RAK Medical and Health

Sciences University 

BSc Nursing III Semester

RAK College of Nursing 

Nursing Ethics Introduction to Nursing Ethics

Mrs.Vimala Edwin MSc N,PGDHM

Lecturer RAK College of

Nursing.

Learning objectivesAt end of the session the student will be

able to1. Define ethics2.Identify the needs to know about

ethics3. Discuss about the history of ethics4.Differentiate the medical and nursing

ethics

Ethics

Ethics is the science relating to moral actions and moral values.

Derived from the Greek word ethos meaning character, customs, or habitual uses, principles of right or good conduct or a body of such principles.(Boyer&Harris 1991)

Ethics is commonly defined as the philosophical study of right and wrong action, also known as morality.

In professional nursing practice,a code of ethics provides guidelines for safe and compassionate care.

Why do we need to understand ethicsIt would be helpful for a nurse to understand

ethics because nurses encounter many of the same ethical problems and questions as any human being.

There are specific moral questions and problems that arise: questions of confidentiality, patient rights, questions of life and death.

An understanding of ethics can help a nurse get a clear view in these difficult cases of the issue at hand, and the principles underlying right action.

Types of EthicsBioethics or Health care Ethics It is specific to healthcare and serve as a

frame work to guide behaviour in ethical dilemmas.

Clinical ethics• Clinical ethics is that branch of bioethics literally

concerned with ethical problems at the bedside, that is, ethical concerns that arise within the context of caring for actual patients, wherever they are found.

• It pertains to the actions and decisions made by clinicians, including nurses in their professional practice.

• Eg) valid consent or refusal

Health care providers have ethical obligations and duties to patients.

There is a duty to prevent harm so that health care providers must remain competent in their skills and specialty areas.

There is an obligation to tell the truth ,to take informed decision making.

In rare cases, the patient may not be told the diagnosis if there is a strong likely hood that he /she would become suicidal or lacks the capacity to make health care decisions.

  History of ethics

• Primum non nocere is Latin for “first do no harm”.

Thus, doing no harm is a physicians first ethical obligation to a patient

• Nursing in the Nightingale tradition manipulated the environment to promote natural healing.

• Nurses did this in the home or hospital and under supervisions of physicians.

Evolution of Medical EthicsThe first mention of ethics in

medical publication was in 1803.Thomas Percival writings became the

foundation for the code of medical ethics introduced in 1847.

This code had more to do with protecting the profession of medicine than protecting the public trust.

But through many revisions, the medical code evolved into discussions of patients’ rights, competence, policing the profession, and maintaining confidentialities.

According to Jonsen (2000), the introduction of new technologies after World War II marked the birth of “bioethics”.

Between 1946 and 1976, there was an exponential growth of medical advances antibiotics, chemotherapy, CPR, Cardiac surgeries etc.,.

The First Clinical Ethics The First Clinical Ethics Education ProgramEducation Program In the late 1970’s, an innovative training

program was held at the University of Chicago in which it provided clinical ethics training for physicians.

The program emphasized the relationship between clinical decision-making and ethical decision-making.

Dr. Mark Siegler, one of the founders of the program, believed that one must be a physician to do ethics consultation.

 

Nursing Ethics Nursing ethics, which is a subset of bioethics,

is the formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments.

Common ethical issues encountered by nurses in daily practice included

End of life decisions, Breaches of patient confidentiality, and incompetent, unethical, or illegal practice of

colleagues

Difference between Medical Ethics and Nursing Ethics

Medicine focuses on the diagnosis, the management and treatment of disease and injuries.

  Nursing focuses on the protection, promotion

and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and population.

Often medical and nursing ethics converge when the focus is on the patient and informed decision-making.

Nursing ethics is embedded in how nurses practice nursing and how they address the ethical issues they encounter in their practice.

 

Teaching Ethics in NursingTeaching Ethics in NursingThe nurses make clinical decision for

patient care are based on respect for the patient’s self-determination as well as on the teaching of self-care, disease prevention, and health maintenance.

Levine (1989) observed that every patient interaction is a moral interaction

Thompson and Thompson developed ethical decision making model (1981) were used in nursing education.

Murphy (1993) described nurses’ function as stuck “in the middle” and torn between their obligations to their patients, loyalty to the physician, their colleagues, and their employers.

But with this, they can also champion certain positions that empower patients and families.

To fulfill this role he believed nurses need to have

a)A strong conception of what it means to be a nurse

b)Specialized knowledgec)Professional support

The Aims and Purposes of The Aims and Purposes of Teaching Nursing EthicsTeaching Nursing Ethics The five (5) goals or aims of ethics

education are observable: Knowledge Perception CognitiveBehavioral Character

Ethical Competence in Nursing: Competence – means a relatively

permanent quality of personality, which is valued positively by the community to which the person belongs.

