Ch 22 Flashcards
Ethics
- the study of what is right and wrong with our conduct
-concerns our obligations to individuals, groups, and society
-The right thing to do can be difficult to determine, particularly when individual values, beliefs, and perceptions conflict. - Use your critical thinking and clinical judgment skills with ethical decision making when working through ethical problems with patients and families
Morals
Ethics
-refer to judgment about behavior, based on specific beliefs
-ethics refers to the study of the ideals of right and wrong behavior.
Value
-deeply held personal belief about the worth a person holds for an idea, a custom, or an object.
-values that a person holds reflect cultural and social influences.
bioethics
-represents a branch of ethics within the field of health care
-In the study of bioethics, health care professionals agree to negotiate these difficult and important questions by referring to a common set of ethical principle
Autonomy
-applies to respect for the autonomy of patients
-can also apply to agency respect for the autonomy of health care professionals
-A commitment to respect the autonomy of others is a fundamental principle of ethical practice.
Beneficence
-refers to taking positive actions to help others
-the best interests of the patient remain more important than self-interest. It implies that nurses practice primarily as a service to others, even in the details of daily work.
Nonmaleficence
-the avoidance of harm or hurt
-health care professional tries to bal- ance the risks and benefits of care while striving at the same time to do the least harm possible
Justice
-refers to fairness and the distribution of resources
-Discussions about health insurance, hospital locations and services, and organ transplants generally are among the issues that cite the concept of justice
-just culture refers to the promotion of open discussion without fear of recrimination whenever mistakes, especially those in- volving adverse events, occur or nearly occur.
Fidelity
- faithfulness or the agreement to keep promises
- a duty to be faithful to the patients you care for, to the health care agency you work for, and to yourself.
-Fidelity is honored when we strive to provide excellent care to all patients, including those whose values are different from our own
Code of ethics
-set of guiding principles that all members of a profession accept
-describe the nurse’s obligation to the patient, the role of the nurse as a member of the health care team, and the duties of the nurse to the profession and to society
-A few of the key principles in the code include advocacy, responsibility, accountability, and confidentiality.
Advocacy
Responsibility
-a willingness to respect one’s professional obligations and to follow through
- As a nurse you are responsible for your actions, the care you provide, and the tasks that you delegate to others.
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Accountability
-refers to answering for your own actions.
Confidentiality
-refers to the health care team’s obligation to respect patient privacy
Values
-A value is a deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors.
-Clarifying values—your own, your patients’, your co-workers’— is an important and effective part of ethical discourse.
Deontology
-defines actions as right or wrong based on their adherence to rules and principles such as fidelity to promises, truthfulness, and justice
-does not look at consequences of actions to determine right or wrong, rather it examines a situation for the existence of essential right or wrong
-requires a mutual understanding of justice, autonomy, and goodness.
Utilitarianism
- proposes that the value of something is determined by its usefulness.
-main emphasis is on the outcome or conse- quence of action.
-The greatest good for the greatest number of people is the guiding principle for determining right action in a utilitarian system
-The difference between utilitarianism and deontology is the focus on outcomes. Utilitarianism measures the effect that an act will have; deontology looks at the act itself and judges its “rightness” by the rules or principles it upholds.
Casuistry
-case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on the details of a situation.
-People who take this approach to ethics find similar precedent cases and determine a course of action on the basis of what was done to manage that prior situation
-A weakness of the casuistry approach is that finding a similar precedent case may be challenging, particularly in complex situations with unique features.
Feminist ethics
- this view holds that the natural caring for others is the basis for moral behavior; it places an emphasis on caring relationships and a strong sense of responsibility
-Those with a feminist perspective tend to concentrate more on practical solutions than on theory and to ask questions about the people involved and their relationships rather than looking to underlying principles.
-Critics of feminist ethics worry about the lack of appeal to tradi- tional ethical principles. Without guidance from concepts such as autonomy and beneficence, they argue, solutions to ethical questions will depend too much on subjective judgment.
Ethics of Care
-offers an alternative view to utilitarianism and deontology.
-Similar to feminist ethics, care-based ethics focuses on understanding relationships, personal narratives, and the context in which ethical problems arise.
-Unlike feminist ethics, ethics of care emphasizes the role of the decision maker in the situation.
