NUR351: Ethics & Values; Legal Issues Flashcards
What is the definition of moral behavior?
Behavior that is in accordance with custom or tradition and usually reflects personal or religious beliefs
What is the definition of ethics?
A systematic study of what is right and wrong conduct in situations that involve issues of values and morals
What is nursing ethics?
A subset of bioethics which refers to the ethical questions that arise from the practice of nursing
Why should nurses study ethics?
- you will encounter ethical questions frequently in work
- ethics is central to nursing and nursing care
- multidisciplinary input is important
- ethical knowledge is necessary for professional competence
- ethical reasoning is necessary for nursing to be taken seriously
- ethical proficiency is essential for providing holistic care
- nurses should advocate for patients
- studying ethics will help you to make better decisions
What is the definition of advocacy?
The communication and defense of of the rights and interests of another
What is the definition of moral agency or ethical agency?
The ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making.
To have choices and responsibility for their actions
Moral distress
The stress caused by situational pressures that prevent a nurse from acting on their moral decisions
What is the definition of impaired nursing practice
When a nurses ability to perform the essential functions of nursing is diminished by chemical dependence on drugs, alcohol or mental illness
What are some Societal factors that give rise to ethical problems?
- Increased consumer awareness
- Technological advances
- Multicultural population
- Cost containment
What is the definition of a value?
A belief that you have about the worth of something
What is the definition of morals?
Private,personal, or group standards of right and wrong
What factors affect moral decisions?
Values, beliefs and beliefs
What is the definition of a belief
Something that one accepts as true
What is the definition of personal value system?
Set of values that you have reflected on and chosen that will help you to lead a good life.
What is value neutrality?
An attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become non-judge mental when providing care to clients
What factors affect moral decisions?
Values, beliefs and beliefs
What is the autonomy model?
Emphasizes patient autonomy as the highest value
What is the patient benefit model?
Assists in decision making for the incompetent or incapacitated patient by using substituted judgement. I.e. What would Alan want if he were capable of making the choice?
What is the social justice model?
Helps make decisions based on broad social issues involving the whole institution, rather than a single patient issue.
From what sources are laws derived?
- The constitutions of federal and state governments
- Federal and state legislatures
- Administrative agencies
- Courts
What are the moral principles?
Autonomy, nonmaleficence, beneficence, fidelity,veracity, and justice
What is autonomy?
a person’s right to choose and his ability to act on that choice
What is nonmaleficence?
the dual duty to do no harm and to prevent harm
What is beneficence?
the duty to do or promote good
What is fidelity?
the obligation to keep promises.
What is justice?
the obligation to be fair. There are three kinds
Distributive justice
Compensatory justice
Procedural justice
What is a moral framework?
systems of thought that are the basis for the differing perspectives people have in ethical situations.
What is consequentialism?
theories where the rightness or wrongness of an action depends on the consequences of the act rather than on the act itself
What is deontology?
a theory where decisions are based on moral rules and unchanging principles
What is utilitarianism?
states that an act must result in the greatest good for the greatest number of people.
Feminist Ethics
Persons connected, interdependent, cultural, historical context of power structures.
Autonomy is relational.
Virtue Theory
What ought to be. Virtuous character and proper motivation leads to moral choices.
“Golden mean” (not too good it’s reckless)
What are the 5 CNO components to a therapeutic relationship?
- Trust
- Respect
- Professional intimacy
- Empathy
- Power
What are the 5 levels of care?
- Health promotion
- Disease and injury prevention
- Diagnosis of treatment
Primary - first contact
Secondary - hospital/home
Tertiary - hospital - Rehabilitation
- Supportive
CNO
- Entry to Practice Competencies
2. Professional Standards (NCLEX & Jurisprudence Exam)
CNA
Code of ethics (aspirational AND regulatory)
Certifications in specialties
Global presence
RNAO
Best practice guidelines
Lobbies government
ONA
Union representatives
Ethical uncertainty
Inability to articulate what the problem is
Ethical problems
Unable to determine the proper solution
Ethical dilemmas
A conflict between two sets of human values, both of which are judged to be good but neither of which can be fully served.
Ethical/moral distress
Arises when nurses are unable to act according to their own moral judgement
Ethical residue
Moral values compromised
Ethical disengagement
Disregard ethical commitment
Ethical courage
Stand firm on principle in face of fear or threat
What are the 7 CNO values (2009)?
