Ethics, Communication, and Nursing Practice PDF

- ETHICS - C O M M U N I C AT I O N A N D N U R S E PAT I E N T R E L AT I O N S H I P D R. S E R P İ L TO P Ç U 1  BASIC TERMS IN HEALTH ETHICS Autonomy Autonomy in health care system refers to the commitment to include p...

- ETHICS - C O M M U N I C AT I O N A N D N U R S E PAT I E N T R E L AT I O N S H I P D R. S E R P İ L TO P Ç U 1  BASIC TERMS IN HEALTH ETHICS Autonomy Autonomy in health care system refers to the commitment to include patients in decisions about all aspects of care For example, when a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient’s autonomy. The consent that patients read and sign before surgery documents this respect for autonomy. 2 BASIC TERMS IN HEALTH ETHICS Beneficence Beneficence refers to taking positive actions to help others. The principle of beneficence is fundamental to the practice of nursing and medicine. 3  BASIC TERMS IN HEALTH ETHICS Non-maleficence Maleficence refers to harm or hurt In health care, ethical practice involves not only the will to do good, but the equal commitment to do no harm. The health care professional tries to balance the risks and benefits of care while striving at the same time to do the least harm possible. 4  BASIC TERMS IN HEALTH ETHICS Justice The term is most often used in discussions about access to health care resources Discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of justice. 5 BASIC TERMS IN HEALTH ETHICS Fidelity Fidelity refers to the agreement to keep promises. As a nurse you keep promises by following through on your actions and interventions. If you assess a patient for pain and offer a plan to manage the pain, you to monitor the patient’s response to the plan. 6 PROFESSIONAL NURSING CODE OF ETHICS A code of ethics is a set of guiding principles that all members of a profession accept. Codes serve as guidelines to assist professional groups when questions arise about correct practice or behavior. The American Nurses Association (ANA) established the first code of nursing ethics decades ago. The ANA reviews and revises the code regularly to reflect changes in practice 7  PROFESSIONAL NURSING CODE OF ETHICS Timeless basic principles nursing code of etics ; responsibility, accountability, advocacy, and confidentiality; Advocacy A nursing student notices that a patient is in more pain than expected, but the doctor has not prescribed an appropriate pain reliever. In this case, the student communicates their observation to their instructor and advocates for the patient’s needs to be addressed. Responsibility A nursing student is assigned to administer medication to a patient during clinical practice. The student ensures they give the right medication, in the correct dose, at the appropriate time. If unsure, they ask their instructor or supervising nurse for clarification. 8 PROFESSIONAL NURSING CODE OF ETHICS Accountability A nursing student accidentally records a patient’s blood pressure incorrectly. Upon realizing the mistake, they immediately inform their instructor. Instead of hiding the error, they take responsibility and work towards correcting it. Confidentiality During clinical practice, a nursing student learns personal information about a patient. They do not share this information with friends or on social media. Instead, they only discuss it with the healthcare team to ensure the patient’s privacy and security. 9  VALUES The values that an individual holds reflect cultural and social influences, and these values vary among people and develop and change over time. 10  VALUES Values Clarification; Ethical dilemmas almost always occur in the presence of conflicting values. Sometimes people have such strong values that they consider them to be facts, not just opinion. Clarifying values—your own, your patients’, your co-workers’—is an important and effective part of ethical discourse. 11  NURSING POINT OF VIEW Nurses generally engage with patients over longer periods of time than other disciplines. Details about family life, information about coping styles, personal preferences, and details about fears and insecurities are likely to come out during the course of nursing interventions. 12 PROCESSING AN ETHICAL DILEMMA Ethical dilemmas cause distress and controversy for both patients and caregivers. However, you do not resolve an ethical dilemma by considering only what people want and feel Resolving an ethical dilemma is similar to the nursing process 13  ISSUES IN HEALTH CARE ETHICS Quality of Life Health care researchers work to develop quality-of-life measures to define scientifically the value and benefits of certain medical interventions. The question of quality of life is central to discussions about futile care, cancer therapy, health care provider–assisted suicide, and DNR discussions 14  ISSUES IN HEALTH CARE ETHICS Genetic Screening Genetic testing can alert a patient to a condition that may not yet be evident but that is certain to develop in the future. If a parent or grandparent has the disease, offspring are at risk for developing it Genetic tests are performed later than the legal abortion period, which creates an ethical dilemma 15  ISSUES IN HEALTH CARE ETHICS Care at the End of Life The term futile refers to interventions unlikely to produce benefit for a patient. Who desided futile? Access to Care As a nurse you will certainly deal with ethical issues related to access to care. 16 KEY POINTS Ethics is concerned with determining what is good or valuable for individuals and society at large. The ANA code of ethics provides a foundation for professional nursing. Professional nursing promotes accountability, responsibility, advocacy, and confidentiality. Standards of ethics in health care include autonomy, beneficence, non-maleficence, justice, and fidelity. The process of values clarification helps you to explore values and feelings and decide how to act on personal beliefs and respect values of others, even if they differ from yours. Ethical problems arise in the presence of differences in values, changing professional roles, technological advances, and social issues that influence quality of life. A nurse’s point of view offers a unique voice in the resolution of ethical dilemmas. 