Ethics in NursingEthics in Nursing

Enie Novieastari, SKp.,MSNEnie Novieastari, SKp.,MSN

DKKD FIK UIDKKD FIK UI

List of contentsList of contents

Definition of key termsDefinition of key terms Ethics in nursing careEthics in nursing care Nurses’ codes of ethicsNurses’ codes of ethics Accountability and responsibilityAccountability and responsibility Moral reasoning and theoriesMoral reasoning and theories Ethical principlesEthical principles Methodology for ethical decision Methodology for ethical decision

makingmaking Institutional ethics committeeInstitutional ethics committee

What is ethics?What is ethics? A term with many meaningA term with many meaning Simply stated, it is concerned with how Simply stated, it is concerned with how

people ought to act and how they ought to people ought to act and how they ought to be in relationship with othersbe in relationship with others

Concerned with establishing norms and Concerned with establishing norms and standards for human life and conduct standards for human life and conduct should beshould be

Good and bad, right and wrong, character Good and bad, right and wrong, character or motivesor motives

Moral and ethics, used interchangeablyMoral and ethics, used interchangeably

Etika: asal kata “ethos” (Yunani kuno) Etika: asal kata “ethos” (Yunani kuno) dalam bentuk tunggal punya banyak dalam bentuk tunggal punya banyak arti: kandang; kebiasaan, adat; akhlak, arti: kandang; kebiasaan, adat; akhlak, watak; perasaan, sikap, cara berpikir. watak; perasaan, sikap, cara berpikir. Dalam bentuk jamak “etha” yang Dalam bentuk jamak “etha” yang berarti adat kebiasaan (Bertens, 2007)berarti adat kebiasaan (Bertens, 2007)

Etika Etika ~ moral~ moral dalam bahasa dalam bahasa Latin berarti kebiasaan, adatLatin berarti kebiasaan, adat

Secara etimologi etika dan moral Secara etimologi etika dan moral sama artisama arti

Menurut KBBI (1999) Menurut KBBI (1999) Etika berarti: ilmu tentang apa yang baik dan Etika berarti: ilmu tentang apa yang baik dan

apa yang buruk dan tentang hak dan kewajiban apa yang buruk dan tentang hak dan kewajiban moral (akhlak)moral (akhlak)

Etik berarti: Etik berarti: 1. kumpulan asas atau nilai yang1. kumpulan asas atau nilai yang

berkenaan dengan akhlakberkenaan dengan akhlak2. nilai mengenai benar dan salah yang 2. nilai mengenai benar dan salah yang

dianut suatu golongan atau masyarakatdianut suatu golongan atau masyarakat Etiket berarti:Etiket berarti:

1. secarik kertas yang ditempelkan pada 1. secarik kertas yang ditempelkan pada kemasankemasan2. tatacara (adat, sopan santun dsb) dalam 2. tatacara (adat, sopan santun dsb) dalam masyarakatmasyarakat

Values and ethics are relatedValues and ethics are related Values: building blocks for personal and Values: building blocks for personal and

professional morality, influence one’s ethical professional morality, influence one’s ethical decision making, relationship and conductdecision making, relationship and conduct

Values are based on experience, religion, Values are based on experience, religion, education, and cultureeducation, and culture

A person’s ethic flows from his/her valuesA person’s ethic flows from his/her values Ethics is a study of good conduct, character, Ethics is a study of good conduct, character,

and motives, and concerned with and motives, and concerned with determining what is good or valuable for all determining what is good or valuable for all peoplepeople

Ethics in nursing careEthics in nursing care

In nursing, specific values and moral In nursing, specific values and moral requirements are necessary to requirements are necessary to maintain integrity of the professionmaintain integrity of the profession

An ethical nurse will act and treat An ethical nurse will act and treat others in specific ways that are others in specific ways that are consistent with the nursing norms consistent with the nursing norms and will be guided by more than and will be guided by more than personal preferences or valuespersonal preferences or values

An ethic of careAn ethic of care Care: an action, a virtue, an affect, an Care: an action, a virtue, an affect, an

ethical principle, or a way of being in the ethical principle, or a way of being in the worldworld

Care as an ethic for nursing is concerned Care as an ethic for nursing is concerned not only with the resolution of ethical not only with the resolution of ethical dilemmas, but also with the ways people dilemmas, but also with the ways people behave towards one anotherbehave towards one another

An ethic of care is concerned with An ethic of care is concerned with relationship between people and with a relationship between people and with a nurse’s character and attitude toward nurse’s character and attitude toward others.others.

