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Ethics in Nursing

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Sarah Jackson

on 19 February 2013

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Transcript of Ethics in Nursing

By: Sarah Jackson, RN, BSN Ethics in Nursing Principles of Ethics Autonomy Nonmaleficence Fidelity Beneficence Veracity Justice What is Ethics? Values Clarification Based on idealized behavior,
not actual behavior
Relates moral actions to values
Seeks to rationally justify decisions Ethical Decision Making Core Values Inherent to Nursing A process of self-reflection that helps to identify what drives underlying behaviors
First step to understanding the values of others
Values are derived from experiences in life
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 Professional Nursing Ethics Consider all issues through a caring perspective
Benefit vs. Burden
Preserve humanity & dignity
Promote well-being Ethical Theories Commonly Used in Nursing Deontological
Ethics of Caring Guided by a systematic approach which utilizes:
Ethical principals
Ethical theories
Other professional resources
Interdisciplinary Ethics Committee Deontological Theory Focused on moral duty
Duty determined by beliefs about intrinsic good derived from God
Clear direction of action
Everyone is treated the same
Fails to consider consequence of action Teleological Theory Focuses on the consequence of an action
Uses human reasoning as its basis
The majority's interest is protected
"The end justifies the means" 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 Professional Resources ANA Code of Ethics
International Council of Nurses Code of Ethics
ANA Bill of Rights for RNs
The Patient Care Partnership
Home Care Bill of Rights
The Nuremberg Code The Interdisciplinary Ethics Committee Consulted when there are perplexing ethical issues
Clarifies the issue at hand
Provides an unbiased opinion
Offers moral support
Authority is limited 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 Euthanasia 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 Abortion
Organ transplantation
Use of fetal tissue
In vitro fertilization
Allocation & rationing of resources Ethical Dilemma A choice between two or more undesirable outcomes 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? Ethics in Nursing Presented By: Sarah Jackson, RN, BSN References

Melenovich, P. (2012). Ethical issues. In J. Zerwekh & A.Z. Garneau, Nursing today Transition and trends (6th ed., pp. 396-422). St. Louis: Saunders Elsevier.

Rich, K., & Butts, J. B. (2009). Ethical issues in professional nursing practice. In K. Masters (Ed.), Role development in professional nursing practice (2nd ed., pp. 217-238). Sudbury, MA: Jones and Bartlett.

Schwarz, J. K., & Tarzian, A. J. (2010). Ethical aspects of palliative care. In M. Matzo & D. W. Sherman. Palliative care nursing: Quality care to the end of life (3rd ed., pp. 119-139). New York, NY: Springer Publishing.

Shaw, H. K., & Degazon, C. (2008). Integrating the core professional values of nursing: A profession, not just a career. Journal of Cultural Diveristy, 15(1), 44-50. Retrieved from http://tinyurl.com/a534pln

Stewart, M. W. (2009). Philosophy of nursing. In K. Masters (Ed.), Role development in professional nursing practice (2nd ed., pp. 69-84). Sudbury, MA: Jones and Bartlett.
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