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Ethics

NUR 212
by

Patty Averre

on 10 March 2016

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Transcript of Ethics

Ethics
NUR 212
Patty Averre, MSN, RN, CNE

Examination of morals and human behavior
Ethics:
Nursing Ethics
Ethical Theory
Standard of conduct for nursing accountability
Utilitarianism
Deontology
Outcome driven
Weighs the consequences
“Greater good for the greater number."
Action driven
Weighs the rightness of the action
“Universal law... equality for all."
Ethical
Decision-making

Ethical Dilemmas
Values
Personal beliefs about worth
Develop to guide behaviors, judgments, and decisions
Categories of Values
Intrinsic values- relate to sustaining life
Extrinsic values- not essential to life
Personal values- qualities people consider valuable in their private lives
Professional values- qualities considered important in the workplace
Development of Values
Some are learned
Some influenced by religion, culture, and/or experiences
Some change with experience and maturity
Ethics
refer to a standard behavior code
Morals
refer to an individual’s code
Autonomy

Veracity

Nonmaleficence

Beneficence
A. Taking positive actions to help others

B. Telling the truth

C. Including clients in decisions about all aspects of care

D. Avoidance of harm or hurt

Review of Ethical Principles
AUTONOMY

Patients make decisions
Respect patient right to choose
Enable patient to choose
Respect patient choice
NONMALEFICENCE

No harm deliberately or unintentionally
Good done for others
Caring and kindness
VERACITY

Truth
Nurses must be truthful
This principle often creates ethical dilemmas
Focuses on the workplace
Aimed at the organizational level
When looking for a job consider the culture of the organization
Organizational Ethics
Dilemmas occur when a problem arises that forces a choice between two or more ethical principles.
Methods to Resolve Ethical Dilemmas
Nursing Process
The “MORAL” Model
Kidder’s Decision-making Checkpoints
Kidder’s Right vs. Right Principles
The
“MORAL”
Model:

M: Massage the dilemma
O: Outline the options
R: Resolve the dilemma
A: Act by applying the chosen option
L: Look back and evaluate the complete process, including actions taken
Institute for Global Ethics
Founder and President
Rushworth M. Kidder, Ph.D
Kidder’s Nine Checkpoints for Ethical Decision-Making
1.Recognize that there is a moral issue.

2.Whose issue is it?
Is anyone responsible?
Is anyone morally obligated to do anything?

3.Gather the relevant facts.
What events have unfolded?
What finally happened?
Who said what to whom?

4.Test for right-vs-wrong issues.
Were any laws broken?
If the answer is “yes, “ the issue is a legal instead of a moral issue.
If the answer is less obviously “yes, “ it is a moral issue.
The stench test:
Does this course of action have an odor of corruption?
The front-page test:
Would you feel uncomfortable if what you are
about to do ended up on the front page of the newspaper?
The Mom test:
If I were my mother, would I do this ?
If your answers to these questions are yes-yes-no, the issue is a choice between right and wrong.

5.Test for right-vs-right paradigms. What sort of dilemma is this?
Is it a case of truth vs loyalty?
Is it a case of self vs community?
Is it a case of short-term vs long term?
Is it a case of justice vs mercy?
6.Apply the resolution principles.
Ends-based thinking: Do what’s best for the greatest number of people.
Rule-based thinking: Follow your highest sense of principle.
Care-based thinking: Do what you want others to do to you.

7.Investigate the “tri-lemma” options.
Is there a third way through this dilemma?
Try to find a creative middle ground.

8.Make the decision.

9.Revisit and reflect on the decision.
Kidder’s Right vs. Right
Core Values
Dilemma Types
Honesty
Responsibility
Respect
Fairness
Compassion
Truth or Loyalty?
Self or Community?
Short-term or Long-term?
Justice or Mercy?
Principles
End-based Thinking

– Choose the greatest good for the greatest number.
Rule-based Thinking
– Decide if this should be a universal law.
Care-based Thinking

– Put your compassion for others first; “the Golden Rule”.
The Guts of a Tough Decision
Ethics Committee
Interdisciplinary dialogue to:
Promote patient rights
Establish resolution
Prevent similar dilemmas
Issues in Nursing Ethics
Bioethical Dilemmas
Right to Life Dilemmas
End of Life Dilemmas
Right to Health Care
Allocation of Scarce Resources
Accountability and Whistle-blowing

1. Compassion and respect
2. Commitment to the patient
3. Promotes health, safety, and rights of the patient
4. Accountable for own professional practice
5. Duty to self
6. Improve and maintain healthcare environment
7. Advance the professional standards
8. Health promotion
9. Profess integrity of nursing practice
ANA Code of Ethics
Set of guiding principles that all professional nurses accept

Helps professional groups settle questions about practice or behavior

Includes responsibility, accountability, and confidentiality
Professional Nursing Code of Ethics
Moral Courage
Case Studies
Truth and trust
Nurses must be honest
VERACITY
The “MORAL” Model:

M:
Massage the dilemma
O:
Outline the options
R:
Resolve the dilemma
A:
Act by applying the chosen option
L:
Look back and evaluate the complete process, including actions taken
6. Apply the resolution principles.
Ends-based thinking: Do what’s best for the greatest number of people.
Rule-based thinking: Follow your highest sense of principle.
Care-based thinking: Do what you want others to do to you.

