1. Way of applying legal and ethical aspects throughout providing optimal nursing care Prepared by Dr. Hanan Said Ali

2. Learning objective Explain the ways of how to apply legal and ethical aspects throughout providing optimal nursing care Explain the ways of how to apply legal and ethical aspects throughout providing optimal nursing care

3. A model for moral deci sion making in crisis situation It is comprising five steps: Assessing the situation. Diagnosing or identifying the moral problems. Setting moral goals and planning an appropriate moral course of action. Implementing the moral plan of action. Evaluating the moral outcomes of the action implemented.

4. Step one: What is Happening (Assessment) The first step asks’ what is happening? This first step asks questions, gathers information, assesses, and builds up a body of knowledge.

5. Step one: What is Happening (Assessment) Kind of questions that may be necessary or helpful: What is happening? Who are the people directly involved here? Who are the people indirectly involved? What is the role of each involved person? What is the history of the problem? How does each person perceive the problem?

6. Step one: What is Happening (Assessment) Kind of questions that may be necessary or helpful: Is it an actual or a potential problem? Why is it a problem that cannot be solved easily? Which facts are important? Which facts are irrelevant or unimportant?

7. Step one: What is Happening (Assessment) Kind of questions that may be necessary or helpful: How is this problem like or unlike other situations or similar cases? What are the dominant presenting feeling or memories? What particular values are involved? Can they be named precisely ( exactly)? Is it a question of opposing values?

8. Step one: What is Happening (Assessment) Kind of questions that may be necessary or helpful: What are the basic (human) needs involved? What are the wants and desires of the individuals concerned? Are there aspects that can be changed or cannot be changed?

9. Step one: What is Happening (Assessment) Kind of questions that may be necessary or helpful: Is it a question of personal relationships? Is it a question of professional relationships?

10. Step one: What is Happening (Assessment) The specifically ethical aspects may need to be considered: Is there a clear duty involved for anyone? Does this change or influence the situation? Is any clause ( part) in the code of professional conduct invoked ( raised)? Is it a question of disregarding (ignore)a specific principles?

11. Step one: What is Happening (Assessment) Is the principle of the value of life involved? Are all persons respected equally? When all the fact- finding questions have been asked and answered : The story becomes the focus and ethical decisions can be made with it.

12. Step one: What is Happening (Assessment) The following questions are therefore necessary: Has everybody said all they needed to say? Does everybody feel they have been heard well? How have relationships been affected by this problem?

13. Step one: What is Happening (Assessment)  Who has suffered, and in what way?  What do they indicate, or point to?  How has care been affected so fare? When everyone and everything is respected can the story begin to make sense and move towards a ‘fitting answer’

14. Step Two: What would Happen if… (planning) The ‘fitting answer’ has to be reached; therefore some questions to attaining this goal:  What action are possible?  What alternative are available?  What are the short-term or long-term possibilities?  What are the possible outcomes of each action?  If there a time limit?

15. Step Two: What would Happen if… (planning) Some questions related to the principles followed:  In what respect does the principle of the value of life give direction at this stage?  What aspects of justice or fairness are involved?  How is the principle of truth telling or honesty involved?

16. Step Two: What would Happen if… (planning)  We have interests, needs, and perhaps agendas.  It may be necessary to consider a specific relationship of any one person with the patient or client of concern.  Who may be the best person to consult if that person is not immediately available.

17. Step Two: What would Happen if… (planning) When the many and varied aspects of the choice in a situation have been gone ( disappeared) over carefully, an end may be in sight:  Is consensus ( agreement) emerging ( rising)?  If not, who will have to make a decision?  The fitting answer should have emerged.

18. Step Three: What is the fitting answer (implementation)  To decide ethically is moral ability; to act ethically is physical ability.  Decisions not only have to be taken, they also have to be implemented.

19. Step Three: What is the fitting answer (implementation)  Every caring act is an ethical act. Every nurse can give an injection, but it is how the injection is given that counts.  It may be necessary to establish timetables or goals and strategies on how these can be achieved.

20. Step Three: What is the fitting answer (implementation)  Is it now a question of putting into action a moral decision.  If all aspects have been considered, the ‘fitting answer’ is obvious ( clear) and it is also obvious how the action is to be carried out.

21. Step four: What has happened? (Evaluation)  The people who have gone through the decision-making process together should ideally also be together for an evaluation session, to consider what has happened to them and their decision.

22. Step four: What has happened? (Evaluation) Some of the questions that may also help evaluation  Has the decision solved the problem? if not, why not?  Were the expected outcomes realistic ( practical) ? if not, why not?  Which ethical theory or principle has been most helpful? Why?

23. Step four: What has happened? (Evaluation)  When it is possible to learn from one problem, the next decision may not be easier because it is necessarily different, but the process may be less traumatic, and more inclusive and creative.

24. Step four: What has happened? (Evaluation) We learn from what has happened:  What has been gained by this decision?  (How) is the person now' more’ a person?  How can this help others in similar situations?  What has changed for the wider community of people involved? How do they now feel?  How any earlier fears been allayed?