1. Ethics Applied to Nursing
Chapter 19
Ethics Applied to Nursing

2. Chapter 19
Lesson 19.1

3. Learning Objectives
List four current ethical issues of concern in twenty-first century health care.
Explain the differences among ethics, morals and values.
Explain nursing ethics.
Identify ethical elements in your state’s Nurse Practice Act.
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4. Learning Objectives (cont’d)
Describe how the role of nursing has changed since the introduction of the nursing process and critical thinking into nursing curricula.
Discuss how nonmaleficence is more complex than the definition of “do no harm.”
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5. Ethical Issues in 21st Century Health Care
In Vitro Fertilization
Artificial Insemination
Surrogate Motherhood
Cloning
Organ Donation
Including cadaver, child, and aborted fetus donations
Stem Cell Research/Procedures
Discuss how new and progressive technology brings up new ethical and moral issues.
Ask class members how they feel about nurses being seen as an authority on ethical issues because they are medical professionals.
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6. Ethical Issues in 21st Century Health Care (cont’d)
Abortion
Euthanasia
Assisted Suicide
Advance Directives
Living wills, power of attorney
Right to Die
How does autonomous decision making come into play in these ethical issues?
Briefly review with the class your state’s legislation on advance directives.
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7. Ethics
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
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8. Morals and Values Morals Values
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
Values are based on an individual’s age, experience, and maturity level.
What are some examples of people’s values changing as they move through life?
Ask the class if in their lifetime they have noticed a change in their values.
The teen years are a time of trying out family values and either incorporating them or rejecting and replacing them with new values.
How are morals and values different? How are they similar?
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9. Nursing Ethical and Legal Responsibilities
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
Nursing ethics goes beyond the legal implications outlined in the Nurse Practice Act.
A nurse may disagree with a patient’s beliefs and lifestyles, but nothing should interfere with the nurse’s belief in providing good nursing care for all patients.
How can a nurse resolve a conflict of personal values with those of a patient?
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10. Ethical Codes in Nursing
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
Nurse Practice Acts differ from state to state, so it is important to understand those in each state in which the nurse holds a license to practice.
In what ways do ethical codes from professional organizations serve as important guidelines for practice?
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11. Your Personal Code of Ethics
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.
What should you do if you object to a medical procedure on religious or moral grounds?
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12. Roots of Nursing Ethics
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.
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13. What Changed? 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.
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14. What Changed?
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 be 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.
Nursing textbooks and curricula both had to change to reflect nursing process, critical thinking, and a focus on the total patient (not just the diseased portion of the patient).
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15. Changing Role of Nursing
Began to see the patient as more than just a disease
Western Secular Belief System
Individual autonomy: patient’s freedom to choose
Individual rights: patients rights are limited if they clash with the health professional’s
Ethical and Legal Responsibilities
Patient advocacy
Accountability
Peer reporting
Ethical issues in nursing are more frequently encountered due to advances in life-prolonging technology.
What ethical, moral, or values situations might a nurse encounter today that he or she might not have experienced 50 years ago?
The Western secular belief system has also contributed to the introduction of principles that revolve around personal choice in determining life and death and end-of-life issues.
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16. Ethics Committees
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.
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17. Western Secular Belief System
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).
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18. Western Secular Belief System
Individual Rights
The ability to assert one’s rights
The extent to which a patient can exert their 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 or refuse treatment
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19. Ethical Responsibilities of Nurses
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.
Sometimes, a problem arises that appears to be an ethical problem.
It may instead be a problem of communication or trust or insufficient information
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20. Principles of Ethics
You can add knowledge of basic ethics to critical thinking as you assist the RN with 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.
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21. Principles of Ethics
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
Nonmaleficence is often a difficult principle to strictly adhere to.
This is because health care professionals could be required to perform something perceived as harmful during the process of improving a patient’s condition.
What are some examples of “harmful” consequences of a beneficial treatment?
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22. Chapter 19
Lesson 19.2

23. Learning Objectives
Differentiate between beneficence and paternal beneficence.
Explain the steps for an autonomous decision.
Describe how fidelity affects nursing care.
Discuss how a nurse applies the principle of justice to nursing.
Discuss the role of beneficent paternalism.
Differentiate between ethical and legal responsibility in nursing.
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24. Beneficence
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
The common belief in nursing should be that the patient’s needs come first, before the nurse’s personal or professional needs of the moment.
Administrative or paperwork requirements, although inconvenient, can wait until the patient’s needs have been met.
How can a nurse self-monitor his or her behaviors to ensure that patient needs are placed first?
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25. Autonomy (Free to Choose)
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
In order to make an autonomous decision, an individual must have all the facts.
What are some examples of situations in which an individual must progress through each of the four steps to ensure a positive outcome?
What is an appropriate role for the nurse?
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26. Autonomy (Free to Choose) (cont’d)
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
It is the physician’s responsibility, not the nurse’s, to obtain informed consent from the patient.
Cosigning the consent if you witnessed the process of informed consent is appropriate.
How should a nurse respond if a patient chooses not to follow a prescribed course of treatment?
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27. Fidelity (Be True)
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
Many nurses find fidelity to be extremely frustrating at times, especially when family members challenge medical opinions.
Is fidelity always crystal clear? What are some examples of gray areas?
Talking to a nursing colleague or supervisor may help the nurse maintain perspective.
Patient confidentiality must be maintained at all times.
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28. Justice (Fair to All)
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.
Which concepts in the ethics of nursing do students anticipate will be the most challenging? Why?
Treating each patient with justice enables the nurse to minimize psychological stress.
This is because the nurse can feel confident that he or she has provided the best patient care possible.
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29. Paternalism and Women’s Health
Anything that is normally different from men is considered an illness and requires the physician’s intervention.
Because women are different from men biologically, medicine has defined what is normal for women as being abnormal.
Women are seen as victims of their own bodies who cannot help being sick.
Your responsibility is to advocate for your female patient.
Speak up when you see decisions being made on incomplete information.
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