Healthcare Ethics & Stewardship in Nursing

Basic Ethical Principles in Healthcare Ethics

• This material elaborates on the basic ethical principles and the Code of Ethics for Registered Nurses in the Philippines.
• Topics include identifying situations where the Code of Ethics is practiced,discussing the Nightingale Pledge, and integrating professional values in case studies.

Stewardship

• Stewardship involves the nurse's responsibility to care for and promote the health and life of those entrusted to them.
• Stewardship includes managing, taking charge, or caring for another's property, understanding that ultimate ownership belongs to a higher power.
• Humans should take care of our bodies, life, health, the earth, and everything in it to the best of our abilities.
• In a hospital, a nurse manager notices that gloves and syringes are wasted due to overstocking and improper storage, while the hospital faces budget constraints.
• The nurse manager needs to ensure patient care isn't compromised due to lack of resources and to manage hospital resources efficiently and effectively.
• A solution would be to implement a new inventory management system to reduce waste and optimize resource allocation.

Totality

• Totality refers to the duty to preserve the physical, bodily, and spiritual nature of a person.
• Each part of the human body “exists for the sake of the whole as the imperfect for the sake of the perfect."
• The whole is greater than its parts, the existence of parts indicates the existence of the whole and vice versa.
• Consider if a patient, Sarah, with severe gangrene needs an amputation to save her life, consider the medical necessity of the amputation.
• Consider the importance of preserving Sarah's bodily integrity, as the body is an integrated whole, and the impact the decision to amputate Sarah's leg will have on bodily and spiritual integrity.

Cooperation

• Cooperation is defined as working with another in the performance of an action.
• Includes the participation of more than one person in an immoral or criminal action.
• An associate may be equally or less guilty than the wrongdoer, or perhaps not guilty at all.

Degrees of Cooperation

• Formal Cooperation consists of an explicit intention and willingness for the evil act.
• Formal Cooperation happens when one takes part in an immoral action and adopts the evil intention of their associate.
• Immediate Material Cooperation consists of an action other than the evil act itself, but facilitates and contributes to its achievement.

Cooperation Examples

• Nurse Sarah agrees to administer a lethal dose of medication to end a patient's life which is formal cooperation because she explicitly intends to contribute to the evil act of ending a human life.
• Pharmacy technician John is asked to prepare a prescription for medication to be used for an abortion, preparing the prescription is immediate material cooperation, facilitating the evil act (abortion) even without sharing the pharmacist's intention.

Solidarity

• Solidarity signifies being one with others and claims that human communities exist to promote and share the common good.
• A severe hurricane hits a coastal town, leaving many residents homeless.
• If healthcare workers organize a team to volunteer in the affected community, providing medical aid, food, and shelter, this demonstrates solidarity.
• Solidarity recognizes the well-being of the community is intertwined with the hospital and its patients, working together promotes the common good and contributing to the wider community.

Ethical Dimensions of Professional Duty in Nursing Introduction

• Knowing the rights and responsibilities that health care professional have, is essential.
• Profession must be practiced within a legally established framework.
• Ethical codes reflect the key values and principles in a profession.
• Ethical codes in clinical practice acts as a rational control mechanism in a group, strengthening the moral responsibility of the medical staff while delineating responsibilities rather than dictating actions.

Medical and Health Care Ethics

• Medical ethics is applied normative ethics, that uses universal ethical principles and rules apply it to specific moral problems arising in medical practice and research.
• The principles and rules ensure the application of humane, value, and moral judgment in medical practice.
• Health care ethics is also applied ethics and shares many principles and rules with medical ethics, it emphasizing relationships, human dignity, and joint patient care.
• Caring for the sick involves emotional commitment, doing good for others, responsibility, trust, devotion, and sensitivity.

Duties of Healthcare Professionals

• Healthcare professionals perform a variety of roles, including caring for patients whom they must also educate and counsel.
• May also perform administrative and management functions by making decisions and coordinating staff activities.

Ethical Framework (Medical Deontology)

• Medical deontology includes the principles of medical behavior aimed at maximizing the effectiveness of medical activity and eliminating the harmful consequences of substandard work.
• Medical deontology provides guidelines for correct behavior in professional activity, in which complex situations, conflicts, and responsibilities arise.

Medical Deontology Example

• A 12-year-old becomes pregnant after being raped and requests an abortion.
• Mother refuses to consent to the abortion.
• This presents a Medical Deontological Dilemma because of conflicting responsibilities like, respect for the patient's autonomy, protection from harm, upholding the mother's rights and authority as the patient's legal guardian, and upholding the law and medical ethics.
• Considerations should include patient's best interests, implications of performing an abortion without parental consent, consequences of not performing the abortion, and moral principles guiding decision-making which will resolve the conflict.
• Imbalance between the rights and responsibilities can cause ethical conflicts, and incorrectly addressing such issues can cause moral harm and distress.

Other Specific Ethical Problems in the Healthcare/Nursing Profession

• Personal
• Interpersonal
• Professional
• Institutional
• Sociocultural challenges

Ethical Problem Examples

• Personal: Covering a colleague's longer-than-allowed break, potentially compromising patient care or damaging your personal relationship.
• Interpersonal: Addressing a doctor's unprofessional behavior towards nurses or ignoring the issue to avoid conflict.
• Professional: Deciding whether to follow a supervisor's instruction to prioritize expensive medication for patients with private insurance, potentially compromising care for others.
• Institutional: Continuing to use a flawed electronic health record system that compromises patient care, or advocating for a new system despite the high cost.
• Socio-Cultural: Respecting a patient's refusal of blood transfusions due to religious beliefs, or prioritizing medical needs despite cultural and religious values.

Explore ethical principles and the Code of Ethics for nurses in the Philippines. Learn about stewardship, the nurse's role in promoting health and responsible resource management. Includes practical examples of ethical dilemmas in healthcare.