Ethics and Values

Ethics Right or Wrong Behavior Value A personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior

Ethics

Right or wrong behavior What is good or valuable for all people Nursing Code of Ethics

Guidelines for safe and compassionate care

Define practice Definition of professional practice standards

Bioethics

Guides the often complicated negotiations that characterize contemporary decisions about health care.

Ethics

Discussion and resolution of ethical issues requires critical thinking skills Negotiating personal values and philosophies not facts or measurable clinical data Incorporates nurses personal values, and interpretation of clients personal values

Terms

Autonomy

Independence Agree to respect anothers right to determine a course of action, self-determination, self-reliance

Informed consent

Beneficence

Actively seek benefits, promote good

Weigh benefits against risks

Nonmaleficence

Do no harm

Do the least harm if benefits must result in some harm Balance risks and benefits

Terms

Justice

Fairness

Fair distribution of resources

determine order clients should receive care Triage (greatest risk treated first Ie: organ transplants

Fidelity

Faithfulness Keep your word

Dont abandon clients Revise care to maintain comfort

Basic Philosophies of Ethics

Professional Nursing

Code of Ethics

Guidelines to assist nurses and other professionals when conflict or disagreement arises about correct practice of behavior

Sets forth ideals of conduct

Accountability Responsibility Accountability Advocacy Confidentiality Veracity

Basic Principles

ANA Code of Ethics

Respect for human dignity Right to privacy Safeguard client and public from incompetence, unethical or illegal practice Assume responsibility and accountability for actions Maintain competence Informed judgment Ongoing development of professions body of knowledge Improve standards of nursing Participate in establishing and maintaining conditions of employment conducive to high-quality nursing care Protect the public from misinformation Collaborate

Nursing Perspectives in Ethics

Accountability

Answer for ones own actions Accountable to self, client, profession, employer, and society Goal: prevent injury to the client Continually evaluate practice evaluate new practices and reassess existing ones Maintain standards of health care Facilitate personal reflection, ethical though and personal growth Provide a basis for ethical decision making

Responsibility

Reliable and dependable Distinguish between right and wrong Perform actions well and thoughtfully

Gains trust from clients, colleagues and society

Confidentiality

Maintain client privacy Do not copy medical records Do not discuss case with those not involved without permission (even family)

Veracity

Accuracy and conformity to truth Practice truthfulness

Values

A personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior

Must be clear about ones own values, where they came from, and how they stand in relationship to others values and to societys values.

Reflect cultural and social influences, relationships and personal needs Develop and change over time

Value Formation

Begins at young age Influenced by how a child is raised

Parenting influences what children come to value as adults

Values formation involves the ability to identify strong feelings ant to act on them

Acquiring of values depends largely on experiences within the family

Once the child experiences life outside the family, new contacts influence values formation

School Church Government Community

Also, individual experiences influences what we come to value NURSE MUST RESPECT WIDE VARIETY OF VALUE SYSTEMS TRY TO UNDERSTAND HOW THESE DIFFERENCES AFFECT HEALTH AND WELLNESS

Values Clarification

Value changes may involve a reordering of values or he replacement of old values with new ones

The willingness to change shows a healthy attitude

To adopt new values, must be aware of existing values and how they affect behavior

Modes of Value Transmission

Modeling

Demonstrate and return demonstration Rigidly force child to conform to parents set of values Informally without restriction No one assumes responsibility for childrens behavior

Moralizing

Laissez-Fairre

No discipline

Responsible Choice

Children make choices, but they are more limited explore within boundaries, new behaviors and their consequences.

