Nursing Ethics for First-Year Students

Nursing Ethics

•  For first-year nursing students at a Technical Institute of Nursing.
•  Prepared by Dr. Naglaa Mohamed El-sayed, Dr. Aida Mahmoud Abdel-Azeem, Dr. Azza Abd Elmawgod, and Dr. Mansour Mohamed, all lecturers of Nursing Administration.

Contents

•  Concepts to nursing ethics (page 3)
•  Ethical Issues in nursing practice (page 10)
•  Principles of nursing ethics (page 19)
•  Nursing legal responsibilities and law (page 24)
•  Ethical responsibilities of the nurse (page 32)
•  Code of nursing ethics (page 39)
•  Ethical decision-making in nursing practice (page 47)
•  Ethical theories (page 58)
•  Applying ethics to nursing practice (9-1- Nurses and people and 9-2- Nurses and practice, etc. page 65)

Introduction of Nursing Ethics

•  Objectives: identify concepts related to nursing ethics, differentiate between law and ethics, enumerate types of ethics, importance of nursing ethics, conclude factors affecting professional nursing ethics development, define ethical principles, list ethical principles of nursing care, describe a code of ethics, and enumerate fundamental responsibilities of nurses.

Ethics versus Morality

•  Ethics is derived from the Greek word "ethos", meaning custom or character.
•  Ethics is the branch of philosophy dealing with standards of conduct and moral judgment, investigating morality.
•  Nursing ethics, physician's ethics, etc., are specific codes of professional conduct within groups.

Ethics vs. Law

•  Ethics deals with what ought to be (right/wrong, good/bad), using moral reasoning to determine right conduct.
•  Law are rules of conduct, formally authored and enforced by authorities to hold people accountable for compliance.

Types of Ethics

•  Descriptive: describes values and beliefs of cultural, religious, or social groups about health and illness.
•  Normative: studies human activities to identify what is right/wrong and good/bad. In nursing, it encompasses practice scope and expected competence levels for different nurse categories.
•  Analytical: analyzes the meaning of moral terms.

Importance of Nursing Ethics

•  Provides guidance through difficult situations.
•  Serves as a common reference for the healthcare team.

Factors Affecting Professional Nursing Ethics Development

•  Individual character & responsibility
•  Communication challenges
•  Organizational preconditions
•  Support systems
•  Educational & cultural development

Ethical Principles

•  Autonomy, beneficence, non-maleficence, confidentiality, double effect, justice, paternalism, respect for persons, sanctity of life, and veracity.

Code of Ethics

•  Formal statement of group ideas and values.
•  Higher than legal standards, encompassing the professional standards.
•  Shared by members, reflective of their moral judgments and professional actions.
•  For nurses, specific code produced by professional organizations.

Nurses' Fundamental Responsibilities

•  Promote health.
•  Prevent illness.
•  Restore health
•  Alleviate suffering.

Caring in Nursing Practice

•  Major administrative restructuring in healthcare systems worldwide has intensified nurse responsibilities and workloads.
•  Nurses must deal with increasing patient acuity and complexity and preserve their caring practice.

Patient and Resident Rights

•  Respect and dignity, privacy, confidentiality, freedom from abuse and neglect, knowledge of medical condition and treatments, choice of doctors, and medical care decisions.

Ethical Issues in Nursing

•  Patient autonomy: freedom to make healthcare decisions, including refusing treatment or therapy.
•  Confidentiality: preserving patient privacy unless absolutely necessary for patient care.
•  Informed consent: ensuring patients receive all necessary information to make informed decisions about their care.
•  Resource allocation: determining fair and equitable distribution of limited resources.
•  Discrimination: treating all patients equally regardless of background or personal traits, ensuring their rights.
•  Conflict of interest: avoiding circumstances where personal interests clash with professional responsibilities.
•  Types of ethical issues: moral/ethical dilemma, moral uncertainty/conflict, moral distress, and moral outrage

Ethical Dilemma in Nursing

•  Ethical dilemma: A situation where ethical principles conflict, or there's no clear course of action.

•  Examples: Patient refusing medication, but posing a risk to self or others, honesty vs. withholding information from family to protect emotions.

•  Resource allocation: Nurses must determine fair distribution of limited resources.

•  Honesty vs. witholding information: Family members may want to withhold information from a patient but patients have a right to know. Honesty vs. witholding information, protecting patient conditions vs. patients' rights.

Honesty in Nursing

•  Truthfulness: essential in maintaining relationships with patients and providing the best possible care.
•  Involves a willingness to diligently search for truth and having the ability to place emphasis on resolve and action to achieve a just society.

Rational is support of truth-telling

•  Lying diminishes social trust.
•  Complete and accurate information is necessary for informed decisions.
•  Truthful communication has greater long-term benefits than harms.
•  Lies and deception require emotional energy to maintain.

How to Deal With Ethical Dilemmas in Nursing

•  Nurses undergo extensive education and training.
•  Gaining clinical experience and empathy is critical.
•  Establishing professional boundaries in the case of patients.
•  Use of, and reference to, the ANA Code of Ethics.
•  Employing nurse managers and colleagues.
•  Open dialogues about ethical issues.

Impact of Ethical Problems on Nurses and Patients

•  Ethical issues cause stress, fatigue, dissatisfaction, and even PTSD in nurses.
•  Ethical issues negatively affect patient quality of life, dignity, autonomy, trust and contentment.

Strategies for Addressing Ethical Issues in Nursing

•  Follow the ANA Code of Ethics for Nurses.
•  Seek continual ethics education.
•  Create an environment where nurses can speak up.
•  Bring diverse disciplines together.
•  Employ clinical ethics experts and add unit-based ethics mentors.
•  Utilize clinical ethics consultation services.
•  Participate in ethics committees.
•  Document ethical issues.
•  Implement ethical concepts and frameworks

Principles of Nursing Ethics

•  Autonomy, beneficence, non-maleficence, confidentiality, double effect, justice, paternalism, respect for persons, sanctity of life, and veracity.

### Ethical Decision Making in Nursing Practice

•  Introduction, definitions (dilemma, decision, ethical decision), factors affecting ethical decision (personal values, professional values, competencies, ethical principles,ethical theories), steps of the ethical decision-making process, models for ethical decision-making.

•  Obstacles to decision making, the ethical decision-making process, utilitarian perspective, deontological perspective, and justice perspective.

Models for ethical decision-making

I. A guide to moral decision-making:

• Recognizing the moral dimension

• Who are the interested parties

• What values are involved

• Weight the benefits and burdens

• Look for analogous cases

• Discuss with relevant other

• Does this decision accord with legal and organizational rules

• Am I comfortable with this decision II. Clinical Ethics Grid system

• Medical indications

• Patient preference

• Quality of life

• Contextual factors

Ethical Theories

•  Teleology (utilitarianism), Deontology, Intuitionism, and The ethic of caring.

Applying Ethics to Nursing Practice

•  Ethical issues between nurses and patients, doctors, employers, and the profession.

Ethical Issues between Nurses and Patients

•  Confidentiality
•  Advocacy

Ethical Issues between Nurses and Doctors

•  Relationship characterized by social and professional inequality
•  Questions of autonomy

Ethical Issues between Nurses and the Profession

•  Making independent decisions, and steps involved in ethical decision-making.
•  Challenges to ethical decision-making: poor moral awareness, failure to gather facts, rationalizing issues, slippery slope, confirmation bias, weighing consequences.

This quiz is designed for first-year nursing students at a Technical Institute of Nursing. It covers critical concepts, ethical issues, principles, responsibilities, and decision-making in nursing ethics, providing a solid foundation for ethical practice in nursing.