Nursing Practice Individual Learning Plans

Week 9: Professional Development I - Module 9: Nursing Ethics

• Land Acknowledgement: Mohawk College acknowledges the territories on which it is situated are governed by the Between the Lakes Treaty, the Dish with One Spoon Wampum Agreement, and the Upper Canada Treaty Agreement
• These agreements represent a commitment to maintain healthy, reciprocal, and respectful relationships with Indigenous peoples and communities.
• The college recognizes the Six Nations of the Grand River and the Mississauga's of the Credit First Nation.

Agenda

• Housekeeping (01): Introductory matters for the session.
• Learning Outcomes (02): Objectives for the module.
• Ethics (03): Discussing ethical concepts.
• Consent & Confidentiality (04): Legal and ethical considerations in patient care consent.
• Coming Up (05): What will happen next week in class
• Questions? (06): Answering questions from students.

Case Scenario Assignment Part B

• Learning Plan (Part B): Building upon Part A, submit a learning plan by next week
• Reflection due Week 5
• Additional instructions are available on Canvas.
• Individual assignment
• Due prior to start of the next class (Week 10).
• Late submissions result in deductions.

Part B: Individual Learning Plan

• Reflect on how to manage a situation, identifying knowledge/skill gaps.
• When a practice issue might potentially harm a patient, nursing professionals need to identify gaps in practice.
• Learning plans help nurses address specific gaps (nursing knowledge or skills)
• They’re an annual quality assurance requirement for registered nurses in Ontario.
• Learning plans demonstrate dedication to excellence and ongoing competence.
• Base Learning plan on the case scenario and reflection from Part A
• Include one learning goal and three learning activities.

Part B: Individual Learning Plan - Steps

• Step 1: Recall knowledge/skill gaps, formulate a learning goal.
• Step 2: Align learning goal with patient safety, relevant best practices, and scholarly sources.
• Step 3: Link learning goal to applicable CNO Code of Conduct principles.
• Step 4: Connect the learning goal with essential practical nurse competencies.
• Step 5: Identify learning activities, create a timeline.

Learning Outcomes (Week 9)

• Discuss ethics and its relationship to practice.
• Explore ethical values and principles from the College of Nurses of Ontario.
• Use an ethical decision-making framework to analyze ethical dilemmas.
• Identify ethical issues in nursing practice.

Small Group Activity (What is Ethics?)

• Discuss, define, and identify examples of ethical situations (written down).
• Prepare to share with the large group. (5 minutes)

Understanding Ethics

• Values: Strong personal beliefs held by a person or a group.
• Ethics: The philosophical study of right/wrong conduct. Reflects what's important to individuals and professions.
• CNA has a published Code of Ethics for nurses.

Nursing & Ethics

• CNA Code of Ethics: A statement of nurses' ethical values and commitments.
• Guides practice, education, administration, research, and policy.
• Nurses are bound by the Code to protect the public and uphold the code in all aspects of practice.

Ethical Terms

• Responsibility: Reliability and dependability, performing tasks accurately and thoroughly. Ability to differentiate right and wrong.
• Advocacy: Acting on behalf of others, emphasizing equity and reducing inequities.
• Accountability: Adherence to moral principles of fidelity and respect. Nurses are responsible for their actions and decisions.

Principles of Health Care Ethics

• Autonomy: Self-determination, client's freedom to make choices. Nurses support client's choices.
• Beneficence: Promoting good and well-being. Considering risks and benefits in treatment decisions. Client's well-being is prioritized.
• Nonmaleficence: Avoiding harm. Balancing risks and benefits in care.
• Justice: Fair and equal treatment. Applying principles to ensure equitable distribution of resources and care.

Ethics in Healthcare

• Health care teams prioritize ethical standards to guide interactions.
• Regulated professions hold codes of conduct, provided by governing bodies.

Codes of Ethics

• Relates values to ethical decisions.
• Guides decision-making within a multidisciplinary team.
• Helps nurses evaluate and reflect on ethical choices.
• Provides a set of foundational values in nursing practice.
• CNO has a specific Practice Standard for Ethics.
• CNA has ethical responsibilities

Canadian Nurses Association (CNA) - Values & Ethical Responsibilities (2017)

• Safe, compassionate, competent, ethical care
• Promote health, well-being
• Respect informed decision making
• Honor dignity
• Maintain privacy and confidentiality
• Promote justice
• Be accountable

College of Nurses of Ontario (CNO) - Ethical Values (2019)

• Client well-being
• Client choice
• Privacy and confidentiality
• Respect for life
• Maintaining commitments
• Truthfulness
• Fairness

Small Group Activity (CNO & Ethics?)

• What do CNO's ethical values mean?
• How do nurses uphold them?
• Prepare to share insights in the large group. (10 minutes)

College of Nurses of Ontario (CNO)

• Ethical well-being for well being, and providing care, respecting opinions.
• Client Choice: Client's right to make decisions and be informed.
• Privacy & Confidentiality: keeping client info private.
• Respect for Life: respecting client choices, even if conflicting personal values, unless there’s no other choice but to respect the needs of the client.
• Maintaining commitments: keeping promises to clients.
• Truthfulness: honesty and disclosing information when appropriate.
• Fairness: allocation of resources equitably.

Ethical Dilemmas

• Conflicts arise when there are multiple values, neither of which can be satisfied fully.
• Examples include when a client refuses treatment.
• Ethical dilemmas cause distress, and confusion.
• Analyze ethical dilemmas by determining if there is a dilemma.
• Gather all relevant information. Assess own values on the issues. Verbalize the problem.
• Consider possible actions. Reflect on the outcome.

Small Group Activity (Ethical Dilemmas?)

• Work through a case study of an ethical dilemma.
• Analyze values and possible actions. (10 minutes).

Resolving Ethical Conflicts

• Working through ethical situations is ongoing in care.
• Finding a solution that satisfies everyone is not always possible.
• Consulting with clients and the healthcare team is important to resolve these situations.
• Documentation of discussions and decisions is crucial.

Consent & Confidentiality (Week 9)

• Nurses have ethical and legal duties to obtain consent for care.
• HCCA (Health Care Consent Act) and SDA (Substitute Decision Act) provide guidelines for obtaining consent.
• The CNO consent practice guideline does not address consent for dying.

Obtaining Consent

• Consent must be informed
• Inform patients about treatment options, risks, and benefits.
• Obtain consent from a substituted decision-maker if the client is unable to consent on their own.

Health Care Consent Act (HCAA)

• Goals include promoting autonomy and communication.
• Consent is an ongoing process which can change.
• No authority for healthcare professionals to make decisions on behalf of clients except in emergencies.
• Client’s wishes can be expressed orally, in writing, through a substitute decision-maker, or be implied.

Substitute Decision Act (SDA)

• Deals with decision-making for incapable individuals.
• Concerns individuals requiring continuous decision-making support.
• Formal appointment of a decision-maker through a Power of Attorney document.

Confidentiality

• Nurses have an ethical and legal duty to maintain client privacy.
• Ontario privacy legislation (PHIPA and QOCIPA) support this duty.

Confidentiality Scenario

• Your client in transfer. How much information should be shared, and with whom?
• Implied consent is allowed for sharing information with the receiving hospital's health care team for care.
• Express consent from the substituted decision-maker for sharing information with the insurance company.

Coming Up...

• Complete 1 hour of asynchronous work in Module 9.
• Prepare for Module 10, reviewing objectives and necessary readings/activities.
• Part B Assignment: Learning Plan due November 15th at 7:00 pm. Consult Canvas for instructions.