Values, Ethics, and Accountability Taylor, chapter 6

Values Ideas or beliefs a person considers highly important. Learned through interactions with social systems such as family, culture, religion, school, work, friends, etc.

Ethics Branch of philosophy dealing with standards of conduct and moral judgment. Professional ethics are values held by a group that has standards to be upheld by its members in all situations. In professional practice, nurses try to avoid allowing personal values to bias their treatment for patients.

Ethics Theories Utilitarianism—base on concept of “The greatest good for the greatest number.” The rightness or wrongness of an action depends on the consequences of the action Deontologic—ethical standards or principles exist regardless of the ends or consequences

Examples of Ethical Guidelines for Practice American Nurse’s Association Code of Ethics--handout The Patient Care Partnership (formerly called The Patient’s Bill of Rights)--handout Principles of Healthcare Ethics

Principles of Healthcare Ethics Autonomy—respecting pts choices Beneficence—doing good Nonmaleficence—avoiding harm Paternalism—combo platter Justice—being fair Fidelity—keeping promises Veracity—being honest Confidentiality—respecting privacy

Autonomy Creating the conditions in which patients can make their own decisions Informed consent and advanced directives protecs the patient’s right for healthcare decision making. Patients of sound mind can choose to be treated or not. We also have to be culturally sensitive Navajo (to speak of ill will cause ill to happen) Asian (may want another to make decision)

Beneficence Doing or promoting good Striving to achieve optimal outcomes Act on behalf of patients to do good as defined by the patient. Administering pain meds, performing dressing changes to promote wound healing, and providing emotional support are acts of goodness.

Nonmaleficence Avoiding or removing harm Protecting patients from impaired co-workers, identifying safety risks and preventing them, and reporting suspected abuse are examples of nonmaleficence.

Paternalism A combo of beneficence and nonmaleficence Intentional limitation of autonomy, justified by the welfare or needs of another The prevention of harm takes precedence over any potential evil caused by interference with the individual’s autonomy or liberty. Consider nursing home placement for the elderly and tube placement for anorexic patients

Justice Treating everyone with dignity and respect Providing comparable care A just healthcare system provides care on the basis of medical need and the degree of that need rather than ability to pay, social status, racial identity, or gender. Deciding how much time to spend with a patient should be based on need not how likable they are. Nurses should be aware of government and community resources for assistance

Fidelity Being faithful to one’s commitments or promises. Providing safe care and maintaining competence. Contract that exists between the patient and the nurse—what the patient can expect regardless of the nurse’s age, background, or personal values.

Veracity Telling the truth and being honest with patients The right to self-determination becomes meaningless if the patient does not receive accurate, unbiased, and understandable information. One common dilemma is whether to tell the patient and/or family about a med error.

Confidentiality Required that patient info remain private Professional duty and legal obligation Only those caring for patient have access unless patient signs consent Nurses have right to access patient’s record, but need to be sure they are doing it for only care-related reasons.

Examples of Ethical Problems Nurse/patient: Paternalism Withholding information Confidentiality Allocation of scarce nursing resources Advocacy in market driven environment Valid consent or refusal Conflict between patient/nurse interest Conflicts concerning new technology

Examples cont’d Nurse/Patient cont’d Withdrawing or withholding tx Family conflicts over care Client mistreatment by staff Maternal issues Pain control

Examples cont’d Nurse/HCP: Disagreement about proposed medical regimen Conflict regarding scope of nurse’s role Unprofessional, incompetent, unethical, or illegal HCP practice

Examples cont’d Nurse/Institution: Nurse/Nurse: Short staffing and whistleblowing Healthcare rationing Nurse/Nurse: Claims of loyalty Unprofessional, incompetent, unethical, or illegal nurse practice

Resolution of Dilemmas Ask if this is an ethical dilemma Gather info (assess) Verbalize problem Consider possibilities Examine your own values Negotiate the outcome Evaluate the action

Functions of Ethics Committee Education Policy recommendation Case consultation or review

Accountability Being attentive and responsive to the healthcare needs of individual patients Concern for patient transcends whatever happens during the shift Ensuring continuity of care when leave patient Try to maintain good judgment—remember that you are not totally responsible for the patient’s outcome.

Accountability The ability and willingness to assume responsibility for ones actions and accepting the consequences of one’s behavior Reliable, trustworthy, credible ANA says, “Being answerable to someone for something done.” Being fully accountable requires autonomy and authority.

To Whom is the Nurse Accountable? The patient The profession Other members of the healthcare team To the employer To self

Accountability to the Profession ANA Code for Nurses Nursing Quality Assurance & Quality Improvement Programs Participate as a member of professional nursing organization(s)

Accountability to Clients Clinical competence: knowing how & why things are done Safe nursing care Allow clients to participate in nursing care activities, including planning Respect individual client differences Altruistic intentions Serve as a client advocate when the need arises

Accountability to Healthcare Team Bring specialized nursing knowledge & skills to the health care delivery situation Share information with team members Confront if potential errors may occur Perform nursing tasks with competence Treat members with dignity & respect

Accountability to Employer Quality of work Protect against unsafe practice situations Attitude conveyed about the agency

Accountability to Self Practice nursing to personal standards using professional standards as a basis Be true to oneself Take care of personal, physical, mental, & spiritual health Protect self from harm

Competence Keeping up with new practices in your area Make sure these practices are evidence-based and researched Maintain competency requirements set up by the BON