Ethical Considerations in Nursing

Ethical Considerations in Nursing

• This presentation covers ethical considerations in nursing practice.
• The agenda includes theory, principles, issues, decision-making, case analysis, and a group assignment due next week.

Ethics in Nursing Practice

• Nurses face complex ethical choices daily.
• Key questions for nurses include:
  • How do nurses know if their actions are right?
  • How do nurses identify ethical issues?
  • How do nurses determine the best option for everyone concerned?
  • How can nurses gain confidence in choosing a course of action?
  • How can nurses demonstrate integrity and maintain trust with patients?
  • How can nurses access support when facing ethical challenges?

Ethical Knowledge Assists Nurses

• Nurses benefit from understanding ethical theories, concepts, and principles.
• This knowledge helps in decision-making related to moral challenges.
• Ethical theory has evolved from historical to contemporary concepts.
• Important elements include the integration of professional and moral rights and obligations, and the value of caring and emotion alongside rationality.

Ethical Theory - Key Terms

• Morality refers to culturally-based beliefs about right and wrong.
• Ethics systematically explores what is morally right and wrong.
• Ethical theory studies the nature and justification of general ethical principles, applicable to various moral problems.
• Biomedical ethics focuses on ethical questions related to health care.

Ethical Theory - Key Terms Continued

• Nursing ethics addresses moral issues in nursing practice, including the nurse-patient relationship and moral character.
• Ethical dilemmas arise when the best course of action isn't clear, and strong moral reasons support competing positions.
• The least wrong choice needs to be chosen.

Moral Distress

• Nurses face a high risk of moral distress due to unaddressed or unmanageable ethical issues.
• This distress can arise when nurses cannot act upon what they believe is right.
• This causes psychological and emotional pain that may lead to anger and powerlessness when there's no support for dealing with issues and their consequences.
• Sources of moral distress in healthcare include inadequate communication, use of healthcare resources, staff training, and pain relief.

Group Activity

• In class, analyze potential sources of moral distress.
• Discuss the impact of these situations on nursing care and the profession.
• Brainstorm strategies to lessen moral distress.

Moral Distress Sources

• Inadequate communication about patient care between providers, families, and patients is a cause of stress.
• Inappropriate use of resources.
• Inadequate staffing.
• Insufficient pain relief.
• Electronic health records can distract from face-to-face care, but are valuable too.
• Pressure to keep up with changing protocols.
• High patient volumes and low resources can make it difficult to maintain proper procedures.

Emergence of Ethical Theory

• Nursing ethics incorporates emotion, caring, relationships, and experiences.
• Modern nursing ethical theories combine nursing concepts (like caring and compassion) with a view of nurses as moral agents influencing professional relationships.

Factors Influencing Morality

• Many things shape ethical thought, including:
  • societal norms and beliefs
  • personal characteristics like gender, age
  • the situation's context, previous experiences
  • potential outcomes of actions
  • relationships involved
  • professional and individual values

Values

• Values are ideals important to individuals, groups, and societies.
• Canadian society values freedom, health, fairness, honesty, and integrity.
• These values are reflected in Canadian laws, professional codes of ethics, the Charter of Rights and Freedoms, and healthcare systems.

Influence of Values on Ethical Decision Making

• Values significantly influence ethical decision-making, including personal beliefs, behaviors, and societal rules.
• Values can change over time, illustrated by shifts from prolonging life at all costs toward quality of life, and a shift toward ethical decision-making informed by respect for individual rights.
• Value conflicts arise when personal values conflict with actions of others or professionals' differing perspectives.
• Value clarification is a process of understanding your personal values and those of others, clarifying them, and articulating them to others.

Categories of Ethical Study

• Nonnormative ethics analyze morality without taking a position. (Descriptive Ethics and Metaethics)
• Normative ethics focuses on defining what is right or wrong. (Virtue Ethics, Teleological Theories, Deontological Theories, Principlism, and Narrative Ethics)

Normative Ethical Theories

• Frameworks guide decisions about right and wrong.
• They use principles and rules to define appropriate actions.
• Some theories are historical, some more contemporary.
• Embedded in the moral tradition of Indigenous communities.

