Nursing Ethics: Core Principles

• Nursing ethics involves the moral principles and values that guide nurses in their professional duties.
• It provides a framework for decision-making in complex situations.
• The goal is to ensure patient well-being, respect, and dignity.

Core Ethical Principles

• Autonomy: Respecting a patient's right to make their own decisions about their care.
  • Patients have the right to accept or refuse treatment.
  • Nurses must provide patients with the information needed to make informed decisions.
• Beneficence: Acting in the patient's best interest.
  • Requires nurses to promote good and prevent harm.
  • Balancing benefits against risks is crucial.
• Non-maleficence: Avoiding harm to patients.
  • Nurses must avoid actions or omissions that could cause injury.
  • Requires careful assessment of potential harm.
• Justice: Treating all patients fairly and equitably.
  • Ensuring equal access to care, regardless of social status or other factors.
  • Requires nurses to advocate for fair resource allocation.
• Fidelity: Maintaining loyalty and commitment to patients.
  • Keeping promises and maintaining confidentiality.
  • Building trust through honest and reliable interactions.
• Veracity: Being truthful and honest with patients.
  • Providing accurate information and avoiding deception.
  • Essential for building a trusting relationship.

Ethical Theories

• Utilitarianism: Focuses on the greatest good for the greatest number.
  • Decisions are made based on the consequences.
  • Actions are morally right if they promote happiness and minimize suffering.
• Deontology: Emphasizes moral duties and rules.
  • Actions are inherently right or wrong, regardless of their consequences.
  • Based on principles like the categorical imperative.
• Virtue Ethics: Focuses on the character of the moral agent.
  • Emphasizes virtues such as compassion, integrity, and courage.
  • A virtuous nurse will act in accordance with these virtues.

Ethical Dilemmas in Nursing

• Definition: Situations where there are conflicting moral principles or values.
• Common Dilemmas:
  • End-of-life care: Balancing the patient's wishes with the need to prolong life.
    • Examples include withdrawing or withholding treatment.
    • Requires careful consideration of patient autonomy and beneficence.
  • Informed consent: Ensuring the patient understands the risks and benefits of treatment.
    • Challenges arise when patients lack capacity or have limited health literacy.
    • Nurses play a role in verifying patient understanding.
  • Resource allocation: Deciding how to distribute limited resources fairly.
    • Ethical considerations arise in situations of scarcity.
    • Nurses may need to advocate for equitable distribution.
  • Confidentiality: Protecting patient privacy while balancing other ethical obligations.
    • Exceptions may exist in cases of suspected abuse or harm to others.
    • Nurses must be aware of legal and ethical guidelines.
  • Whistleblowing: Reporting unethical or illegal conduct.
    • Nurses have a responsibility to report concerns to protect patients.
    • Can be challenging due to potential repercussions.

Ethical Decision-Making Process

• Identify the ethical dilemma: Clearly define the problem and conflicting values.
• Gather relevant information: Collect all facts, including medical, social, and legal aspects.
• Identify stakeholders: Determine who is affected by the decision.
• Identify options: Brainstorm possible courses of action.
• Apply ethical principles: Consider which principles are relevant and how they apply.
• Make a decision: Choose the best course of action based on ethical reasoning and values.
• Evaluate the outcome: Reflect on the decision and its consequences to inform future practice.

Code of Ethics for Nurses

• A guide for nurses' conduct and decision-making.
• Provides a framework for ethical practice.
• Highlights the nurse's responsibility to patients, society, and the profession.
• Articulates the values and principles that guide nursing practice.
• Examples include the International Council of Nurses (ICN) Code of Ethics.

Professional Boundaries

• Guidelines that define appropriate relationships between nurses and patients.
• Maintaining professional boundaries is essential for ethical conduct.
• Examples:
  • Avoiding dual relationships: Not engaging in personal or business relationships with patients.
  • Respecting patient privacy: Maintaining confidentiality and avoiding unnecessary disclosure.
  • Avoiding conflicts of interest: Not using the nurse-patient relationship for personal gain.
• Boundary violations can lead to ethical and legal consequences.

Patient Advocacy

• Speaking up for patients' rights and needs.
• Nurses advocate for patients by:
  • Ensuring they receive appropriate care
  • Providing them with information
  • Supporting their decisions
• Advocacy is particularly important for vulnerable populations.

Ethical Issues in Specific Nursing Contexts

• Mental Health Nursing:
  • Balancing patient autonomy with safety concerns.
    • Issues related to involuntary treatment and seclusion.
    • Protecting patient confidentiality.
  • Ensuring informed consent for treatment.
• Paediatric Nursing:
  • Making decisions on behalf of children.
  • Balancing parental rights with the child's best interests.
  • Addressing issues of child abuse and neglect.
• Geriatric Nursing:
  • Addressing issues of capacity and decision-making for older adults.
  • Preventing elder abuse and neglect.
  • Providing culturally sensitive care.
• Critical Care Nursing:
  • Making decisions in high-pressure, time-sensitive situations.
  • Addressing end-of-life care issues.
  • Managing conflicts between families and healthcare providers.

Ethical Challenges in a Changing Healthcare Environment

• Technological advancements:
  • Ethical issues related to the use of artificial intelligence and robotics.
  • Ensuring patient privacy in the digital age.
• Globalization:
  • Ethical considerations related to providing care across cultural boundaries.
  • Addressing health disparities and inequities.
• Resource constraints:
  • Ethical challenges related to rationing care and making difficult choices.
  • Advocating for fair allocation of resources.

Moral Distress

• Definition: Occurs when nurses know the ethically appropriate action but are unable to act upon it due to internal or external constraints.
• Causes: Limited resources, organizational policies, powerlessness.
• Consequences: Emotional exhaustion, burnout, moral residue.
• Strategies for addressing moral distress:
  • Self-awareness and reflection.
  • Seeking support from colleagues or ethics committees.
  • Advocating for changes in policies or practices.

Ethical Committees

• Multidisciplinary groups that provide consultation and support for ethical issues.
• Roles:
  • Reviewing and analyzing ethical dilemmas.
  • Providing recommendations for decision-making.
  • Developing policies and guidelines.
  • Offering education and training.

Legal Aspects of Nursing Ethics

• Nurses are accountable for their actions under the law.
• Legal frameworks related to nursing practice include:
  • Tort law: Addressing issues of negligence and malpractice.
  • Contract law: Governing nurse-patient relationships.
  • Criminal law: Addressing issues of criminal conduct.
• Nurses must be aware of relevant legislation and regulations.