Post on 16-Aug-2015
Post-test
1. Give the fundamental human events (3 points)2. these are two most important role of a nurse when
faced with patient that has moral dilemma in decision making? (2 points)
3. Give steps on how will a nurse become an advocate and support for client during a moral dilemma? (3 points)
4. Give 2 ways to acquire Value? (2 points)5. Give at least 2 reasons why there’s such a growth
in awareness of ethical problem ?6. Give at least 3 moral principles?
Legal Issues in Nursing practice
PHYSICIAN’S ORDER Nurses are
responsible for their actions regardless of
who told them to perform those
actions.
FLOATING Nurses should be given orientation to the
unit. The supervisor should be informed about a float nurse’s lack of experience on
the new unit.
INADEQUATE STAFFING
• A nurse who leaves an inadequately staffed unit could be charged with client abandonment.
CRITICAL CARE Constant
observation and assessment of
clients are required, especially in ICUs
that have monitors.
PEDIATRIC CARE Suspected child
abuse or neglect be reported.
FUNDAMENTAL HUMAN EVENTS
Birth
Death
Suffering
SENSISTIVE AREAS
SUPPORTADVOCATE
SOUND MORAL DECISIONS
NURSES NEEDS TO:
1. Examine their own values and their cl ient’s values? Understand how their values inf luence their decisions?
2. Develop sensit ivi ty to the ethical dimensions of nursing practice?
3. Think ahead what are the possible moral problems they are l ikely to face?
HOW?
VALUES
Freely chosen
Values underlie all moral dilemmas. though, not all
values are moral values (people values about work,
family, religion, politics, money and relationships.
IMPORTANT: Values influence decisions and actions,
such as nurses’ ethical decision making.
Beliefs or attitudes about the worth of a person,
object, idea, or action.
VALUES
Values
ATTITUDES
BELIEFS
BELIEFS Opinion, interpretation, or
conclusions that people accept as true (may it not be true)
“I believe if I study hard I will get a good grade”
“Good grades are really important to me. I believe I must study hard to obtain good grades”
ATTITUDES Mental position or feelings
toward a person, object, or idea (compassion, acceptance)
Some clients may feel strongly about their need for privacy, whereas others may dismiss it as unimportant.
VALUES
BELIEFS ATTITUDES
FAITH than FACT.
Last only briefly.
Judged as correct or
incorrect.
THINKING and
BEHAVIORAL aspects.
Continuous overtime.
Judged as bad or
good, positive or
negative.
ACTIVITY 1
Beliefs? Attitudes?
LIFE?
DEATH/DYING?
HEALTH?
ILLNESS?
VALUES TRANSMISSION
VALUES CLARIFICATION
Acquired through Observation and Experience.
Affected by Socio-Cultural environment (societal conditions, family and peers)
PERSONAL VALUES
Nurses should keep in mind the influences of Values on health.
PROFESSIONAL VALUES
A process by which people identify,
examine, and develop their own
individual values.
It promotes personal growth (promotes
awareness, empathy, and insight)
It is an important step for nurses to
take in dealing with ethical problems.
No One set of values is right for everyone.
People can retain or change the freely
chosen values
CLARIFYING THE NURSES’ VALUES
CLARIFYING CLIENT VALUES
FROM?
Professional ValuesClarifying Nurse’s Values
Acquired during experience from code of ethics, nursing, teachers, and peers.
5 VALUES ESSENTIAL FOR PROFESSIONAL NURSE: ALTRUISM AUTONOMY HUMAN DIGNITY INTEGRITY SOCIAL JUSTICE
Nurses and nursing students need to examine the values they hold about life, death, health and illness.
FROM?
Essential Nursing Values and Behaviors
VALUES Professional Behaviors
AltruismNurse’s concern for the welfare of patients, other nurses, and other health care providers.
•Understands cultures, beliefs, and perspectives of others.•Advocates for patients.•Take risks on behalf of patients and colleagues.
AutonomyNurses respects patient’s right to make decisions about their health care.