Virtue Ethics

• The focus in virtue ethics is the character and virtues of the individual making the decision.
• Virtues are positive characteristics (e.g., courage, compassion, generosity).
• Those with strong moral virtues are more likely to make the right decisions and act correctly.

Teleological Theories

• Focuses on the outcomes and consequences (immediate and long-term).
• Judgments are based on a theory of value, such as utility (e.g., utilitarianism).
• Act utilitarianism considers the specific act, while rule utilitarianism looks at general patterns of behavior.

Modern/Contemporary Theories

• Ethical principles guide decision-making (Principlism).
• Social justice theories consider fairness and equity.
• Feminist perspectives are important in decision-making.
• The "ethic of care" focuses on empathy and personal relationships.
• Caring and relational ethics is a focus in nursing.
• Narrative ethics emphasizes sharing stories and experiences to better understand ethical dilemmas.

Principle-Based Ethics

• Beauchamp and Childress introduced principles of ethical conduct to healthcare in 1983.
• These principles are found in professional codes of ethics and provide a framework for decision-making.

Autonomy

• The principle of autonomy emphasizes the freedom of competent individuals to make decisions.
• This freedom is limited to actions that do not harm or interfere with the rights of others. This principle is foundational to informed consent.
• May create conflict with other ethical principles.

Fidelity

• The principle of fidelity emphasizes loyalty to promises and truthfulness in nursing relationships.
• Fidelity upholds commitment with actions such as adequate pain control, comfort and support, and person-centered care.

Nonmaleficence

• The principle of nonmaleficence emphasizes "first, do no harm."
• This principle guides individuals on acting to prevent or remove harm.

Beneficence

• The principle of beneficence focuses on acts that produce good for others.
• Health professionals should help those in need or further legitimate interests.

Justice

• Based on fairness, justice focuses on how individuals treat each other.
• Distributive justice ensures the equitable distribution of benefits and burdens.
• Compensatory justice compensates for harms caused by negligence or malpractice.

Social Justice

• Social justice emphasizes equity and opportunity in society.
• It promotes the well-being of all members, particularly vulnerable groups, through policy and action.
• Indigenous children have a first priority in healthcare access and services (Jordan's Principle).
• Policies and laws help to address social determinants of health and support for issues such as homelessness and disabilities.

An Ethic of Care

• Emphasizes feelings, emotion, empathy, and care.
• Prioritizes the context and complexities of relationships and needs of the person.

Caring and Relational Ethics in Nursing

• Focuses on care, connections, and trust in relationships.
• Aims at avoiding objectification of the patient.
• Preserves human dignity.

Uncovering the Story - A Narrative Approach to Ethics

• Ethical dilemmas can be better understood by sharing real stories.
• Ethical themes, values, and perspectives can be revealed.
• Discussion and questioning are essential to thoroughly understand moral dimensions.

Ethical Concerns

• Scenario about a patient handcuffed in the emergency department.
• Issues of patient privacy, physical safety, and best practices are significant.

Case Scenario Questions

• Should least restraint policies apply to the situation? Which particular ethical principles are related?
• How do the standards and conduct of the Canadian Nurses' Association (CNO) apply?
• Does provincial legislation need to be considered?
• Do restraints interfere with medical treatment?
• Who should create the care plan?

Escape Room

• Students work through an escape room related to ethics.

Break

• A break is scheduled.

Ethical Decision Making

• Making ethical decisions requires deliberate, critical thinking, and systemization.
• Nurses need to use frameworks to ensure fairness and consistency.

An Ethical Decision-Making Process

• A 7-step process is described for making ethical decisions

Critical Thinking Scenario

• Students analyze a scenario posted online, and address 3 questions about the situation.

Scenario 1 and 2 (examples of potential critical thinking scenarios)

• Detailed scenarios for critical thinking.

Critical Thinking Questions

• Questions to guide the students' analysis. (4 questions presented).

Clinical Ethics Committees

• Provide consultations, education, and policy development for complex ethical issues.

Case Analysis (next class activity)

• Students will analyze specific case studies.

Plan for Next week

• Review of professional rights and obligations.
• Due date for group assignment.