Oberle Flashcards
What does Oberle consider to be at the “heart” of nursing ethics?
Relationship
Relational Ethics:
says our ethical understanding are formed in, and emerge from, our relationship with others
- refers to individual relationships but also helps to consider how we relate within an institutional structure
- *a relationship ethic requires nurse enter into dialogue to determine the pt wishes (must set aside authority + certainty_
6 elements of ethical relationships (according to 2 Canadian ethics scholars)
embodiment, mutuality, engagement, non-coercion, freedom + choice
(plus environment)
Embodiment
- in relational ethics means recognizing mind-body split is artificial one –. Healing only comes from equal weight of scientific knowledge + human compassion, emotions as important as physical signs + symptoms in life
• Requires nurse become aware of what person is truly experiencing – extension of own self to the point that their experience becomes a part of the nurse’s own experience
- requires commitment to care for others, moral imperative becomes to value + respect others
Mutuality
The nature of this relationship?
- Relationship benefits both and harms neither
- requires that the interaction goes both ways (even though nurses sometimes thought to provide service with no expectation of return)
- both committed to relationhip
Engagement
Connecting with others in what way?
What kind of awareness does this require?
Connecting with others in open, trusting, and responsive manner
- requires being aware of how to engage within professional limitations (connection without overstretching boundaries of the nursing role)
What is non-coercion?
Not pressuring or forcing someone into a particular choice
Choice =
Making one’s own decisions.
Being self-determining.
Is very linked to freedom.
Freedom involves?
Creating an environment in which choices are available.
Environment as theme identified in relational ethics:
- Discussed by Bergum
- Describes relationship as “each of us - a living system - that changes through daily action” . We are the healthcare system, we are environment”
- Each action we take affects the system in some way
- Makes us aware of how the ways in which the power structures and politics of the overall system can afect care and relationship
- Encourages us to look at bigger picture
- if nurse feels oppressed by hierarchical structures, relationship of nurse to client and to system could be jeapordized
3 questions asked in relational ethics in nursing?
o What kind of relationship in important in the clinical situation?
oWhat makes for right and good health care relations?
oWhat are our ethical commitments to one another in a professional relationship?
Is the ability to form relationships define by the principles listed before (non-coercion, etc) a responsibility or a moral obligation for a nurse? (from the relational ethics point of view)?
Moral obligation
Moral relativism =
Any and all ideas have equal moral weight
implies that no single solution is any more right than another…
not what we use in nursing
WHERE DOES IDEA OF “RIGHT” COME FROM IN NURSING?
Why is this perhaps controversial?
o Guided by set of professional standards, which was informed by experienced nurses
o W/o universal concept of where right came from, authors say that our idea of “good” came out of practice – values in the Code grew out of practical wisdom of expert nurses through reflection of practice + in consideration of ethical theories
**Criticism comes from the idea that by being developed by nurses, nursing ethics uses what “is” rather than what “ought to be”
Moral sensitivity
must be able to recognize the moral dimensions of situations and to call on a sound knowledge based for guidance in making right decisions
What is the difference between “narrative” ethics and relational ethics?
Narrative depends on hearing the other’s story
Relational requires that we enter into a relationship with that person in such a way as to better understand the meaning of that story
**
Is it possible to call on “standard practice” to answer all moral questions?
No, nurses face situations for which no common wisdom exists, - must take into account particular context
What is “virtue”?
Behavior showing high moral standards
A virtuous person is one who aspires to be the best person possible
- The ethic of care is essentially a virtue ethic that gives moral weight to caring for others
What is nursing ethics as a “negotiated morality”?
Is there one ethical lens through which nurses should look?
No
= answers have to be negotiated in their particular context; must apply appropriate “lens” that a particular ethical perspective provides (as there are many)
ETHICS COMPOSITE MODEL components:
Institutional values
Legal context
social Context
Other values
Bioethical principles
Normative theories
Code of Ethics
Clinical competence
Virtue ——-> beneficience
What are normative ethics theories?
Deontology (Kantianism) + utilitarianism
What is beneficence?
How is viewed in the ethics composite model?
A bioethical principle that states our obligation to good.
In the model, see it as the goal of care = doing “good” for the patient…= non-maleficence”
According to Oberle, what is the starting point of ethical practice?
Virtue
Deontology =
Utilitarianism =
Deontology = judges the morality of an action based on the action’s adherence to a rule or rules. It is sometimes described as “duty-“ or “obligation-“ or “rule-“ based ethics, because rules “bind you to your duty.”
Utilitarianism = the doctrine that an action is right insofar as it promotes happiness, and that the greatest happiness of the greatest number should be the guiding principle of conduct.
The virtuous nurse is one who….
… aspires towards excellence as a professional → have to consider both virtue and obligation…both “what must I do” and “what kind of person should I be”
- Oberle believes virtue provides moral motivation that makes the nurse want to act to bring about human-well being (beneficence)
What personal characteristics make a “good nurse”
- Motivation, compassion, caring, trustworthiness, fidelity + integrity
How does motivation relate to being a “good” nurse?
A “good” nurse means having the moral motivation to work toward a professional goal of acting in the patient’s best interest
Compassion =
Having a feeling for the pain and suffering experienced by others
Fidelity =
Loyalty
Practical wisdom (being able to make good practical decisions) is enhanced through….
…praxis = “reflection in action”
How can virtue be thought of as something that is taught?
oNurses begin with moral motivation to “do good”, then develop skills through praxis → by thinking of virtue in this way, can think of it as something that can be taught
What is moral agency?
= the actual carrying out of a moral act
-“Virtue in nursing then means having the intent to act well, having the necessary chracteristics that enable one to choose well, having the skills and abilities to carry out chosen actions, and having the moral courage to act ⇒ result = moral agency (key to ethical care)
What is moral courage?
Strength to act on one’s beliefs
4 bioethical principles:
beneficence, non-maleficence, autonomy + justice
Which bioethical principle is the basis of informed consent?
Autonomy
What is practical wisdom in nursing?
Knowing the how, when, and why of appropriate interventions
= being able to make good practical decisions
How can practical wisdom in nursing be enhanced?
Through praxis
How does the concept of moral courage fit into virtue?
Is an element of virtue…
Can have the intent to act in best interest of client, the characteristics that enable one to choose well, the knowledge to do so…but then is another story to have the courage to do so.
(all of these make up virtue in nursing)
Justice
Requires that we go beyond relationships as guiding principles to idea of what is just or fair
How might normative theories aid nurses in making decisions?
Situations in which values conflict or nurse has competing obligations, may need to look through lens of utilitarian or a deontologist to see what kind of solution this might evoke
