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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.
Slide 2
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 4
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 5
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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.
Slide 10
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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.
Slide 12
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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)
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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.
Slide 16
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 18
Question 1
Which of the following deal with right or wrong
behavior and character?
1.
2.
3.
4.
Ethics
Morals
Values
Laws
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 19
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.
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 21
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 24
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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
Copyright © 2013 by Elsevier Inc. All rights reserved.
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.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 27
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.
Copyright © 2013 by Elsevier Inc. All rights reserved.
Slide 28