Prepared By Prepared By

HananHanan Saca-Hazboun Saca-Hazboun

LecturerLecturer

Faculty of Nursing and Health ScienceFaculty of Nursing and Health Science

Bethlehem University Bethlehem University

The objectives The objectives

To identify and describe the nurses duty of To identify and describe the nurses duty of care in the emergency care settings. care in the emergency care settings.

To apply ethical principles and rules using To apply ethical principles and rules using case-studies, and to test ethical decision-case-studies, and to test ethical decision-making processes. making processes.

Ethics is the study Ethics is the study of decisions of decisions

and and

the bases of those the bases of those decisions.decisions.

CODE OF ETHICS FOR CODE OF ETHICS FOR EMERGENCY NURSESEMERGENCY NURSES

1   The Emergency Nurse provides care with 1   The Emergency Nurse provides care with compassion and respect for humancompassion and respect for human dignity dignity and the uniqueness of the individual.and the uniqueness of the individual.

2   The Emergency Nurse maintains 2   The Emergency Nurse maintains competence within, and accountability competence within, and accountability for, emergency nursing practice. for, emergency nursing practice.

3   The Emergency Nurse acts to protect the 3   The Emergency Nurse acts to protect the individual when health care and safety are individual when health care and safety are threatened by the incompetent, unethical or threatened by the incompetent, unethical or illegal practice of any person.illegal practice of any person.

4   The Emergency Nurse exercises sound 4   The Emergency Nurse exercises sound judgement in accepting responsibility, judgement in accepting responsibility, delegating, and seeking consultation.   delegating, and seeking consultation.  

CODE OF ETHICSCODE OF ETHICS

5   The Emergency Nurse respects the 5   The Emergency Nurse respects the individual's right to privacy and individual's right to privacy and confidentiality.confidentiality.

6   The Emergency Nurse continues to study, 6   The Emergency Nurse continues to study, implement, and promote scientific implement, and promote scientific knowledge.knowledge.

7   The Emergency Nurse collaborates with 7   The Emergency Nurse collaborates with other health professionals and the public in other health professionals and the public in meeting community and national health meeting community and national health needs.needs.

CODE OF ETHICSCODE OF ETHICS

Difference between ethics and lawDifference between ethics and law

EthicsEthics is internal to an individual, looks to the good is internal to an individual, looks to the good of an individual rather than society as a whole, and of an individual rather than society as a whole, and concerns the "why" of one's actions.concerns the "why" of one's actions.

LawLaw: compromise rules and regulations pertinent to : compromise rules and regulations pertinent to society as a whole, is external to oneself and society as a whole, is external to oneself and concerns one's actions and conduct. concerns one's actions and conduct.

Ethics and LawEthics and Law

Ethics what is right Ethics what is right and what is wrongand what is wrong

Low: consensus can be Low: consensus can be enforced enforced

The utilitarian approachThe utilitarian approach

Seeks the greatest good for the Seeks the greatest good for the greatest number and focuses greatest number and focuses primarily on consequences of action - primarily on consequences of action - frequently used in justifying decisions frequently used in justifying decisions made in the health care delivery made in the health care delivery system.system.

The formalist or deontologic The formalist or deontologic approachapproach

Concerned with determination of Concerned with determination of duties and obligations using moral duties and obligations using moral principles and rules, such as respect principles and rules, such as respect for the individual and telling the truth.for the individual and telling the truth.

The Rawisian approach The Rawisian approach

No one should benefit unless all No one should benefit unless all person's benefit from a proposed person's benefit from a proposed action, always considering the least action, always considering the least fortunatefortunate..

  

General Ethical Concepts General Ethical Concepts

1.1. Autonomy:Autonomy: it is the personal freedom and the right to it is the personal freedom and the right to choose what will happen to one's own person. choose what will happen to one's own person.

2.2. Beneficence:Beneficence: the actions one takes should promote the actions one takes should promote good, acting in the best interest of the patients. good, acting in the best interest of the patients.

3.3. Nonmaleficence: Nonmaleficence: one should do no harm one should do no harm

4.4. VeracityVeracity: telling the truth and incorporates the concept : telling the truth and incorporates the concept that individuals should always tell the truth. that individuals should always tell the truth.

