1. Rank Each Profession by Level of Trust Teacher Clergy Doctor Nurse Attorney

2. Presented by Marlene Meador RN, MSN, CNE

3. Ethics vs. Morals Ethics- by definition is the study of philosophy that deals with the distinction between right and wrong, and the moral consequences of human action. Morals- pertaining to the rightness or wrongness of an act. Stedman’s Medical Dictionary for the Health Professions and Nursing, 2005

4. Code of Ethics ANA - Code of Ethics for Nurses The Code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. ANA web page http://nursingworld.org/MainMenuCategories/ThePra cticeofProfessionalNursing/EthicsStandards/CodeofEt hics.aspx http://nursingworld.org/MainMenuCategories/ThePra cticeofProfessionalNursing/EthicsStandards/CodeofEt hics.aspx

5. ANA Code of Ethics for Nurses 1. Practices with compassion and respect for inherent dignity 2. Commitment is to the patient. 3. Promotes, advocates for and strives to protect the health, safety and rights of the patient. 4. Responsible and accountable for nursing practice & delegation of tasks to provide optimum care. 5. Owns the same duties to self as to others; preserve integrity, maintain competence & professional growth.

6. ANA Code of Ethics for Nurses 6. Participates in establishing, maintaining, and improving health care environment. 7. Contributes to advancements of the profession through contributions in practice, education, administration & knowledge 8. Collaborates with other health professionals and the public in promoting community, and national efforts to meet health needs. 9. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social policy.

7. Ethical Principles and Nursing Practice (p.11 Box 1-3) Beneficence- a nurse is required to promote good for others Nonmaleficence- “do no harm” a nurse must avoid risk or causing harm to others Autonomy- respect of self-determination (patient’s right to respect, privacy, and information necessary for decisions) Justice- duty to treat others fairly Fidelity- obligations to the client

8. Developmental Stages of Value Formation Kohlberg Theory Preconventional: 4-7yrs Conventional: 7-12 yrs Post Conventional: 12+ Page 136 McKinney Imprinting: 0-7 years Modeling: 8-13 years Socialization: 14-20 yrs Value Development: 20+ years

9. Kohlberg Theory Derived from Piaget’s cognitive theory Preconventional- 4-7 yrs: decisions based on desire to please others and “avoid punishment” Conventional- 7-12 yrs: conscience or internal standards important- follow rules and be good “fairness” comes into play Post Conventional- >12 yrs: internalized ethical standards to base decisions on different moral approaches “social responsibility”

10. Social & Cultural influences on value/ethical development: Family Friends Religion Geography School Family Income Nursing

11. Ethical Dilemma No absolute right or wrong answer Both sides have merit Outside the scope of written law

12. Role of Ethics Committee: Act as representative for the clients who cannot speak for themselves Render judgment when an ethical dilemma exists

13. Members of the Ethics Committee: What members of the healthcare team does the ethics committee need? Who should not serve on an ethics committee?

14. Ethics Committee at Work Review previous ethical decisions and adapt to current standards of care and culture If an dilemma occurs the committee must render a judgment in writing based on the evidence presented and values of the facility.

15. Professional Obligations Nurses have no obligation to support a position with which they disagree. Must relinquish care using appropriate means: Notify immediate supervisor prior to providing any care Make certain that the patient is cared for by a qualified member of the nursing staff (cannot delegate to lesser healthcare provider)

16. Current Issues Related to Childbearing and Childrearing Definition of family Gestational vs. genetic parental rights Maternal vs. fetal rights

17. Nursing Process and the Ethical Dilemma Assessment Analysis Planning Implementation Evaluation

18. Note from another professor (aka: something to think about) “ Many health care providers claim to utilize the problem solving model when in fact they often determine their course of action and then use ethical principles to rationalize their response.” Marita Peppard RN, DN

19. Use the nursing process to reach a decision on the following: What would you do? A woman serves as a surrogate (gestational mother= egg + sperm of biologic couple). During the labor and delivery process she decides she wants to keep the newborn. Does your response change if the egg belongs to the surrogate?

20. A couple undergoes in vitro fertilization with successful implantation of 5 embryos. The obstetrician suggests selective reduction of 3 embryos as a measure to increase viability of the pregnancy

21. What is the nurses’ role? A fetus is delivered at 37 weeks gestation. Anencephaly is discovered at delivery. The parents decline medical intervention and request that no extraordinary measures prolong the newborn’s life. In the current situation the newborn is unable to suck and swallow, has no brain waves and no cry. The parents, physician and hospital agree on the plan of treatment. An outside source learns of the situation and notifies the press and other groups who actively seek legal action for life support for this infant.

22. What is the role of the nurse as client advocate? A young child sustains a brain injury and prognosis is dire. The physicians place the child on life support and attempt to correct the injury. As time passes the prognosis worsens and the physicians seek world- wide assistance to locate additional treatment to benefit the child or transfer to another facility. The physicians/hospital order removal from life support and the mother refuses to remove the child from life support equipment.

23. Let’s do some math:

24. 1 One Nurse

25. 5 patients/day X 5 days/week 25 patients/week

26. x 50 weeks/year 1250 patients/year

27. x 25 years 31,250 patients/career

28. 31250 pts/career X 20 people who love them 625,000 people you will impact in the course of your nursing career

29. 610,000 Population of Austin, Texas for 2000 census

30. Thank you for choosing to become a nurse. We need highly trained, ethical individuals to carry the lamp.

31. It has been my pleasure to share the art of nursing with you this semester. Please contact me if you have any questions or concerns regarding this lecture Marlene Meador RN, MSN, CNE mmeador@austincc.edu