Week 3 (Class 2) - Becoming a Nurse: Profession of Nursing Values & Ethics

Question 1

What are nurses ranked as?

Answer 1

1 Most Ethical Profession By 2019 Gallup Poll

Question 2

As we consider why nurses are ranked as the #1 most ethical profession… go over values, beliefs, and attitudes:

Answer 2

Values: Things that really matter to you; determinants that guide human actions

Beliefs: Lens through which we view the world; convictions a person holds as true - guides behaviour and action
- How the person understands the self and the world

Attitudes: Judgments - comprised of three components:

• Affective (emotion)
• Behavioural
• Cognitive (thinking)

Question 3

What are values and beliefs of client-cantered care (RNAO)?

Answer 3

Respect: Respect clients wishes, concerns, values, priorities, perspectives, and strength

Human Dignity: Care for clients as whole and unique human beings, not as problems or diagnoses

Clients are Experts for their Own Lives: Clients know themselves best

Clients as Leaders: Follow the lead of the clients with respect to info giving, decision making, care in general and involvement

Clients’ goals coordinate care of the health care team: Clients define the goals that coordinate the practices of the health care team
- All members of the team work toward facilitating the achievement of these goals.

Continuity and consistency of care and caregiver: Provides a foundation for client centred care.

Timeliness: The needs of clients and communities deserve a prompt response.

Responsiveness and universal access: Care that is offered to clients is universally accessible and responsive to their wishes, values, priorities, perspectives, and concerns.

Question 4

What is ethics?

Answer 4

Study of right and wrong behaviour based on things one what ought to do and what one must not ought to do

Question 5

What are nursing codes of ethics?

Answer 5

Embedded in nursing organizations and provide a foundation for professional nursing
- Ex. ICN, CNA, CNO

Question 6

Describe the 4 principal elements that outline the ethical conduct (ICN):

Answer 6

1) NURSES and PEOPLE
- The nurse’s primary professional responsibility is to people requiring nursing care
- Nursing care respects/promotes human rights, values, customs and spiritual beliefs of the individual, family and community

2) NURSES and PRACTICE
- The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning
- Personal conduct reflects positively on the profession

3) NURSES and NURSING PROFESSION
- The nurse assumes the major role in determining and implementing acceptable standards of critical nursing practice, management, research, and education
- Active in developing research-based professional knowledge
Contributes to equitable social and economic working conditions in nursing

4) NURSES and CO-WORKERS
- The nurse sustains a cooperative relationship with co-workers in nursing and other fields
- Takes action to safeguard people when care is endangered by a co-worker of the nurse or by any other person

Question 7

Describe the 3 principal elements that outline the ethics of the CNA:

Answer 7

1) Responsibility:
- Characteristics of reliability and dependability - Recognizing right and wrong, and acting on it thoughtfully.

2) Accountability:
- Grounded in moral principles of faithfulness with respect for dignity, worth, and self determination of the client
- Accept responsibility and account for own actions
- I.e. Documenting care provided

3) Advocacy:
- Acting on behalf of another person, speaking for a person who cannot speak for themselves, intervening to make sure they are heard when they cannot be heard themselves, etc.

Question 8

CNA ethical values:

CNO ethical values:

Answer 8

CNA ethical values:

• Safe, compassionate, competent and ethical care
• Promoting health and well-being
• Promote/respect informed decision-making
• Preserving dignity
• Maintaining privacy and confidentiality
• Promoting Justice
• Being accountability

CNA ethical values:

• Client well-being
• Client choice
• Privacy and confidentiality
• Respect for life
• Maintaining commitments
• Truthfulness
• Fairness

*These undergo revisions to update based off of social contents over time

Question 9

What are the 2 primary values of the CNA?

Answer 9

1) Safe, Compassionate, Competent & Ethical Care
- Nurses value the ability to provide safe, competent and ethical care that allows them to fulfill their ethical and professional obligations to the people they serve.

2) Promoting Health and Well-Being
- Nurses value health promotion and well-being, and assisting persons to achieve their optimum level of health in situations of normal health, illness, injury, disability, or at the end of life

Question 10

What are the 5 ethical values of the CNA?

Answer 10

1) Promoting & Respecting Informed Decision-Making
- Nurses respect and promote the autonomy of persons and help them to express their health needs and values, and also to obtain desired information and services so they can make informed decisions

2) Preserving Dignity
- Nurses recognize and respect the inherent worth of each person, and advocate for respectful treatment of all persons

3) Maintaining Privacy and Confidentiality
- Nurses safeguard information learned in the context of a professional relationship, and ensure it is shared outside the health care team only with the person’s informed consent, or as may be legally required, or where the failure to disclose would cause significant harm.

