2. Objectives
• Know the definition of and differences
between the terms: Ethics, Values, Morals, &
Laws
• Discuss Code of Ethics: ANA and ICN
• Discuss ethical principles and concepts
• Name the steps in the ethical decision-making
process and apply it
• Discuss Nursing Standards
3. Ethics
• In health care, actions related to preserving
and enhancing life
• Doing the right thing, at the right time, for the
right reason
• Ensure individual’s rights are protected
• A system of morals for a group
4. Values
• Concepts that give meaning to an individual’s
life
• Derived from social norms, religion and family
• Help the individual make decisions and take
certain actions
• Value conflicts are part of life
• Example: Work versus sick child
5. Morals
• Fundamental standards of right & wrong
• Learned in childhood
• In accordance with group’s norms, customs, &
traditions
• Example: Mormonism
6. Laws
• Rules of social conduct to protect society
• Fairness & Justice
• Laws protect rights of individuals
• Enforceable by authority
• Example: Euthanasia is illegal
7. 1. The nurse practices with compassion and
& respect for the dignity, worth, &
uniqueness of every individual
2. Primary commitment is to the patient
(community, group, or population)
3. Promotes & advocates to protect the
health, safety, & rights of the patient
4. Responsible & accountable for nursing
practice
5. Owes same duty to oneself as to others
ANA Code of Ethics
8. ANA Code of Ethics, cont’d
6. Improves health care environments and
employment
7. Participates in advancement of the
profession
8. Collaborates with other health care
professionals to meet health needs
9. The profession of nursing is responsible for
articulating nursing values, maintaining the
integrity of nursing practice, &
shaping social policy
9. International Council of Nurses
(ICN)
1. Nurses and people
2. Nurses and practice
3. Nurses and the profession
4. Nurses and co-workers
10. Ethical Principles & Concepts
Autonomy-Self determination, freedom
Justice-Fairness to all people. Equal
treatment
Fidelity-Faithful to commitments made to self
and others
Beneficience-Doing good
Nonmaleficence-Do not harm
Veracity-Truthfulness
CAN YOU THINK OF EXAMPLES?
11. The point of the ethical principal to “do no harm” is an agreement to reassure
the public that in all ways the health care team not only works to heal patients
but agree to do this in the least painful and harmful way possible. Which
principle describes this agreement?
A. Beneficence
B. Nonmaleficence
C. Accountability
D. Respect for Autonomy
Beneficence
Nonm
aleficence
Accountability
RespectforAutonom
y
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12. Areas of Ethical Dilemmas
• Genetics and Genomics (DNA sequencing &
structure)
• Protecting against identity theft
• Technology
• Organ donation/transplantation
13. A precise definition for the word quality is difficult to
articulate when it comes to quality of life. Why? (Select
all that apply.)
A. Quality of life is measured by
potential income, and average
income varies in different regions of
the country.
B. Individual experiences influence
perceptions of quality in potentially
different ways, making consensus
difficult.
C. Placing measurable value on elusive
elements such as cognitive
skills, ability to perform meaningful
work, and relationship to family is
challenging.
D. Community values are subject to
change, and communities influence
definitions of “quality.”
Qualityoflife
ism
easure...
Individualexperiencesin...
Placingm
easurablevalu...
Com
m
unityvaluesare
su...
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14. 1. Collect, analyze, & interpret information
2. State the ethical dilemma
3. Consider the courses of action
4. Consider advantages and disadvantages of
course of action
5. Make a decision
Sound like the Nursing Process & Critical
Thinking?
Steps to Ethical Decision Making
15. Nursing Standards
• Form basis of competent, high-quality safe
care
• “Yardstick” for legal actions
• Skill, care, & diligence
• Fidelity to profession
• TJC, ANA, state law, facility policies
• Incompetence, gross
negligence, negligence, malpractice
16. What is the best example of the nurse
practicing patient advocacy?