- Client well-being
- Client choice
- Privacy & confidentiality
- Respect for life
- Maintaining commitment (oneself, colleagues, nursing profession, team members, and quality practice settings)
- Truthfulness
- Fairness
Values formation
Influenced by social, relational, cultural, and contextual factors
Bioethics
Obligation-based, outcome-oriented and based on reason.
- guided by autonomy, beneficence, nonmaleficence, and justice
Relational Ethics
Relationships are basis of ethics in nursing. Ethical understandings are formed in and emerge from relationships.
Medical futility
A medical treatment that is considered impossible or unlikely to achieve its therapeutic goal or suggests that there is something problematic about the goal.
Advanced Care Planning (ACP)
Multidimensional process that involves health care providers in discussion with patients to ensure that they clearly understand their illness, it’s trajectory, and available treatment options.
What are the 4 CNO Practice Standards?
- Therapeutic communication
- Client-centred care
- Protecting client from abuse
- Maintaining boundaries
Fiduciary responsibility
A person with particular knowledge and abilities accepts the trust and confidence of another to act in that person’s best interest.
- asymmetrical relationship
Values clarification
Helps articulate priorities
Values conflict
Occurs when personal values may be at odds with patients/colleagues/institutions
What is the LHINs mandate?
To plan, find, and integrate the health care providers within the 14 geographical areas.
What are controlled acts?
Activities that are considered to be potentially harmful if performed by unqualified persons.
What is emancipatory reflexivity?
Challenging our assumptions that were held to be true, and looking at our values
CNA Code of Ethics
- Safe, compassionate, competent and ethical care
- Health and well-being
- Informed decision making
- Dignity
- Privacy and confidentiality
- Justice
- Accountability
Canada’s Health Act
- Public administration (non-profit)
- Comprehensiveness
- Universality
- Portability (no costs bw provinces)
- Accessibility
Health Insurance Act of Ontario
Insured for hospitals/health facilities, medically necessary devices rendered by physicians
Local Health Systems Integration Act
14 LIHNs “plan, fund, and integrate”
Regulated Health Professional Act
- openness and responsiveness
- greater consumer choice
- public participation in regulation
- Scope of practice
- controlled acts
- Health regulatory colleges
Nursing Act
- Scope of practice
- Categories and certificates
- Entry requirements
- Title protection
- Controlled acts
- Professional misconduct regulations
- Self-reporting obligations
CNO Entry-to-Practice Competencies
- relational skills
- honesty, integrity and respect
- appropriate professional boundaries
- client privacy, confidentiality and security
6 P’s of social media use
Profesional Positive Patient/person free Protect yourself Privacy Pause before you post
HwalthCare Consent Act (HCCA) 1996
- promoting individual autonomy and communication
- HCPs do not have authority to make treatment decisions (except in emergency)
Decisions for:
- specific treatment plan
- admission to care facility
- personal assistance services
Substitute Decisions Act (SDA)
Substitute decision-maker (SDM)
HCCA Hierarchy:
- Courts appointed guardian of personal care
- Attorney for personal care
- Representative appointed by CCB
- Spouse, common law spouse or partner
- Parents and children
- Brothers and sisters
- Relative by blood, marriage or adoption
- Public Guardian and Trustee IF
Primary ethical principle underlying HCCA
Autonomy
Conditions for consent (CNO)
- Informed
- Voluntary, not coerced
- Not obtained through fraud or misrepresentation
Informed consent
- nature of treatment
- risks and side effects
- alternative courses of action
- likely consequences of not having the treatment
- Capable and Competent
Assault
Verbal or physical act that creates fear of imminent harmful contact
Does not require actual contact
Battery
Intentionally physical contact without the person’s consent
Invasion of Privacy
Free from unwanted intrusion into private life
False imprisonment
Inappropriate or unjustified use of restraints
Negligence
Conduct that does not meet the standard of care established by law
Unintentional Negligence
Committed by inattention, thoughtlessness, or carelessness
Performing a procedure bit educated in.