Reward and Punishment

Values Clarification

Process of self discovery

Make choices when alternatives are presented Determine whether choices are carefully made Choose freely, from alternatives, considering all consequences Publicly affirm the choice Act like you believe in it Incorporate the belief into your behavior Act with a pattern of consistency and repetition Is it able to guide individuals through dissent or confusion? Nurses are more able to advocate for a client when the nurse can identify personal values and then accurately identify the values of the client

Choose Ones Behavior

Prize Ones Beliefs and Behaviors

Act on Ones Beliefs

Ultimate test of a value system

need structured communication open ended questions, brief and nonjudgmental clarifying responses

Terms

Cultural Values

those adopted as a result of the social setting in which a person lives. belief ones own culture is superior

Ethnocentrism

Seven Values Essential for the Professional Nurse

Altruism

Human dignity

Concern for the welfare of others Same rights, privileges, and status for all Irrespective of personal characteristics Pleasing environment Positive image Capacity to exercise choice

Equality

Inherent worth and uniqueness of an individual

Right to privacy Address how they prefer Maintain confidentiality Treat all with respect

Esthetics

Justice

Freedom

Act as advocate Report incompetent, unethical and illegal practice objectively and factually Document accurately and honestly Obtain sufficient data to make sound judgment before reporting Participate in professional efforts to protect the public from misinformation

Truth

Nurses Role in Implementing Patients Bill of Rights

Be patient advocate. Know what the individual Bill of Rights states Follow ethical and professional guidelines.

Bioethics

Health care is no longer accepted without question

No longer the assumption that the physician knee everything Consent Shared knowledge

Tuskegee experiment

Deontology

Actions are right or wrong, regardless of outcome

Is there justice, autonomy and beneficence

Problem when you have conflicting principles health care of children

Utilitarianism

Right or wrong based on outcome

Was it useful Consequentialism Teleology

Study of the ends or final causes Greatest good for the greatest number of people

Feminist Ethics

Focuses on continuing inequalities between people

Do away with gender based tests and treatment Value role of relationships Role of community

Fetal surgery

Mothers autonomy or fetuss

Ethics of Care

Nurturing Ethical dilemmas solved by attention to relationships and clients stories

Not universal principle

Bioethics Concesus

Bioethics consensus promises to diminish ethnocentricity by encouraging respect for unusual points of view while still striving to come to agreement between all participants

Promotes respect and agreement

Nursing Point of View

Nurses have information not available to any other providers

Knows details about family life, coping styles, personal preferences, fears and insecurities

Nurses obligation and privilege to accumulate information on the issues, examine personal values, and share knowledge with clients and colleagues in an effort to address the difficult issues that constitute ethical dilemmas in health care

How Values Influence Patient Care

If nurse is comfortable with her values, she is more able to assist the client making decisions and clarifying their values Nursing profession identified professional values it prizes and nurtures in all members

Altruism Equality Dignity Justice Truth Esthetics

Processing an Ethical Dilemma

Similar to nursing process

Gather information

Determine if it is an ethical dilemma

Not just question of procedure, legality, or medical diagnosis Cannot be resolved solely through a review of scientific data Perplexing, cannot easily think logically or make a decision Difference of opinion is perplexing The answer will have a profound relevance for several areas of human concern

Examine own values Clear statement of ethical problem

Assess

Remains focused and constructive when all parties agree on the statement of the dilemma

Plan

List all possible courses of action Agree on action Take action Document

Intervene

Evaluate

Ethics Committee

(Functions of Ethics Committee)

Multidisciplinary Purposes

Education Policy recommendation Case consultation Review

Call for questions or problems that cannot be solved

Issues in Bioethics

Informed consent

Protect patients rights, autonomy Patient Self-Determination Act

Advanced Directives
Must inform about rights to made a living will, refusal of certain treatments, name durable power of attorney

Quality of Life

Personal and particular Rights of handicapped More than organ transplants Lack of health insurance Resources for research on devastating disease or prevention?

Allocation of Scarce Resources

More Bioethics Issues

Reproductive rights

Minors rights to seek health care for sexually related issues

Genetic engineering

Genetic testing for pre-existing conditions

Multiple-embryo pregnancies

Advances in management of infertility

Selective abortion

Physician-assisted suicide