1. N246 Leadership Ethics & Quality S
N246 Leadership Ethics & Quality S. Buckley, (Adapted from Nursing Leadership and Management, Whitehead, Weiss, Tappen)

2. In the beginning… There were no antibiotics There were no ICUs
There were no CT scanners and MRIs
There were just physicians and nurses who cared for people in sickness and in health
Were there ethics?

6. Early nursing leaders

9. finances

10. 1960s
Technological advances allowed for the development of intensive care units
New biomedical developments
Advances in surgical techniques, such as open heart surgery

11. Reasons for new inquiries in nursing
Technological advances created new questions for health-care professionals regarding the use of technology, RN role and outcomes
Changing views and perspectives on the concepts of life and death
Dissatisfaction of RN’s with traditional manner of learning (mentoring) and desire to have a scientific base for practice (professional scientists)
Interest by healthcare practitioners about application of values in professional practices, and how to discuss these issues.

12. Bioethics
A sub discipline of ethics
The study of medical morality

13. Concepts of Ethics
Ethics evolve from moral perspectives, which form values and standards. Influenced by families, environment, social issues, culture, religion, cognition, law.
Ethical action depends, in part, on the ability of people to recognize that a moral issue exists in a given situation, knowing how to take appropriate ethical action if and when required, and on personal commitment and a genuine desire to achieve a moral outcome
(Johnstone, 1999, from:Ethics in Nursing Practice, 2nd ed, Fry, S.T,Johnstone, M.)

14. Value Systems definitions
A set of related values
Intrinsic values-located within, the real nature of a thing.
Extrinsic values-from without
Personal values
Professional values
Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.

15. Historical values of nursing:

16. Nursing today
Values in nursing today:

17. Value Formation
Values are learned-therefore, influenced by family, culture, environment, cognition.
Values change with maturity and experience
The number of values an individual holds is not as important as what values they consider important

18. Types of Values
Personal
Cultural
Religious
professional

19. Values Clarification Critical thinking Choosing
Identifying-verbalizing?
Acting

20. Belief Systems
These are organized ways of thinking about why people exist within the universe
Their purpose is to explain such concepts as:
Life and death
Good and evil
Health and illness
Individualism/rights

21. ETHICS AND MORALS

22. Morals An individual’s own code for acceptable behavior
Standards of goodness or rightness that arise from an individual’s conscience
They act as a guide for individual behavior
Learned
Capable of making a distinction between right and wrong in conduct

23. Values
Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.

24. Standards
Something established for use as a rule or basis of comparison in measuring or judging quality, value, extent.

25. Laws
Rule of conduct established and enforced by the authority, legislation or custom of a given community, state, or other group.
May change with fluctuating social morals and viewpoints.

26. Ethics
Having to do with moral standards, conforming to the standards of conduct of a given professional group. Implies conformity with an elaborated, ideal code or moral principles.
Concerned with the motivation behind the behavior
Bioethics is the application of these principles to life-and-death issues

27. Ethical Theories
Deontological-based on duty to commitment, considers the intention of the action, not the consequences of the action. It is the individuals goodwill that determines worthiness, not the outcome.
Teleological-(utilitarianism)-what makes an action right or wrong is its usefulness. Right encompasses actions that have positive outcomes, wrong is composed of actions that result in poor outcomes.
Principalism-involved in biomedical issues, integrates ethical principles to resolve conflicts in situations.

28. Ethical Principles Autonomy Nonmaleficence Beneficence Justice
Fidelity
Confidentiality
Veracity
Accountability

29. Autonomy The freedom to make decisions about oneself
Nurses need to respect clients’ rights to make choices about health care

30. Nonmaleficence
Requires that no harm be caused to an individual, either unintentionally or deliberately
This principle requires nurses to protect individuals who are unable to protect themselves

31. Beneficence This principle means “doing good” for others
Nurses need to assist clients in meeting all their needs
Biological
Psychological
Social

