Chapter 1 Flashcards
What is nursing ethics?
Nursing ethics means the ideal and values of nursing and ethical principles that serve as standard for nurses actions.
What is jurisprudence?
Jurisprudence is the scientific study of law which is the set of rules made by humans which regulate social conduct in formally presented and legally binding manner.
What is nursing code of ethics?
Nursing code of ethics is a formal statement of the ideal and values of nursing and ethical principles that serve as a standard for nurses actions.
What is morality?
Morality usually refers to private, personal standards of what is right and wrong in conduct, character and attitude.
What is moral development?
Moral development is the process of learning to tell the difference between right and wrong, and of learning what ought and ought not to be done. It is a complex process that begins in childhood and continues throughout life.
What is Lawrence kohlberg theory of moral development
According to Kohlberg, moral development progresses through three levels and six stages. The levels and stages are not linked to a specific developmental stage because some people progress at a higher level of moral development than others.
Levels of Kohlberg’s Moral Development Process
- Pre-moral or pre-conventional level – children are responsive to cultural values and labels of good and bad, right and wrong. However, they interpret these in terms of the physical consequence of their action that is punishment or reward.
- Conventional level – here the individual is concerned about maintaining the expectations of the family, group or nation and sees this as right. The emphasis at this level is conformity and loyalty to one’s own expectations as well as society’s.
- Post conventional, autonomous or principle level – at this level the individual makes an effort to define valid values and principles without regard to outside authority or to the expectations of others. The stages that come under these levels and the accompanying examples are presented in table
What is Carol Gilligan stages of moral development?
Carol Gilligan believes that most frameworks for research in moral development do not include the concept of caring and responsibility. She described three stages in the process of developing an ‘ethic of care’. Each stage ends with a transitional period that is a time when the individual recognises a conflict or discomfort with some present behaviour and considers new approaches.
Stage 1 – Caring for oneself
In this stage the person is concerned only with caring for self. The focus of this stage is survival. The end of the stage occurs when the individual begins to view this approach as selfish. The person also begins to see a need for relationships and connections with other people.
Stage 2 – Caring for others
During this stage, the individual recognises the selfishness of earlier behaviour and begins to understand the need for caring relationship with others. Caring relationships bring with them responsibility. The individual now approaches relationships with a focus of not wanting to hurt others. This approach causes the individual to be more responsive and submissive to others needs, excluding any thoughts of meeting his own. A transition occurs when the individual recognises that this approach can cause difficulties with relationships because of the lack of balance between caring for oneself and caring for others.
Stage 3 – Caring for self and others
During this stage a person sees the need to balance between caring for others and caring for self. The concept of responsibility now includes responsibility for self and for other people. Care remains the focus on which decision is made. However, the person recognises the interconnection between self and others and realises that if one’s own needs are not met, others may also suffer. This is to say that if you do not take good care of yourself, you will not be healthy enough to take good care of the clients. So you owe it as a moral duty to make effort to meet your needs and be in good health.
Examples of moral principles
Autonomy – This refers to the right to make one’s own decisions. Nurses who follow this principle recognise that each client is unique, has the right to be what that person is and has the right to choose personal goals. People have “inward autonomy” if they have the ability to make choices; they have “outward autonomy” if their choices are not limited or imposed by others.
Honoring the principle of autonomy means that the nurse respects a client’s right to make decisions even when those choices seem not to be in the client’s best interest. It also means treating others with consideration. This principle can be seen in the requirement that clients provide informed consent
Non malfeasance is duty to do no harm. Although this would seem to be a simple principle to follow, in reality it is complex. Harm can mean intentional harm, risk of harm or unintentional harm. In nursing, intentional harm is never acceptable. However, the risk of harm is not always clear. A client may be at risk of harm during a nursing intervention that is intended to be helpful. For example, a client may react adversely to a medication, and care givers may or may not always agree on the degree to which a risk is normally permissible.
Beneficence means “doing good”. Nurses are obligated to doing good, that is, to implement actions that benefits and their persons. However ‘doing good’ can also pose a risk of “doing harm”. For example, a nurse may put on extra clothing for a child to provide warmth but the child may sweat and wet the clothing and have the risk of pneumonia. You should be careful to avoid such incidents.
Justice is often referred to as fairness. Nurses often face situations in which a sense of justice should prevail. For example, a nurse making home visits finds one client fearful and depressed and knows she could help by staying for about one hour more to talk with the patient. However, that would take time from her next client, who is a diabetic who needs a great deal of teaching and observation. In such a situation, you will need to weigh the facts carefully in order to divide your time justly among your clients.
Fidelity means to be faithful to agreements and promises. By virtue of their standing as professional care givers, nurses have responsibility to clients, employers, government, and society, as well as to themselves.
Nurses often make promises such as “I’ll be right back with your pain medication“, “you will be alright”, “I will find out for you”. Clients take such promises seriously so you too should take them seriously and fulfill them, as you have promised.
Veracity refers to telling the truth. Although this seems straight forward, in practice choices are not always clear. Should a nurse tell the truth when it is known that the lie will relieve anxiety and fear? Lying to sick persons is rarely justified. The loss of trust in the nurse and the anxiety caused by not knowing the truth, usually outweigh any benefit derived from lying.