•Plans care in partnership with patients
Human DignityNurses values and respects the inherent worth and uniqueness of all patients and colleagues.
•Provides culturally competent and sensitive care.•Protects patient’s privacy.•Designs care with s sensitivity to individual patient needs.
IntegrityNurses acts honestly and provides care based on an ethical framework.
•Provides honest information to patients and the public.•Document care honestly and accurately.•Seeks to remedy errors made by self or others.•Demonstrates accountability of own actions
Social JusticeNurse upholds moral, legal, and humanistic principles by ensuring equal treatment under the law and equal access to quality health care.
•Supports fairness and nondiscrimination in the delivery of care.
VALUES TRANSMISSION
VALUES CLARIFICATION
Acquired through Observation and Experience.
Affected by Socio-Cultural environment (societal conditions, family and peers)
PERSONAL VALUES
Nurses should keep in mind the influences of Values on health.
PROFESSIONAL VALUES
A process by which people identify,
examine, and develop their own
individual values.
It promotes personal growth (promotes
awareness, empathy, and insight)
It is an important step for nurses to
take in dealing with ethical problems.
No One set of values is right for everyone.
People can retain or change the freely
chosen values
CLARIFYING THE NURSES’ VALUES
CLARIFYING CLIENT VALUES
FROM?
Professional ValuesClarifying Nurse’s Values
Acquired during experience from code of ethics, nursing, teachers, and peers.
5 VALUES ESSENTIAL FOR PROFESSIONAL NURSE: ALTRUISM AUTONOMY HUMAN DIGNITY INTEGRITY SOCIAL JUSTICE
Nurses and nursing students need to examine the values they hold about life, death, health and illness.
FROM?
Theory of Values Clarification (Raths, Harmin, and Simon, 1978)
Valuing Process
Choosing Cognitive
•Beliefs are freely chosen.
•Without outside pressure
•After reflecting and considering
consequences or alternatives
Prizing Affective•Chosen beliefs are cherished or prized
Acting Behavior
•Chosen beliefs are affirmed to others, incorporated into one’s behavior and repeated consistently in one’s life.
Clarifying Client Values
Is an intervention used by the nurse s when clients experiences unclear values that are harmful to their health.
Behavior Example
Ignoring a health professional’s advice
A child client’s parent who values the
Inconsistent communication behavior
A n elderly who says she don’t want anymore to use cane when walking, but won’t cooperate during her therapy.
Numerous admissions to a health agency for the same problem
A hypertensive client repeatedly seeks help for headache but does not take the prescribed maintenance medicine.
Confusion about which course of action to take
A pregnant woman who values her job to meet financial obligations, but also needs to have complete bed rest for a safe labor and delivery.
Clarifying Client Values
Process How?
List Alternatives Ask: “Are you considering other alternative courses of actions?” “Tell me about them”
Examine possible consequences of choices
Ask: “What do you think you will gain from doing that?”
Choose freely Ask: “Did you have any say in that decision?”
Feel good about the choice
Ask: “How do you feel about that decision?” “Some people feel good after a decision is made; others feel bad. How do you feel?”
Affirm the choice Ask: “What will you say to family or friends about this?”
Act on the choice Ask: “Will it be difficult to tell your wife about this?” (it determines the client’s preparedness to act in his decision)
Act with a pattern Ask: “How many times have you done that before?” or “Would you act that way again?”
ACTIVITY 2
Observations and experience?
Examine the values you have about…?
LIFE?
DEATH/DYING?
HEALTH?
ILLNESS?
NURSES NEEDS TO:
1. Examine their own values and their cl ient’s values? Understand how their values inf luence their decisions?
2. Develop sensit ivi ty to the ethical dimensions of nursing practice?
3. Think ahead what are the possible moral problems they are l ikely to face?
HOW?
Standards of Professional Performance (ANA,1998)
Standard V: EthicsThe nurse’s decisions and actions on behalf of patients are determined in an ethical manner.
