1. Prepared By Hanan Saca-Hazboun Lecturer Faculty of Nursing and Health Science Bethlehem University

2. The objectives To identify and describe the nurses duty of care in the emergency care settings. To apply ethical principles and rules using case-studies, and to test ethical decision- making processes.

3. Ethics is the study of decisions and the bases of those decisions.

4. CODE OF ETHICS FOR EMERGENCY NURSES

5.  1 The Emergency Nurse provides care with compassion and respect for human dignity and the uniqueness of the individual.  2 The Emergency Nurse maintains competence within, and accountability for, emergency nursing practice.  3 The Emergency Nurse acts to protect the individual when health care and safety are threatened by the incompetent, unethical or illegal practice of any person.  4 The Emergency Nurse exercises sound judgement in accepting responsibility, delegating, and seeking consultation.  4 The Emergency Nurse exercises sound judgement in accepting responsibility, delegating, and seeking consultation. CODE OF ETHICS

6.  5 The Emergency Nurse respects the individual's right to privacy and confidentiality.  6 The Emergency Nurse continues to study, implement, and promote scientific knowledge.  7 The Emergency Nurse collaborates with other health professionals and the public in meeting community and national health needs. CODE OF ETHICS

7. Difference between ethics and law  Ethics is internal to an individual, looks to the good of an individual rather than society as a whole, and concerns the "why" of one's actions.  Law: compromise rules and regulations pertinent to society as a whole, is external to oneself and concerns one's actions and conduct.

8. Ethics and Law  Ethics what is right and what is wrong  Low: consensus can be enforced

9. The utilitarian approach  Seeks the greatest good for the greatest number and focuses primarily on consequences of action - frequently used in justifying decisions made in the health care delivery system.

10. The formalist or deontologic approach  Concerned with determination of duties and obligations using moral principles and rules, such as respect for the individual and telling the truth.

11. The Rawisian approach  No one should benefit unless all person's benefit from a proposed action, always considering the least fortunate.

12. General Ethical Concepts 1. Autonomy: it is the personal freedom and the right to choose what will happen to one's own person. 2. Beneficence: the actions one takes should promote good, acting in the best interest of the patients. 3. Nonmaleficence: one should do no harm 4. Veracity: telling the truth and incorporates the concept that individuals should always tell the truth.

13. General Ethical Concepts 5. Rationing: or limiting available resources, is closely related to the concept of justice. 6. Justice: the principle of treating all persons equally and fairly, refers to fairness in the allocation of resources in regard to health care delivery. 7. Paternalism: allows one person to make decisions for another and often is seen as a negative or undesirable principle. 8. Fidelity: keeping one's promise or commitments. 9. Respect for others: the highest principle and incorporates all other principles.

14. Moral model for ethical decisions making  Massage the dilemma  Outline the options  Resolve the dilemma  Act by applying the chosen option  Look back and evaluate the entire process

15. The department staffs were doing resuscitation for Mr. G., 34 year old man, who was mentally retarded. Later, after 5 minutes, a 55 years old well-known businessman, a father of 3 children, came to the emergency room with MI. He shortly needed cardiac resuscitation. The emergency team, needed the cardiac shock machine that has been used by the team who are resuscitating Mr. G. Scenario

16. Mrs. A, 74 years old, was admitted to the emergency department by the EMT staff. Patient was unconscious, had kussmaul's respiration. When Neurologist assessed her, she had neurological deficit and first diagnosis was brain stem injury. The patient was placed on ventilator regardless of knowing she will not benefit. Scenario

17. A 38 years old female was admitted for incomplete miscarriage with severe bleeding. Her hemoglobin was 7.8. A blood transfusion was ordered and the patient refused stating she is a member of Jehovah's witness and they can't get blood. A 38 years old female was admitted for incomplete miscarriage with severe bleeding. Her hemoglobin was 7.8. A blood transfusion was ordered and the patient refused stating she is a member of Jehovah's witness and they can't get blood. Scenario

18. A 9 years old female was brought to the emergency department due to vaginal bleeding due to falling down on a hard material. When the patient was assessed, she had a tear and laceration in the vulva. MD thought it is a sexual violence, shall we inform or not. Scenario

19. One evening, a 65 years old male patient came to emergency department complaining of shortness of breath. While Ahmad, RN, who has worked in the emergency center for several years was working with him, patient went into respiratory arrest, and Ahmad intubated the patient successfully. Thus, the hospital policy forbids the intubation of patients by nurses. Scenario

20. If the emergency care professional understands the basic concepts of ethics and how those concepts relate to law, a framework for decision making can enhance the care patients receive.

21. Good decision-making … seems to require human sensitivity, illuminating and useful principles, access to pertinent information, methods of weighing and balancing options - reasons and feeling, private meditation and public discussion, god sense and good sensibilities.