Nursing History and Ethics

History of Nursing and Ethics

• Florence Nightingale saw nursing as a call to service and believed that nurses should be people of good character, giving enduring morals and values to the profession of nursing.

Code of Ethics

• 1893: The Nightingale Pledge was considered nursing's first code of ethics.
• 1950: The Code for Professional Nurses was adopted by the American Nurses Association (ANA) and revised five times.
• 1954: The first known international code of ethics for nursing was developed by the International Council of Nurses (ICN), adopted in Canada.
• 1980: The Canadian Nurses Association (CNA) Code of Ethics was developed, revised, and updated three times by 2002, and finally entitled Code of Ethics for Registered Nurses.

Nursing Ethics

• Morals: Shared and generational societal norms about what constitutes right or wrong conduct.
• Values: Standards or qualities that are esteemed, desired, considered important, or have worth or merit (e.g., competent, compassionate care).

Ethical Decision Making

• Ethical decision making: The process of how ethical decisions are made.
• Ethical issues: Moral challenges facing the nursing profession.
• Ethical dilemmas: Puzzling moral problems in which morally justified reasons for both taking and not taking a certain course of action are envisioned.
• Ethical decision-making framework: Uses problem-solving processes to guide ethically sound decisions.

Theories of Ethics

• Consequentialism: Decision-based on outcomes or consequences.
• Utilitarianism: A well-known consequentialist theory that appeals exclusively to outcomes or consequences in determining which choice to make.
• Deontology: Based on the premise that persons should always be treated as ends in themselves and never as mere means to the ends of others.
• Principism: Healthcare professionals have specific obligations that exist because of the practices and goals of the profession.
• The 4 Ethical Principles:
  • Respect for Autonomy: Based on human dignity and respect for all.
  • Nonmaleficence: "Do no harm" or "do no evil."
  • Beneficence: "To do good" or an obligation to care for others.
  • Distributive Justice: Fair distribution of benefits and burdens within a society based on needs and contributions.

Communitarian Theories

• Virtue Ethics: Focuses on practical reasoning applied to character development.
• Caring and the Ethic of Care: Based on feminist theory, emphasizes a belief in the morality of responsibility in relationships.
• Feminist Ethics: Supports critical thinking and focuses on issues such as gender, power, and socioeconomic status.

Advocacy

• Definition: The application of information and resources to effect systemic changes that shape the way people in a community live.
• For Community Health Nursing: Advocacy is intended to benefit aggregates, e.g., to reduce death or disability in groups of people.
• For Public Health Nursing: Advocacy is intended to benefit aggregates, e.g., to reduce the occurrence or severity of public health problems.

Indigenous Peoples of Canada

• Animism: The belief that life exists in all objects, from rocks and trees to lakes and mountains, or inanimate objects and spirits of the dead.
• Indigenous Views of Health: Sickness is seen as immoral, reckless, and/or offensive behavior.
• Petroglyphs Provincial Park: Sacred site for Indigenous peoples, featuring ancient rock carvings.

Historical Context of Indigenous Peoples

• The term Indigenous refers to the First Nations, Inuit, and Métis Peoples in Canada.
• First Peoples is another collective term used to refer to the original inhabitants of Canada.
• The Indian Act: First enacted in 1876, still current in Canadian law, reflecting government policies of assimilation of Aboriginal people in Canada and appropriation of Aboriginal lands.

Impacts of Colonization

• Persistent and ongoing effects of colonization include:
  • Dislocation from traditional lands and lifestyles.
  • Policies of cultural or linguistic suppression and forced assimilation.
  • Industrial processes degradation of traditional lands.
  • The impacts of interpersonal and institutional racism.

Health Status of Aboriginal Peoples

• Health status of Indigenous people in Canada falls below that of the general Canadian population.
• Indigenous people have higher rates of chronic and infectious diseases.
• Possible reasons for increased vulnerability of Indigenous population:
  • Biological susceptibility.
  • Rural and remote lifestyle.
  • Health practices.
  • Low socioeconomic status that limits access to social determinants of health.
  • Lack of culturally appropriate health education programs.### Historical Abuses and Intergenerational Grief
• The "Sixties Scoop" (1960s-1980s) involved taking children from Indigenous families and placing them in non-Indigenous families, leading to intergenerational grief and affecting mental, physical, emotional, and spiritual well-being.

