Ethics in Nursing Communication

Ethics in Nursing Communication and Patient Relationships

• Ethics in healthcare emphasizes including patients in decisions about their care.
• Surgeons have an obligation to review surgical procedures, risks, and benefits with patients.
• Patient consent before surgery is crucial to respect patient autonomy.

Basic Terms in Health Ethics

• Autonomy: Commitment to involving patients in all aspects of care.
  • Surgeons must explain procedures and risks to patients.
  • Patient consent documents this respect for autonomy.
• Beneficence: Taking positive actions to help others, a fundamental principle in nursing and medicine.
• Non-maleficence: Avoiding harm and striving to do the least harm possible.
  • Balancing risks and benefits is part of ethical care in healthcare.

Justice in Healthcare Ethics

• Justice is about equal access to healthcare.
  • Discussions about healthcare coverage, hospital locations, and organ transplants involve justice issues.

Professional Nursing Code of Ethics

• Codes of ethics provide guidance for professional practice and behavior, acceptable to all profession members.
  • These act as guidelines aiding questions around correct practice.
• American Nurses Association (ANA) established the first code of nursing ethics, reviewed and revised over time to adjust to changes in practice.
• Advocacy: Nurses advocate for patient needs, communicating observations to their instructors for patient care.
• Responsibility: Nurses ensure they administer medications correctly, at the correct dose, and at the appropriate time. Asking for clarification when needed showing duty.
• Accountability: Nurses take responsibility for errors and work to correct them, informing their instructors, instead of hiding them.
• Confidentiality: Maintaining patient privacy, not sharing personal information unless through healthcare team to protect patient privacy, and ensure security.

Values

• Values reflect cultural and social influences, changing over time.
• Clarifying values—personal, patient, and coworker's—is critical for ethical discourse, essential in patient care.
• Ethical dilemmas happen when conflicting values occur, sometimes considering values as facts or beliefs.

Nursing Perspective

• Nurses have interactions with patients for longer durations than other disciplines.
• Relevant details like family dynamics, coping styles, personal preferences, fears, and insecurities are part of caring, understanding the patient in-depth.

Processing Ethical Dilemmas

• Ethical dilemmas bring distress and controversy to patients and caregivers.
• Resolve ethical dilemmas by considering facts, gathering relevant information, clarifying values, verbalizing the problem, identifying possible courses of action, negotiating a plan, and evaluating the plan over time.

Issues in Healthcare Ethics

• Quality of life: Measurement of quality of life, central to decisions of medical interventions, care, and futility, cancer therapy, health care provider assisted suicide, and DNR (Do Not Resuscitate) discussions.
• Euthanasia/Do-not-resuscitate (DNR): Centeral to health care ethical discussions.
  • These decisions can involve family preferences.
  • Decisions include quality of life, and treatments as related futile treatments
• Genetic Screening: Genetic testing identifies conditions that might develop, but not always, immediately, creating an ethical dilemma.

Care at the End of Life

• Futile interventions are those unlikely to benefit a patient.
• Access to healthcare is crucial and ethical considerations are involved in its assessment.

Key Points

• Ethics deals with what's good and valuable for individuals and society.
• ANA code forms a foundation for nursing.
• Standards: Autonomy, beneficence, non-maleficence, justice, and fidelity.
• Values clarification and respecting others values is important to exploring and resolving ethical issues.
• Ethical problems happen from value disagreements, technological advances in healthcare, and evolving professional roles and social views on quality of life.

Key Steps in the Resolution of an Ethical Dilemma

• Step 1: Ask if it's an ethical dilemma through assessment of different views, and gathering data, determining if dilemma exists.
• Step 2: Gather information relevant to the case, including patient, family, institutional, and social perspectives.
• Step 3: Identify and clarify relevant values.
• Step 4: Clearly and simply state the problem, creating an accurate summary.
• Step 5: List and identify courses of action.
• Step 6: Discuss and negotiate a plan that respects various views.
• Step 7: Evaluate the plan over time and adjust depending on findings.

Ethical Dilemma Simulation

• To allow students to explore ethical dilemmas and develop solutions.
  • Students work individually or in groups in various scenarios that include decisions about withdrawing life support, patient privacy, and treatment conflicts with religious or spiritual beliefs.
  • This is meant to help develop solutions for ethical issues that may arise in nursing practice.

Communication and Nursing Practice

• Communication is essential for patient care.
• Effective communication for patient safety.
• Breakdown in communication can lead to errors and threaten professional credibility.
• Communication skills are essential for patient safety and high-quality care.

Developing Communication Skills

• Individuals use their senses of sight, hearing, taste, touch, and smell to interpret information, and culture and education will influence perceptions.
• Communication techniques are easy to learn but challenging to apply appropriately to particular patient needs, scenarios, or diagnoses (cancer or end-of-life issues).

Levels of Communication

• Interpersonal: Face-to-face one-on-one exchange. Essential part of nursing.
• Small-group: Goal-oriented interactions in meetings, committees, patient support groups, research teams, or conferences.
• Public: Communication with an audience, sharing health information, or presenting at events.

Basic Elements of the Communication Process

• Referent: The initial stimulus for communication.
• Sender: The person encoding and giving the message.
• Message: The content of the communication.
• Channel: Method of delivering the message (visual, auditory, tactile).
• Receiver: Person receiving the message.
• Feedback: Response from the receiver, demonstrating if understood or not.

Forms of Communication-Verbal

• Vocabulary: Avoid technical medical jargon, clarity, and conciseness.
  • Use patient-centered language, taking into account culture differences.
• Denotative and connotative meaning: Shared meaning of words in a language, but also considering how words might be perceived or interpreted in certain contexts.
• Pacing and tempo: Speak slowly when considering cultural differences.
• Clarity and brevity: Speak with clear and concise language, to avoid confusion and give clear direction.
• Timing and relevance: The timing of interactions is important according to patient needs and environment.

Forms of Communication-Nonverbal

• Personal appearance: Physical characteristics, dress and grooming, create first impressions that reflect health and emotional state.
• Facial expressions: convey emotions such as surprise, fear, anger, happiness, and sadness.
• Eye contact: Shows respect and willingness to listen, considering cultural norms of eye contact.
• Personal space: Invisible, individual space, nurses must consider patient's need for space.

Nurse-Health Care Team Relationships

• Using clear communication among teams is important for patient safety.
• Using standardized tools, such as SBAR, to improve communication.
• Lateral violence, behavior that expresses disapproval, is not tolerated and should be reported as inappropriate conduct.

Elements of Professional Communication

• Courtesy/Kindness: Using respectful language shows courtesy and kindness, through greetings, use of "please" and "thank you".
• Use of names: Use patient's names, not just diagnoses, when referring to them to show respect to the patient.

This quiz explores ethical principles in nursing communication and patient relationships. Key topics include autonomy, beneficence, non-maleficence, and justice in healthcare. Test your understanding of how these principles apply to patient consent and decision-making in nursing practice.