1. Ethical Concerns in Nursing Practice

2. Learning Objectives:
1. Discuss the concepts of ethics and morality and how they are applied in the healthcare field. 2. Describe ethical decision making 3. Explain the Codes for Nurses, and documents addressing patients’ rights are used as a basis for ethical decision making. 4. Outline a framework for ethical decision making.

3. Introduction
Have you ever overheard a physician discussing with a patient’s family whether to start an elderly comatose patient on a series of antibiotics to treat pneumonia? Or perhaps you have observed a staff nurse leaving the unit after completing the shift with a pocket full of pens, Band-Aids, or tape.
These are examples of situations that involve moral and ethical judgments.
Judgments as to what is right, what is wrong, and what one ought to do in a given situation.

4. Terminology Related to Ethics
Ethics: Specific area of study of morality that concentrates on human values.
Ethics of care: Focuses on those traits valued in intimate personal relationships, such as compassion, love, sympathy, and trust.
Moral: Generally accepted as dealing with what is good and what is bad, what is right and what is wrong

5. Ethical vs. Unethical Decisions
Ethical decision – reasonable and acceptable because it aids stakeholders, organization, and society.
Unethical decision- decision that a manager would prefer to hide from other people because of individual gain is placed above others needs.

6. Ethical Perspectives for Evaluating Behavior
Societal
Organizational
Legal
Individual

7. BASIC ETHICAL CONCEPTS

8. 1. Autonomy
Autonomy involves the right of self-determination or choice, independence, and freedom.
As with most other rights, there may be restrictions on the right to choose, autonomy does not mean that individuals can do anything they want.
So what happens when the family decision is not what health providers think is best for the patient?

9. 1. Autonomy Individual rights Privacy Freedom of choice Examples:
informed consent.
Patient has right to know procedure, complications, other options.

10. 2. Beneficence and Nonmaleficence
Beneficence: means “doing good”
Nurses should implement actions that benefit clients and their support persons.
Such as nursing care.
Nonmaleficence:
Harm can mean deliberate harm, risk of harm, and unintentional harm.
In nursing, intentional harm is always unacceptable.
Such as injection.
Duty: NOT TO CAUSE harm
Duty: PREVENT harm
Duty: REMOVE harm

11. 3. Justice
Justice and fairness in nursing care is often related to the delivery of services
E.g. busy unit, new admission

12. 4.Fidelity
Fidelity refers to the obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others, both implicitly and explicitly.
Fidelity is the foundation of the concept of accountability that we hear about so often in nursing today.
Implicit – those promises that are implied, not verbally communicated.
Like when patient comes into the hospital, they expect to be cared.
Explicit – those that we verbally communicate
Like if you tell patient you’ll be back with pain meds, you’d better come back.

13. 5. Veracity Refers to telling the truth
As a nurse should I tell the truth when it is known that doing so will cause harm?
Does tell a lie when it is known that the lie will relieve anxiety and fear?
Should I lie to dying people?
The obligation to tell the truth and not to lie or deceive others.

14. 6. Paternalism
When one individual assumes the right to make decisions for another
Limits freedom of choice
Examples:
Parents making decisions for children
Terminal cancer patient

15. Nursing Codes of Ethics
A code of ethics is a formal statement of a group’s ideals and values.
It is a set of ethical principles that is shared by members of the group, reflects their moral judgments over time and serves as a standard for their professional actions.
International, national, state nursing associations have established codes of ethics

16. Nursing Codes of Ethics (purposes)
To inform the public about the minimum standards of the profession.
To provide a sign of the profession’s commitment to the public it serves.
To outline the major ethical considerations of the profession
To guide the profession in self-regulation
To remind nurses of the special responsibility they assume when caring for clients.

17. Nursing Codes of Ethics (elements)
Nurses and people
Nurses and practice
Nurses and the profession
Nurses and the co-workers

18. American Nurses Association (ANA) Code of Ethics
Applies to all nurses in all healthcare settings
Ethical principles agreed upon by members of the nursing profession
Sets standards of conduct and behaviors for nurses

19. ANA Code of Ethics – Key Points
Primary commitment is to patient (individual, family or community)
Demonstrates compassion and respect for all patients regardless of patient status
Promotes the health and welfare of patients.
Accountable for individual practice.
Maintains and increases own knowledge base.
Works to improve healthcare environment for providers and patients.

20. ICN Code of Ethics International Council of Nurses Code of Ethics
4 fundamental responsibilities of Nurses
Promote health
Prevent illness
Restore health
Alleviate suffering

21. Nursing Code of Ethics: General Nursing Administration, MOH-KSA
Code of Ethics: a branch of philosophy dealing with standard of conduct and moral judgments Purpose: To provide basis for interpreting and analyzing clinical situations in decision making.
Nursing Directorate, MOH-KSA,

22. Patient’s Bill of Rights
Affirms the basic human rights of all clients who seek health care services to:
Receive considerate and respectful care
Obtain complete medical information
Receive information necessary for giving informed consent
Refuse treatment
Request services
Refuse participation in research projects
Expect reasonable continuity of care
Be informed of institutional regulations
Have privacy
Have personal information and medical records treated confidentially
Be provided with information on other institutions and individuals related to care and treatment
Examine and obtain explanations of financial charges
.library.armstrong.edu

23. Ethical decision-making
refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternative.

24. How to make an ethical decision
1. Identify the problem
2. Gather additional information
3. Identify all options open to the decision maker.
4. Think the situation through.
5. Make the decision
6. Act and assess the decision and its outcomes
.library.armstrong.edu

25. Factors that influence EDM
Codes for Nurses
The patient’s rights
Social and cultural attitudes
Science and technology
Legislation
Funding
Personal religious and philosophic viewpoint

26. Ethical Dilemmas
An ethical dilemma is a decision-making problem between two possible moral imperatives.

27. How to manage an Ethical Conflict
Discuss the client care situation with the following:
Another nurse
Nursing leadership
A representative from the Ethics Committee
The patient or the patient’s family
The patient’s physician
A religious counselor

28. Ethics Committees
With the increasing complexity of ethical issues in health care, ethics committees have been created to assist in making ethical decisions in clinical settings. Ethical committees can:
1. Provide structure and guidelines for potential problems.
2. Serve as an open forum for discussion and debate.
3. Function as a patient advocate by placing the patient at the core of the committee’s deliberations.

29. Examples
Euthanasia
Greek words meaning “easy death”.
Euthanasia is an act by which the causative agent of death is administered by another with the intent to end life.
Assisted Suicide
Patient actively seeks physician/nurse to “help” them commit suicide

30. References
Ethics in Community-Oriented Nursing Practice. Chap _MAHAN/500006dunCh6.pdf
International Council of Nurses [ICN] (2012). The ICN Code of Ethics for Nurses. Geneva, Switzerland.
Code of Ethics for Healthcare Practitioners
MOH-KSA, General Directorate of Nursing. (2011). Manual of Nursing Policies and Procedures (2nd ed.).