Nursing Values Clarification

Values Clarification

• Chosen beliefs are affirmed to others, incorporated into one's behavior, and repeated consistently in one's life.
• Nurses need to reflect on their values about life, death, health, and illness to clarify their values.
• Awareness of personal and professional values is essential to consider attitudes about specific issues.

Clarifying Client Values

• Nurses need to identify clients' values as they influence and relate to a particular health problem.
• The following process helps clients clarify their values:
  • List alternatives
  • Examine possible consequences of choices
  • Choose freely
  • Feel about the choice
  • Affirm the choice
  • Act with a pattern

Ethics

• Ethics is a method of inquiry that helps people understand the morality of human behavior.
• Ethics can refer to the practices or beliefs of a certain group (e.g., medical ethics, nursing ethics).
• Ethics can also refer to the expected standards of moral behavior of a particular group as described in the group's formal code of professional ethics.

Bioethics and Nursing Ethics

• Bioethics is ethics applied to human life or health.
• Nursing ethics refers to ethical issues that occur in nursing practice.
• The American Nurses Association (ANA) has updated its Nursing: Scope and Standards of Practice (2010) publication, which holds nurses accountable for their ethical conduct.

Morality and Moral Development

• Morality refers to private, personal standards of what is right and wrong in conduct, character, and attitude.
• Moral development is the process of learning to tell the difference between right and wrong and of learning what ought and ought not to be done.
• It is a complex process that begins in childhood and continues throughout life.

Nursing Codes of Ethics

• Nurses are responsible for being familiar with the code that governs their practice.
• The Code of Ethics for Nurses outlines the minimum standards of the profession and helps the public understand professional nursing conduct.

Ethical Problems in Nursing

• Nurses' growing awareness of ethical problems has occurred largely because of social and technologic changes and conflicting loyalties and obligations.
• Ethical problems in nursing include conflicting loyalties and obligations to clients, families, primary care providers, employing institutions, and licensing bodies.

Making Ethical Decisions

• A difficult choice exists between actions that conflict with the needs of one or more persons.
• Moral principles or frameworks exist that can be used to provide some justification for the action.
• The choice is guided by a process of weighing reasons.
• The decision must be freely and consciously chosen.

Moral Distress

• The nurse may feel torn between obligations to the client, the family, and the employer.
• The 4A's to Rise Above Moral Distress: Ask, Affirm, Assess, Act.

Ethics IDEA Framework

• I – Identify the facts and the ethical question
• D – Determine the ethical principles in conflict
• E – Explore your options
• A – Act on your decision and evaluate

Examples of Nurses' Obligation in Ethical Decision Making

• Maximize the client's well-being.
• Balance the client's need for autonomy with family members' responsibilities for the client's well-being.
• Support each family member and enhance the family support system.
• Carry out hospital policies.
• Protect other clients' well-being.
• Protect the nurse's own standards of care.

Strategies to Enhance Ethical Decisions and Practice

• Become aware of your own values and the ethical aspects of nursing.
• Be familiar with nursing codes of ethics.
• Seek continuing education opportunities to stay knowledgeable about ethical issues in nursing.

Informed Consent

• The nurse acts as a client advocate to ensure that the following three major elements of informed consent have been addressed:
  • Knowledge
  • Competency
  • Free Will

Confidentiality and Privacy

• Protecting the confidentiality of client records and communications.
• The nurse has a duty to protect confidential patient information.
• Protected health information is any individually identifiable health information in oral, written, or electronic form.

Euthanasia

• Euthanasia fundamentally upsets the balance between doctor and patient.
• It is an inhuman act that neglects the proclamation of the inviolable right to life.
• It is an offense against the virtue of hope.

Refusal of Treatment

• The client's right to refuse treatment is based on the principle of autonomy.
• A competent patient is the decision-maker who can refuse treatment, and whose decision should be followed.