Nurses Code of EthicsNurses Code of Ethics Nursing has developed code of ethics that Nursing has developed code of ethics that

describe ideals for professional conductdescribe ideals for professional conduct Codes reflect ethical principles widely Codes reflect ethical principles widely

accepted by members of the professionsaccepted by members of the professions See Kode Etik Keperawatan Indonesia:See Kode Etik Keperawatan Indonesia:

- Perawat dan klien- Perawat dan klien- Perawat dan praktek- Perawat dan praktek- Perawat dan masyarakat- Perawat dan masyarakat- Perawat dan teman sejawat- Perawat dan teman sejawat- Perawat dan profesi- Perawat dan profesi

Accountability and responsibilityAccountability and responsibility Nurse assumes responsibility and accountability Nurse assumes responsibility and accountability

for nursing care providedfor nursing care provided Responsibility: execution of duties associated Responsibility: execution of duties associated

with the nurse’s particular rolewith the nurse’s particular roleExample: when administering the meds, the Example: when administering the meds, the nurse is responsible for assessing the client’s nurse is responsible for assessing the client’s need for the drug, giving them safely and need for the drug, giving them safely and correctly, and evaluating the responsescorrectly, and evaluating the responses

A nurse who acts in a responsible manner gains A nurse who acts in a responsible manner gains the trust of client and other professionalsthe trust of client and other professionals

A responsible nurse: competent in knowledge and A responsible nurse: competent in knowledge and skills and demonstrates a willingness to perform skills and demonstrates a willingness to perform within the ethical guidelines of the professionswithin the ethical guidelines of the professions

Accountability means being answerable for Accountability means being answerable for one’s own actionsone’s own actions

A nurse is accountable to self, the client, A nurse is accountable to self, the client, the profession, the employer, and societythe profession, the employer, and society

If a wrong dose of meds given, the nurse is If a wrong dose of meds given, the nurse is accountable to the client who receive it, accountable to the client who receive it, the physician who ordered it, the nursing the physician who ordered it, the nursing service that set standard of expected service that set standard of expected performance, and the society, which performance, and the society, which demands professional excellencedemands professional excellence

To be accountable, the nurse acts To be accountable, the nurse acts according to the professional code of according to the professional code of ethicsethics

The purpose of professional The purpose of professional accountability:, accountability:,

To evaluate new professional practices To evaluate new professional practices and reassess existing onesand reassess existing ones

To maintain standards of health careTo maintain standards of health care To facilitate personal reflection, ethical To facilitate personal reflection, ethical

thought, and personal growth on the thought, and personal growth on the part of health care professionalspart of health care professionals

To provide a basis for ethical decision To provide a basis for ethical decision makingmaking

Moral reasoning Moral reasoning ““Doing ethics” involves participating in a Doing ethics” involves participating in a

critical thought process about right and critical thought process about right and wrong, good and bad, or thinking about wrong, good and bad, or thinking about situationssituations

A process that occurs in many client-nurse A process that occurs in many client-nurse interactioninteraction

Developing an understanding of the Developing an understanding of the complex thought process (moral reasoning) complex thought process (moral reasoning) involved in processing ethical situations involved in processing ethical situations helps nurses participate more fully in the helps nurses participate more fully in the discussionsdiscussions

Most moral reasoning happens after an Most moral reasoning happens after an ethical situation has been recognized and ethical situation has been recognized and before one acts on the situationbefore one acts on the situation

Emotions play an important role in ethical Emotions play an important role in ethical reasoningreasoning

People feelings or emotions are different and People feelings or emotions are different and change in the same person from day to day change in the same person from day to day or hour to houror hour to hour

Feelings should be honored, acknowledged, Feelings should be honored, acknowledged, and used as a consideration in moral and used as a consideration in moral reasoning without making ethics simply a reasoning without making ethics simply a discussion about the validity and sincerity of discussion about the validity and sincerity of individual’s feelingindividual’s feeling

Ethics is concerned with developing a system Ethics is concerned with developing a system of shared values in a pluralistic societyof shared values in a pluralistic society

Legal considerations also affect moral Legal considerations also affect moral reasoningreasoning

It is important to consider the law, the policies, It is important to consider the law, the policies, or the guidelines of policy and procedure in or the guidelines of policy and procedure in moral thinkingmoral thinking

Ethics and laws are often in harmony, but not Ethics and laws are often in harmony, but not alwaysalways

