44 Nursing: A Concept-Based Approach to Learning Ethics MODULE VOLUME TWO | SECOND EDITION 44 MODULE Ethics

The Concept of Ethics Ethics Morality Standards governing behaviors and relationships Morality Personal standards of right and wrong 2

Values Values Personal beliefs about truth and worth of behaviors, thought, objects Beliefs Interpretations or conclusion that one accepts as true 3

Professional Values Values essential for the professional nurse Altruism Autonomy Human dignity Integrity Social justice 4

Principles of Ethical Decision Making Autonomy Beneficence Nonmaleficence Justice Veracity 5

Commitment to include patients in decisions Beneficence Autonomy Commitment to include patients in decisions Beneficence Taking positive actions to help others Nonmaleficence Avoidance of harm or hurt Justice Being fair Fidelity Agreement to keep promises Veracity Truth telling •Ethics describes right and wrong behaviors. •Ethical issues differ from legal issues. Legal issues will be discussed in Chapter 23. •Standards of ethics in health care include autonomy, beneficence, nonmaleficence, justice, and fidelity. •Respect for autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence. •The principle of beneficence is fundamental to the practice of nursing and medicine. •Maleficence refers to harm or hurt; thus nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good, but an equal commitment to do no harm. •Justice refers to fairness. It is used most often in discussions about access to health care resources, including the just distribution of resources. •As a nurse, you keep promises by following through on your actions and interventions.

Nursing Codes of Ethics General codes of ethics Guide for a profession's membership, social contract with public that it serves American Nurses Association (ANA) Code of Ethics for Nurses International Council of Nurses (ICN) Code of Ethics 7

The ANA Code of Ethics The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. Code of Ethics [Box 22-1 (on text p. 287) covers the entire ANA Code of Ethics (the first and summary paragraphs are shown on the slide)]. [Have one of the nursing students read the first paragraph. Then review the specific points below before covering the summary paragraph (second bullet on the slide) after a student reads the paragraph.] •Following are the specific points of the code: •The nurse’s primary commitment is to the patient, whether an individual, family, group, or community. •The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. •The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. •The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. •The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. •The nurse participates in advancement of the profession through contributions to practice, education, administration, and knowledge development. •The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. (Copyright © 2001 Code of Ethics for Nurses with Interpretive Statements. By American Nurses Association. Reprinted with permission. All rights reserved.)

Strategies to Enhance Ethical Decisions and Practice Strategies to help nurses Becoming aware of own values, ethical aspects of nursing Becoming familiar with nursing codes of ethics Seeking opportunities for education Respecting values, opinions, responsibilities 9

Exemplar 44.2 Patient Rights

Overview Patient rights Nurses should be aware of national and state laws pertaining to patient rights 11

Nursing Practice Follow ANA Code of Ethics Adhere to employer's policies Make use of additional resources 12

Nursing Practice, continued Ensure patient rights Bill of Rights Box 44-7 Information disclosure Choice of providers and plans Access to emergency services Participation in treatment decisions Respect and nondiscrimination Confidentiality of health information Complaints and appeals 13