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Team 6 Presentation

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Ethics Team6

on 7 April 2015

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Transcript of Team 6 Presentation

Ethical Principles in the Care of Children, the Homeless, and the Mentally Ill
Melissa Becker
Erika Bejarano
Benjamin Delgado Ekk
Marlon Howell
Linda Lanier

Kelly Malchow
Brigette Ortiz
Tonya Simko
Tami Tibett
Peta-Gaye White
Indian River State College
Ethical Principles in the Care of Children
Autonomy in the Care of Children:
Middle Ages:
children were considered “adults in miniature” (Sousa & Araujo, 2011, p.141), but they had little to no social significance.

a child was considered “a full human being to be cared for and developed” (Sousa & Araujo, 2011. p. 142).

20th Century
September, 1924: "Declaration of Geneva" granted rights to children.
1959: "Declaration of the Rights of the Child" granted additional rights:
Freedom of speech and thought
Freedom of choice and the right to make decisions
Ownership over one’s body

(Sousa & Araujo, 2011)

Because informed consent requires competence, children's parents are legally responsible for granting informed consent. However, it is recommended that children be given information regarding risks and benefits and that children provide assent.

Children need to be aware that participation in care is voluntary and that they may end participation at any time.

Nurses should respect even the youngest child’s sense of developing autonomy. However, many children are not fully autonomous simply due to age and/or complete dependence upon parents. Examples include the very young or developmentally delayed.

(Cowell, 2011; Edwards & Coyne, 2013)
Autonomy in the Care of Children:
Informed Consent
Nonmaleficence in the Care of Children:
”The primary ethical consideration in all research is to avoid harming the informants”
(Buchwald, Delmar, & Schantz-Laursen, 2011, p. 29)

Ensuring the wellbeing of child participants should be of the utmost importance.

Initial considerations for utilizing children in research:
Is the research is necessary?
Should children be involved?
To what extent will the child be involved?

The potential for harm coming to the participant must be thoroughly assessed and evaluated prior to conducting any study.

(Ethical Research Involving Children, 2013)

Nonmaleficence in the Care of Children:
Much like with adults, nonmaleficence involves upholding expected standards of care.

This includes avoiding negligent care, such as unnecessarily imposing harm or the risk of harm upon the patient.

The benefits of a procedure or treatment must outweigh the risks.

As in all populations, first, do no harm.

(Butts & Rich, 2013)
Beneficence in the Care of Children
Beneficence is achieved by providing care that has been designed with the child’s best interests in mind.

Assessment of the child should identify treatments which will benefit the child’s health and well-being.

Parents may disagree with medical treatment, so it is up to healthcare providers to find alternative treatment for the child. For example, if a baby with symptomatic anemia has parents who are Jehovah's Witnesses, they may refuse blood transfusions for the child. The healthcare team can practice beneficence toward the patient and the family by recommending alternative treatment options and absolute criteria for blood transfusion, and by demonstrating respect toward the parents' beliefs.

(Edwards & Coyne, 2013; Sundean & McGarth, 2013)
Justice refers to an equal and fair distribution of resources. It implies that all citizens have an equal right to the goods distributed, regardless of who they are or what they have contributed.

Providers often fail to inquire about family conditions such as homelessness, social problems, substance abuse, and poverty because they are unsure about resources that are available or because they believe that they have no way to help families solve these problematic issues. Nurses need to educate themselves and assess for these issues in order to provide the proper resources.

To practice justice, nurses should support and participate in locally developed, community-based activities that increase access to health care for immigrant children.

(American Nurses Association [ANA], 2011; Butts & Rich, 2013)

Justice in the Care of Children
When caring for children, ethical nursing practice involves coordinating assessments, decision-making, the plan of care, and the provision of resources for the good of patients who cannot do these things for themselves.
Justice in the Care of Children
This video from 2014 presents one way in which the justice of healthcare resource distribution could be improved for Florida children. 2015 legislation on this issue includes House Bill 829 and Senate Bill 294.

(KidsWell Florida, 2015)
Ethical Principles in the Care of the Homeless
(Akron Children's Hospital, 2012)
Homeless men and women are part of an increasing community in the world. The causes of homelessness are many and include a decrease in job opportunities, a shortage of affordable housing, general poverty, mental illness, and physical handicaps. Unfortunately, many people view the homeless negatively. There are feelings of anger, disdain, and annoyance toward the homeless. These feelings of prejudice and ignorance occur due to a lack of understanding of homeless people's situations.