Measurement Criteria
1. The nurse’s practice is guided by the Code for Nurses.2. The nurse maintains patient confidentiality within legal and
regulatory parameters.3. The nurse acts as a patient advocate and assists patients in
developing skills so that they can advocate for themselves.4. The nurse delivers care in a non-judgmental and non-
discriminating manner that is sensitive to patient diversity.5. The nurse delivers care in a manner that preserves patient
autonomy, dignity, and rights.6. The nurse seek, available resources in formulating ethical
decisions.
NURSING ETHICS
No One profession is responsible for ethical decisions, nor does expertise in one discipline necessarily make a person an expert in ethics
(ethics committee)
Nursing Codes of Ethics
Purposes:
Inform the public about the minimum standards of the
profession and help them understand professional nursing
conduct.
Provide a sign of the profession’s commitment to the public
it serves.
Outline the major ethical considerations of the profession.
Provide standards for professional behaviors.
Remind nurses of special responsibility they assume when
caring for the sick.
CODE OF ETHICS
ETHICAL CODES are:
Systematic guides for developing ethical behavior.
Answers normative questions of what beliefs and
values should be morally accepted.
NO CODE could possibly provide absolute or
complete rules without conflict and ambiguity.
Four-fold responsibilities of nurses (PD 223)
Responsibility Ethical PrinciplesGuidelines to be
observed
NURSES AND PEOPLE
• Values, spiritual beliefs, and customs held by individual•Respect patient’s autonomy.•Personal information confidentiality.
•Consider individuality when giving care.•Take into consideration the spiritual beliefs (diet and treatment), the rights and the culture of patients.•However, welfare and safety must take precedence.
NURSES AND PRACTICE
•Human Life in inviolable.•Quality in care for patients•Accuracy in documentation of actions and outcomes of care.•Advocate to patient.•Awareness to ethic-moral and legal dimensions of practice.
•Know the scope of her practice•Acquire and develop necessary competence in knowledge, skills, and attitudes.•Ensure patient's records.•Respect “Patient’s Bill of rights”
Four-fold responsibilities of nurses
Responsibility Ethical PrinciplesGuidelines to be
observed
NURSES AND CO-WORKERS
•Maintain a collaborative working relationship
•Maintain their professional role/identity while working with other members.•Honor and safeguard the dignity and reputation of members of nursing.•Contribute to professional growth and development of other members.
NURSES AND SOCIETY/ENVIRONMENT
•Preservation of life, respect for human rights and promotion of a healthy environment•Establishment of linkages with the public in promoting local an national, and international efforts to meet health and social needs of people.
•Be conscious of their obligations as citizens.•Be equipped with knowledge of health resources within the community•Project an image.
ETHICAL PROBLEMS IN NURSING
Growing awareness of ethical problems has occurred because of:
SOCIAL AND TECHNOLOGICAL CHANGES
CONFLICTING LOYALTIES AND OBLIGATIONS
SOCIAL AND TECHNOLOGICAL CHANGES
CONFLICTING LOYALTIES AND OBLIGATIONS
Large number of people without health insurance.
High cost of health care Workplace redesign under managed
care
ISSUES OF FAIRNESS AND RESOURCE ALLOCATION
Before technology, there was no questions about whether to “allow”….who should be treated?...
According to nursing code of ethics, the nurse’s first loyalty is to the client.
However, it is not easy to determine which action best serves the client’s needs.
Client needs may conflict with the institutional policies, physician preferences, needs of their family, or even laws of the state.
ETHICAL PROBLEMS IN NURSING
SPECIFIC ETHICAL ISSUES• Sanctity of life vs. principle of Autonomy and the
woman’s right to control her own body.
• No public consensus has yet been reached.• Nurses have no right to impose their personal
values, instead, nurses have the right to inform and counsel the client in making decisions.
Abortion
• Nurses should help develop and follow security measures and policies to ensure appropriate use of client’s data.
Management of
Computerized Information.