Confidentiality involves not divulging to others privilege information entrusted to one without good judgment. You must not divulge any information that the client gave to you in confidence except divulging the information will help solve the problem of the client. In such a case, you must obtain the permission of the client to do so after having explained to him the reason you think it is necessary to do so. If the permission is not obtained before divulging, the client may lose confidence and trust in you and that will hamper the success of the nurse-client interaction.
Types of ethics
Personal Ethics – refer to a person’s moral principles and values acquired as the person develops and matures through the life span. An individual’s personal code of behaviour might include “ought to do” things such as being honest , spending time in worthwhile activities, helping and being kind to people and the “ought not to do “ things like, not stealing, not cheating other people or organisation, or consciously causing harm to others. Personal ethics are influenced by family, religion, education, peer group, and so on, and therefore vary from one individual to another. Personal ethics may change or be modified as a result of age, environmental or situational influence.
Professional Ethics – refers to the formal or informal moral responsibilities peculiar to a profession which are not shared by members of the society. The informal professional ethics are unwritten while the formal ones are the written ethical codes. Members not only agree to subscribe to the ethical codes to govern their conduct but also monitor other member of the profession to ensure conformity to them as well. Failure to conform may earn the individual a dismissal from the profession or suspension.
What are the purposes of professional code of ethics?
Professional codes of ethics set guidelines to demonstrate levels of minimum practice required to maintain standards of conduct within the profession.
• Ethical codes inform members and the society of the primary goals and values of the profession.
• Ethical codes provide a sign of the profession’s commitment to the public it serves.
• Professional ethics allows the people outside the profession to know the ways that members of that profession are expected to consistently act.
• The professional standards help when judging the actions of a professional to see whether it is ethical or unethical. It guides the profession in self-regulation.
• A code of ethics serves as a framework for making ethical decisions as it provides a means of evaluating alternative course of action.
• Ethical code serves as a mark of professional maturity.
• Reminds nurses of the special responsibility they assume when caring for the sick.
American Nurses Association Codes for nurses
- The nurse provides services with respect for human dignity and the uniqueness of the clients unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
- The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature.
- The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetence, unethical, or illegal practice of any person.
- The nurse assumes responsibility and accountability for individual nursing judgments and actions.
- The nurse maintains competence in nursing.
- The nurse exercises informed judgment and uses individual competence and qualification as criteria in seeking consultation, accepting responsibilities and delegating nursing activities to others.
- The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.
- The nurse participates in the profession’s effort to implement and improve standards of nursing
- The nurse participates in the profession’s effort to establish and maintain conditions of employment conducive to high quality nursing care.
- The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentations and to maintain the integrity of nursing.
- The nurse collaborates with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public.
ICN codes for nurses
Preamble
Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering
The need for nursing is universal; inherent in nursing is respect for life, dignity, and rights of man. It is unrestricted by considerations of nationality, race, creed, colour, age, sex, politics or social status. Nurses render health services to the individual, family and the community and coordinate their services with those related groups.
The Code
The ICN code of ethics for nurses has four principal elements that outline the standards of ethical conduct.
Elements of the Code
- Nurse and People
The nurse’s primary responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.
The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment
The nurse holds in confidence personal information and uses judgment in sharing the information.
The nurse shares with society the responsibility for initiating and supporting actions to meet the health and social needs of the public in particular, those of vulnerable population.
The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.
- Nurses and Practice
The nurse carries responsibility and accountability for nursing practice and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgment regarding individual competence when accepting and delegating responsibility.
The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence.
The nurse in providing care ensures that use of technology and scientific advances are compatible with the safety, dignity and right of people.
The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management research and education.
The nurse is active in developing a core of research-based professional knowledge.
The nurse acting through the professional organisation, participates in creating and maintaining equitable social and economic working condition in nursing.
- Nurses and Co-Workers
The nurse sustains a cooperative relationship with co-workers in nursing and other fields.
The nurse takes appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person.
Ethical Code for National Association of Nigeria Nurses and Midwives (NANNM)
As a nurse, your fundamental responsibility is four fold: To promote health, to prevent illness, to restore health, to alleviate suffering. Most important is the respect for life, dignity and right of man.
Your primary responsibility is to those who need nursing care regardless of race, creed, religion, culture, values and custom.
You should also hold in sincere confidence personal information about all your clients and use judgment in sharing this information.
As a professional nurse, you carry personal responsibility for nursing practice and for maintaining competence by continuous learning.
When acting in a professional capacity, you should at all times maintain standards of personal conduct, which reflect credit upon the profession.
You must at all times be prepared to share with other citizens the responsibility for initiating and supporting the health and social needs of the public. It is your duty to sustain a co-operative relationship with colleagues in nursing and co-workers in other fields.
You must always take appropriate action to safeguard the individual when his or her care is endangered by a co-worker or any other person.
You and the Profession
You must at all times be prepared to play the major role in determining and implementing desirable standards of nursing practice and nursing education.
You must be active in developing a core of professional knowledge. You must act through the professional organisation; participate in establishing and maintaining equitable, social and economic working conditions in nursing.
