Ethical Issues in Critical Care Nursing PDF

Prepared by Yousria Abdelsalam Assistant Professor of Critical Care and Emergency Nursing  Learning Objectives Identify main concepts relevant to Describe ethical principles Discuss specific ethical issues facing critical ca Develop methods to ma...

Prepared by Yousria Abdelsalam Assistant Professor of Critical Care and Emergency Nursing  Learning Objectives Identify main concepts relevant to Describe ethical principles Discuss specific ethical issues facing critical ca Develop methods to make ethical de 2  Outlines Introduction to ethics. Major concepts relevant to ethics. Common principles for resolving e t h i c a l d i l e m m a s / issues/problems/conflicts. Specif ic ethical dilemmas/issues facing critical care nurses today. Ethical decision making. 3  Introduction. Critical care nurses are often confronted with ethical and legal dilemmas related to informed consent, wi thholdi ng or wi thdrawal of li fe-sustai ni ng treatment, transplantation, privacy, and justice in the distribution of health care resources. Many dilemmas are by-products of advanced medical technologies developed over the past several decades.  Major concepts Ethics is what is right or wrong & what must to be Health Care Ethics or Bioethics : using ethical knowledge to resolve health care problems Ethical decision makingis making a choice that is consistent with an ethicalprinciples A code of ethics is a guide for an individual or group to follow in making decisions regarding ethical issues 5  Major concepts (cont,.) E t h ic a l I s s u e s / P ro b l e m s / Dilemmas: –Situations in which there are conflicting moral claims where we: Do not know what the ethically right thing to do. Do not agree about the ethically right thing to do. Can not find a satisfactory 6  Ethical Issues/ Dilemmas Critical care nurses confront in everyday practice – Informed consent and confidentiality – Withholding or withdrawal of treatment – Organ and tissue transplantation – Distribution of health care resources  Ethical Decision Making One of the primary ethical obligations of professional nurses is protection of their patients’ basic rights. This obligation requires nurses to recognize ethical dilemmas that actually or potentially threaten patients’ rights and to participate in the resolution of those dilemmas.  Ethical Decision Making steps Chief goal = determining right from wrong in situations where clear demarcations do not exist or are not apparent – State the dilemma – Collect, analyze & interpret the data – Consider the choices of action – Analyze the advantages & disadvantages – Make the decision  Ethical Principles Autonomy – Right of self-determination concerning medical care – It is the capacity to think, decide, and act freely and independently. Beneficence – Do the good of the patient Nonmaleficence – Not to intentionally harm  Ethical Principles
(Continued) Justice – Fair distribution of health care resources Veracity – Truthfulness/ the patient’s right to know Confidentiality – Respect for right to control information  Legal accountability in nursing Nurses in the critical care setting have legal responsibilities to patients. An awareness of evolving case law and judicial trends also helps nurses prevent allegations of negligence and malpractice.  negligence Negligence is the failure of a person to act in a reasonable manner. e. g., giving a wrong medication to a patient and failing to raise the side rails on the bed of a sedated patient. Elements of a malpractice claim The nurse had a specific professional duty to the patient. The nurse did not carry out his or her duty. The nurse caused injury to his or her patient. The patient’s injury resulted from the nurse’s negligence action. Example, a patient develops a corneal ulcer while unconscious.  The informed consent  The belief of informed consent is based on the principle that competent adults have the right to self-determination or to make decisions regarding their acceptance or rejection of medical or nursing treatment.  Elements of informed consent  Capacity, refers to an individual’s ability to understand information regarding a proposed medical or nursing intervention.  Voluntariness, requires that a person’s consent be given without coercion. Information, include the following:  A diagnosis of the patient ‘s specific health problem and condition.  The nature, duration, and purpose of the proposed treatment or procedures.  The probable outcome of any medical or nursing intervention.  The benefits of medical or nursing intervention.  The potential risks that are generally considered hazardous or common.  Alternative treatments and their feasibility.  Short-term and long-term prognosis of treatment.  Informed consent of a competent adult must be obtained before any intervention Groups who may be unable to give informed consent:  Infants  Some mentally ill patients  Some elderly patients  Unconscious  Critically ill  Neurological deficits How do we obtain informed consent in the following situation? A patient is admitted to the Accident and Emergency Department. He is unconscious and requires an emergency operation. How will consent for this intervention be obtained?  Informed consent of adolescents Persons younger than 18 years are considered to be minors and are unable to give consent for medical or nursing treatments. Consent must be obtained from a parent or legal guardian. Three exceptions to the requirement of parental consent are emergency care, care of emancipated minors, and minor treatment conditions.  Summary Ethical issues are seldom easy to resolve Often, there are no easy “right and wrong” decisions Attempt to foresee issues and discuss possible solutions early 23 Questions? 24 25