NUR 410 Week 9

Ethics and Values

• Ethical challenges in nursing are difficult to navigate
• Scientific and technological advancements and system complexities contribute to ethical issues
• Nurses need skills to defend complex ethical decisions
• Requires study of philosophical ideals of right and wrong, based on one's beliefs
• A value is a strong personal belief or ideal for a person or group
• Personal and professional values can conflict
• Values differ based on upbringing and relationships
• Values are not static and evolve over time

Ethical Theories

• Guide decision-making when faced with ethical tension

Utilitarianism

• Based on the principle of utility
• Prioritizes interests of many over few
• Aims for the greatest good for the greatest number
• Value is determined by usefulness
• Good can be quantified
• Determines right from wrong, focusing on outcomes
• Used mostly in business
• May struggle to define "greatest good,"
• Individual rights and justice may be difficult to preserve
  • Example: sacrificing one life to save four

Deontology

• Guided by absolute rules, judging actions as right or wrong
• Guided by principles or duty
• Standards for moral behavior exist regardless of consequences
• Doesn't require weighing costs and benefits
• Avoids subjectivity and uncertainty
• Not helpful when principles conflict
• Rigid, lacking flexibility
• Disregards possible consequences when determining right and wrong

Virtue Ethics

• Personal characteristics are the center of moral action
• Those with virtues will likely make ethical decisions
  • Examples: compassion, courage, honesty
• Quest to live a life of moral character as a person
• Virtue is acquired through practice to develop moral character
• Ethics are more than formal principles or rules
• Ethics are enacted through relationships between people and connection to others
• Defining "good" values can be ambiguous
• Lacks consistency because virtues change and vary with people etc.
• Limited practical guidance on decision making

Feminist Ethics

• Grounded in feminist theory which views oppression of women as unacceptable
• Corrects problems with oppression and power imbalance
• Everyone has responsibility to care for others and relieve pain and suffering
• Feminist ethics includes helping others with basic needs and sustaining capabilities
• Other theories don't always apply to women and are more related to men’s values
  • Women’s values include empathy, relatedness, and responsiveness
  • Men’s values include reason, law, and justice
• Emphasizes listening attentively and denounces exclusion and stereotyping of others
• Defining feminist ethics can be challenging
• Implementing feminist ethics can be time-consuming
• Establishing consensus is difficult due to the challenge of understanding everyone's ethical perspective
• Criticized for being too female-based, focusing on biological differences

Principlism

• Autonomy: the freedom to make decisions for oneself
• Beneficence: doing good and what is in the patient’s best interest
• Non-maleficence: not harming others
• Justice: fairness and equity
• Simple and applicable in many situations and easily understood
• Aligned with commonly held values
• May oversimplify situations
• Places emphasis on autonomy vs. the collective
• Principles may conflict with each other

Practice Standards: Code of Conduct Principles

• Nurses respect client's dignity
• Nurses provide inclusive and culturally safe care
• Nurses provide safe and competent care
• Nurses work respectfully with the health care team
• Nurses act with integrity
• Nurses maintain public confidence

Ethical Tensions

• Healthcare system is complex for health professionals
• Moral complexity involves interactions between personal, professional, client/patient and workplace values, leading to internal conflicts
• Can cause ethical tensions through conflicts between moral values, beliefs, and non-moral factors
  • Includes ethical uncertainty, distress, and dilemmas

Ethical Uncertainty

• Occurs when it's unclear if a scenario presents a moral problem
• Involves uncertainty about which moral principles apply
• May arise when new graduates are expected to perform duties without adequate orientation
  • Example: giving medication without knowing all the information

Ethical Distress

• Occurs when the correct action is known, but institutional factors impede one's ability to act
• Example: wanting to provide compassionate care but being impeded by heavy workload

Ethical Dilemma

• Occur when the best choice is unclear with strong arguments on both sides
• Results in a decision that is either most right or least wrong
• Example: patient wants palliative care, but family wants all possible treatments

Personal Consequences of Ethical Issues

• Moral distress: occurs when unable to pursue the right course of action
• Moral injury: enduring psychological and emotional effects when actions oppose values or beliefs
• May reduce job satisfaction and turnover
• May cause feelings of frustration, powerlessness, and anger
• Can result in deteriorating mental health, burnout, and chronic exhaustion

Common Ethical Challenges

• Futility in health care
• Differences in patient and family perspectives
• Inability to provide desired level of care
• Personal safety vs. providing care

Contributors to Ethical Challenges

• Environmental factors: workload, unsafe staffing, and time pressures
• Personal factors: self-doubt
• Clinical situations: unnecessary or inadequate treatment and confidentiality
• Organizational factors: policies and administrative support

Legal vs. Ethical

• Legal actions may fall outside ethical conduct
• The law may influence response to ethical challenges
• Laws vary by jurisdiction

Moral Courage and Resilience

• Moral courage: standing firm on moral principle in face of fear
• Moral resilience: ability to make ethical decisions while remaining open to possibilities
  • Requires maintaining perspective and understanding control limits
  • Courage and confidence to handle uncertain situations

Building Ethical/Moral Resilience

• Understanding moral and ethical values is central
• Recognize that ethical values come from various sources
• Practice mindfulness and self-awareness:
  • How are you feeling about the situation?
  • Where are these feelings coming from?
  • What makes you uncomfortable?

Strategies to Address Moral Distress

• Speak up
• Act deliberately
• Be accountable
• Build networks of support
• Advocate for changes in the work environment