1. Rels 300 / Nurs 330 October 2015 Nursing Ethics & Moral Distress

2. Nurses as advocates Within the health care team, no one is likely to provide greater continuity of care than the nurse o If the nurse is witness to patient dissatisfaction with treatment orders, or confusion or disagreement among the patient’s family, the nurse is uniquely positioned to make the decision- making process explicit o Where teamwork is valued, the nurse can make valuable contributions to the ethical process by raising alternative paths & voicing the patient’s concerns 300/330 - appleby2

3. Nursing Roadblocks In some situations, nurses may have to carry out orders that conflict with their ethical judgement This may lead to experiences of Moral distress – over sub-optimal care plans Moral uncertainty – when a decision seems to lead to turmoil or patient distress Subversion of moral agency – when nurses cannot exercise their own capacity for moral choice or action Moral residue - personal feelings of guilt, remorse or inadequacy in providing an excellent standard of nursing care 300/330 - appleby3

4. MORAL DISTRESS “80% of nurses experience moral distress at work. It's one of the main reasons why nurses quit the profession.” (click here) (up to 18:00) http://www.cbc.ca/whitecoat/blog/20 11/03/24/moral-distress-show/ http://www.cbc.ca/video/news/audio player.html?clipid=1856555522http://www.cbc.ca/video/news/audio player.html?clipid=1856555522 (27:30) 300/330 - appleby4

5. CNA Code of Ethics (2008) excerpts: http://www.cna- aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf http://www.cna- aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf 300/330 - appleby5

6. CNA Code of Ethics (2008) excerpts: http://www.cna- aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdfhttp://www.cna- aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf 300/330 - appleby6

7. What is a person to do?  Be ethically knowledgeable  know your moral theories  know your principles of health care ethics  learn to analyze and articulate your own moral concerns and judgements  Be alert for and aware of power dynamics  between doctor & patient  between doctor & other health care professionals  among nurses, patients and loved ones  Ensure communication excellence on behalf of health care providers and patients  Learn to be advocates for colleagues and patients 300/330 - appleby7