-In the ethics of care, nurses participate in clinical ethics consultation, with patient advocacy being a top priority
-An ethical problem is called a dilemma when two opposing courses of action can both be justified by ethical principles
Moral distress
- In moral distress, instead of competing options for action, the nurse feels the need to take a spe- cific action while believing that action to be wrong
-Distinguishing between ethical dilemmas and moral distress is important to achieving resolution. When the problem is a dilemma, with two opposing but justifiable options, often the application of the nursing process will include identifying more options.
Processing an Ethical Problem
-similar to the nursing process in its methodical approach to a clinical issue
- differs from the nursing process in that it requires negotiation of differences of opinion and clarity about situations where there may not be a single right answer
- Finding clarity and consensus can occur when the following elements remain essential to the process: the presumption of goodwill on the part of all participants, strict adherence to confidentiality, patient-centered decision making, and the welcome participation of families and primary caregivers.
1. Processing an ethical problem begins with recognizing that an ethical problem exists
2. You then gather pertinent information about the case, including recent clinical evaluations, the views of colleagues, and the values and perspectives of the patient and family involved.
3. Examining your personal values at this point can help to differentiate between fact and opinion, an important part of the process.
4. Once information is gathered and ethical elements identified, developing a statement of the problem will facilitate discus- sion.
5. The next step, listing all possible courses of action, requires some creativity and is best done in a conversation with others.
6. The final step is an evaluation of the outcome
7. If the process involves a family conference or changes in the treat- ment plan, you document all relevant information in the medical record.
PICOT Question: Do strategies that build moral resilience reduce moral distress among acute care nurses?
Evidence Summary
Moral distress describes the anguish experienced when a person feels unable to act according to closely held core values. Evidence indicates that causes of moral distress among critical care nurses include quality of life concerns for patients, lacking a voice in documentation, difficulty with their advocacy role, ambiguity between the guidelines of care and limitation of licensure, trying to implement personal values to provide care, communication issues when full disclosure has not been implemented with the patient and family, and role conflict between goals of care and barriers to care delivery (Burton et al., 2020). Nurses need to be aware of moral distress, which is foundational to developing strategies for moral resilience (Burton et al., 2020). While multiple studies document the existence of moral distress and its association with aspects of the work environment, interventions to address moral distress are an area of evolving research (Burton et al., 2020). Strategies to address moral distress consider not only the individual experiencing the problem but also the work environment. Health care agencies often offer services such as an ethics resource or a moral distress service to specifically address the needs of nurses. Sonya et al. (2020) described a Moral Distress Consult Service that is accessible in the hospital and helps address pervasive or persistent issues that are causing moral distress. The American Association of Critical-Care Nurses (AACN) created the Standards for Establishing and Sustaining Healthy Work Environments and an Assessment Tool that health care teams can use to identify and address gaps (AACN, 2016). Moral resilience is the ability to grow and even gain confidence from adverse and complex ethical problems. While further study is needed, deliberate attention to building moral resilience among nurses may reduce their susceptibility to moral distress.
Application to Nursing Practice
• Develop and practice skilled communication. Learning to talk with col- leagues, patients, and families in a professional manner that conveys a desire to share your own views and an openness to theirs can help prevent conflicts and reduce moral distress.
• Identify resources available to help you reduce moral distress. Find out whether your hospital has an ethics committee or other resource for support and how that resource is consulted.
• Find a mentor or leader on your unit with a particular skill in examining ethical problems to help you process ethical situations.
•Create a culture of moral resiliency w targeted formal and informal support and education for staff
• Collaborate with health care administrators regarding ways to better inkstand, recognize, and manage patient and nurse factors related to moral distress
• Design education programs to assist nurses to recognize and respond to stressful situations
• Educate staff members on how to use their voices to communicate constructively and confidently about morally challenging situations.
• Evaluate existing programs, including just-in-time support, a health care ethics residency, and moral resiliency training.
Key Steps in the Resolution of an Ethical Dilemma
Step 1: Ask: Is this an ethical problem?
Step 2: Gather information relevant to the case. Patient, family, health care agency, and social perspectives are important sources of relevant information.
Step 3: Identify the ethical elements in the situation by clarifying values and recognizing the principals involved. Distinguish among fact, opinion, and
values.
Step 4: Name the problem. A clear, simple statement of the problem is not
always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion.
Step 5: Identify possible courses of action. Access others for their input and
be creative in identifying different options.
Step 6: Create and implement an action plan. Gather support from others and
identify an alternative action if the chosen one does not achieve resolution.
Step 7: Evaluate the action plan to determine whether further action is needed
or if lessons learned in this experience can be applied forward.