Relying on law as the primary consideration of Relying on law as the primary consideration of moral standards is a form of legalismmoral standards is a form of legalism

For example: refuse to act the request a For example: refuse to act the request a terminally ill, competent client to stop terminally ill, competent client to stop treatment, because of practitioners are afraid treatment, because of practitioners are afraid of being sued of being sued

Ethical principlesEthical principles The most fundamental principle: The most fundamental principle:

respect for personsrespect for persons The 4 other primary principles stem The 4 other primary principles stem

from this basic principle:from this basic principle:

1. respect for autonomy1. respect for autonomy

2. beneficence2. beneficence

3. nonmaleficence3. nonmaleficence

4. justice4. justice

Autonomy: individual should have Autonomy: individual should have freedom to choose their own life plan freedom to choose their own life plan and ways of being moraland ways of being moral

The principles of nonmaleficence and The principles of nonmaleficence and beneficence are viewed on a beneficence are viewed on a continuum ranging from not inflicting continuum ranging from not inflicting harm (nonmaleficence) to benefiting harm (nonmaleficence) to benefiting others by doing good (beneficence)others by doing good (beneficence)

Justice: treating others fairly and Justice: treating others fairly and giving persons their duegiving persons their due

The secondary principles:The secondary principles:- veracity: the duty to tell the truth- veracity: the duty to tell the truth- confidentiality; the duty to protect - confidentiality; the duty to protect privileged informationprivileged information- fidelity: the duty to keep promises- fidelity: the duty to keep promises

Informed consent: promotes and respects Informed consent: promotes and respects autonomy by expanding the client’s autonomy by expanding the client’s knowledge of his/her opinionsknowledge of his/her opinions

Advance directives: a form of Advance directives: a form of communication in which the persons can communication in which the persons can give direction on how they would like to be give direction on how they would like to be treated when they cannot speak for treated when they cannot speak for themselvesthemselves

Case for discussionCase for discussion A woman was receiving treatment for advance cancer A woman was receiving treatment for advance cancer

in a large hospital. Her condition deteriorated and in a large hospital. Her condition deteriorated and meaningful recovery from her illness was highly meaningful recovery from her illness was highly unlikely. She was taken to an intensive care unit for unlikely. She was taken to an intensive care unit for impending respiratory failure. She was competent and impending respiratory failure. She was competent and indicated that she did not want any further aggressive indicated that she did not want any further aggressive medical therapies but believed she needed the medical therapies but believed she needed the approval of the male members of her family (her approval of the male members of her family (her brothers), who lived in other city. Efforts were made to brothers), who lived in other city. Efforts were made to contact them and they indicated that they would contact them and they indicated that they would come. Because they had 2 days of travel time, she come. Because they had 2 days of travel time, she had to be placed on a regimen of ventilator therapy had to be placed on a regimen of ventilator therapy and blood pressure medication to prolong her life until and blood pressure medication to prolong her life until they could arrive and decide what to do. The nurse felt they could arrive and decide what to do. The nurse felt moral distress because she believed that the client moral distress because she believed that the client should have been able to make the decision about her should have been able to make the decision about her own life and death by her self. It seemed wrong that own life and death by her self. It seemed wrong that she have to defer to the decision of her brothersshe have to defer to the decision of her brothers

Kerangka pemecahan masalah etikKerangka pemecahan masalah etik

Mengembangkan data dasarMengembangkan data dasar Mengidentifikasi konflikMengidentifikasi konflik Membuat tindakan alternatifMembuat tindakan alternatif Menentukan siapa yang terlibat dan Menentukan siapa yang terlibat dan

siapa pengambil keputusansiapa pengambil keputusan Mengidentifikasi kewajiabn perawatMengidentifikasi kewajiabn perawat Membuat keputusanMembuat keputusan

Pengambilan keputusan etisPengambilan keputusan etis

Menunjukkan maksud baik yang relevanMenunjukkan maksud baik yang relevan Mengidentifikasi semua orang yang Mengidentifikasi semua orang yang

pentingpenting Mengumpulkan informasi yang relevanMengumpulkan informasi yang relevan Mengidentifikasi prinsip etis yang pentingMengidentifikasi prinsip etis yang penting Mengusulkan tindakan alternatifMengusulkan tindakan alternatif Melakukan tindakanMelakukan tindakan

ReferencesReferences

Some text book in fundamentals Some text book in fundamentals nursing & ethics nursing & ethics