Nursing Ethics and Communication in Healthcare

Ethics in Communication and Nurse-Patient Relationships

• Ethics in healthcare involves determining actions considered good and valuable for individuals and society.
• The American Nurses Association (ANA) code of ethics provides a foundation for professional nursing practice, emphasizing accountability, responsibility, advocacy, and confidentiality.
• Key ethical principles in healthcare include autonomy (patient involvement in decisions), beneficence (taking positive actions to help others), non-maleficence (doing no harm), justice (fair access to resources), and fidelity (keeping promises).

Basic Terms in Health Ethics

• Autonomy: Patients have the right to make decisions about their care. Surgeons must review procedures and risks/benefits to respect this. Pre-surgery consent documents this.
• Beneficence: Taking positive actions to help others is fundamental to nursing/medicine.
• Non-maleficence: Ethical practice focuses on doing good and also doing no harm. Health professionals balance risks/benefits and minimize harm.
• Justice: Accessing healthcare resources fairly, particularly in discussions about access to insurance, hospital services, and organ transplants.
• Fidelity: Keeping promises is critical; nurses must follow through with interventions. Example: if assessing for pain, providing pain relief and monitoring response.

Professional Nursing Code of Ethics

• A code of ethics is a set of guiding principles to help professionals with dilemmas about correct practice/behavior.
• ANA established the first nursing ethics code, regularly reviewed and revised to reflect current practices.
• Important themes include responsibility (administering correct medication), advocacy (addressing patient needs) accountability (correcting errors), and confidentiality (protecting patient privacy).

Values

• Values reflect cultural/social influences and change over time.
• Values clarification is crucial for resolving ethical dilemmas; it involves understanding one's own values and respecting those of others.
• Ethical dilemmas are typically in the presence of conflicting values; considering them facts rather than opinions can be a factor .

Nursing Point of View

• Nurses interact with patients over longer periods than other disciplines.
• During those interactions this deeper level of interactions often reveals details about family life, coping styles, personal preferences, fears, and insecurities.

Processing an Ethical Dilemma

• Ethical dilemmas cause distress/controversy for both patients and caregivers.
• Resolving ethical dilemmas is analogous to applying the nursing process. Do not solely rely on patients' feelings or desires when trying to resolve the issue.

Issues in Healthcare Ethics

• Quality of Life: Researching/developing standardized measures to define quality of life is important for medical interventions, particularly when discussing futile care, cancer treatment, physician-assisted suicide, and Do Not Resuscitate (DNR) orders. Euthanasia is also relevant to these discussions.
• Genetic Screening: Genetic testing can reveal conditions that may/may not develop in the future for a patient. Family history is very important in assessing potential risks, which leads to ethical issues around preconception, prenatal, and post-natal care.

Care at the End of Life

• "Futile" interventions are those unlikely to benefit the patient; such interventions require clear decisions about how they apply and who makes them.
• Access to care is a critical ethical challenge and has numerous factors that influence ethical issues.

Key Points

• Ethics deals with defining what is good/valuable for individuals and society.
• ANA codes provide guidelines for professional nursing practices.
• Principles of ethics include autonomy, beneficence, non-maleficence, justice, and fidelity.
• Values clarification helps to understand and respect differing values; resolving ethical dilemmas requires considering one’s own and others’ values.
• Nurses have unique perspectives in ethical dilemmas.

Key Steps in Resolving an Ethical Dilemma

• Step 1: Determine if the issue is truly an ethical dilemma.
• Step 2: Gather relevant information (patient, family, institutional, social contexts).
• Step 3: Clarify values.
• Step 4: Verbalize the problem (clearly define the dilemma).
• Step 5: Identify possible courses of action.
• Step 6: Negotiate a plan (considering multiple perspectives).
• Step 7: Evaluate the plan over time.

Ethical Dilemma Simulation Technique

• Dividing students into groups, presenting a scenario, and having groups discuss and develop solutions, then presenting to the class for a larger discussion and evaluation of the presented solution.

Communication and Nursing Practice

• Effective communication is essential for patient-centered care and patient safety.
• Breakdown in communication negatively influences credibility among healthcare members; effectively implemented processes (such as SBAR) can help avoid these problems.
• Critical communication skills are essential for patient safety and high-quality care.
• Communication development depends on the senses and includes verbal/nonverbal elements.

Developing Communication Skills

• Effective communication skills; listening, nonverbal communication, trust, and effective interpersonal communication are important components of communication skills.
• Cultural differences influence, even if using a shared language.
• Specific diagnoses (cancer, end-of-life) create particular challenges.

Levels of Communication

• Interpersonal: Face-to-face communication, core of nursing.
• Small group: Meetings, committees, support groups, research.
• Public: Presentations, conferences; engaging with an audience.

Basic Elements of Communication Process

• Referent: Motivates communication (e.g., physical pain, emotional distress).
• Sender/Receiver: Encode/decode message, including emotional tone.
• Message: Content (verbal, non-verbal, symbolic).
• Channel: Routes for conveying messages (visual, auditory, tactile).
• Feedback: Receiver’s response indicating whether meaning was understood.
• Environment: Conditions affecting communication.

Forms of Communication-Verbal

• Vocabulary: Health jargon, different vocab levels between patients/providers.
• Denotative/Connotative Meanings: The intended objective (denotation) meaning vs. personal meanings (connotation) associated with a message.
• Pacing/Tempo: Maintaining appropriate speed and clear communication.
• Clarity/Brevity: Simplicity and directness in communication..
• Timing/Relevance: Choosing the right moment for communication.

Forms of Communication-Nonverbal

• Body Language
• Personal Appearance
• Facial Expression
• Eye Contact
• Personal Space

Nurse-Health Care Team Relationships

• Communication with other healthcare team members directly impacts patient safety/work environment.
• Common language helps prevent misunderstandings.
• Tools such as SBAR (Situation, Background, Assessment, Recommendation) standardize communications.
• Lateral violence is unacceptable and should be addressed.

Elements of Professional Communication

• Polite communication includes common courtesy, proper introductions, and professional language.
• Avoid terms of endearment and always respect patients.

This quiz focuses on key principles of nursing ethics, including autonomy, non-maleficence, and fidelity. It also explores effective communication strategies in healthcare settings, emphasizing the importance of interpersonal relations and cultural influences. Test your knowledge on how ethical principles shape nursing practice and patient interactions.