Transcript Chain of Survival and EMSC

Ethics Applied to Nursing: Personal vs. Professional
Ethics
Copyright © 2013 by Elsevier Inc. All rights reserved.
Ethical Issues in 21st Century
Health Care (p. 118 )
 In vitro fertilization
 Artificial insemination
 Surrogate motherhood
 Cloning
 Organ donation
 Including cadaver, child, and aborted fetus donations
 Stem cell research/procedures
Copyright © 2013 by Elsevier Inc. All rights reserved.
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Ethical Issues in 21st Century
Health Care (cont’d) (p. 118 )
 Abortion
 Euthanasia
 Assisted suicide
 Advance directives
 Living wills, power of attorney
 Right to die
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Slide 3
Description and Scope of Ethics (p.
118-119 )
 Ethics is a system of standards or moral principles that
directs actions as being right or wrong.
 Concerned with the meaning of words such as right,
wrong, good, bad, ought, and duty.
 Concerned with the ways people, either individually or as
a group, decide the following:
 What certain actions are right or wrong
 If one ought to do something
 If one has the right to do something
 If one has the duty to do something
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Morals and Values (p. 119 )
 Morals
 Concerned with dealing with right or wrong behavior
(conduct) and character
 Values
 Involve the worth you assign to an idea or an action
 Freely chosen and are affected by age, experience, and
maturity
 Continue to be modified throughout your lifetime, as
you acquire new knowledge and experience
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Comparison of Legal Aspects of
Nursing and Ethics (p. 119 )
 Nursing Ethics: the values and principles governing
nursing practice, conduct, and relationships
 Responsibilities: focused on ideal behavior, morality,
and higher standards
 Legal Aspects: state statutes that apply to licensed
persons and the situations in patient care that could
result in legal action
 Responsibilities: focused on rules, regulations, and
obligations mandated by law
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Slide 6
Ethical Codes of NAPNES and
NFLPN (p. 119 )
 NAPNES Codes—National Association of Practical
Nurse Educators and Services
 NFLPN Codes—National Federation of Licensed
Practical Nurses
 Nurse Practice Acts—published by each state
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 7
Your Personal Code of Ethics (p. 120 )
 You ultimately choose what your personal code of
ethics will include.
 Will influence your nursing ethics
 When personal ethics conflict with the law, you are
obligated to follow the law.
 You may ethically refuse to assist with a procedure, but
postprocedure you cannot refuse to give nursing care
to the patient involved
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Slide 8
Roots of Nursing Ethics (p. 120-121 )
 Before nursing process and critical thinking were
added to nursing curricula, those in the nursing
profession did not see themselves as having something
separate to contribute to patient care
 Nursing ethics was primarily a modification of medical
ethics and ethics of other professions at that time
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Slide 9
What Changed? (p. 121 )
 Past
 Study of nursing was initially disease-oriented
 Nursing assessments did not exist
 Additional concerns the patient might have had were
not routinely assessed
 Patients were expected to follow physicians’ orders
without question
 The nurse’s job was to see that the orders were followed
Copyright © 2013 by Elsevier Inc. All rights reserved.
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What Changed? (cont’d) (p. 121
)
 Present
 Nurses discovered that in addition to their dependent role
to physicians, they had something special to contribute to
the patient
 Nursing process helped nurses identify additional needs
that could be responded to through nursing care
 Patients were encouraged to play an active part in planning
and implementing their nursing care plan
 Adding nursing process and critical thinking changed the
nursing role and changed nursing philosophy
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Slide 11
Ethical Decisions in Health Care (p. 121 )
 Began to see the patient as more than just a disease
 Western secular belief system
 Individual autonomy: patient’s freedom to choose
 Individual rights: patient’s rights are limited if they clash
with the health professional’s
 Ethical and legal responsibilities
 Patient advocacy
 Accountability
 Peer reporting
Copyright © 2013 by Elsevier Inc. All rights reserved.
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Ethics Committees (p. 121 )
 Multidisciplinary team assists with difficult ethical
decisions
 Usually the discussions relate to new or unusual
ethical questions
 Patients arrive with their cultural- and/or their
religion-based ethics
 What the person can and cannot do in regard to their
health care has already been established by the culture
of which they are a part
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Slide 13
Western Secular Belief System (p. 121 )
 Individual autonomy
 “Self-rule”
 Individuals have the capacity to think, and based on
these thoughts, make a decision freely whether or not to
seek health care (the freedom to choose)
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Slide 14
Western Secular Belief System (cont’d) (p.
121 )
 Individual rights
 The ability to assert one’s rights
 The extent to which a patient can exert his or her rights
is restricted
 An individual’s right has become a central theme of
health care




