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Ethical Foundation of Professional Nursing

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Yadiris Ruiz

on 25 February 2014

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Transcript of Ethical Foundation of Professional Nursing

Ethical Foundation of Professional Nursing
Value Transmission
Values are learned and influenced by sociocultural environment though
Value Transmission Conti..
Nurses hold values that relate to competence and compassion
Nurses need to be

Value-neutral
Nonjudgmental

Nurses need to understand their values about
Life
Health
Illness
Death
Ability to identify personal values leads to better understanding of situations that may affect care

Helping Clients Identify Values
Moral Development
Challenges and Opportunities
Values Conflicts
Nurses’ established values and beliefs may conflict with clients’
Ethical-Legal Conflicts
“Right” thing to do versus what is legal

Kohlberg’s Levels and Stages


Level I premoral or preconventional
-Stage 1: Punishment and obedience orientation
-Stage 2: Instrumental-relativist orientation

Level II conventional
-Stage 3: Interpersonal concordance
-Stage 4: Law and order orientation

Kohlberg’s Levels and Stages
Level III postconventional, autonomous or principled
-Stage 5: Social contract, legalistic orientation
-Stage 6: Universal-ethical principle
Values Clarification
Process by which individual values are identified, examined, and developed
No one set of values is right for everyone
Identified values can be retained or changed


Values
Values are freely chosen,enduring beliefs or attitudes about the worth of a
person
Theory of Moral Development
Lawrence Kohlberg
Theory focuses on structure of thought about moral issues
-Moral development progresses through three levels and six stages
-Not always linked to age or growth and development

objects
idea
actions
Values frequently derive from
cultural
religious backgrounds
peer groups
Observation
Experiences
Family
Community
Professional values of the nurse are acquired during socialization into nursing from

Nursing experience
Teachers
Peers

Identifying Personal Values

Help identify how values influence and relate to a particular health problem

List alternatives
Examine possible consequences of choices
Choose freely
Feel good about the choice
Affirm the choice
Act on the choice
Act with a pattern

Process of learning what ought to be done and what ought not to be done

Morality-requirements necessary for people to live together
Moral behavior-the way the person perceives the requirements and responds to them
Moral development-is the pattern of change with age.

Ethics in Nursing

Ethics
Is a study of morality and an activity
Refers to practices, beliefs, and standards of behavior

Bioethics
Applies to life sciences and healthcare in an in disciplinary settings
Nurses are accountable for their ethical conduct
Scopes and Standards of Practice

Nursing Codes of Ethics
Formal statement of a group’s ideal and values
Higher than legal standards
Established by the International Council of Nurses
First adopted in 1953, revised 1973

ANA Nursing Code of Ethics
Purpose

Succinct statement of ethical obligations and duties
Nonnegotiable ethical standard
Expression of nursing’s commitment to society

Types of Ethical Problems
Decision-focused
What should I do?


Action-focused
Moral distress. What can I do?

Making Ethical Decisions
Catalano’s five step ethical decision-making algorithm for the nurse
Identification of potential ethical dilemma
Collect, analyze, and interpret data
State the dilemma
Can be resolved
Cannot be resolved

Making Ethical Decisions
Questions to ask
For whom is the decision being made?
Who should be involved in making the decision, and why?
What criteria should be used in determining who makes the decision?
What degree of consent is needed by the subject?
When compromise is necessary, the desirable outcome is preservation of each person’s integrity

Making Ethical Decisions
Winslow and Winslow’s elements of an integrity-preserving moral compromise
Some basic moral language must be shared.
A context of mutual respect must exist.
The moral perplexity of the situation must be honestly acknowledged.
Legitimate limits to compromise must be admitted.

Specific Ethical Issues
Increased incidences of conflict

Elective abortion
End-of-life care
Organ transplantation
Allocation of healthcare

Three categories of ethical issues

Moral uncertainty
Moral dilemma
Moral distress

Strategies to Enhance Ethical Decision Making
Become aware of one’s own values and ethical aspects of nursing situations.

Be familiar with nursing code of ethics.

Understand the values of other health care professionals



Participate on ethics committees.

Participate in or establish a nursing ethics group.

Participate in or establish educational ethics rounds.

Advocacy
Advocacy = providing support for a patient’s rights/best interests
Three models of nurse advocacy

Rights protection

Values-based

Respect-for-persons

To be an advocate a nurse needs

Self-knowledge

Professional knowledge

Advocacy encompasses range of approaches
Legal
Self
Collective
Citizen

A therapeutic nurse-patient relationship in which to secure patient’s freedom and self-determination
Promoting and protecting patients’ rights to be involved in decision making and informed consent
Acting as an intermediary between patients and their families or significant others, and between them and health care providers

An advocate support clients decisions It can involve:
Action
Nonaction

Advocacy
To select values deemed necessary to save own life
To decide which course of action will best achieve the chosen values
To dispose of values in a way they choose without coercion by others

Advocacy
To be a client advocate involves

Being assertive
Recognizing that the rights and values of their clients and families must take precedence when they conflict with those of health care providers
Ensuring that clients and families are adequately informed to make decisions about their own health and healthcare
Advocacy
Recognizing that the rights and values of their clients and families must take precedence when they conflict with those of health care providers
Ensuring that clients and families are adequately informed to make decisions about their own health and healthcare

Reference
Questions
Question 1
_____ refers to the requirements necessary for the people to live together in society.
A- Morality
B- Moral behavior
C- Moral development
D- Moral dilemma

Answer : A
Question 2
In which stage of Kahlberg's stages of moral development is punishment and obedience orientation?

A- Stage 1
B- Stage 2
C- Stage 3
D- stage 4
Answer: A
Question 3
Which of these is not a models of nurse advocacy

a-Rights protection
b-Values-based
c-Respect-for-persons
d-Society-based
Answer: d
Which of these is not one of Catalano’s five steps for ethical decision-making algorithm?
a- Identification of potential ethical dilemma
b- Collect, analyze, and interpret data
c- State the dilemma
d- Reevaluate the ethical dilema
Question 4
Answer: d
Blais, K. K., & Hayes, J. S. (2011). Professional

Nursing Practice: Concepts and Perspectives (6th

ed. pp.49-74). Upper Saddle River, NJ: Pearson.


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