Ethics, values and Legal Aspects of Nursing Ethics and values are part of nursing and nursing practice. Legal aspects of nursing focuses on the relationship between nursing practice and the law. A system of valued behaviors/beliefs that direct individual manner or behaviors to protect individual rights.
Ethics, values and Legal Aspects of Nursing Recent changes in the provision of health care have made knowledge of this relationship more important than before and many topics are involved. These topics include; nursing legislation, standards of care, patient rights,informed consent, malpractice liability, patient safety, and documentation and confidentiality. Every nurse should have a basic understanding of the law.
Definition of terminology Values: Personal belief about the worth of a given idea, attitude, or object Personal values: Beliefs and ideas that form basis for behavior; moral & non-moral beliefs Morals : Standards of right or wrong, how things get done
Ethical Principles and Importance to nursing practice Autonomy – individuals have the right to determine own actions, make own decisions Beneficence – “the doing of good”, inflict no harm Veracity – telling the truth. No deception (trick) Fidelity – faithfulness, Faithful to address ethical issues, practicing within scope of nursing, Code of Ethics, keeping commitments. Basis of nurse-patient relationship
Philosophical analysis of moral phenomena in the practice of nursing Laws: Rules of social conduct devised to protect society. Nursing ethics: Philosophical analysis of moral phenomena in the practice of nursing Code of Ethics A written list of a profession’s values and standards of conduct, it is also a framework for decision making and orientation towards day to day decision making
Purpose of the Code of ethics Purpose of the Code of ethics 1-It gives guidance for decision-making concerning ethical matters, 3-serves as a means for self-evaluation and self-reflection regarding ethical nursing practice 4- and provides a basis for feedback and
Foundation for ethical decision making in nursing 1-Advocacy Active support of an important cause Nurse as advocacy: defender patient’s rights Assistant to patient to make decisions based on his/her values and lifestyle
Accountability Accountability health, prevent illness and to alleviate suffering. Cooperation Active participation with others to obtain quality care for patients Caring Kind nurse/patient relationship
Ethical decision making process 1-Collect, analyze, and interpret data ( (State the dilemma 2- Consider choices of action 3-Analyze pros/cons of each choice (what is for and what is against) 4- Make a decision about how to resolve the dilemma
Nursing Values and Responsibility Statements Safe, Competent and Ethical Care Nurses must strive for the highest quality in determining and expressing their own moral choices
Safe, Competent and Ethical Care - Nurses should be sufficiently clear and reflective about their personal values to recognize potential value conflicts - Nurses must maintain an acceptable level of health and well-being - Nurses must base their practice on relevant research findings and acquire new skills and knowledge in their area of practice their career.
Nursing values and Health and Well-being -Nurses should respect and value the knowledge, skills and perspectives of the persons in their - Nurses must foster comfort and well-being when persons are terminally ill and dying - Nurses should recognize the need to address organizational, social, economic and political factors influencing health
Choice Nurses respect and promote the autonomy of persons and help them to express their health needs and values and obtain desired information and services so that they can make informed decisions. Nurses must be committed to building trusting relations
Choice Nurses should provide the desired information and support required so people are enabled to act on their own behalf in meeting their health Nurses must continue to provide opportunities for people to make choices and maintain their capacity to make decisions, even when illness or other factors
Dignity 1- Nurses recognize and respect the inherent worth of each person and advocate for respectful treatment of all persons 2-Nurses must be sensitive to an individual's needs, values and choices. 3-Nurses must recognize the vulnerability of persons 4-Nurses must respect the physical privacy of persons when care is given, by providing care in a discreet manner and by minimizing
Confidentiality 1- Nurses must respect the right of each person to informational privacy 2- Nurses must protect the confidentiality of all information gained 3-Nurses must intervene if other participants in the health care delivery system fail to maintain their duty of confidentiality
Confidentiality 4- Nurses should inform the persons in their care that their health information will be shared (informed consent). 5-Nurses must advocate for and respect policies and
Justice Nurses uphold principles of equity and fairness to assist persons in receiving a share of health services and resources proportionate to their needs and promoting social justice. Nurses must not discriminate in the provision of nursing care based on a person's race, ethnicity, culture, spiritual beliefs, social or marital status, sex, sexual orientation, age, health status, lifestyle,
Justice Nurses should be aware of broader health concerns such as :- environmental pollution, violations of human rights, world hunger
Accountability 1- Nurses are answerable for their practice, and they act in a manner consistent with their professional responsibilities and standards of practice 2- Nurses must respect and practice according to the values and responsibilities in this Code of Ethics for Registered Nurses
Accountability 3- Nurses, in clinical, administrative, research or educational practice, have professional responsibilities and accountabilities 4- Nurse educators, to the extent possible, must ensure that students will possess the required knowledge, skills and competencies
Accountability 5- Nurses should advocate for discussion of ethical issues among health team members, patients and families. 6- Nurses should advocate for changes to policy, legislation or
Legal aspects of care Standards of Care A standard of care tells us what a person should do. One standard of care can describe what you should do Scope of Practice the scope of practice for nurses, doctors, nursing assistants and others. They list what a person can and cannot do in the job eg; a registered nurse's scope of practice may list that the nurse can give medicines.