Near miss
Incident did not reach the patient, act of omission or commission
No-harm incident
An incident that reached the patient, but no discernible harm resulted
Culture of blame
Focuses on the person
Culture of discovery
Focused on the system features that led to the error
Swiss Cheese Model
- each slice is a “barrier” out in place to make health care safer
- each barrier has number of weaknesses
- constant motion
- multiple factors are involved, especially with complex processes and structures
Lack of agency/fiduciary concern
- clinician doesn’t advocate for best interests
- no intervention in the patient’s behalf
Care erosion
Gradual decline in quality of care, gradual increase in violations of standards, inconsistencies between professional values and practice, decrease in compassionate care
Cognitive Dissonance
Response to inconsistencies within our thinking and between behaviour and thinking
Dissonances - feelings of embarrassment, Shane, regret, anger at oneself
Patient advocacy identity
Precious life experience
Role modeling
Consequences to the patient and participants
- knowledge if potential harm, moral distress of not acting
- consequences: praise or isolation
Impact of key individuals
Reinforcing behaviour
Praised by mentors or isolated on unit
Interactionist Model
Nursing as an interactive interpersonal process
Needs Theory
Basic human psychosocial needs. Nurses help gain independence as rapidly as possible.
Systems Theory
The person is an adaptive system in constant interaction with environment. Nurse’s goal to promote modes of adaptation that support overall health.
Simultaneity Theory
Persons as an “irreducible whole”. The individual as “an embodied spirit”. Transpersonal transcendent evolving consciousness.
Unity of the mind body and spirit.
Person-nature-universe as oneness, connected
Critical thinking competencies
- Noticing the situation
- Developing a sufficient understanding
- Deciding on a course of action
- Reflecting on action/outcome
Propositional/ codified knowledge
Formal, explicit, derived from research, concerning generalizability
Non-propositional or personal knowledge
Informal, implicit, derived primarily though practice
Tacit knowledge
Tacit knowledge
Derived primarily through practice
Professionally craft.
Four sources of knowledge
- Research (qualitative, quantitative)
- Clinical experience (Tacit knowledge)
3 patients, clients and carers (authoritative knowledge) - Local context and environment
Ostorgosky (2015) Role Perception
- Narrow understanding of the role
“Fake it until you make it” - Increased confidence in technical skills.
- Developing sense of empowerment and moral dimensions of the role
- Internalizing “being a nurse”
- Refocus on skill mastery with the context of increased complexity “doing it all”
CNO Practice Standards
- Knowledge - understanding legislation
- Leadership - ipe and rights of client
- Relationships - protection against client abuse
- Professional relationships - sharing knowledge
Conditions for consent (CNO 2017)
- Related to treatment being proposed
- Informed
- Voluntary, not coerced
- Not obtained through fraud or misrepresentation
Competence for consent
Capable of understanding the relevant information and appreciating the consequences of consenting or not to treatment
Paternalism
Overriding patient preferences (liberty) for presumed benefit of patient (beneficence vs autonomy).
Knowledge and values if the nurse, SDMs, or HCPs are privileged over the patient’s
Intentional torts
- Assault
- Battery
- Invasion of Privacy
- False imprisonment
Unintentional torts
Negligence
Personal Health Information Protection Act (PHIPA)
- supports and extends CNO standards and CNA ethical guidelines
- balances client’s rights and HCPs need for information in order to provide effective care
Professional Liability Protection (PLP)
- all members are required to hold PLP (CNO)
- employee may provide the coverage
- offered by ONA, RNAO
CNA: Canadian Nurses Protective Society
Indigenous Knowledge (IK) Systems
- ecology and spirituality as foundation
- Teachings from Elders (intergenerational knowledge)
- empirical observation and revelation
- oral and symbolic knowledge transmission
- technologies developed and sustained by indigenous civilizations
Structural racism
The legitimized and normalized spectrum of attitudes, practices and polices that consistently result in chronic continuous substandard outcomes for indigenous people.
Colonialism
The development of instituían and policies by settler governments towards indigenous people that resulted in historical and intergenerational trauma
Cultural competence
Application of skills, knowledge and attitudes or personal attributes to maximize respectful relationships with diverse populations.
Values: inclusivity, respect, valuing difference
Cultural Safety
Promotes equity in health care by addressing root causes of inequities (social determinants of health).
Emphasis on critical self-reflection, critique of structures, discourse, power, relations, and assumptions
Essentialist
Culture is objective, static, defined differences between people
Emphasis on cognitive aspects of culture
Minimizes complexities, does not allow for self-reflection
Constructivist
Culture as socially constructed, reflecting the values and assumptions of the society.
Dynamic, relational process of shared meanings.