When people lose their homes, they also lose their self-esteem and sense of belonging and safety. When providing care for the homeless, nurses must remember that homeless people are a part of the community and deserve the same rights as anyone else. It is the nurse's job to provide dignity, self-worth, and a sense of safety.

(Butts & Rich, 2013; Herel, 2012; Kertesz, 2009)
To respect homeless people’s autonomy, or right to self-determination, nurses should implement the following practices.

Understand who the homeless person is.
­Most homeless people are victims and not that way by choice.
­Many homeless people are still working.
­Some have mental and physical handicaps and need appropriate care.
­Some are substance abusers.

(Butts & Rich, 2013; Herel, 2012; Kertesz, 2009)
Autonomy in the Care of the Homeless
Nonmaleficence in the Care of the Homeless
Nonmaleficence in the Care of the Homeless
When caring for the homeless, the principle of nonmaleficence, or doing no harm, is essential from both a physical and a psychological standpoint.

Respond with kindness.
​­Responding to the homeless respectfully rather than dismissing or ignoring them will build trust.
­Improving their self-esteem and self-worth may help them take an active role in their care.
­Nurses can do harm by dismissing them, as low-self confidence can lead to not taking advantage of care in the future.

(Butts & Rich, 2013; Herel, 2012; Kertesz, 2009)
Avoid unnecessary treatments.
​­Restrict the use of restraints.
­Reduce unnecessary invasive procedures.

Provide equal care.
​­Confront any bias against the homeless.
­Whether you believe they just want shelter or have a legitimate health issue, do not ignore complaints.
During the course of care at a healthcare facility, it is important to follow the same standards as those followed for the general population.

(Butts & Rich, 2013; Herel, 2012; Kertesz, 2009)
Respect the homeless as individuals.
​­Give them choices regarding treatment options.
­Acknowledge their right to refuse treatment.

Maintain privacy and confidentiality.
­Obtain informed consent for any treatment.
­Disclose information to appropriate personnel on a need-to-know basis only.

(Butts & Rich, 2013; Herel, 2012; Kertesz, 2009)
Autonomy in the Care of the Homeless
Beneficence, or the responsibility to do good by contributing to client welfare, means that nurses should follow these rules when caring for the homeless:

Protect and defend the rights of the homeless.
Strive for a general benefit.
Develop and maintain skills and knowledge.
Practice fidelity by honoring commitments.

Prevent harm from occurring to the homeless.
Remove conditions that will cause harm.
Do not threaten the therapeutic relationship or leave obligations unfulfilled.

(Butts & Rich, 2013; Kitchener, 1984; Kogel, Melamid, & Burnam, 1995 )
Help homeless persons with disabilities.
Take action in a way that will provide benefit.
Any procedures must be provided with the intent of doing good for the patient involved.

Rescue homeless persons in danger.
Consider individual circumstances of all patients and how they can be improved.
Understand causes of homelessness and how to prevent crisis or recurrence.

(Butts & Rich, 2013; Kitchener, 1984; Kogel et al., 1995 )
Beneficence in the Care of the Homeless
Beneficence in the Care of the Homeless
Justice in the Care of the Homeless
Nurses must treat all patients equally, with respect and without prejudice.
In order to promote an equitable distribution of benefits, nurses must also advocate for housing options and funding for medical programs for the homeless.

(Butts & Rich, 2013; Kertesz, 2009; Kitchener, 1984)
(Kunze, 2015)
In order to practice the principle of autonomy in the care of the mentally ill, nurses must help empower patients in this population by:
Stimulating the process of goal setting.
Giving patients choices with limits (for example, a choice between injections and oral medication).
Using the nurse-patient relationship of trust.
Listening and respond to needs without a hidden agenda.

Patients must be presumed competent unless proven otherwise. Nurses violate the principle of autonomy when patient autonomy is legally constrained without good reason.

(Puthran, Vaswani, Jain, & Kakunje, 2013; Sitvast, Widdershoven, & Abma, 2011)

Autonomy in the Care of the Mentally Ill
Ethical Principles in the Care of the Mentally Ill
Nonmaleficence in the Care of the Mentally Ill
Practicing the principle of nonmaleficence in the care of the mentally ill involves the following strategies:

Preventing harm and removing harmful conditions
Avoid negative labeling.
Base practice on evidence, not assumptions.

