Module 2 Flashcards
CNA seven Primary Values
- Providing safe, compassionate, competent, and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision- making
- Preserving dignity
- Maintaining privacy and confidentiality
- Promoting justice.
- Being accountable
Utilitarian ethical theory
Rightness or wrongness of action is always a function of its consequence
•Rightness is the extent to which performing/omitting action contributes to “good”
•Good = maximum welfare/happiness
•Rights of client/duty of nurse are determined by
the resulting maximum welfare
•Correct action results in greatest good for majority
What is Deontologic/duty based model
Based on moral duty (decided by you, society, institution?)
•Derived from Kant’s deontological philosophy
•Rights determined by other factors, in addition to outcome
•Respect for person’s dignity is a consideration
•Rightness determined by moral worth of action,
regardless of circumstance
•Nurse cannot violate basic rights
•Discussions about best interest require consensus
Human rights based model
Autonomy
• Belief that each client has basic rights
• Health care providers’ duties arise from those
rights
• Client has right to refuse care
• Conflict can occur when HCP’s duty is not in best interest of the patient
3 guiding ethical principles?
Autonomy, beneficence, justice
Autonomy guiding principle
- Client’s right to self determination •Fundamental ethical principle
- Right to decide about own health care •Basis of informed consent
- Autonomy vs. Paternalism
- When autonomy puts others at risk •Overriding clients right to autonomy
Beneficence
•Decision results in the greatest good
•Least harm (nonmaleficence)
•Obligation to act for benefit of client
• Nurses must advocate for best interest
• e
Ethical dilemmas: treatment withheld, treatment results in death
Justice
- Being fair or impartial
- Equality- social and distributive justice
- Who gets/pays for HC resources
- Unnecessary treatment – who, why? •Social worth: who deserves resources
**elements of ethical relationship (MFENCE)
Embodiment: recognition that the mind/body split is artificial and healing cannot occur unless both are given equal consideration (watson)
Mutuality: the relationship benefits both; harms neither
Engagement: connecting in an open, responsive, trusting manner
Non-coercion: forcing someone into an action limits choice and freedom
Freedom: creating an environment in which choices are available
Choice: making one’s own decisions
Three barriers to critical thinking
PAC
Attitudes and Habits
Cognitive Dissonance
Personal Values vs. Professional Values
Steps in critical thinking (10 steps)
Step 1: Clarify concepts
Identify the problem
Is it a moral problem? Then, who are the stakeholders?
Step 2: Identift your own values
Avoid imposing your own values on situation
Client’s values should be taken in consideration in every step of care
Step 3: Integrate data and identify missing data
Identify what date is significant to the situation
Systematic collection, organization, and pattern recognition reveals gaps
Step 4: Obtain new data
Modify interventions based on response Evaluate conflicting information
Step 5: Identify the significant problem
Analyze existing information
Make inferences and prioritize problems
Step 6: Examine skeptically
Weigh factors and differentiate between fact and opinion Challenge your own assumptions and raise questions
Step 7: Apply criteria
Think about appropriate responses Applicable laws, legal precedents, protocols
Step 8: Generate options and look at alternatives
Identify major alternative POVs. Can you identify all the pros and cons? Involve experienced peers
Step 9: Consider whether factors change if the context changes
Will a change in circumstance affect your decision?
Step 10: Make the final decision
Be able to communicate your decision coherently to others
Justify conclusion, evaluate outcomes, implement actions, reflect on outcome
What is moral imagination
AKA empathy
Pask, E
To be receptive to their patient, the nurse must bring understanding to practice, and this is achieved through an ability to see what is salient from the patient’s POV
- The nurse may be distracted from this work by strain experienced in the health care world, and the character of the nurse may make a difference to their practice when they are subjected to strain
- Compassion involves feeling with another person while recognizing that one’s feelings are not the same as that other person’s
- Compassion is also understood as an emotion.
- “the affective dimension of emotion”: when we experience emotion, it permeates our perceptions, desires, and actions in ways which we are not always aware of. Emotions affect our “mental tone”
- The nurse who exhibits compassion therefore responds with feeling towards the suffering, and also will care about their patient in an ongoing way that they may not always be aware of
- Knowing about the existence of others doesn’t guarantee our ability to understand them
- To understand, we must train out ability to focus attention on the other; imagination is necessary
- When we exercise out capacity for empathic or moral imagination we escape our egoism and focus on the real world before us. Moral imagination and moral sensitivity focuses the nurse’s attention during patient care
- A nurse’s ability to see what is morally salient in a situation is a product of their ability to exercise a capacity for moral imagination
- Nurses learn to act with compassion through conscious training
- Nurses should be proactive in shaping a moral climate that supports compassionate care
- Education should be designed to develop nurses’ imaginative awareness of patients’ suffering
What is cognitive dissonance
Mental discomfort with a discrepancy between what you believe and some new information
Five core values of professional nursing
Arnold p.51
human dignity integrity autonomy altruism social justice
Major contributing factor to lack of safe pt environment
poor communication
Med errors, miscommunication in handoffs
Communication problems for patients
difficulty obtaining, processing and understanding information health system complexity practice pressures cultural/language issues lack of clinician communication low health literacy
Common communication problems for health workers
usual practice vs best practice
reluctance to report errors
low level patient literacy
fragmentation of health system prevents dissemination of best practices
Strategies to aid health workers in developing safe practices
standardize (communication and assessment tools
Report errors (use error data to improve)
use checklists
use SBAR and IDRAW
interdisciplinary rounds”
Technological solutions (bar code wrist bands)
Ongoing training and simulations
What is bioethics?
Bioethics is the study of the typically controversial ethical issues emerging from new situations and possibilities brought about by advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice.
General ideas of Austin’s “ethics of everyday practice”
Existing Bioethic theories are not help “in the trenches”
bioethics is failing to account for the actual experiences of practitioners in real time and space. They find “bioethical theory to be essentially irrelevant” in practice.
ordinariness of everyday ethical issues can mean that their moral significance goes unrecognized. They are viewed rather as clinical/logistical problems to be solved.
Can create moral distress —situations of not knowing how to act—from what is experi- enced when one believes one knows how to act but is thwarted by constraints
ethics is fundamentally a matter of questions, questions that require openness, deliberation, self-questioning, uncertainty, and contemplation. Should be approached interdisciplinary
What is relational ethics?
Ethical understanding is formed in- and arises from- relationships with others
Is Ethics enough?
What 3 kinds of competence must accompany ethics.
No…
Theoretical
Relational
Technical
