Week 8 - Nursing Ethics: Principles, Values, and Contexts

Question 1

What is ethics?

Answer 1

The study of the philosophical ideals of right and wrong behaviour based on what you think you ought (or ought not) to do

Question 2

Characteristics of ethical thinking (3)

Answer 2

• Critically reflective
• Systematic examination of moral life
• Compells us to consider and reconsider our ordinary actions, judgments and justification

Question 3

Critical reflection of ethical dillemas (DeVries & Timmins)

Answer 3

Critical reflection focuses on “consistency and inconsistency of actual care delivery with values, standards, and regulations

Question 4

Characteristics of NURSING ethics (2)

Answer 4

1. Relational. Focuses on everyday relationships and processes of care
2. “Boundary work”: moral ‘in-between’ position; values of patient, family, other health providers, institutions, and self

Question 5

Ethical uncertainty

Answer 5

Occurs when a nurse feels indecision or lack of clarity, or is unable to even know what the moral problem is

Question 6

Ethical problems

Answer 6

Conflicts between one or more values and uncertainty about the correct course of action

Question 7

Ethical dilemmas

Answer 7

When there are equally compelling reasons for and against one or more possible courses of action

Question 8

Ethical (moral) distress

Answer 8

Nurses know or believe they know the right thing to do, but do not or cannot take the right action (Can vs Ought)

Question 9

Ethical residue

Answer 9

What nurses carry from morally distressing times in our lives when, in ethically distressing situations, we feel as though our values were compromised;

“Right” decisions might still feel bad going forward

Question 10

Ethical disengagement

Answer 10

Can occur if nurses begin to see the disregard of their ethical commitment as normal

Question 11

Ethical courage

Answer 11

When a nurse stands firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself

Question 12

Three overarching principles of nursing ethics

Answer 12

Advocacy
Responsibility
Accountability

Question 13

Advocacy (4)

Answer 13

• Acting on behalf of another person
• Speaking for persons who cannot speak for themselves
• Includes protecting patient’s right to choice
• Requires attention to power dynamics

Question 14

Responsibility

Answer 14

Reliability, dependability

Responsible actions lead to trust (patients, colleagues, society)

Question 15

Accountability (3)

Answer 15

• Accepting responsibility, accounting for your actions (and inactions)
• Offering reasons, explanations for aspects of nursing practice
• Awareness of professional standards, laws, regulations; ensuring competence and fitness to practice safely

Question 16

“Allyship”

Answer 16

Using position to workwiththose from an oppressed group to remedy the systemic denial of privilege and power

Creating opportunities for others to be heard

Question 17

What are “ethical values” ?(3)

Answer 17

• Strong personal belief and an ideal that a person or group believes to have merit
• Inner standards which motivate you to act as you do and by which you judge behavior
• Influence how you interpret confusing/conflicting information

Question 18

Values formation

Answer 18

Influenced by social, relational, cultural, contextual/environmental factors

Chosen/discarded/transformed based on reflection, experience, dialogue

Question 19

Values clarification (3)

Answer 19

• process of appraising personal values
• helps to articulate the priorities that guide decision making
• leads to greater self-awareness

Question 20

Values conflict

Answer 20

Occurs when personal values may be at odds with those of patients/families, colleagues, institutions

Question 21

CNA (2017) Values (7)

Answer 21

1. Promoting Health & Well-being
2. Promoting and Respecting Informed Decision Making
3. Maintaining Privacy and Confidentiality
4. Providing Safe, Compassionate, Competent and Ethical Care
5. Promoting Justice
6. Being Accountable

Question 22

CNO (2009) Values (7)

Answer 22

1. Client Well-being
2. Client Choice
3. Privacy & Confidentiality
4. Respect for Life
5. Maintaining Commitments:
   - To clients
   - self
   - colleagues
   - profession
   - team members
   - quality practice settings
6. Truthfulness
7. Fairness

Question 23

Concept of “Moral Environments in Nursing Practice”

Answer 23

• Healthcare environments have “ethical lives”
• Moral agency is dialogical, relational, and influenced by context
• Social positioning and proximity can leave nurses feeling overburdened by, and uncertain of, their responsibilities.
• Work environments can become morally uninhabitable

I.e.,: Care erosion, cognitive dissonance, dialogue, and critical reflection

Question 24

Deontology

Answer 24

Kant

• Right action based on duty and reason
• Based on rationality and obligation to “good”

Critiques:

• abstract, irrelational
• conflict of “obligations”

Contribution:
- moral rules applied to all

Question 25

Utilitarianism

Answer 25

Betham and Mill - Concept of utility; greatest good for greatest number of people - Calculated Critiques: - who decides what's "good"? Contribution: - used often in public policy (e.g., COVID) - beneficence based

Question 26

Virtue Ethics

Answer 26

Aristotle - How we ought to be (versus what we should do or how we should act) - Reason, virtuous character and proper motivation leads to moral choices - ‘Golden mean’ – be brave but not reckless (there is a limit) Critique: - What is a ‘good’ person? Contribution: - Emphasizes the development of good moral character

Question 27

Feminist Ethics

Answer 27

- Makes visible the moral significance of values/virtues associated with women and other people historically discounted from ethical reasoning - Integrates moral emotion, subjective knowledge - Relational. Attends to power dynamics in everyday life Critique - Relativistic and not generalizable Contribution: - Captures the ethical complexity in the ‘everyday’ - Addresses vulnerable populations - Sensitive to socio-political context

Question 28

Relational Ethics

Answer 28

Bergum Environment – influence of context on N-P relationship Embodiment – mind/body connection Mutual respect – attention to both pt and caregiver needs Engagement – open, trusting, responsive Critique: - Doesn’t address power dynamics within relationships Contribution - Focus on ethics enacted through relationships

Question 29

Moral Principles (4)

Answer 29

Respect for Autonomy Beneficence Non-Maleficence Justice

Question 30

Process of ethical decision making

Answer 30

Follows the nursing process: - Assessment - Plan - Implement/act - Evaluate - Reassess and re-plan

Question 31

Special considerations for ethical decision making (3)

Answer 31

- Both action and inaction have moral consequences. - You remain accountable - Would the decision be the same if something about the person or the context was different?