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Copy of Ethics in Nursing

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Alana Weber

on 21 January 2014

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Transcript of Copy of Ethics in Nursing

When you think of an overcrowded hospital, do you think of these?
By: Sarah Jackson, RN, BSN
Ethics in Nursing
Principles of Ethics
Hospitals overcrowded, understaffed
LPNs must:
Advocate for quality practice environments
If/when in a leadership role, strive to provide adequate staffing to meet nursing care requirements
Set priorities reflecting the allocation of resources and inform clients, families and employers of resultant changes in routine.
Advocate for sufficient human and material resources to provide safe and competent care
LPNs value the ability to provide safe, competent and ethical care
Implications of Unsafe Staffing
Core Values Inherent to Nursing
Written by Linda Silas, President of the Canadian Federation of Nurses Union
States that hospitals across the country are at overcapacity
Hospitals are understaffed for the number of clients and the acuity of care needed
The equivalent of 11,400 full time positions were worked by nurses in paid and unpaid overtime
Altruism- selfless concern for the welfare and well-being of others
Autonomy- self-determination even amid challenges
Human Dignity- respecting & valuing worth and uniqueness of others
Integrity- acting in accordance with professional standards & code of ethics
Social Justice- fair treatment to everyone & equitable distribution of resources
LPNs have the opportunity to participate in leadership training courses.
LPNs have the right to delegate tasks to other health care personnel as appropriate
LPNs guide other members of the health care team
LPNs can be a part of Ethics Committees and Health and Safety Committees to advocate for change
LPNs can write letters to their government asking for change to staffing levels
Moral Dilemma

In 40 years specializing in stress and burnout, one thing is clear to me – burnout is the result of people working in conflict with their deepest values. Nurses have the capacity to work tirelessly and hard for years when they feel good about themselves and the value of their work. However, working for prolonged periods with no personal satisfaction from the effort is a situation ripe for burnout. While physical stress is tiring, the spiritual stress of being out of harmony with your truth and your values is devastating. -(Accad, 2009).
In a study done in 2004, it was concluded that longer working hours and increased workloads for nurses often was the main cause for medication errors or near errors

. A Statistics Canada study carried out in 2005 involving 19,000 nurses revealed that among nurses who regularily worked overtime, 22% made medication errors. Compare this with the 14% of nurses who made errors, and never worked overtime.
The Reality
In 2012, 5,600 members of the British Columbia Nurses’ Union were surveyed about staffing issues in the workplace.
81% indicated that workload was a problem
51%reported that the staffing complement was insufficient to meet the workload
80% reported that they worked short of the planned baseline staffing complement
35% saying they worked short-staffed most or all of the time
Of acute care nurses surveyed, 45% said that they had cared for patients in hallways, closets or unfunded beds with no additional nurses assigned
Situational Theory
Each situation is unique
There are no specific sets of rules
The only norm is love
Autonomy & respect are emphasized
Lack of generalizability
Ethics of Care Theory
Centered on love, compassion, care, & empathy
Emotions are paramount to rational thinking
Focuses on actions that facilitate and maintain relationships
Considered unpredictable, since it is context based
The solution?
Systematic Approaches to Ethical Decision Making
1. Find out the facts surrounding the situation
2. Identify what the ethical issue is
3. Consider possible actions and outcomes
4. Evaluate outcomes
Four Step Approach
Six Step Approach
1.Retrieve all relevant information
2. Identify the type of ethical issue
3. Evaluate the issue using ethical approaches/principles
4. Explore practical alternatives
5. Implement action
6. Evaluate process & outcomes
Community approach, rather than hierarchical approach
Working together for the patient's best interest
Nurse-Physician Relationships
Nurse-Patient-Family Relationships
Patients often feel uncomfortable
Unavoidable trust creates power imbalance
Nurse must respond by:
Taking care of & caring for
Respecting patient dignity
Acting as a patient advocate
Nurse-Nurse Relationships

