman recently hospitalized with bipolar disorder who is in the first trimester of an unplanned pregnancy and who is expressing great ambivalence about continuing the pregnancy. You personally believe that your ethical obligation is to assist this woman in exploring abortion as an option and to refer her to outside resources if she elects to abort. The charge nurse tells you that these are not appropriate options within this hospital.
End-of-life issues
You are the nurse case manager for a woman with a history of cancer whose cancer has recurred after many years and is now seriously advanced. She frequently tells you when you come to visit her at home that she is unwilling to fight anymore and wants to die with some dignity while she is still in control. She begs you to get her something that will "put me gently to sleep once and for all before my pain gets worse." You believe that this is her sincere wish, not just depression speaking, and you honestly believe that she would be better off spared the last stage of her fatal illness. According to your religious beliefs, however, assisted suicide is wrong under any circumstances. How do you reconcile your desire to help this woman with your profession's ethical code and your religious conviction that what she is asking for is wrong? For a fuller discussion of ethical issues at the end of life, see Chapter 42.
Code of ethics
a set of ethical principles- collective statement about a group's expectations and behaviors
Modeling
children learn values modeled by parents and others
Utilitarianism-teleology
consequences of an actions greatest good (happiness) for the greatest # of people ex: letting one patient die, to save 10 others
Personal values
ideas or beliefs a person considers important and feels strongly about.
Prizing (treasuring)
involves pride, happiness, and public affirmation
Ethical distress
knows the right decision but constraints prevent from acting on the right decision- may violate the conscience ex: Jehovah witness- needing blood
Fidelity
obligation to honor commitments and obligations- keep promises
Veracity
one's duty always to be truthful and honest- privacy-confidentiality
Beneficence
one's duty to benefit or promote the good of others
Values Systems
organization of values ranked in a list of importance
Value
personal belief about the worth of a given idea attitude, custom or objective that sets standards that influence behavior
Ethics
refers to the philosophical ideals of right and wrong behavior - the study of good conduct/character/motives Why did they make the decision they did
Responsibility
reliability/ dependability for roles in scope of practice- right/wrong-duty
ANA code
report incompetent, unethical, and illegal practice
Reward and punishment
rewards to strengthen preferred values, punishment if fails to behave in a certain way
Moralizing
rigidly forced to follow values of right and wrong- authoritarian values of parents, teachers, ect. fosters dependency ex: Catholic schooling
Nursing ethics
subset of bioethics-analysis to make ethical judgements (common ethical issues; cost-containment issues, end of life decisions, breaches of confidentiality)