A. Seek out the nursing
supervisor in conflicting
procedural situations
B. Document all clinical
changes in the medical
record in a timely manner
C. Work to understand the
law as it applies to an
error in following
standards of care
D. Assess the patient's point
of view and prepare to
articulate it
Seekoutthenursingsup...
Docum
entallclinicalch...
W
orkto
understand
the...
Assessthe
patient'spoint..
0% 0%0%0%
17. The ANA code of nursing ethics articulates that the nurse “promotes, advocates for, and
strives to protect the health, safety, and rights of the patient.” This includes the
protection of patient privacy. On the basis of this principal, if you participate in a public
online social network such as Facebook, could you post images of a patient's x-ray film if
you deleted all patient identifiers?
A. Yes because patient privacy would not
be violated as long as the patient
identifiers were removed
B. Yes because respect for autonomy
implies that you have the autonomy to
decide what constitutes privacy
C. No because, even though patient
identifiers are removed, someone
could identify the patient based on
other comments that you make online
about his or her condition and your
place of work
D. No because the principal of justice
requires you to allocate resources
fairly
Yesbecausepatientpriva..
Yesbecauserespectfor...
No
because,even
thoug...
No
because
theprincipal..
0% 0%0%0%
18. Group Activity
Using the provided ethical dilemmas, use the
decision-making process to determine the
best course of action.
Use the provided flow chart.
Share with the class.
19. American Nurses Association. ANA Code of Ethics. Retrieved from
www.ANA.org
Husted, G. L., & Husted, J. H. (2001). Ethical decision making in nursing and
healthcare (3 ed.). New York, N.Y.: Springer Publishing.
Liaschenko, J., & Peter, E. (2004). Nursing ethics and
conceptualizations of nursing: profession, practice and work.
Journal of Advanced Nursing, 46(5), 488-495. doi:10.1111/j.1365-
2648.2004.03011.x
International Council of Nursing (2012). ICN Code of Ethics. Retrieved from
http://www.icn.ch/images/stories/documents/about/ic
ncode_english.pdf
International Council of Nursing (2010). International Council of Nursing.
(2010). Genetics and Genomics. Retrieved from
http://www.icn.ch/publications/ethics
Potter, P., Perry, A., Stockert, P., & Hall, A. (2013). Fundamentals of nursing.
8th Ed. Elsevier Mosby. St. Louis, MO.
References
Hinweis der Redaktion
Nursing ethics is concerned with actions in relation to the vital and fundamental goals of preserving and enhancing life (Husted & Husted, 2001). Ethics can be summarized as doing the right thing, at the right time, for the right reason. The is not easily understood; the clinical skills necessary for fulfillment of the nurse’s role oftentimes is the main focus in both academia and practice. Nursing as a discipline should seek congruence with ethics and practice. The conceptualization of nursing historically has intermingled with the moral and ethical considerations of agency, responsibility, relationships, and virtue (Liaschenko & Peter, 2004).
Give out sheet
Give Out notes
Autonomy-Patients have a right to self-determine. The nurse has the responsibility to respect a patient’s choices, even if she or he does not agree with them. Some conditions exist that override the concept of autonomy. Example: A patient who is infected with TB can be put in isolation to prevent the spread of the disease (Greater good).Justice-Equal medical treatment for the same diagnosis. No discrimination based on race, gender, age, marital status, economic status. Example-The patient with BC/BS gets the same treatments as the patient who has Medicaid. Fidelity-Nurse’s faithfulness to the tenets of the profession. Sometimes there are dilemmas. Example: A nurse who is asked to work overtime must weigh her fidelity to the unit and coworkers against fidelity to patients to give the best care possible. This would be difficult if the nurse is overtired. Beneficience-Doing good. Good care dictates that the nurses treats the patient holistically, taking into account the patient’s beliefs, feelings, and wishes. Nurses must decide what is good for the patient. Example: Starting an IV, even though it hurts. Nonmaleficence-Not harming the patient. Closely related to beneficience. Protection from harm for vulnerable populations. Example: The abused child. A nurse has the ethical responsibility to notify authorities in cases of suspected abuse. Veracity-Telling the truth about a patient’s illness. Example-Nurses feel uncomfortable dealing with ‘the bad news’. But it is a ethical obligation to be truthful to our patients.