Lateral & horizontal violence are common
Today's nursing culture often discourages success
Community approach
Sympathetic joy
Professional Boundaries
Indications of Boundary Violations
Flirtatious Behavior
Secretive behavior
"Super Nurse" Behavior
Singled-out patient treatment
or attention to the nurse
Selective Communication
Personal Gain
Excessive disclosure
Personal/Business Relations
Informed Consent
Includes meaningful information, even if not beneficial
What a reasonable person wants to know
Based on subjective interest of patient
Advanced Directives
Living wills, medical directives,durable POA
Patient Self-Determination Act
Requires healthcare institution to:
Inquire about whether patients have advance directive
Provide information about advanced directives
Use opportunity to educate & facilitate moral right
Active vs. passive
Physician-assisted suicide
Withholding & withdrawing care
Voluntary vs. nonvoluntary
Surrogate Decision Making
Standard of substituted judgment - based on how they believe patient would decide
Pure autonomy standard - based decision made by the formerly competent patient
Best interest standard - applies when patient has never been competent
Common End of Life Ethical Issues
Futile care- no physiological benefit
Palliative care- focuses on comfort rather than curing
Rule of double effect- COPD pt. with uncontrolled pain
Terminal sedation- used to control intractable symptoms in actively dying pts.
Other Pertinent Ethical Issues
Organ transplantation
Use of fetal tissue
In vitro fertilization
Allocation & rationing of resources
Terri Schiavo Case Video (Schindler's Perspective)
What are the key ethical issues in this case?
When is it ethical to withdraw care, when there are no advanced directives in place?
At what point is it ethical to withdraw artificial hydration & nutrition?
Should the Schindler's have been allowed to care for Terri?
Ethically and Legally Speaking
Presented By: Alana Weber, Student PN
Unsafe Staffing Issues
Its your fourth 12 hour shift this week......
You show up to find out you are shortstaffed.
Instead of having the 6 patients you had yesterday, you now have 8.....
2 of them have q 15 min neurovascular checks...
3 of them are vomiting and on isolation precautions....
1 pushes her call bell every 15 minutes asking to be turned....
You have a phone call from the OR, and you have another patient coming and needs admitting, and you have no beds....
That family member wants to know why her dad hasn't had a bath yet?
When the new building opened, 19 new positions were created.

10 of those positions were in nursing.

Nurses stance: safe patient care requires a nurse to patient ratio of 1:4

Hospital stance: Budgets are created with a 1:4 ratio.

Nursing reality: Nurses are working in a 1:7 or 1:8 ratio daily.

The nurses made a point of stating that even though hundreds of millions of dollars have been poured in to the hospital in construction in recent years, it is still not uncommon to see patients in beds in hallways, and stating that lack of nurses is affecting safe patient care.
In 2012 the new
Centennial Building
opened in Kelowna.

Nurses protested the fact that little to no extra staff were hired for the building.

Nurses are advocating for safe staffing levels.

