ethics applied to nursing: personal vs. professional ethics copyright © 2013 by elsevier inc. all...
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Ethics Applied to Nursing: Personal vs. Professional Ethics
Copyright © 2013 by Elsevier Inc. All rights reserved.
Ethical Issues in 21st Century Health Care (p. 118 )In vitro fertilizationArtificial inseminationSurrogate motherhoodCloningOrgan donation
Including cadaver, child, and aborted fetus donations
Stem cell research/procedures
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 2
Ethical Issues in 21st Century Health Care (cont’d) (p. 118 )AbortionEuthanasiaAssisted suicideAdvance directives
Living wills, power of attorneyRight to die
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 3
Description and Scope of Ethics (p. 118-119 )Ethics is a system of standards or moral
principles that directs actions as being right or wrong.
Concerned with the meaning of words such as right, wrong, good, bad, ought, and duty.
Concerned with the ways people, either individually or as a group, decide the following:What certain actions are right or wrongIf one ought to do somethingIf one has the right to do somethingIf one has the duty to do something
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 4
Morals and Values (p. 119 )Morals
Concerned with dealing with right or wrong behavior (conduct) and character
Values Involve the worth you assign to an idea or an
actionFreely chosen and are affected by age,
experience, and maturityContinue to be modified throughout your
lifetime, as you acquire new knowledge and experience
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 5
Comparison of Legal Aspects of Nursing and Ethics (p. 119 )Nursing Ethics: the values and principles
governing nursing practice, conduct, and relationshipsResponsibilities: focused on ideal behavior,
morality, and higher standardsLegal Aspects: state statutes that apply to
licensed persons and the situations in patient care that could result in legal actionResponsibilities: focused on rules, regulations,
and obligations mandated by law
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 6
Ethical Codes of NAPNES and NFLPN (p. 119 )NAPNES Codes—National Association of
Practical Nurse Educators and ServicesNFLPN Codes—National Federation
of Licensed Practical NursesNurse Practice Acts—published by each
state
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 7
Your Personal Code of Ethics (p. 120 )You ultimately choose what your personal
code of ethics will include.Will influence your nursing ethics
When personal ethics conflict with the law, you are obligated to follow the law.
You may ethically refuse to assist with a procedure, but postprocedure you cannot refuse to give nursing care to the patient involved
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 8
Roots of Nursing Ethics (p. 120-121 )Before nursing process and critical thinking
were added to nursing curricula, those in the nursing profession did not see themselves as having something separate to contribute to patient care
Nursing ethics was primarily a modification of medical ethics and ethics of other professions at that time
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 9
What Changed? (p. 121 )Past
Study of nursing was initially disease-orientedNursing assessments did not existAdditional concerns the patient might have had
were not routinely assessedPatients were expected to follow physicians’
orders without questionThe nurse’s job was to see that the orders were
followed
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 10
What Changed? (cont’d) (p. 121 )Present
Nurses discovered that in addition to their dependent role to physicians, they had something special to contribute to the patient
Nursing process helped nurses identify additional needs that could be responded to through nursing care
Patients were encouraged to play an active part in planning and implementing their nursing care plan
Adding nursing process and critical thinking changed the nursing role and changed nursing philosophy
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 11
Ethical Decisions in Health Care (p. 121 )Began to see the patient as more than just a
diseaseWestern secular belief system
Individual autonomy: patient’s freedom to choose
Individual rights: patient’s rights are limited if they clash with the health professional’s
Ethical and legal responsibilitiesPatient advocacyAccountabilityPeer reporting
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 12
Ethics Committees (p. 121 )Multidisciplinary team assists with difficult
ethical decisionsUsually the discussions relate to new or
unusual ethical questionsPatients arrive with their cultural- and/or
their religion-based ethicsWhat the person can and cannot do in regard
to their health care has already been established by the culture of which they are a part
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 13
Western Secular Belief System (p. 121 )Individual autonomy
“Self-rule” Individuals have the capacity to think, and
