1. Ethics

2. The systematic study of what a person’s conduct and actions ought to be with regard to him- or herself, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships ought to be, not necessarily what they are.

3. Ethical Issues Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals.

4. Nurses as Agents Bruhn – Bruhn (2005) contends that it is often the interaction of the culture of the organization and the character of the leader that creates ethical failure.

5. The Management Challenge Because personal, organizational, subordinate, and consumer responsibilities differ, there is great potential for managers to experience intrapersonal conflict.

6. Moral Uncertainty and Moral Conflict Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Also referred to as moral conflict “when the duties and obligations of health care providers or general guiding ethical principles are unclear” (Jormsri, 2004, p. 217).

7. Moral Distress and Moral Outrage On the other hand, moral distress is the result of the individual knowing the right thing to do, but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it.

8. Reminder The way managers approach and solve ethical dilemmas is influenced by their values and basic beliefs about the rights, duties, and goals of all human beings.

9. Ethical Dilemma Defined as making a choice between two or more equally undesirable alternatives. The individual who must solve an ethical dilemma is the only person who can ascertain if actions taken were congruent with personal values. Self-awareness is vital in ethical decision making, as it is in other aspects of management.

10. Three Characteristics of an Ethical Dilemma (Leah Curtin, 1982) 1. The problem cannot be solved using only empirical data. 2. The problem must be so perplexing that it is difficult to decide what facts and data need to be used in making the decision. 3. The results of the problem should have far- reaching effects.

11. Three Approaches to Ethical Decision Making Deontological—duty-focused normative approach centered on rules from which all action is derived. Teleological—outcome-focused approach that places emphasis on results and protects the interest of the majority. Situational—no prescribed rules, norms, or majority-focused results that must be followed.

12. Frameworks for Ethical Decision Making Utilitarianism Duty-based reasoning Rights-based reasoning Intuitionism

13. Principles of Ethical Decision Making Autonomy – Promotes self-determination/freedom of choice Beneficence – The actions one takes should be done in an effort to promote good. Non-malfeasance – To do no harm Paternalism – One individual assumes the right to make decisions for another.

14. Utility – The good of the many outweighs the wants/needs of the individual. Justice – Seeks fairness. – Treats “equals” equally. – Treats “unequals” according to their differences. Veracity – The obligation to tell the truth. Fidelity – The need to keep promises. Confidentiality – Keeping privileged information private.

15. To Make Appropriate Ethical Decisions: The manager must use a professional approach that eliminates trial and error and focuses on proven decision-making models or problem-solving processes.

16. The MORAL Decision Making Model (Crisham, 1985) M—Massage the dilemma. O—Outline options. R—Review criteria and resolve. A—Affirm position and act. L—Look back. Evaluate the decision making.

17. Error in Ethical Problem Solving An error made by managers in ethical problem solving is using the outcome of the decision as the sole basis for determining the quality of the decision making.

18. Ethics in Action In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse–managers involves some ethical component. Perhaps the most important thing a manager can do to create an ethical work environment is to model ethical behavior.

19. Structured Approach to Problem Solving “If a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, even with a poor outcome, the manager should accept that the best possible decision was made at that time with the information and resources available.”

20. Professional Codes of Ethics One tool managers can use for guidance in ethical problem solving is a Professional Code of Ethics. A code of ethics is a set of principles, established by a profession, to guide the individual practitioner. The first code of ethics for nurses was adopted by the American Nurses Association in 1950 and has been revised five times since then. Professional codes of ethics do not have the power of law. They do, however, function as a guide to the highest standards of ethical practice for nurses.

21. Reasons Why Ethics Is Becoming a Greater Force in Management Decision Making Increasing technology, regulatory pressures, and competitiveness among health care providers National nursing shortages Reduced fiscal resources Spiraling costs of supplies and salaries The public’s increasing distrust of the health care delivery system and its institutions

22. Legal and Ethical Are Not the Same! Illegal Unethical Legal Unethical Illegal Ethical Legal Ethical

23. Institutional Review Boards (IRB) Primarily formed to protect the rights and welfare of research subjects.