NUR 209 Chapter 2 Notes PDF

Spring 2025 NUR 209 ___ Chapter 2 Notes Ethics in Nursing Practice ​ Morality – personal and adaptable over time ​ Ethics – results of a disciplined study of mortality expressed in systematic norms ​ Current norms in nursing – ANA code of ethics – BINDING to nurses ANA Code of...

Spring 2025 NUR 209 ___ Chapter 2 Notes Ethics in Nursing Practice ​ Morality – personal and adaptable over time ​ Ethics – results of a disciplined study of mortality expressed in systematic norms ​ Current norms in nursing – ANA code of ethics – BINDING to nurses ANA Code of Ethics ​ Applies to all nurses ​ Nonnegotiable standards for the profession ​ Reflection of professions own understanding of societal commitments ​ statement on ethical duties and obligations ​ Resource for nurses confronted with ethical dilemmas ​ 9 provisions Ethical Principles ​ Beneficence – obligation to do good ​ Nonmaleficence – obligation to do no harm ​ Fidelity – being accountable for actions and loyal to commitments ​ Veracity – being truthful ​ Autonomy – right to self determination ​ Justice – ensures resources are used equitably Ethical Approaches ​ Three primary philosophies ​ Utilitarianism: distributing resources to produce greatest good for most amount of people. Doesn’t use large amounts of resources for benefit of a few ​ Libertarianism: some people are more valuable to society than others – need to be given the resources to survive ​ Egalitarianism: all people are equal. Distributing resources according to need to protect those who are marginalized and vulnerable Ethical Dilemmas ​ When there is a difficulty in deciding which action takes precedence over the other ​ Common in perinatal and neonatal care – we must consider both mother and her neonate ​ Most suitable approach for decision making – recognizing pregnant woman’s freedom to make decisions, incorporated a commitment to informed consent and refusal. Respect patients as individuals. PRIMARY DUTY TO PREGNANT WOMAN ​ Other issues ○​ Court-ordered tx that infringe on autonomy of pregnant woman ○​ Criminalization of pregnant women with SUDs ○​ Life support withdrawal from infant or mom ○​ Treating genetic disorders/fetal abnormalities ○​ Equal access to prenatal care ○​ Genetic engineering, cloning, surrogacy ○​ Fetal reduction and preconception gender selection ​ Ethics committee made up of doctors, nurses, lawyers, clergy Ethics in Neonatal Care ​ Infants who aggressive care will likely be futile ​ Infants who aggressive care will probably have benefit to overall well-beings ​ Infants who aggressive care effects are mostly uncertain ​ Keep parents fully informed – allows them to make decisions ​ Developing plan of care that encompasses ○​ Parental wishes ○​ Ethical standards ○​ Realistic assessments of available resources ​ Nurses are primary link between NICU babies and parents Ethical Decision-Making Models ​ Multiple facts to consider – patient & family values, concerns, and preferences ​ Four topics method ○​ Medical indications ○​ Patient preferences ○​ Quality of life ○​ Contextual features. Medical Indications ​ Articulate medical facts – dx, prognosis, tx options, how they will benefit Patient Preferences ​ Expressed or presumed wishes and values of patient ​ Consent – benefits/risks – understanding Quality of Life ​ Consider – beneficence, nonmaleficence, autonomy ​ What are prospects w/wo treatment ​ What deficits will likely be present ​ Are there biases ​ Plans for comfort or palliative care? Contextual Features ​ Consider if any contextual features are relevant to case and analysis ​ Family dynamics, culture, religion Health disparities ​ Result in worse outcomes and lower quality of healthcare ​ Consider – family issues, financial factors, religion/culture, allocation of resources, law impact Cultural Humility ​ Core value ​ Informs the ways in which people build trusting and intentional relationships Ethics & Practice: Nurses’ Rights and Responsibilities ​ AWHONN – professional nsg association representing nurses in neonatal nursing ○​ Considers access to affordable and acceptable care a basic human right ○​ Nurses should not abandon a pt or refuse to provide care based on prejudice or bias ○​ Responsibility to provide high-quality, impartial nursing care to all patients ○​ Professional obligation to inform employers of any attitudes or beliefs that can interfere with job functions ○​ Core values – CARING ​ Commitment to professional and social responsibility ​ Accountability for personal and professional contribution ​ Respect for diversity of and among colleagues and clients ​ Integrity in exemplifying highest standards in personal and professional behavior ​ Nursing excellence for quality outcomes  ​ Generation of knowledge Standards of Practice ​ ANA charged with maintaining scope of practice statement and standards that apply to practice of all nurses ​ Practice standards from AWHONN help guide nursing practice ​ These are general guidelines – additional considerations or procedures may be warranted. ​ Best interest of the patient ​ Act in accordance with laws, institution rules and procedures ​ Guide for optimal practice ​ May change with research and practice ​ 6 components – assessment, diagnosis, outcomes, planning, implementation, evaluation – based on the nursing process Legal Issues in Delivery of Care ​ Failure to communicate – major issue in most malpractice suits with nurses ○​ Issues and concerns to colleagues, charge nurses, and providers ○​ Maternity care – most litigious of all practice areas – two patients at once ○​ Five situations account for most injuries and litigation in obstetrics ​ Unable to recognize or appropriately respond to intrapartum fetal compromise ​ Inability to perform timely cesarean – 30 minutes from decision to incision ​ Inability to appropriately initiate resuscitation of neonate ​ Inappropriate use of oxytocin or misoprostol – leading to uterine tachysystole, uterine rupture, and fetal intolerance of labor/fetal demise ​ Inappropriate use of forceps/vacuum or preventable dystocia Fetal Monitoring ​ Key element of litigation ​ Common allegations ○​ Failure to accurately assess maternal and fetal status ○​ Failure to appreciate a deteriorating fetal status ○​ Failure to treat abnormal/indeterminate FHR ○​ Failure to reduce or d/c oxytocin with abnormal/indeterminate FHR ○​ Failure to communicate maternal/fetal status to care provider ○​ Failure to institute chain of command in clinical disagreement.  ​ AWHONN strongly advises course for interpretation of EFM ​ Interpretation of FHR data can cause conflict Risk Management ​ Systems approach to litigation prevention that involves identification of systems problems, analysis, and tx of risks ​ Successful programs avoid preventable adverse outcomes to the fetus, and decreases risk of liability exposure EBP ​ Widely recognized as key to improving health-care quality and patient outcomes ​ EBP is a conscientious and judicious use of current best evidence in conjunction with clinical expertise, patient values, and circumstances to guide health-care decisions. Utilization of Research in Clinical Practice ​ We need to utilize quantitative and qualitative research findings in practice ← levels of evidence Research Utilization Challenges ​ Large gaps remain between what we know and what we do Barriers to EBP ​ Inadequate knowledge and skills in EBP by healthcare professionals ​ Lack of cultures/environments that support EBP ​ Misperceptions that EBP take too much time ​ Outdated organizational politics and policies ​ Resistance ​ Inadequate # of EBP mentors in healthcare systems Strategies to Enhance EBP  ​ Formation of a committee dedicated to developing and implementing EBP ​ Initiatives to reduce variation in nursing care delivered ​ Target knowledge, skills, and attitudes ○​ Grand rounds ○​ Sim training ○​ Learning and skill fairs ○​ Posters ○​ One-on-one meetings ○​ Case conferences AWHONN Perinatal Quality Measures ​ Provides evidence-based education and practice resources, legislative programs, research, and interprofessional collaborations