7. Investigate the “tri-lemma” options.
Is there a third way through this dilemma?
Try to find a creative middle ground.

8. Make the decision.

9. Revisit and reflect on the decision.

End-based Thinking
– Choose the greatest good for the greatest number.
Rule-based Thinking
– Decide if this should be a universal law.
Care-based Thinking
– Put your compassion for others first; “the Golden Rule”.
Moral Courage with a Dying Patient
Mr. T is an 82 y/o widower who has been a patient on your unit several times over the past 5 years. His CHF, COPD, and diabetes have taken a toll on his body. He now needs oxygen 24 hours a day and still has dyspnea and tachycardia at rest. On admission, his ejection fraction is less than 20%. EKG shows a QRS interval of greater than 0.13 seconds and his functional class is IV on NYHA assessment. He has remained symptomatic despite maximum medical management with a vasodilator and diuretics. He tells you “This is my last trip. I am glad I have made peace with God and my family. Now, I am ready to die.” You ask about an advanced directive and he tells you his son knows that he wants no heroics, but they have just never gotten around to filling out the form. When the son arrives, you suggest that he speak with the social worker to complete the advance directive and he agrees reluctantly. You page the physician to discuss DNR status with the son. Unfortunately, Mr. T experiences cardiac arrest before the discussion occurs and you watch helplessly as members of the Code Blue Team perform resuscitation. Mr. T is now on a ventilator and the son has dissolved into tears with cries of “Don’t let him die!” What is the action the nurse needs to take?
Moral Courage with a Family Disruption
Tom has been a clinical nurse on the unit for 3 years and tonight is charge nurse for a fully occupied 30-bed unit. Even though two staff members called in sick, the supervisor was able to pull a RN and CNA from another unit. In shift report, Tom had heard again in detail about the Host family. This family has been problematic for the last week and the staff has complained constantly about their continuous, frequent requests, rudeness, and unwillingness to leave the room when the patient in the other bed requests privacy.
The 79 y/o patient in the Host family has COPD and mild dementia and is currently hospitalized because of diagnosis of CVA. The CVA has left her with partial paralysis of the left side and inability to speak. The family expects the nurses to do everything for her, even though she is able and willing to do a number of basic care functions herself.
The crisis occurs when the son comes to the nurses’ station screaming at the unit secretary about the staff’s incompetence and demanding to see the nursing supervisor. The charge nurse is in the nurse’s station and is able to address the hostile situation. What actions should the charge nurse take?
Moral Courage to Confront Bullying
Melissa started on the unit as a new graduate 5 weeks ago. She is still in orientation and has a good relationship with her preceptor. The preceptor has been assigned consistently to Melissa for most of the last 4 weeks, but due to family emergency has not been available in the last week. Melissa has been told that she will be precepted by a different nurse for the remainder of her orientation. The new preceptor has not been welcoming, supportive, or focused on the educational goals of the orientation. In fact, this new preceptor has voiced to all who will listen her feelings about the incompetence of new BSN graduates.
The crisis occurs when Melissa fails to recognize a patient’s confusion as a result of an adverse medication effect. The preceptor berates Melissa in the nurses’ station, makes sarcastic comments in shift report about the “inability of university-educated nurses to recognize the basics,” and informs the nurse manager “that new graduates are a danger to patients.”
Melissa tells you that she thinks she should resign and that maybe her previous preceptor was too easy on her. You know her preceptor is an excellent clinician and experienced teacher. What is your advice to Melissa?
Moral Courage to Confront Unethical Behavior In Management
Sarah was promoted to nurse manager because of her excellence in delivering patient care and recognized leadership ability. She was a preceptor, excellent charge nurse, outstanding patient advocate, and chair of the practice council. Sarah has been a medical-surgical nurse for over 10 years and loves the variety of patients under her care. She only recently completed her BSN degree and earned her certification in medical-surgical nursing.
When Sarah was in her position for less than 3 months, her immediate supervisor moved to another state because of his wife’s promotion. This individual had been a mentor, confidant, and recognized leader in the organization. Sarah tried to make the best of the situation and follow the direction of her new supervisor. However, right from the beginning, she found this individual to be very focused on the negative. As an optimistic person, Sarah found this approach counter to her basic instincts about people.
Every time she tried to discuss this difference in approach, her supervisor would say she was naïve and the staff was taking advantage of her good nature. The supervisor used several of Sarah’s recent project failures to justify her position. However, Sarah understood that these disappointments had been the result of staff illness and institutional reorganization.
The crisis point was reached when the supervisor told Sarah to get rid of two staff members who were the most vocal in their dissatisfaction with the reorganization. These individuals are excellent clinical nurses, well-liked by staff, and each has over 12 years of seniority in the organization. Sarah knew that the supervisor did not like these nurses for reasons unrelated to reorganization and their performance. After her third sleepless night, Sarah comes to you for advice. What advice do you give?
By Vicki D. Lachman, PhD, APRN, MBE
Medsurg Nursing (August, 2007)
Resolution Principles
BENEFICENCE
Outline the AACN's essential nursing values and behaviors.
Moral Distress
physical, emotional behavioral signs
cumulative effect
novices most vulnerable
Full transcript