Nursing values and ethics Flashcards
Ethics
- The study of the philosophical ideals of right and wrong behaviour based on what you think you ought (or ought not) to do
- Reflects what matters to people
Values
- A strong personal belief and an ideal that a person or group (such as nurses) believe to have merit
- Influence our behaviour
- Reflect all our influences
Nursing ethics
- Focuses on the moral questions within the sphere of nursing practice, the nurse–patient or nurse–client relationship, the moral character of nurses, and the nurse as a moral agent
- Nurses in Canada are guided by the CNA Code of Ethics for Registered Nurses
- As a moral agent, we (nurses) do or direct our actions towards something good or positive
- Nurses do actions to lead to positive outcomes
CNA code of ethics
- Nurses need to recognize that they are moral agents in providing care…they have a responsibility to conduct themselves ethically in what they do…this includes self-reflection and dialogue
- Self-reflections and dialogue is KEY
- Communication
- Self check
- With regards to any ethical issues
CNA code of ethics for RNs (2017)
- Purpose is to serve as a foundation for nurses’ ethical practice
- Two (2) parts
Part I: Values and Ethical Responsibilities - Grounded in professional relationships we have
Part II: Ethical Endeavours r/t Broad Societal Issues
- Ways to address social inequities as part of ethical practice
- Address ways or actions that we an use to address social inequities
Ethical problem
- Conflicts between one or more values and uncertainty about the correct course of action
- Questions about what is right or wrong
Ethical dilemma
- When there are equally compelling reasons for and against one or more possible courses of action
- This is a type of ethical problem
- What makes it different; once you choose a course of actions you dismiss the other options
Ethical (moral) distress
- Nurses know or believe they know the right thing to do, but do not or cannot take the right action
- Because of structural or systemic issues that inhibit them from doing the right thing
- Personal limitations; not having a strong enough ‘voice’
Ethical residue
- What nurses experience when they seriously compromise themselves or allow themselves to be compromised
- Team meeting situation
- You didn’t say something and allowed your values to be compromised
Ethical disengagement
- Can occur if nurses begin to see the disregard of their ethical commitment as normal
- Begin to feel or realize that their voice doesn’t matter
- Become disengaged
Ethical courage
- Is exercised when nurses stand firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to themselves
- Standing firm in what they believe and insistent on their viewpoint
Professional Standards: “ethics” (CNO) - how a nurse demonstrates the standard
A nurse demonstrates the standard by:
- Identifying ethical issues and communicating them to the health care team;
- Identifying options to resolve ethical issues;
- Evaluating the effectiveness of the actions taken to resolve ethical issues; and
- Identifying personal values and ensuring they do not conflict with professional practice
CNO ETP #80 (ethical practice)
80. Demonstrates knowledge of the difference between ethical and legal considerations and their relevance when providing nursing care
CNO ETP #84 (ethical practice)
#84. Respects and preserves clients’ choices based on an ethical framework - Important because we are advocating for the client
CNO ETP #85 (ethical practice)
85. Uses an ethical framework and evidence informed decision-making process to address situations of ethical distress and dilemmas
Ethical considerations in relationships with students: nurses
Nurses:
- Recognize power differentials and treat each other, colleagues and students in a respectful manner
- Share knowledge, provide feedback, and guidance for the professional development of the student
Ethical considerations in relationships with students: students
Students:
- (Nurses) and nursing students treat each other with respect and honesty
- Informs and requests permission from the person receiving care
Ethical considerations in relationships with students: nurses and nursing students
Nurses and Nursing Students :
- “Place the safety and well-being of the person in care above all other objectives, including fulfilling educational obligations
- Students need to inform and request permission to the person receiving care
- Identify yourself as a student
- Safety always has to come first before education opportunities
- Patient comes first before student learning
- i.e. suctioning a patient when they really don’t like it or it evokes a lot of anxiety and discomfort
- Priority is the patient
What are values?