32. Justice Every individual must be treated equally
This requires nurses to be nonjudgmental

33. Fidelity Loyalty The promise to fulfill all commitments
The basis of accountability (moral concept that involves acceptance by a professional nurse of the consequences of a decision or action)

34. Confidentiality
Anything stated to nurses or health-care providers by clients must remain confidential
The only times this principle may be violated are:
If clients may indicate harm to themselves or others
If the client gives permission for the information to be shared

35. Veracity This principle implies “truthfulness”
Nurses need to be truthful to their clients
Veracity is an important component of building trusting relationships

36. Accountability
Individuals need to be responsible for their own actions
Nurses are accountable to themselves and to their colleagues

37. Ethical Codes
These are formal statements of the rules of behavior for a particular group of individuals
Ethical codes are dynamic
Most professions have a “code of ethics” to guide professional behavior

38. Organizational Ethics
Focus on the workplace
Ethical culture makes a difference
Senior leadership must promote an ethical culture-do they?

39. Ethical Dilemmas
Occur when a problem exists between ethical principles
Deciding in favor of one principle usually violates another
Both sides have “goodness” and “badness” associated with them

40. Ethical decision making
Consider cause, variables, precipitating events and implications
Reflect upon one’s own perspective and values
Explore options for action:
ANA code of ethics, facility standard and ethics, nurse practice act (BRN), legal issues, rights.
Select appropriate plan. Understand consequences of the plan.
Implement
Evaluate results

41. Current Ethical Issues

42. Issues to Consider Assisted suicide
Technology issues-as RN, as patient.
Gene therapies, genetic counseling
“Designer babies”, fertility issues, fetal success
Organizational climate
Family planning
Social responsibility
Immigration policies
Resource management.
Stem cell research
DNR status

43. Conclusion
An issue is not an ethical issue for the nurse unless he or she has been asked
Always gather the facts prior to decision-making
Consider your personal beliefs and values

44. Quality issues What is it??
The degree of excellence that distinguishes one thing from another
Relates to education and practice; professionals perceive that they are providing high-quality nursing education and patient care.

45. Why do we need it?
* current health care system is fragmented, poorly organized, inefficient use of resources.
*New technologies, availability of information (it), decreasing resources, increasing chronic disease states mandate a change.
* consumer dissatisfaction with current system

46. Quality improvement
Also known as performance improvement, focuses on processes or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change or improve the quality of care.(Saunders NCLEX review, 5th edition, Silvestri, L.,2011)

47. Professional organizations that focus on quality
* Joint commission on Accreditation of Healthcare Organizations (JACHO)
* American Nurses Association (ANA)
*Institute of Medicine (IOM)

48. IOM essential competencies
Provide patient centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement
Use informatics

49. Aims of IOM quality of care
Safe
Effective
Patient centered
Timely
Efficient
equitable

50. IOM- cost of inefficiency
44,000-98,000 die each year
$17-29 billion in total costs
Nursing errors:
*Medication
*knowledge
*procedure

51. Continuous Quality improvement (CQI)
Identify indicators
Collect ongoing data on indicators
Analyze and evaluate data
Implement change
(utilize evidence based practice)

52. How to monitor quality of care
Guidelines
Protocols
Algorithms
Standards of care
Critical pathways

53. How does structured care methodologies work?
Link process of care (issue) and outcome
Determine method of measurement
Clarify responsibilities of interdisciplinary team
Facilitate communication among team members
Document, apply systematic approach to measurement.

54. Root cause analysis Process of learning from consequences;
Determine influences, establish linked chains of influences, determine necessary influences, analyze root (initial) cause.
Currently used to analyze errors and mistakes; attempts to evaluate series of events that may lead to errors (safety errors) and determine causative reason for error (process), rather than punitively blame a person

55. Risk management part of QA Identify potential problems, risks
Incident investigation
Sentinel events
Anticipate outcome, prevent recurrence

56. conclusion To enhance quality of care; Think critically
Plan and report outcomes
Make introductory rounds
Plan partnership with the client
Communicate plan
Evaluate progress