It is the ability of the individual to meet specific demands which are placed upon him to their full extent.

This ability is acquired as a result of personal effort.

To be competent – to be able to do what is required.

A person is competent by being able to perform a certain kind of task.

If the person possesses the character for certain kinds of success then he is described as competent in relation to his task ( competent to work, professionally competent, a competent sportsman, morally competent, and so forth).

There is also a possibility of There is also a possibility of professional being competent in professional being competent in some areas but not in others.some areas but not in others.i. Ethical KNOWING -Promoting the

knowledge component of ethical competence.

ii. Ethical SEEING -Promoting the perceptual component of ethical competence

iii. Ethical REFLECTING -Promoting the Reflective component of ethical competence.

iv. Ethical DOING- Promoting the Action component of ethical competence.

v. Ethical BEING- Promoting the Character component of ethical competence.

To become competentNurses require up to date knowledge Understanding the implications for nursing

practice of biomedical ,technical and scientific innovations.

Nurses need to have relevant skills in applied ethics.

It includesSkills in clarifying and differentiating

personal Professional and organizational valuesSkills in setting practical ethical standards

and policy with in their own teams and institutions

I.Ethical KNOWING Promoting the knowledge component of ethical competence.

In 1994, Ian thomson ., et al proposed the following areas of knowledge that continue to be applicable to nurses in 2004

a.Relation between personal, public and professional ethics.

Nurses need to understand particularly the nature of and relationship between personal and professional values.

Students need to understand code of ethics Nursing Values and professional obligations.

b. Ethics in health care and in specific nursing application

C. Ethics in theory and in practical moral decision making

ii. Ethical SEEING Promoting the perceptual component of ethical competence

Tadd(1994) emphasized seeing with a moral eye as a key outcome of ethics education.

Perception is an important part of ethical competence.

If nurses do not know how to draw on their moral imagination to perceive or see what a situation presents, they are unlikely act well.

iii. Ethical REFLECTING-Promoting the Reflective component of ethical competence.

Three kinds of reflection seem most relevant to ethical practice and education

Reflection on ethical ideas, concepts and theories

Reflection on professional practice, people and events

Reflection on self

iv. Ethical DOING -Promoting the Action component of ethical competence.

To act ethically in relation to patients, families and colleagues.

iv. Ethical BEING -Promoting the Character component of ethical competence

It can be promoted in professional education by learning about the nurses role and values.

Ethical Standards of Nursing EducationBy Krista Sheehan , eHow Contributor updated: January 3, 2010

The ethical standards of nursing aim to provide nursing students with an ethical framework in which to work.

Identification Ethical standards of a nursing

education are put into place to ensure nursing students understand proper nursing practice, including the knowledge, skills, attitudes and judgments required to safely practice in the field of nursing.

Respectful Environment When working with patients, nurses must

provide an environment that respects the patient's rights, values, beliefs and customs. Regardless of the nurse's own attitudes and beliefs, the environment must protect those of the patient.

Confidentiality One of the most important ethical

standards taught in nursing education is that nurses must hold patient's personal information in complete confidentiality.

Source of Information In addition to basic nursing care, nurses

are also ethically required to provide patients with the medical information they need to make educated decisions regarding their medical care.

Continuing Education In regards to their education, nurses are

also ethically responsible for maintaining their base of knowledge. As nursing practices evolve and change, nurses agree to be accountable for this continually changing information.

Linus VanlaereChris Gastmans ,Ethics in Nursing Education: Learning To Reflect On Care Practices, Nurs Ethics November 2007 vol. 14 no. 6 758-766

Abstract Providing good care requires nurses to reflect critically on their nursing practices.

Ethics education must provide nurses with tools to accomplish such critical reflection.

It must also create a educational context in which a caring attitude can be taught and cultivated.

Abstract continued.,To achieve this two fold goal, the

principles of a right-action approach, must be integrated into a virtue ethics approach that cultivates a caring attitude.

Ethics education that incorporates both the critical companionship method and the use of codes of ethics contributes positively to cultivating critical reflection by nurses.

ConclusionConclusion Nursing ethics permeates all aspects of

nursing practice and professional relationships. Collaboration, based on mutual respect, is the basis for the nurse-physician relationship. Provided they are followed in response to an individual patient’s needs, the use of clinical pathways and standing orders allows for nursing decision that increase responsibility in nursing practice.

References1.Bosek,Marcia Sued and Svage,

The Ethical component of nursing education,2004,Lippincott williams &wilkins.

2.ThompsonIE , Melia K.M, boyd KM&Horsebury.D, Nursing Ethics V Edition ,2006 ,churchill Livingstone Elsevier.

3.Patricia Kelly, Nursing Leadership & Management, 2008, 2ndedition, Delmar Cengage Learning, USA.