4) Justice
- Nurses uphold principles of equity and fairness to assist persons in receiving a share of health services and resources proportionate to their needs and in promoting social justice

5) Accountability
- Nurses are answerable for their practice, and they act in a manner consistent with their professional responsibilities and standards of practice.

Question 11

What are the 8 values of the CNO ethical framework?

Answer 11

1) Client Well-Being
- Promoting well-being means both facilitating someone’s good health and welfare, and preventing and removing harm

2) Client Choice
- Client choice means self-determination and includes the right to the information necessary to make choices, and to consent to or refuse care

3) Privacy
- is limited access to a person, the person’s body, conversations, bodily functions, or objects immediately associated with the person

4) Confidentiality
- Involves keeping personal information private. All information relating to the physical, psychological, and social health of clients is confidential, as is any information collected during the course of providing nursing services/care

5) Respect for Life
- means the human life is precious and needs to be respected, protected, and treated with consideration

6) Maintaining Commitments
- Nurses have an obligation to maintain commitments that they assume as regulated health professionals:
- To clients
- To oneself
- To nursing colleagues
- To nursing profession/team
members
- To quality practice settings

7) Truthfulness
- Truthfulness means speaking or acting without intending to deceive

8) Fairness
- Fairness means allocating health care resources on the basis of objective health related factors

Question 12

What is bioethics based on?

Answer 12

4 Principles:

1) Autonomy
- Ability to make own decisions/choices

2) Beneficence
- Doing or promoting good for others
- Used as a response to a specific treatment

3) Non-maleficence
- Not intentionally inflicting harm - avoidance of harm or hurt
- Balance of benefit outweighs risks
- Good effect is intended
- Good outweighs bad
- Acts as a threshold
- Constant in clinical practice

4) Justice
- Fairness
- Discussion about resources

Question 13

What 3 major types of ethics are there?

Answer 13

1) Meta-ethics
- Theoretical meaning
- Truth values

2) Normative ethics
- Practical means of determining a moral course of action

3) Applied ethics
- What a person is obliged to do in a particular situation
- Relational Ethics - basis of nursing

Question 14

What are barriers to providing ethical care?

Answer 14

1) Ethnocentrism
- Judging another culture solely by the values of ones own cultures
- Biased bc their values are not aligned with ours

2) Stereotyping
- Generalization, usually exaggerated, that is used to describe or distinguish a group

3) Prejudice
- Preconceived opinion not based on reason or actual experience

4) Discrimination
- Unjust treatment of people or things (i.e. race, age, sex)

5) Racism
- Antagonism of someone of a different race with the beliefs that ones own race is superior

Question 15

What is an ethical dilemma?

Answer 15

Ethical paradox: a decision-making problem between two possible moral imperatives.

• The complexity arises out of the situational conflict in which obeying one would result in transgressing another.
• The ethical dilemmas which nurses face are vast in scope

Question 16

What are sources of personal moral conflict?

Answer 16

1) Moral distress
- Occurs when ones knows the right thing to do but institutional constraints makes it difficult to follow

2) Moral integrity
- Being morally accountable and responsible for ones judgement
- Strong sense of self
- Right thing to do

3) Moral residue
- Left over from moral distress
- Long lasting effects of moral distress, esp. when repeated

4) Adverse events
- Unattended injuries or complications that can result in death or prolonged hospital stays that arise from healthcare management
- Nurse will have a source of moral conflict as they reflect on the adverse event

5) Whistle blowing
- Situations where there is something wrong going and it is identified and reported

Question 17

In nursing, as in life generally, you are presented with all sorts of issues and situations to which you will respond. What is to say about the way you deal with problems? What will majority of your problems consist of?

Answer 17

The way you deal with problems that arise will be based on the values that you have and the moral standpoint you take.

Many of the problems you will face have to do with things like honesty, doing good, having a choice, valuing someone’s worth and being fair about something.

Question 18

How do you approach an ethical dilemma?

Answer 18

1: Determine whether the issue is an ethical dilemma.
2: Gather all the information relevant to the care.
3: Examine and determine your own values on the issue.
4: Verbalize the problem.
5: Consider possible courses of action.
6: Reflect on the outcome.
7: Evaluate the action and the outcome.

Question 19

What is the framework for ethical decision making (IDEA)?

Answer 19

1) Identify the Facts
2) Determine the Relevant Ethical Principles
3) Explore the Options
4) Act
* See slide for picture explanation and link for further explanation.