Lecture 8: Ethical Considerations

Question 1

Morals

Answer 1

A sense of right +/or wrong

Question 2

Ethics

Answer 2

Right +/or wrong according to a community/organization (rules/allowable actions as defined by your organization)

Question 3

Morals vs Ethics

Answer 3

Morals = A sense of right and/or wrong
Ethics = Right +/or wrong according to a community/organization (rules/allowable actions as defined by your organization)

Question 4

What is the Canadian Nurses Association (CNA) Code of Ethics?

Answer 4

A statement of the ethical values of RNs and NPs. It demonstrates nurses’ commitment to person with healthcare needs and persons receiving care
(the code defines expectations of behaviour and nurse’s are bound to the code)

Question 5

What is the purpose of the Canadian Nurses Association (CNA) Code of Ethics?

Answer 5

Serves as a foundation for nurse’s ethical practice
- Provides guidance for ethical relationships, responsibilities, behaviours and decision-making,
- Used in conjunction with the professional standards, laws and regulations that guide practice
- Regulatory Tool: Nurses are bound to the code

Question 6

Personal & Professional Values

Answer 6

• Professional Values: are LEARNED during your professional education and experiences (Enculturation)
  
  • Personal Values: are INFLUENCED by childhood caretakers, spiritual/religious beliefs, & life experiences (acculturation). Personal values CANNOT obstruct care for patients with different values

Question 7

Science vs Spirituality

Answer 7

• Healthcare is mainly science-based = can be at odds with patients’ personal beliefs
  
  • Some religions restrict medical interventions & life saving techniques (e.g. blood transfusions, abortion)

Question 8

Reflexivity

Answer 8

A cognitive skill where a conscious effort is made to examine a situation with an awareness of own beliefs and values
“Being aware of what we are doing, & what you are thinking as it is happening”

Question 9

7 Key Ethical Values for RNs in Canada

Answer 9

1) Providing safe, compassionate, competent & ethical care
2) Promoting health & well-being
3) Promoting & respecting informed decision making
4) Honoring dignity
5) Maintaining privacy & confidentiality
6) Promoting justice - Fair allocation of resources
7) Being accountable - assume responsibility for your actions

Question 10

Issues to focus on when promoting health and well being

Answer 10

• Therapeutic communication skills
  
  • Examples of the range of nursing practice
  • Ethical/Moral dilemmas in nursing
  • Types of clients & families
  • Demonstration of competency linked to CRNS competencies

Question 11

Take away messages from Becky & Liz videos: People who live on the street and use drugs…

Answer 11

• Live in a world of chaos (Becky should stay at shelter, so RN needs to advocate for her)
  
  • To truly help them we need to make things easier = better success (Becky is given an Rx but can’t fill it = if possible, fill & give prescription right then)
  • HCP not treating people with respect or offer treatments (when Becky goes to the ER… the staff make assumptions a/b her drug use)

Question 12

Rebecca offers the same treatment options to a patient who is 65 years old who has lung cancer despite having lived a healthy lifestyle and to another patient who has developed lung cancer due to choosing to smoke for the last 50 years. This is an example of the nurse using which of the principles in the Code of Ethics?

Answer 12

Justice

Question 13

A patient with a terminal illness expresses a strong desire for assisted suicide to end their suffering. What ethical principles are primarily involved?

Answer 13

Autonomy
Honoring Dignity

Question 14

What principle is violated when the nurse forgets to give a pain med as promised?

Answer 14

Promoting health and well-being

Question 15

Kinds of Ethical Challenges

Answer 15

Ethical Dilemma
Moral/Ethical Distress
Ethical Disengagement
Ethical Courage

Question 16

Ethical Dilemma

Answer 16

Equally compelling reason for 2 or more possible courses of actions - when choosing 1 course of action means that something else is relinquished or let go (dilemma occurs when there is a choice to be made & no matter which choice you make there are consequences)

Question 17

Moral/Ethical Distress

Answer 17

When nurses feel they know what they should do but circumstances make it difficult to take the appropriate course of action = system structures make it nearly impossible to pursue the right course of action

Question 18

Ethical Disengagement

Answer 18

Can occur when nurses normalize unethical behaviour
Apathetic or disengaged to the point of being unkind, non-compassionate (e.g. ‘Frequent flyers’)

Question 19

Ethical Courage

Answer 19

When nurses stand firm on a point of moral principle or a particular decision a/b something in the face of overwhelming fear or threat to themselves

Question 20

5 Common Examples of Ethical Distress for RN’s

Answer 20

1. Inadequate staffing - unable to provide safe care
2. End of life issues - MAID, etc..
3. Inappropriate resource allocation
4. Inappropriate discussion of patient cases - confidentiality issues
5. Colleagues’ irresponsible activities

Question 21

When nurses experience moral/ethical distress they respond in 1 of 3 ways…

Answer 21

1) Withdraw from ethically challenging situations (disengage)
2) Change positions/wards (leave the profession all together)
3) Continue to raise objections and voice concerns

Question 22

Moral or ethical distress can be best described as:

Answer 22

A psychological response to moral dilemmas

Question 23

Oberle & Raffin Model

Answer 23

1. Assess the ethics of the situation understand your own values in the situation as well as the values in the code that apply. Do our values conflict
2. Reflect on and review potential actions- recognize available choices/what actions will do the best
3. Select an ethical action: maximize the good – can I support the patient’s choice…if not what now. Do I have the moral courage
4. Engage in ethical action/choice.
5. Reflection and review Did I report through the right channels What did I do well. What would we change next time?

Question 24

Signs of distress

Answer 24

1) Emotional Signs: Negative feelings such as anger, frustration, depression, shame, sadness, fear…
2) Physical Signs: Internal or external symptoms such as crying, sleep changes, appetite changes, heart flutter, headaches, or unexplained aches/pains in body
3) Intellectual Signs: Difficulty concentrating or focusing
4) Spiritual signs: Questioning self or spirit, “searching”

Question 25

Burnout

Answer 25

burnout is a result from chronic workplace stress that has not been successfully managed (recognized as an “occupational phenomenon”)

Question 26

How to build Moral Courage

Answer 26

1) Strong character - Overcome fear and stand up for moral principles
2) Commitment to ethical principles - Learn the code and values
3) Know how to ethically reason through dilemmas - learn the models