Right to consent to care
Right to choose between alternative treatments
Women’s rights over their own bodies
Right to consent to or refuse treatment
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Slide 15
Ethical Responsibilities of Nurses (p. 122 )
 Patient advocacy
 The patient needs to be informed of what you will be
doing with him or her (e.g., steps of a procedure)
 Accountability
 You are answerable to yourself, to your assigned patient,
to the team leader, to the physician, and to your
instructor who evaluates your work
 Peer reporting
 Report peers for behaviors that are potentially harmful to
patients
Copyright © 2013 by Elsevier Inc. All rights
reserved.line.
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Principles of Ethics (p. 122 )
 You can add knowledge of basic ethics to critical
thinking as you assist the RN with the nursing process
 Learning about ethics is more than being able to recite
the definition to pass a test. It means being able to
help make ethical decisions when ethical dilemmas
arise
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Slide 17
Principles of Ethics (cont’d)
(p. 122-123 )
 Nonmaleficence (Do No Harm): the principle of
doing the least amount of harm possible to a patient
 Most beneficial treatments involve harming the
patient to some extent
 Examples:
 Skin puncture
 Drug side effects
 Physical manipulations
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Slide 18
Question 1
Which of the following deal with right or wrong
behavior and character?
1.
2.
3.
4.
Ethics
Morals
Values
Laws
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Question 2
Jessica is assigned to a patient named Bill, who is AIDSpositive. She tells her charge nurse that she refuses to take
care of the patient. Which is the correct statement?
1.
She is entitled to refuse the patient.
2.
She is entitled to refuse the patient as long as it is
before she enters the room.
3.
She may not refuse to take care of the patient.
4.
She may talk to her nurse manager to see what the
policies in the facility state.
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Slide 20
Question 3
Sherry is having a difficult time with a patient situation. A
2-year-old patient needs a blood transfusion and it has
become a life-threatening situation. Her parents are
Jehovah’s Witnesses and refuse the treatment. What
hospital area should get involved in this situation?
1.
2.
3.
4.
Medical ethics committee
Employee improvement committee
Personal values committee
Law enforcement committee
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Beneficence (p. 123 )
 Two major nursing duties associated with beneficence
(do good):
 Put patient interests first
 Place the good of patients before one’s own needs

Includes organizational and other work-related needs
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Slide 22
Autonomy (Free to Choose) (p. 124 )
 Four steps of autonomous decisions
 Thinking through all the facts
 Deciding on the basis on an independent thought
process
 Acting based on a personal decision
 Undertaking a decision voluntarily, without pressure
from anyone else
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Slide 23
Autonomy (Free to Choose)
(cont’d) (p. 123 )
 Patient’s right to privacy
 Choose care based on personal beliefs
 Accept or reject treatment
 Avoid needless exposure
 Personal values may be contrary to medical ethics
 Patient can refuse care for religious, cultural, or personal
reasons
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Fidelity (Be True) (p. 125 )
 Fidelity: Acting in patients’ best interests when they
are unable to make free choices
 Does not include resuscitation or paternalistic decisions
 Must differentiate between your own feelings and those
of the patient
 Maintain patient confidentiality
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Slide 25
Justice (Fair to All) (p. 125 )
 Justice: Give patients their due and treat each patient
fairly and equally (i.e., with dignity and respect)
 Avoid letting personal ethics and values interfere with
patient justice
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Slide 26
Question 4
Autonomy means all of the following except:
1.
2.
3.
4.
thinking through all the facts.
deciding on the basis of an independent
thinking process.
having patients do whatever they want.
undertaking a decision voluntarily.
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Question 5
Two nurses are discussing a very difficult patient on their
floor in a full elevator on the way to lunch. The patient’s
mother was in the back of the elevator and heard every
word. This is an example of:
1.
2.
3.
4.
injustice.
breaching fidelity.
beneficence.
nonmaleficence.
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