17 KEY STEPS IN THE RESOLUTION OF AN ETHICAL DILEMMA Step 1: Ask the question, is this an ethical dilemma? If a review of scientific data does not resolve the question, if the question is confusing, and if the answer will have relevance for areas of human concern, an ethical dilemma probably exists. Step 2: Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information. Step 3: Clarify values. Distinguish among fact, opinion, and values. Step 4:Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Negotiation requires a confidence in one’s own point of view and a deep respect for the opinions of others. Step 7: Evaluate the plan over time. 18  Ethical Dilemma Simulation Purpose: To have students discuss ethical dilemmas they may encounter in nursing practice and develop solutions. How to do it: Students are divided into groups and each group is given an ethical dilemma scenario. Examples from the real world are selected, such as the decision to withdraw life support, patient privacy and information sharing, and requests for treatment that are not in accordance with religious beliefs. Each group discusses the given scenario and tries to find the most appropriate solution within the framework of ethical rules. The groups then present their solutions to the class and a discussion is initiated with the rest of the class. Evaluate the ethical dilemma in the simulation and the solutions you found in writing. 19 COMMUNICATION AND NURSING PRACTICE 20 COMMUNICATION AND NURSING PRACTICE As a nurse you communicate with patients and families to collect meaningful assessment data, provide education, and interact using therapeutic communication to promote personal growth and attainment of health-related goals. 21 COMMUNICATION AND NURSING PRACTICE Communication is an essential part of patient-centered nursing care Patient safety requires effective communication among members of the health care team as patients move from one caregiver to another Breakdown in communication among the health care team is a major cause of errors in the workplace and threatens professional credibility (World Health Organization, 2023). Effective team communication and collaboration skills are essential to ensure patient safety and high-quality patient care 22  DEVELOPING COMMUNICATION SKILLS Each individual bases his or her perceptions about information received through the five senses of sight, hearing, taste, touch, and smell An individual’s culture and education also influence perception. 23 DEVELOPING COMMUNICATION SKILLS Effective communication techniques are easy to learn, but their application is more difficult. Deciding which techniques best fit each unique nursing situation is challenging. Communication about specific diagnoses such as cancer or end of life can be challenging 24 LEVELS OF COMMUNICATION Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. Nurses work with people who have different opinions, experiences, values, and belief systems 25 LEVELS OF COMMUNICATION Small-group communication is interaction that occurs when a small number of persons meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees, lead patient support groups, form research teams, or participate in patient care conferences, they use a small-group communication process. 26  LEVELS OF COMMUNICATION Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health- related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. 27  BASIC ELEMENTS OF THE COMMUNICATION PROCESS Communication is an ongoing, dynamic, and multidimensional process. This simple linear model represents a very complex process with its essential components. 28 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Referent The referent motivates one person to communicate with another. In a health care setting sights, sounds, odors, time schedules, messages, objects, emotions, sensations, perceptions, ideas, and other cues initiate communication. A patient request for help prompted by difficulty breathing brings a different nursing response than a request prompted by hunger. 29 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Sender and Receiver The sender is the person who encodes and delivers the message, and the receiver is the person who receives and decodes the message. The sender is responsible for the accuracy of its content and emotional tone. The more the sender and receiver have in common and the closer the relationship, the more likely they will accurately perceive one another’s meaning and respond accordingly 30 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Messages The message is the content of the communication. It contains verbal, nonverbal, and symbolic language. Two nurses can provide the same information yet convey very different messages because of their personal communication styles. Two persons understand the same message differently. Communication is difficult when participants have different levels of education and experience. 