Malpractice A person who does not give care with same level of skill that they learned e g:- when a nursing assistant does NOT wash their hands between patients and some of the patients get a serious infection, this nursing assistant can be found guilty of malpractice.
Negligence Negligence is when a person does not act the way they should. For example, a nursing assistant is negligent when they do not take vital signs when they should have . For example, a nursing assistant can be found guilty of criminal negligence if their falls risk patient falls and dies after they were left alone for hours in a bath tub.
Ethical care -Privacy -Confidentiality -Freedom from abuse and neglect All patients and residents have a right to: - Respect and dignity -Privacy -Confidentiality -Freedom from abuse and neglect -Control over their own money -Have their personal property - Know about their medical condition & treatments -Choose their own doctor's) - Make decisions about their medical care -
American Nurses Association Code of Ethics The nurse provides services with respect for human dignity and the uniqueness of the client, The nurse safeguards the client's right to privacy The nurse assumes responsibility and accountability for individual nursing judgments and actions
Code of Ethics American Nurses Association The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to thers. The nurse participates in activities that contribute to the ongoing development of the profession's body of knowledge.
Code of Ethics American Nurses Association The nurse participates in activities that contribute to the on going development of the profession's body of knowledge. The nurse participates in the profession's effort to:- - implement and improve standards of nursing. - establish and maintain conducive to high quality nursing care
Code of Ethics American Nurses Association - The nurse protect the public from misinformation and misrepresentation and to maintain the integrity of nursing. -The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public
ETHICS & ETHICAL ISSUES IN NURSING PRACTICE
OUTLINE OF THE LECTURE Concepts of Ethics Ethical principles Ethical theories ICN & ANA code for Nurses Framework for ethical decision making Factors influencing ethical decision making Specific ethical issues related to nursing profession Boundary violations
INTRODUCTION Nurses who understand how patient’s values and their own values shape patient – nurse interactions, and who continually develop sensitivity to the ethical dimensions of nursing practice, are best able to provide quality care and advocates for their patients.
DEFINITIONS VALUES ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups, or society usually not written down VALUES CLARIFICATION refers to the process of becoming more conscious of & naming what one values or considers worthy
DEFINITIONS VALUES CONFLICT internal or interpersonal conflict that occurs in circumstances in which personal values are at odds with those of patients, colleagues or the institution
DEFINITIONS MORALS standards of right & wrong learned & internalized at early age society & culture play important role moral orientation generally based on religious beliefs MORAL VALUES preferences or dispositions reflective of right & wrong, should or should not, in human behavior
DEFINITIONS MORAL INTEGRITY A focal virtue that relates to soundness, reliability, wholeness, an integration of character & fidelity in adherence to moral norms sustained over time MORAL THOUGHT individual’s cognitive examination of right & wrong, good & bad
DEFINITIONS MORAL DISTRESS the reaction to a situation in which there are moral problems that seem to have clear solutions, yet one is unable to follow one’s moral beliefs because of external restraints; this may be evidenced in anger, frustration, dissatisfaction & poor performance in the work setting
DEFINITIONS ETHICS declarations of what is right or wrong & what ought to be a formal process for making logical & consistent decisions based upon moral beliefs generally no system for enforcement ETHICAL PRINCIPLES basic & obvious moral truths that guide deliberation & action
TYPES OF ETHICS BIOETHICS: which governs life sciences like responsible research conduct, environmental ethics & sustainable healthcare. CLINICAL ETHICS: is a branch of bioethics concerned with ethical problems at the bedside. NURSING ETHICS: is a subset of bioethics which is concerned with the study of ethical issues that arise in nursing practice.