• Advance Directives• Euthanasia• Termination of Life-sustaining treatment• Withdraw or withholding Food and
fluids
End-of-Life Issues
• Health resourcesAllocation of
scarce resources
MAKING ETHICAL DECISIONS
It should be based on ethical principles and codes rather than emotions, intuition, or precedent.
GOOD DECISION The one that is in the Client’s best interest and at the same
time preserve the integrity of all involved.
Establish support system; use of counseling
professionalsCollaboration, communication, and compromise
(important skills)Determine EXISTENCE OF MORAL SITUATION
(important first step)
EXISTENCE OF MORAL SITUATION?
1. A diff icult choice exists?
2. There are moral principles exist that can
be used to justify the action?
3. The decision must be freely and
consciously chosen?
4. The choice is aff ected by personal
feelings?
MORAL PRINCIPLES
AUTONOMYNONMALEFICENCEBENEFICENCEJUSTICEFIDELITYVERACITY
AUTONOMY - Autos ( self)- nomos (governance)- born from The New Testament (freedom to make decisions)- In Health care Setting: “ Principle of INFORMED CONSENT”- IMPORTANT : while you respect patient’s autonomy, it is also our
duty to explain clearly to them what are the consequences or effect of their decision, explain to them the purpose of informed consent the treatment and its alternatives which are all indicated or written in the informed consent.
OVERRIDING PATIENT’S AUTONOMY( Paternalism) > MEDICAL --acting without consent to benefit the patient and
prevent harm (ex. emergency cases, incompetency etc.) > STRONG – benefit is stronger than autonomy (ex. Refusal to
treatment) > WEAK – if our purpose is to help patient in restoring his/her
competence to decide.
MORAL PRINCIPLES
JUSTICE- the right to demand a just, fair and treatment- “we get what we merit from our conduct in life”- uses TRIAGE SCHEMES:
1. According to medical prognosis (who is most likely to survive)
2. Social value (must favor first the socially disadvantaged, ill,elderly,disabled,women and children (ART.III of PHILIPPINE CONSTITUTION))
3. First come first serve (for patients with same cases and treatment)
- this DOESN’T tell us what needs are most important.
Fidelity Being faithful to ones commitments (providing self
care and competence in nursing care) and promises.
Veracity Telling the truth (essential to nurse-client
relationship)
MORAL PRINCIPLES
BENEFICENCE NONMALEFICENCE
-“do good” (stated in positive form)
-Do good for patient’s interest
-However, this can pose patient at risk of harm (provided, that patient’s values and dignity are considered first)
-Good communication with patient of his/her desires and needs promotes acceptance.
-“do no harm” (stated in negative form
-Avoid harm which is against patient’s interest.
- harm may be INTENTIONAL (never accepted because it places patient to harm) or UNINTENTIONAL (risk was inevitable or not anticipated, example is catching a falling patient)
-Unintentionally created a needless harm, provided, that nurse should do what’s best for her patient.
-PATIENT: the one who determines or interpret what is harmful.
MORAL PRINCIPLES
AUTONOMY – self governance; Informed Consent
NONMALEFICENCE- do no harmBENEFICENCE- do goodJUSTICE- fair treatmentFIDELITYVERACITY
Criteria if Moral aspects exists
A difficult choice exists?
There are moral principles exist that can be
used to justify the action?
The decision must be freely and consciously
chosen?
The choice is affected by personal feelings?
SITUATION
Mrs . L , a 67 -year -o ld woman, i s hosp i ta l i zed w i th mu l t ip le f rac tu res and lacera t ions caused by an au tomob i le acc iden t . Her husband , who was k i l l ed in the acc iden t , was taken to the same hosp i ta l . Mrs . L , who had been d r i v ing the au tomob i le , cons tan t l y ques t ions her p r imary nurse abou t he r husband . The su rgeon has to ld the nurse no t to te l l Mrs . L ; however, he does no t g ive the nurse the reason fo r these ins t ruc t ions . The nurse expresses concern to the charge nurse , who says the su rgeon ’s o rder mus t be fo l lowed. However, the nurse i s no t comfor tab le w i th th is and wonders wha t shou ld be done .