Indigenous Determinants of Health

• Proximal determinants: health behaviors, physical environments, employment, income, social status, education, and food security.
• Intermediate determinants: health care systems, education systems, community infrastructure and resources, environmental stewardship, and cultural continuity.
• Distal determinants: colonialism, racism, social exclusion, and repression of self-determination.

Truth and Reconciliation

• The federal government officially apologized to Aboriginal peoples for their role in establishing and maintaining residential schools.

Aboriginal Resilience

• Despite the disruption of family and culture, there is evidence of resilience in extended family kinship systems and transmission of language and culture.

Vulnerable Populations

• Definition: susceptibility to negative events, specific at-risk populations more susceptible to poor health due to socioenvironmental factors.
• Characteristics: often experience multiple cumulative risks, underserved and disadvantaged, fewer resources for promoting health and treating illness.
• Examples: one-parent families, people with disabilities, children, visible minorities, Indigenous persons, those with lower socioeconomic status, and older adults.

Health Disparities and Inequities

• Health disparities: wide variations in health services and health status among certain population groups.
• Health inequities: differences in health that could be avoided if reasonable action were taken, considered unfair and socially unjust.

Marginalization and Vulnerability

• Marginalization: treatment of individuals or groups as outside, insignificant, or peripheral.
• Marginality: outside of mainstream discourse.
• Sources of marginality: gender, physical fitness, social status/class/income, ethnicity, skin color, religion, marital status, language, age, and education/career.

Resilience and Vulnerability

• Definition: ability to cope with threats of hardship or adversity.
• Support needs to be provided to those with decreased resilience to enhance coping skills and provide a greater sense of personal autonomy.

Poverty

• Definition: insufficient financial resources to meet basic living expenses.
• Approaches: absolute poverty, relative poverty, subjective poverty.
• Types: crisis poverty (temporary), persistent poverty (chronic).
• Poverty is a major factor in health inequality: chronic conditions, infant morbidity and mortality, shorter life expectancies, and more complex health problems.

Homelessness

• Definition: lack of permanent housing, estimated 150,000 to 300,000 individuals in Canada.
• Types: absolute homelessness, sheltered homelessness, hidden homelessness.
• Risk factors: lack of affordable housing, poverty, mental health issues, substance abuse, unemployment, immigration, violence, and being an ex-offender.

Health Concerns and Homelessness

• Increased risk for: substance abuse, mental illness, HIV/AIDS, tuberculosis, sexually transmitted infections, unplanned pregnancies, seizures, chronic obstructive pulmonary disease, musculoskeletal disorders, skin and foot problems, and malnutrition.

Nursing and Vulnerable Populations

• Community health nurses (CHNs) need to be aware of the unique needs of vulnerable clients at every age.
• Assessment should include: living environment, neighborhood surroundings, perceptions of socioeconomic resources, congenital and genetic predisposition to illness, preventive health needs, and stress.
• CHNs should create a trusting environment, show respect, compassion, and concern, and coordinate services and providers.

Primary, Secondary, and Tertiary Prevention

• Primary prevention: affordable housing, housing subsidies, effective job-training programs, employer incentives, preventive health care services, safer-sex education, and birth control services.
• Secondary prevention: early diagnosis, prompt treatment, and limitation of disability.
• Tertiary prevention: restoring and enhancing functioning, promoting psychosocial rehabilitation programs.

Family Health

• Definition: the health of a family system that is ever-changing and encompasses a holistic focus including biological, psychological, sociological, cultural, and spiritual factors.
• Characteristics of healthy families: good communication, affirmation and support, respect for others, and valuing teaching respect.

Indigenous Determinants of Health and Family

• The determinants of health impact the family, and family health is influenced by colonialism, racism, social exclusion, and repression of self-determination.