based on these thoughts, make a decision freely whether or not to seek health care (the freedom to choose)
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 14
Western Secular Belief System (cont’d) (p. 121 )Individual rights
The ability to assert one’s rightsThe extent to which a patient can exert his or
her rights is restrictedAn individual’s right has become a central
theme of health care Right to consent to care Right to choose between alternative treatments Women’s rights over their own bodies Right to consent to or refuse treatment
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 15
Ethical Responsibilities of Nurses (p. 122 )Patient advocacy
The patient needs to be informed of what you will be doing with him or her (e.g., steps of a procedure)
Accountability You are answerable to yourself, to your assigned
patient, to the team leader, to the physician, and to your instructor who evaluates your work
Peer reporting Report peers for behaviors that are potentially
harmful to patientsCopyright © 2013 by Elsevier Inc. All rights reserved.line. Slide 16
Principles of Ethics (p. 122 )You can add knowledge of basic ethics to
critical thinking as you assist the RN with the nursing process
Learning about ethics is more than being able to recite the definition to pass a test. It means being able to help make ethical decisions when ethical dilemmas arise
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 17
Principles of Ethics (cont’d) (p. 122-123 )Nonmaleficence (Do No Harm): the
principle of doing the least amount of harm possible to a patient
Most beneficial treatments involve harming the patient to some extent
Examples:Skin punctureDrug side effectsPhysical manipulations
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 18
Question 1Which of the following deal with right or wrong behavior and character? 1. Ethics 2. Morals 3. Values 4. Laws
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 19
Question 2Jessica is assigned to a patient named Bill, who is AIDS-positive. She tells her charge nurse that she refuses to take care of the patient. Which is the correct statement? 1. She is entitled to refuse the patient.2. She is entitled to refuse the patient as long as it is before she enters the room.3. She may not refuse to take care of the patient.4. She may talk to her nurse manager to see what
the policies in the facility state.
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 20
Question 3Sherry is having a difficult time with a patient situation. A 2-year-old patient needs a blood transfusion and it has become a life-threatening situation. Her parents are Jehovah’s Witnesses and refuse the treatment. What hospital area should get involved in this situation? 1. Medical ethics committee2. Employee improvement committee3. Personal values committee4. Law enforcement committee
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 21
Beneficence (p. 123 )Two major nursing duties associated with
beneficence (do good):Put patient interests firstPlace the good of patients before one’s own
needs Includes organizational and other work-related
needs
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 22
Autonomy (Free to Choose) (p. 124 )Four steps of autonomous decisions
Thinking through all the facts Deciding on the basis on an independent
thought process Acting based on a personal decisionUndertaking a decision voluntarily, without
pressure from anyone else
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 23
Autonomy (Free to Choose) (cont’d) (p. 123 )Patient’s right to privacy
Choose care based on personal beliefsAccept or reject treatmentAvoid needless exposure
Personal values may be contrary to medical ethicsPatient can refuse care for religious, cultural,
or personal reasons
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 24
Fidelity (Be True) (p. 125 )Fidelity: Acting in patients’ best interests
when they are unable to make free choicesDoes not include resuscitation or paternalistic
decisionsMust differentiate between your own feelings
and those of the patientMaintain patient confidentiality
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 25
Justice (Fair to All) (p. 125 )Justice: Give patients their due and treat
each patient fairly and equally (i.e., with dignity and respect)
Avoid letting personal ethics and values interfere with patient justice
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 26
Question 4Autonomy means all of the following except: 1. thinking through all the facts.2. deciding on the basis of an independent
thinking process.3. having patients do whatever they want.4. undertaking a decision voluntarily.
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 27
Question 5Two nurses are discussing a very difficult patient on their floor in a full elevator on the way to lunch. The patient’s mother was in the back of the elevator and heard every word. This is an example of: 1. injustice.2. breaching fidelity.3. beneficence.4. nonmaleficence.
Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 28
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