Ethical issues of particular concern to nurses and other health care providersinclude: privacy, confidentiality, access to healthcare, and informed healthdecisions. Major ELSI concerns include:2· Stigma, discrimination, stereotyping, and misuse of genetic data topromote racism.· Lack of access to discoveries for research purposes - throughpatenting of genes.· Simplistic view of humans as assemblage of genes.· Attribution of behavioural and social ills to genes.· Lack of respect for individuals, families and populations.Other concerns related to implications for privacy, access to care, anddiscrimination based on genetic information are growing. Examples ofconcerns and unresolved questions include: · Privacy and confidentiality of genetic information. Individualsown and control their genetic information and are entitled to privacyof genetic data just as other personal health data.· Misuse of genetic information by insurers, employers, courts,schools, adoption agencies, and the military, among others. Thereare major concerns about who should have access to personalgenetic information, and how will it be used.· Stigmatisation and discrimination due to an individual's geneticdifferences. There are concerns about use of personal geneticinformation to marginalize and discriminate people based on theirgenes.· Reproductive issues including adequate and informed consent andthe use of genetic information in reproductive decision-making. Thechallenge for healthcare personnel is to counsel parents about risksand limitations and about new reproductive technologies.· Uncertainties associated with gene tests for susceptibilities andcomplex conditions (e.g., heart disease, diabetes, and Alzheimer'sdisease). Should testing be performed when no treatment isavailable or when interpretation is unsure? Should children be testedfor susceptibility to adult-onset diseases?· Conceptual and philosophical implications regarding humanresponsibility, free will versus genetic determinism, and concepts ofhealth and disease. Do our genes influence our behaviour, and canwe control it? What is considered acceptable diversity? Where is theline drawn between medical treatment and enhancement?· Health and environmental issues concerning genetically modified(GM) foods and microbes. Are GM foods and other products safe forhumans and the environment? How will these technologies affectdeveloping nations' dependence on industrialized nations?· Commercialisation of genetic products including property rights(patents, copyrights, and trade secrets) and accessibility of data andmaterials. Will patenting genetic materialsAs a nurse, you often have access to documents and or patient’s valuablesincluding those that can be used for the purposes of identity theft. Make surethat local policies for protecting information and valuables are understood andrigorously followed.High demand and poor supply have resulted in a growing illegal trade inorgans, especially in developing countries, such as Brazil, India and SouthAfrica. In some cases people may be forced to sell an organ as a means ofattempting to alleviate their own poverty. China addressed the demand fororgans by legally removing organs and tissue from executed prisoners. Nurses can play an important role in relation to advising people to avoid lifechoices that increase the risk of chronic diseases leading to organ failure. Inaddition, nurses can educate the public on the value of donating organs afterdeath.This is a rapidly expanding field and it is import for nurses to keep pace withchanges and actively engage in the ethical issues associated with organsupply and new technologies that play a part in reducing the demand forreplacement human organs. Organ theft is unethical and every effort to stopsuch practice should be pursued, including advising suspected victims toreport the assault to the authorities.
Obtain as much information as possible about the situation. Know the patient’s wishes, the family’s wishes, and the physical or emotional problems causing the dilemma. After collecting the information, the nurse needs to bring it together to form a clear picture of the dilemma. State the dilemma in a short statement. This will help narrow down the opposing ethical principles that are causing the dilemma.What are the course of action? Which ethical principle will take precedence? Determine the advantages and disadvantages of each course of action. Who will be affected by each action? This helps to narrow down viable options.Make a decision using the available standards and codes of ethics. This is the most difficult part.