- A strong personal belief and an ideal that a person or group (such as nurses) believe to have merit
- Influences behaviour
- Reflects cultural and social influences, relationships, and personal needs
- Varies among people; develops and changes over time
- Inner standards the motivates us to do what we do
- Also inner standard with regards to judging behaviour (of ourselves and others)
- They also influence how we interpret dilemmas, or confusion/conflicting situations
- They influence how we take the next step
Value formation
- Family experience
- Moral development
- Cultural, ethnic, and religious communities (cultural values)
- Individual experience
- Your values can change as you have different experiences and opinions
- Change over time
Professional nursing values: CNA (2017)
- Providing safe, compassionate, competent and ethical care
- Promoting health and well-being
- Promoting and respecting Informed Decision Making
- Honouring dignity
- Maintaining Privacy and Confidentiality
- Promoting Justice
- Being accountable
Professional nursing values: CNO (2019)
- Client Well-being
- Client Choice
- Privacy & Confidentiality
- Respect for Life
- Maintaining Commitments
- Truthfulness
- Fairness
Values clarification
- The process of appraising one’s values helps a person decide priorities and make decisions
- Very important to identify one’s own values and beliefs
- Leads to better understanding of others
- Plays a key role in communication
- Need to be aware of values of employers, patients, physicians, and other groups
- Be aware of the mission and vision of your institution; and that you believe in it
- Ongoing process that requires self-reflection and examination
Understanding your personal and professional values
- Most things we assume to be “just common sense” are often culturally formulated
- All professions hold covert values, practices, and standards not written or articulated
- We are highly influenced by the values ascribed to by our peers in our working environment
- Consider: If we follow our instincts and reactions alone we may be following belief systems that are based on unjust reasoning
- When things become routine that’s when you really need to step back and evaluate
Ethical theory (and decision making)
- Introduces clarity, substance, and precision of argument into the domain of morality
- Helps to identify, articulate and analyze the ethical concerns/dilemmas
- Facilitates the development of (justifiable) action
- Ethical theory is how we articulate the issues
- Gives is the words to articulate the issue
Ethical theory: deontology
- Defines actions as right or wrong
- Regardless of the outcome
Ethical theory: utilitarianism (consequentialism)
- Proposes that the value of something is determined by its usefulness
Ethical theory: bioethics
- Obligation and reason-based, outcome-oriented
- Decision making is guided by four (4) principles:
- Autonomy
- Beneficence
- Nonmaleficence
- Justice
- Based on the outcome; having a positive or good outcomes
- Nursing ethics falls under bioethics
Ethical theory: feminists ethics
- Focuses on inequalities between people
- Looks at power dynamics within a system
Ethical theory: relational ethics
- Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
- Especially when patient is articulating their needs in the relationship
Ethical theory: virtue ethics
- Focuses on question of character rather than action
- About one’s character without really thinking about the action
- Someone with moral virtues will make the moral or right decision
Bioethics: beneficence
- To protect the patient from harm
- To promote the patient’s welfare
- Rooted in utilitarianism
- Doing or promoting good
Bioethics: non-maleficence
- Obligation to do no harm
- One ought not to inflict evil or harm
- One ought to prevent evil or harm.
- One ought to remove evil or harm
- Doing no harm to the patient
Bioethics: autonomy
- Personal self-governance
- Free from controlling interferences
- Key Characteristics: choice, privacy, self-mastery, freedom, self-determination
- Personal choice for the patient
Bioethics: justice
- Fair, equitable, and appropriate distribution of societal goods, including health care services
- Fairness
Working though ethical conflict
Assessment/description of situation
- Examine not only your belief, values, and knowledge, but also those of others on the health care team
- Consider policies and guidelines
Plan/approach
- Develop a plan that takes into account factors from the assessment, options, and consequences
- Decide best course of action (can be to do nothing)
Implementation/action
- Good communication and interpersonal skills are key
Evaluation/outcome
- Determine if the result is satisfactory
- Reassess and re-plan if needed
How to analyze an ethical dilemma
Ethical dilemma - when there are equally compelling reasons for and against one or more possible courses of action
Step 1: Determine whether the issue is an ethical dilemma
Step 2: Gather all relevant information
Step 3: Examine and determine your own values
Step 4: Verbalize the problem
Step 5: Consider possible course of action
Step 6: Reflect on the outcome
Step 7: Evaluate the action and the outcome
Ethical issues in nursing practice: futile care (quality of life)
- If the person is alert, orientated and can make decisions then go right to be person; not a dilemma
- If unable then usually go to the family or substitute decision maker; explain the situation and tell the consequences and outcomes of each potential course of action
- Medical assistance in Dying (MAID)
- Allocation of (scarce) resources/access to care
Ethical issues in nursing practice: issues of safety and ethics in the work environment
- Social networking and safety
- Working with health care team to promote safe care
Ethical (moral) distress
- The obligation to protect
Ethical (moral) integrity
Ethical (moral) residue
- When feeling compromised or allowing themselves to be compromised in a situation
- Feel like your opinions don’t mean anything
- The way you address it (in your own personal practice) is to talk to someone about it
- A lot of time the residue happens is when you are expressing you opinion it becomes personal and emotional
- Need to keep it to facts and data, speaking on behalf of the family and patient and people will listen (once it becomes emotional people will stop listening to you)
- Always bring it back to the patient and the scenerio at hand
Ethical issues in nursing practice: advance care planning
- Under utilized
- Includes the expression and comprehension of a patient’s beliefs and values
- Multi-dimensional process that involves health care providers
- Patients can also identify surrogate decision makers should they become unable to make their own healthcare decisions
