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Nursing practice and decision making

Sara Fernández

on 21 November 2012

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Sara Fernández Barreira and Dorina Pozsgay 1.What are the
duties and obligations
for ethical nursing practice? MODERN BIOETHICS 2. What are the common
in the process of
ethical decision making? 3.When is it ethical not to treat?
Why? Dorina and Sara The current Code for Nurses,
developed by the American Nurses
Association (ANA), is a set of
11 statements of duties and
obligations related to ethical
nursing practice. The effects of the business world
on the nursing workplace
has suggested that the code
needs updating to reflect
the changes in nursing.
Modern bioethics is a form of
the deontological approach
to ethics Base your actions on informed judgment

Keep your knowledge and skills in a continual process of self-examination.

Provides patients enough information about the therapeutic process.

Respecting the autonomy of the patient. Moral dilemmas in nursing
Ethical codes
Moral distress
Moral integrity
Moral thought Thank you ! Ethics and health in community health nursing These duties and obligations are: 1.Respecting human
dignity and
providing service
without prejudice. 2.Safeguarding the
of privacy and the
nature of the client´s
health information. 3.Protecting the public
from the incompetent,
unethical, or illegal practice
of any health care
provider. 4.Assuming personal
responsibility for
and actions. 5.Maintaining
competence 6. Using good judgment
in seeking consultation,
accepting responsibility,
delegating nursing
activities. 7. Contributing to
the body of
nursing knowledge 8. Participating in
improvement of
standards of care. 9. Promoting
conditions that affect
the quality of care. 10. Protecting the public
from misinformation
maintaining the integrity
of nursing. 11. Collaborating in efforts
at all levels of
society to meet
the public´s health
care needs. Increasingly more sophisticated technology has created new ethical dilemmas.
Thats why nowadays four principles are consider essential to a theory of modern bioethics. respect for autonomy,
justice Respect for the
autonomy Nonmaleficence Justice MODERN BIOETHICS Beneficence "it is the capacity
of a rational individual
to make an informed decision,
free from controlling
by others and from
personal limitations" These are the guidelines to make a good decision about treatment: 1.The individual must be competent.

2.The provider or researcher must disclose all information that would influence the individual´s decision.

3.The individual must understand the meaning and consequences of information provided.

4.The decision to consent to or refuse treatment must be voluntary.

5.Consent must be given. As nurses, we can´t never forget principles of privacy and confidentiality. “First of all, do not harm” This is the cornerstone of ethical practice
in medicine and nursing.
highest priority = no harm
second priority = prevent harm
third priority= removing harm
fourth priority = promote health. not taking undue risk
or performing
procedures for which the person
is not qualified. the treatment must be used
without undue pain,
and it may offer
a reasonable hope of benefit. The level “quality of life” keeping someone alive by food
and water
technology and other treatments. The most important ethical issues
related to nonmaleficence
and prolonging the life include
the following: What ethics means? Declarations of what is
right or wrong and what
is it ought to be The obligations to act
in ways that would
benefit or provide
some good
to others. There are two principles of beneficence: positive beneficence: moral rules generally accepted by our society Utility: balancing benefits against the risk of probable harms of the individual Protect and defending the rights of others.
Prevent harm from occurring to others.
Help persons with disabilities.
Rescue persons in danger. “fair, equitable, and
appropriated treatment of
what is due or owed
to persons” “right to health care” or Individual characteristics Health care and
public funds All nurses have an
ethical responsibility
to promote
health care as best way. "no one person
is more deserving
than another" ethnicity,
social status,
place of birth,
genetic inheritance,
prenatal environment,
family structure "Sometimes requires hard decisions" to stay within
reasonable limits
and to apply what is
with justice To make the
ethical decisions
we need to separate for
steps Making ethical
decisions should be a
collaborative process
client and counselor
(when is appropiate) 6th step 5th step 3rd step 4th step 2nd step 1st Step Do not decide for them! Stop and think!
no rash decisions,
more reflexion
mobilization of our
knowledge Clarify goals! Determining “wants”
and “doesn't wants”
affected by the
are the
most important. Determine facts be sure that you have
adequate information
to support a choice.

what you know and what
do you need to know.

prepared for additional information. Developing options you have to know. make your best judgment as to the relevant facts

make a list of actions to get your goals.

talk to somebody you trust and think of new choices
Identify and eliminate any unethical options. Identify who will be affected
and how the decision is going to affect them. Choose, you have to make a decision! Follow the golden rule:

" treating others the way
you want to be treated " 7th step Reassess the situation Make a new one! If decision-makers are
not producing the
intended results
or are causing
undesirable results Based on these concepts we can reach the answer 1st the nursing must give an enforceable standard of conduct

2nd indicate some of the ethical considerations professionals take into account in deciding on conduct Moral dilemmas Ethical codes Moral distress Alternatives are justified by fundamental moral rules or principles. Moral integrity Moral thought Individual’s cognitive
examination of
right and wrong,
good and bad Dilemma:is a situation
requiring a choice
between desirable
and undesirable
alternatives It can causes moral distress.

It can be supported moral principles.
example: the reduction of pain and suffering The emotional suffering
that is experienced when
we refuse to following
the course of action
that one believes
is right. Sometime is important
to act in a manner
contrary to personal
and professional values ideals
qualities or goals Essential elements which we consider worthy A virtue based on:


wholeness integration of

fidelity People who have integrity
follow a moral compass
they do not vary by appeals
to act immorally. People with moral integrity understand their moral obligations in the community. honesty
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