safecarenow.ca promotes

Safe Patient Care = Safe Staffing

Code of Ethics
You are working with two casuals who have never been on this floor before.....
And the phone is ringing, and scheduling wants to know if you can stay for overtime.....
LPNs must:
Practice within the departmental policies and protocols in the health care setting
Maintain mental, emotional, spiritual and physical well being, while recognizing their own limits.
Advocates for and participates in changes to improve client care and nursing practice.
Recognizes and reports situations that are unsafe, or potentially unsafe, for clients and health care team members
Article 1
Article 1
Article 1
Article 2
Decades of research shows the relationship between inadequate staffing and poor patient outcomes, includes:
urinary tract infections
nosocomial infections
pressure ulcers
shock and cardiac arrest
medication errors
longer hospital stays
Author is calling for the government to make safe staffing levels a priority in health care budgeting
Article 2
and you really really have to pee.
the lab is calling and wants a sample redone because the first one was contaminated
1 patient has been waiting to be discharged for the last 4 hours
Feeling overwhelmed? Its not even 10 am, and you are not going to get a break anytime soon.....
Make no mistake...
recognizes and reports situations that are unsafe, or potentially unsafe, for clients and health care team members
must maintain mental, emotional, spiritual and physical well-being
advocates for and participates in, changes to improve client care on an ongoing basis
advocates for resources to support safe practice and to improve client care
recognizes and reports incompetent practice and communicates using protocols of the health care agency.
The solution?
In Australia and California, mandated patient ratio standards have become law
In Australia, the original 1:4 ratio evolved in to a 5:20 ratio. This allows for flexibility and leadership by the charge nurse to assign nurses at a lower ratio for very sick patients
After mandated staff ratios were implemented:
in medical surgical patients the death rate decreased by 25%
surgical patients experienced a 54% drop in central nervous system complications
a 37% decrease in ulcers, gastritis and upper gastrointestinal bleeding rates
medical patients experienced a decreased death rate from shock and cardiac arrest
sepsis rates decreased for all patients
medical patients had lower rates of pressure ulcers, sepsis and mortality, and length of stay decreased by an average of 0.67 days
The solution?
do not be shy to speak up and report unsafe working conditions
LPNs and fellow team members need to band together and collaborate on a “plan of attack” for prioritizing care and balancing workloads
delegate some tasks to health care aides as appropriate
ask family members to assist with as much care as they can
feel empowered to call a meeting with her manager to discuss the staffing issues and pick their brain for any ideas on working in such an environment.
Today’s nurses continue to experience high levels of burnout, absenteeism, turnover and fatigue, and lack of job satisfaction. Nurses experiencing burnout no longer believe that they can make a difference.
There is undeniable evidence showing that there are increases in infection, hospital stays, complications and repeat admissions when there are unsafe staffing levels. We need to take a leadership role in our workplace, and advocate for our workplace rights, and our clients rights.
It is our legal and ethical obligation.
Berry, D. L., & Curry, P. (2012). Nursing Workload and Patient Care. Ottawa, Ontario: The Canadian Federation of Nurses Unions.
Camphor, S. (2013, January 10). Literature Review: Safe Nurse Staffing. RN Journal. Online, Worldwide, Worldwide. Retrieved from http://rnjournal.com/journal-of-nursing/literature-review-safe-nurse-staffing
Canada, S. (2005). Correlates of medication error in hospitals. Retrieved January 4, 2014, from Statistics Canada: http://www.statcan.gc.ca/pub/82-003-x/2008002/article/10565-eng.htm
Clements, A., Halton, K., Graves, N., Morton, A., Pettitt, A., Looke, D., et al. (2008). Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission. The Lancet Infectious Diseases, 427 - 434.
CLPNBC. (2014, January 1). CLPNBC. Retrieved January 5 2014, from Code of Ethics: https://www.clpnbc.org/Practice-Support-Learning/Practice-Support-Documents/Code-of-Ethics
Rogers, A., Hwang, W.-T., Scott, L., Aiken, L., & Dinges, D. (2004, July). The Working Hours Of Hospital Staff Nurses And Patient Safety. Retrieved December 10, 2013, from Health Affairs: http://content.healthaffairs.org/content/23/4/202.long
Silas, L. (2012, August 2). Hospitals over-crowded, under-staffed. Winnipeg Free Press - Online Edition. Winnipeg, Manitoba, Canada. Retrieved 2013, from http://www.winnipegfreepress.com/opinion/analysis/Hospitals-over-crowded-under-staffed-164780676.html
Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. (2010). The impact of nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 48, 540-548.
Waters, A. (2012, May 30). Nurses rally at Kelowna General hospital for more nurses. Capital News. Kelowna, BC, Canada. Retrieved from http://www.kelownacapnews.com/news/155834615.html
Wood, D. (2012, August 3). Healthcare News. Retrieved January 4, 2014, from American Mobile Nurses: http://www.amnhealthcare.com/latest-healthcare-news/333/1033/

How about this modern scene?
After all, we don't want to be these nurses:
Do we?
Full transcript