MAJOR ETHICAL PRINCIPLES Autonomy Beneficence Nonmaleficence Veracity Confidentiality Justice Fidelity
AUTONOMY self-governing; having the freedom to make independent choices self-determination r/t health care deals with professionals willingness to respect client’s rights to make a free choice given that they have been provided with all necessary information & knowledge not an absolute right except in some cases
BENEFICENCE Views the primary goal of health care as “doing good” for clients Includes more than just technical competency Client approached in holistic manner Very old requirement for health care providers Good care = clients beliefs, feelings & wishes as well as those of the clients family & SO’s Difficulty implementing the principle lies in determining what exactly is good for another & who can BEST MAKE THE DECISION about this good
NONMALEFICENCE Requirement that health care providers “do no harm” to their client’s – intentionally or unintentionally Opposite side of the coin from beneficence Difficult to discuss without mentioning beneficence In current health care practice, the principle of nonmaleficence is often violated in the short run in order to PRODUCE A GREATER GOOD in the LONG TERM TX of the client May undergo painful & debilitating surgery to remove a cancerous growth in order to prolong life in the future
VERACITY TRUTHFULNESS Requires the health care provider to tell the truth & not intentionally deceive or mislead clients Limitations = in situations where telling clts the truth would seriously harm (principle of nonmaleficence) their ability to recover or would produce greater illness FEELING UNCOMFORTABLE is NOT a good enough reason to avoid telling clts the truth about their dx, tx or prognosis The client has a RIGHT to know this information
JUSTICE an ethical principle that relates to fair, equitable & appropriate treatment in light of what is due or owed to persons, recognizing that giving to some will deny receipt to others who might otherwise have received these things obligation to be fair to all people 1st statement in ANA Code of Ethics for Nurses
FIDELITY The individual’s obligation to be faithful to commitments made to self & others In health care, includes the professional’s faithfulness or loyalty to agreements & responsibilities accepted as part of the practice of the profession Main support for the concept of ACCOUNTABILITY
ETHICAL THEORY An ethical theory provides a framework within which agents can reflect on the acceptability of actions and can evaluate moral judgments and moral character
ETHICAL THEORIES 1- Teleology 2- Deontology 3- Institutionism 4- Ethic of caring
ETHICAL THEORIES….(CONTINUE) Teleology: looks to the consequences of an action in judging whether that action is right or wrong Deontology: proposes that the mortality of a decision is not determined by its consequences. It emphasizes duty, rationality, and obedience to rules The difference between Teleology and Deontology can be seen when each approach is applied to the issue of abortion
ETHICAL THEORIES…..(CONTINUE) Example: Teleology approach/abortion: saving the mother’s life (the end, or consequence) justifies the abortion (the mean, or act) Deontology approach/abortion: consider any termination of life as a violation of the rule “do not kill” and therefore, would not abort the fetus, regardless of the consequences to the mother
ETHICAL THEORIES…..(CONTINUE) Institutionism: summarized as the notion that people inherently know what is right or wrong; determining what is right is not a matter or rational thought or learning (e.g. the nurse inherently knows it is wrong to strike a client, the nurse does not need to be taught this or to reason it out) The preceding three theories are based on the concept of fairness (justice)
ETHICAL THEORIES…..(CONTINUE) Ethic of caring: it is based on relationships. Caring is a force for protecting and enhancing client dignity Caring is of central importance in the client-nurse relationship (e.g. nurses use trust-telling to affirm clients as a persons rather than objects and to assist them to make choices and find meaning in their illness experiences)
ETHICAL DILEMMA no one good solution occurs when there are conflicting moral claims a situation that requires an individual to make a choice between two equally unfavorable alternatives no one good solution the decision made often has to be defended against those who disagree with it
CODE OF ETHICS written list of a profession’s values & standards of conduct framework for decision making general statements offer guidance periodically revised not legally enforceable as laws but consistent violations indicate an unwillingness by the person to act in a professional manner & license can be suspended or revoked
ICN Code of Ethics for Nurses 1. Nurses and people The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgement in sharing this information. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.