APPLICATION
MODELS of decision-making
CASSELLS and REDMAN (1989)SITUATIONMrs. L, a 67-year-old woman, is hospitalized with multiple fractures and lacerations caused by an automobile accident. Her husband, who was killed in the accident, was taken to the same hospital. Mrs. L, who had been driving the automobile, constantly questions her primary nurse about her husband. The surgeon has told the nurse not to tell Mrs. L; however, he does not give the nurse the reason for these instructions. The nurse expresses concern to the Charge nurse, who says the surgeon’s order must be followed. However, the nurse is not comfortable with this and wonders what should be done.
ACTION CONSIDERATIONS1. Identify the moral
aspects.
2. Gather relevant facts that relate to the issue
Whether to tell the truth or not?Honesty and loyalty (moral principles)
Client’s health problem information?Who is involved? Nature of involvement? Motives of actions (not known)
MODELS of decision-making
3. Determine for whom the decision being made? Who should decide and why?
4. Clarify and apply personal values
5. Identify ethical theories and principles
6. Identify applicable laws or agency policies
7. Use competent interdisciplinary resources
8. Propose alternative actions
Mrs. L values her husband’s welfare, the charge nurse values policy and procedure, the nurse value a client’s right to have information.
Autonomy? Beneficence?
Nurse might consult literature
Follow the charge nurse; possible outcome: Mrs. L might become anxious and angry, wait Mr.s L to recover
The agency may not allow the nurse to follow the doctor’s order (instructions rather than order)
MODELS of decision-making
9. Apply nursing code of ethics
10. For alternative action, identify the risk and seriousness of consequences
11. Evaluate the action taken
If the nurse follows the charge nurse and doctor?If the nurse tells Mrs. L?
If the client is not satisfied the nurse can review other alternatives and work through the process again.
STRATEGIES TO ENHANCE ETHICAL DECISIONS AND PRACTICE
√ BE AWARE OF YOUR OWN VALUE.
√ BE FAMILIAR WITH THE CODE OF ETHICS
RESPECT VALUES, OPINIONS, AND
RESPONSIBILITIES OF OTHER HEALTHCARE
PROFESSIONALS
SERVE ON INSTITUTIONAL ETHICS COMMITTEE
STRIVE FOR COLLABORATIVE PRACTICE
PATIENT’S BILL OF RIGHTS
• Right to considerate and respectful care.• Right to obtain from his doctor complete current information about his diagnosis.• Obtain from his doctor complete current information about his diagnosis, treatment
and prognosis in terms patients can be reasonably expected to understand.• Right for complete and accurate information necessary to give informed consent
prior to start of procedure or treatment.• Right to refuse treatment .• Right to privacy.• Right confidentiality.• Right to expect that a hospital must take reasonable response for the client’s
request for services, within the hospital’s capacity.• Right to obtain information: any relationship of the hospital to other healthcare and
educational institutions concerning his care; human experimentation• Right to expect reasonable continuity of care.• Right to examine and receive an explanation of his bill, regardless of source.• Right to know what hospital rules and regulations apply to his conduct as a patient.
Project
Using the following phases of the Nursing Care Process, create your own diagram or illustration on how the process works. (50 points)
•Assessing•Diagnosing•Planning•Implementing•Evaluating
Rubrics
Criteria 10 5 2Use of the following phases given
All of the items given were used in the diagram
Some of the items given were used in the diagram
All of the items given were not used in the diagram
Creativity The illustration is creative
The illustration in some way shows creativity
The illustration do not show creativity
Effectiveness of the illustration
The diagram shows exact process on how NCP works
The diagram somehow shows a process on how NCP works
The diagram doesn’t show any relevance on the NCP
KOZIER, ERB G. , BERMAN A. , SNYDER S. (2004) “FUNDAMENTALS OF NURSING” 7 T H EDITION
UDAN “FUNDAMENTALS OF NURSING”
Reference