Advocating for patients
Remember that the patient’s needs come first.
Stand firm on ethical principles and beliefs.
Research new standards of care and evidence-based practice.

(Puthran et al., 2013; Sitvast et al., 2011)

Provisions 4 and 8 of the ANA Code of Ethics call for nurses to demonstrate beneficence and have respect for the dignity, inherent worth, and human rights of every individual.

The practice of beneficence, or the ethical principal of taking action for the good of the mentally ill, should afford the patient:
A safe environment.
Adequate nourishment.
Means for proper hygiene: clean clothes and medical and dental care.
Socialization through group therapy.

Therapies that have proven to be effective in promoting the good of these patients involve the formation of relationships.

(ANA, 2015; Butts & Rich, 2013)
Justice, the moral concept of fairness and equality, should be provided in a way that is appropriate to meet the needs of acute or chronic illness. It should provide the patient with:
A secure, controlled environment.
Advocacy for sustaining a means of living, whether in a facility or as an outpatient.
Resources for access to medication and mental health counseling.

Inequality, poverty, and social marginalization are key factors in failure to maintain health. Nurses must develop public health awareness and policies to promote and restore mental health.

(ANA, 2015; Butts & Rich, 2013)
Ethical Successes and Failures in the Care of the Mentally Ill
Beneficence in the Care of the Mentally Ill
Justice in the Care of the Mentally Ill
The following documentary shows interviews with doctors, nurses, and other associates of King’s Park Psychiatric Center (KPPC). This facility was described as a place of great hope, and was called the "country club of psychiatric wards" in its day. It was revolutionary in its treatment modalities, which attempted to alleviate stress through a communal environment. At its peak, KPPC provided long-term care for over 10,000 patients.
(Weber, 2007)
After the development of new psychotropic drugs, some patients began to demonstrate the ability to function outside of such asylums, thereby reducing the need for these facilities. Consequently, many large facilities such as KPPC closed. Society and the medical community failed to provide promised resources to help patients manage their conditions outside of a facility, however, and some patients, unable to maintain life outside the hospital, ended up homeless or in jail (Butts & Rich, 2013).

In a 2015 interview, E. Tibett, a past mental hygeine therapist at KPPC, recounted how many other residents from KPPC were transferred to other facilities in Queens, the Bronx, or upstate New York because they had nowhere to go and no family willing take them in due to fear of their mental condition or lack of resources. These events ultimately show a failure to ensure ethical practice.

Ethical Successes and Failures in the Care of the Mentally Ill
Providing care for the mentally ill is different from caring for the physically ill. It is difficult to get quantitative data to diagnose the severity of mental illness, and the efficacy of treatment modalities is measured largely by subjective responses that can be manipulated by the patient, whether intentionally or not.

It can therefore be difficult to establish a standard for what ethical nursing care looks like. Nurses must be vigilant in making sure that their care meets ethical standards.

(Butts & Rich, 2013)
(KidsWell Florida, 2014)
Akron Children’s Hospital. (2012, August 31).
Akron Children’s Hospital nurse
practitioners earn statewide recognition
[Online article with photograph]. Retrieved from https: //www.akronchildrens.org/cms/news/pediatric_nurse_practitioners_of_the_year/index.html

American Nurses Association. (2011).
Short definitions of ethical principles and
theories: Familiar words, what do they mean?
Retrieved from http: //www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf

American Nurses Association. (2015).
Code of ethics for nurses with interpretive
. Retrieved from http: //www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Buchwald, D., Delmar, C., & Schantz-Laursen, B. (2011). Ethical dilemmas in
conducting research with children.
International Journal for Human Caring, 15
(2), 28-34. Retrieved from https: //iafhc.wildapricot.org/page-18066

Butts. J. B., & Rich, K. L. (2013).
Nursing ethics: Across the curriculum and into
(3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Copeland, D. A. (2007). Conceptualizing family members of violent mentally ill
individuals as a vulnerable population. I
ssues in Mental Health Nursing, 28
(9), 943-975. doi:10.1080/01612840701522127

Cowell, J. M. (2011). Ethical treatment of school children in research: Assuring
informed consent.
Journal of School Nursing, 27
(4), 247-248. doi:10.1177/1059840511414384

Edwards, S. L., & Coyne, I. (2013).
A survival guide to children’s nursing
[Kindle DX
version]. Retrieved from http: //www.amazon.com/