ICN Code of Ethics for Nurses 2. Nurses and practice The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgement regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.
ICN Code of Ethics for Nurses 3. Nurses and society The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations.
ICN Code of Ethics for Nurses 4. Nurses and co-workers The nurse sustains a co-operative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals when their care is endangered by a coworker or any other person.
ICN Code of Ethics for Nurses 5. Nurses and the profession The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research based professional knowledge. The nurse, acting through the professional organisation, participates in creating and maintaining equitable social and economic working conditions in nursing.
American Nurse’s Association Code of Ethics for Nurses (July, 2001) 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 nurse's primary commitment is to the patient, whether an individual, family, group, or community.
The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
The nurse collaborates with other health 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, for maintaining the integrity of the profession and its practice, and for shaping social policy.
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 promotes, advocates for, and strives to protect the health, safety, and rights of the patient. 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.
EXAMPLES OF ETHICAL PROBLEMS NURSES & PATIENTS Paternalism (acting for patients without their consent to secure good or prevent harm) Deception Confidentiality Allocation of scarce nursing resources, etc. NURSES & PHYSICIANS Disagreements about the proposed medical regimen Conflicts regarding the scope of Nurse’s role Unprofessional, incompetent or illegal nurse practice
EXAMPLES OF ETHICAL PROBLEMS NURSES & OTHER NURSES Claims of loyalty Unprofessional, incompetent or illegal nurse practice NURSES & INSTITUTIONAL AND PUBLIC POLICY Short staffing and whistle blowing Healthcare rationing
STANDARD OF BEST INTEREST A decision made about individual client’s health care when they are unable to make an informed decision for their own care Very important to consider the individual’s expressed wishes, either formally or what they may have said Based upon what the HCP &/or family DECIDE is best for that individual Formal = written, living will, patient advocate Should be based on the principle of beneficence PATERNALISM = UNILATERAL DECISION by HCP which implies that they know what is best, disregarding the clts wishes
ETHIC OF CARE an approach to ethical decision making grounded in relationship & mutual responsibility in which choices are contextually bound & strategies are focused on maintaining connections & not hurting anyone
ETHIC OF JUSTICE an approach to ethical decision making based on objective rules & principles in which choices are made from a stance of separateness
MAKING ETHICAL DECISIONS Ethical decision making process = provides a method for nurses to answer KEY QUESTIONS about ethical dilemmas & to organize their thinking in a more logical & sequential manner. Chief goal = determining right from wrong in situations where clear demarcations do not exist or are not apparent
A framework for Ethical Decision Making (EDM) Identify and clarify the ethical problem: review the situation to gain a clear perception of the problem. Gather factual data: seek other viewpoints to help everyone involved to see the situation more clearly. Identify and evaluate options: the more options identified, the more likely those involved will find one they can support. Make a decision, though at times it is difficult & in some cases painful. Act and assess: once a course of action is chosen, it must be carried out. Assess the outcomes as the processes go forward.
FACTORS THAT INFLUENCE EDM Codes for Nurses The patient’s rights Social and cultural attitudes Science and technology Legislation Judicial decisions Funding Personal religious and philosophic viewpoint
SPECIFIC ETHICAL ISSUES RELATED TO THE PROFESSION OF NURSING 1-Commitment to the patient 2- Commitment to your employer Responsible work ethics Responsible use of supplies 3- Commitment to your colleagues 4- Commitment to personal excellence 5- commitment to nursing profession Formal evaluation Informal evaluation Addressing substandard care
BOUNDARY VIOLATIONS Boundary violation is used to refer to situations in which nurses move beyond a professional relationship and become personally involved with a patient and the patient’s life. It is the nurses’ responsibility to define the boundaries of the relationships & ensure that they are maintained.
DIFFERENCE BETWEEN - Overinvolvement with patient NON – PROFESSIONALISM PROFESSIONALISM - Overinvolvement with patient - Patient safety & welfare first - Exploitation Helpfulness - Excessive self- disclosure Professional distance - Abuse of power respect for patient & family - Secretiveness Professional behavior