General Ethical ConceptsGeneral Ethical Concepts

5.5. RationingRationing: or limiting available resources, is closely related to the : or limiting available resources, is closely related to the concept of justice.concept of justice.

6.6. Justice: Justice: the principle of treating all persons equally and fairly, the principle of treating all persons equally and fairly, refers to fairness in the allocation of resources in regard to health refers to fairness in the allocation of resources in regard to health care delivery.care delivery.

7.7. Paternalism: Paternalism: allows one person to make decisions for another allows one person to make decisions for another and often is seen as a negative or undesirable principle. and often is seen as a negative or undesirable principle.

8.8. FidelityFidelity: keeping one's promise or commitments. : keeping one's promise or commitments.

9.9. Respect for others: Respect for others: the highest principle and incorporates all the highest principle and incorporates all other principles. other principles.

Moral model for ethical decisions Moral model for ethical decisions makingmaking

Massage the dilemmaMassage the dilemma Outline the optionsOutline the options Resolve the dilemmaResolve the dilemma Act by applying the chosen optionAct by applying the chosen option Look back and evaluate the entire Look back and evaluate the entire

processprocess

The department staffs were doing The department staffs were doing resuscitation for Mr. G., 34 year old man, resuscitation for Mr. G., 34 year old man, who was mentally retarded. Later, after 5 who was mentally retarded. Later, after 5 minutes, a 55 years old well-known minutes, a 55 years old well-known businessman, a father of 3 children, came businessman, a father of 3 children, came to the emergency room with MI. He to the emergency room with MI. He shortly needed cardiac resuscitation. The shortly needed cardiac resuscitation. The emergency team, needed the cardiac emergency team, needed the cardiac shock machine that has been used by the shock machine that has been used by the team who are resuscitating Mr. G.team who are resuscitating Mr. G.

  

ScenarioScenario

Mrs. A, 74 years old, was admitted to the Mrs. A, 74 years old, was admitted to the emergency department by the EMT staff. emergency department by the EMT staff. Patient was unconscious, had Patient was unconscious, had kussmaul's respiration. When kussmaul's respiration. When Neurologist assessed her, she had Neurologist assessed her, she had neurological deficit and first diagnosis neurological deficit and first diagnosis was brain stem injury. The patient was was brain stem injury. The patient was placed on ventilator regardless of placed on ventilator regardless of knowing she will not benefit.knowing she will not benefit.

  

ScenarioScenario

A 38 years old female was admitted for A 38 years old female was admitted for incomplete miscarriage with severe incomplete miscarriage with severe bleeding. Her hemoglobin was 7.8. A bleeding. Her hemoglobin was 7.8. A blood transfusion was ordered and the blood transfusion was ordered and the patient refused stating she is a member patient refused stating she is a member of Jehovah's witness and they can't get of Jehovah's witness and they can't get blood.  blood.  

ScenarioScenario

A 9 years old female was brought to the A 9 years old female was brought to the emergency department due to vaginal emergency department due to vaginal bleeding due to falling down on a hard bleeding due to falling down on a hard material. When the patient was material. When the patient was assessed, she had a tear and laceration assessed, she had a tear and laceration in the vulva. MD thought it is a sexual in the vulva. MD thought it is a sexual violence, shall we inform or not.violence, shall we inform or not.

    

ScenarioScenario

One evening, a 65 years old male patient One evening, a 65 years old male patient came to emergency department came to emergency department complaining of shortness of breath. complaining of shortness of breath. While Ahmad, RN, who has worked in While Ahmad, RN, who has worked in the emergency center for several years the emergency center for several years was working with him, patient went into was working with him, patient went into respiratory arrest, and Ahmad intubated respiratory arrest, and Ahmad intubated the patient successfully. Thus, the the patient successfully. Thus, the hospital policy forbids the intubation of hospital policy forbids the intubation of patients by nurses. patients by nurses.

ScenarioScenario

If the emergency care professional understands the basic concepts of ethics and how those concepts relate to law, a framework for decision making can enhance the care patients receive.

Good decision-making … seems to require human sensitivity, illuminating and useful

principles, access to pertinent information, methods of weighing and balancing options - reasons and feeling, private meditation and

public discussion, god sense and good sensibilities.