Ethical Research Involving Children. (2013).
Ethical guidance
. Retrieved from http: //

Herel, B. (2012).
Treat homeless men and women with dignity
. Retrieved from
http: //www.volunteerguide.org/minutes/service-projects/homelessness

Kertesz, S. G. (2009, March 2). Treating the homeless can go beyond medical care.
American Medical News
. Retrieved from http: //www.amednews.com/

KidsWell Florida. (2014, February 6).
PSA: Health care access for lawfully residing
immigrant children in Florida (HB 7 and SB 282)
[Video file]. Retrieved from https: //youtu.be/rSIXNBu6Hsc

KidsWell Florida. (2015).
End the 5 year wait for all legally residing children
Retrieved from http: //www.kidswellflorida.org/5yearwait/

Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The
foundation for ethical decision making in counseling psychology.
The Counseling Psychologist, 12
(3-4), 43-55. doi:10.1177/0011000084123005

Koegel, P., Melamid, E., & Burnam, M. A. (1995). Childhood risk factors for
homelessness among homeless adults.
American Journal of Public Health, 85
(12), 1642-1649. Retrieved from http: //ajph.aphapublications.org/

Kunze, A. (2015, January 29). Event helps homeless make connections:
Attendance down from previous years, but reasons why are unclear [Photograph slide show].
The Columbian
. Retrieved from http: //www.columbian.com/

New York City Rescue Mission. (2014, April 22).
Have the homeless become
[Video file]. Retrieved from https: //youtu.be/u6jSKLtmYdM

Puthran, S., Vaswani, V., Jain, A., & Kakunje, A. (2013). Perception about autonomy of
patients having psychiatric disorder/illness by psychiatry nursing staff.
The International Journal Research, 3
(7), 47-53. Retrieved from http: //www.theinternationaljournal.org/ojs/index.php?journal=tij&page=index

Sitvast, J. E., Widdershoven, G., & Abma, T. A. (2011). Moral learning in psychiatric
Nursing Ethics, 18
(4), 583-595. doi:10.1177/0969733011408047

Sousa, C., & Araujo, C. (2011). The ethical rights of children: Yesterday and today.
Pediatric Nursing, 37
(3), 141-144. Retrieved from https: //www.pediatricnursing.net/index.html

Sundean, L. J., & McGrath, J. M. (2013). Ethical considerations in the neonatal intensive
care unit.
Newborn & Infant Nursing Reviews, 13
(3), 117-120. Retrieved from http: //www.nainr.com/

U.S. Department of Health and Human Services, National Institutes of Health. (2002).
Strategic research plan and budget to reduce and ultimately eliminate health disparities: Volume I, fiscal years 2002-2006
. Retrieved from http: //www.nimhd.nih.gov/documents/VolumeI_031003EDrev.pdf

Weber, S (Ed.). (2007, February 21).
Kings Park Psychiatric Center – closing the center
Retrieved from https: //youtu.be/PH0CKsWOjbw

Vulnerable populations are social groups who have limited access to resources. This lack of access puts them at increased risk for adverse health outcomes and health disparities. Health disparities are defined by the National Institutes of Health as “differences in the incidence, prevalence, morbidity, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States” (U.S. Department of Health and Human Services, National Institutes of Health, 2002, p. 7).

This presentation will review the ethical issues that surround nursing care of vulnerable populations. Those that are considered vulnerable are children, the homeless, and the mentally ill. The five ethical principles are also defined in terms of how they pertain to each vulnerable group. These include: autonomy, nonmaleficence, beneficence, justice, and privacy/confidentiality.

(Copeland, 2007)
"Nurses are supposed to be respectful of all other people’s beliefs, treat people as equals, care personally to the extent that they enter patients’ subjective worlds, uphold their dignity, ensure their privacy, be ethical at all times, nurture all patients and—of course—work for their health" (Butts & Rich, 2013, p. 292).

Thank you for viewing our presentation! As nurses, we must advocate for these vulnerable populations. Any nurse who works with people in these groups should be educated on how to properly care for them. As advocates, we must aid in facilitating the patient’s best outcomes, even in their current situation.
The following video provides a helpful perspective on changing the way that we view the homeless men and women whom we encounter in both personal and professional contexts.
Ethical Treatment of the Homeless
(New York City Rescue Mission, 2014)
Full transcript