31 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Channels Channels are means of conveying and receiving messages through visual, auditory, and tactile senses. Individuals usually understand a message more clearly when the sender uses more channels to convey it. 32 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Feedback Feedback is the message the receiver returns. It indicates whether the receiver understood the meaning of the sender’s message. The sender and receiver need to be sensitive and open to one another’s messages, clarify the messages, and modify behavior accordingly. 33 BASIC ELEMENTS OF THE COMMUNICATION PROCESS Environment For effective communication the environment needs to meet participant needs for physical and emotional comfort and safety. Noise, temperature extremes, distractions, and lack of privacy or space create confusion, tension, and discomfort. You should control the environment as much as possible to create favorable conditions for effective communication. 34  FORMS OF COMMUNICATION- VERBAL COMMUNICATION Verbal communication uses spoken or written words. The most important aspects of verbal communication; Vocabulary; Medical jargon (technical terminology used by health care providers) sounds like a foreign language to patients unfamiliar with the health care setting. Children have a more limited vocabulary than adults. Teenagers often use words in unique ways that are unfamiliar to adults. 35  FORMS OF COMMUNICATION- VERBAL COMMUNICATION Denotative and Connotative Meaning Individuals who use a common language share the denotative meaning: football has the same meaning for everyone who speaks Turkish, - Your hepatitis B test result is positive - Your hepatitis B antibody result is positive (i.e. you are immune to the disease) 36 FORMS OF COMMUNICATION- VERBAL COMMUNICATION Pacing Conversation is more successful at an appropriate speed or pace. Speak slowly, intonation and pronounce clearly. Long pauses and rapid shifts to another subject give the impression that you are hiding the truth. 37 FORMS OF COMMUNICATION- VERBAL COMMUNICATION Clarity and Brevity Effective communication is simple, brief, and direct. Fewer words result in less confusion. “Where is your pain?” is much better than “I would like you to describe for me the location of your discomfort.” 38 FORMS OF COMMUNICATION- VERBAL COMMUNICATION Timing and Relevance Timing is critical in communication. For example, you do not begin routine teaching when a patient is in severe pain or emotional distress. Often the best time for interaction is when a patient expresses an interest in communicating. 39 FORMS OF COMMUNICATION- NONVERBAL COMMUNICATION Nonverbal communication includes the five senses and everything that does not involve the spoken or written word. Researchers have estimated that approximately 7% of meaning is transmitted by words, 38% is transmitted by vocal cues, and 55% is transmitted by body cues 40 FORMS OF COMMUNICATION- NONVERBAL COMMUNICATION Personal Appearance Personal appearance includes physical characteristics, facial expression, and manner of dress and grooming. First impressions are largely based on appearance. Nurses learn to develop a general impression of patient health and emotional status through appearance, 41  FORMS OF COMMUNICATION- NONVERBAL COMMUNICATION Facial Expression The face is the most expressive part of the body. Facial expressions convey emotions such as surprise, fear, anger, happiness, and sadness. Patients closely observe nurses. The slightest change in the eyes, lips, or facial muscles are important. 42 FORMS OF COMMUNICATION- NONVERBAL COMMUNICATION Eye Contact Eye contact during conversation shows respect and willingness to listen. Always consider a person’s culture when interpreting the meaning of eye contact. Interacting at the same eye level indicates equality in the relationship. 43  FORMS OF COMMUNICATION- NONVERBAL COMMUNICATION Personal Space Personal space is invisible, individual, and travels with the person. Nurses frequently move into patients’ personal space because of the nature of caregiving. You need to convey confidence, gentleness, and respect for privacy, especially when your actions require intimate contact or involve a patient’s vulnerable zone. 44  FORMS OF COMMUNICATION Nurse–Health Care Team Relationships Communication with other members of the health care team affects patient safety and the work environment. Use of common language when communicating critical information helps prevent misunderstandings. SBAR is a popular communication tool that helps standardize communication among health care providers. SBAR stands for Situation, Background, Assessment, and Recommendation 45  FORMS OF COMMUNICATION Nurse–Health Care Team Relationships Lateral violence between colleagues sometimes occurs It includes behaviors such as withholding information, backbiting, making snide remarks, and nonverbal expressions of disapproval such as raising eyebrows or making faces. There must be zero tolerance of lateral violence. 46 ELEMENTS OF PROFESSIONAL COMMUNICATION Courtesy/ Kindness Common courtesy is part of professional communication. To practice courtesy, say hello and goodbye to patients and knock on doors before entering. State your purpose, address people by name, and say “please” and “thank you” to team members. When a nurse is discourteous, It sets up barriers between nurse and patient and causes friction among team members. 47 ELEMENTS OF PROFESSIONAL COMMUNICATION Use of Names Always introduce yourself. Give your name and status (e.g., nursing student, registered nurse...) Addressing people by name conveys respect for human dignity and uniqueness. Using first names is appropriate for infants, young children, patients who are confused or unconscious, and close team members. Avoid terms of endearment such as “honey,” “uncle, aunt,” or “grandma,” Avoid referring to patients by diagnosis, room number, or other attribute, which is demeaning 48