Ethical Issues in Critical Care Nursing PDF

Ethical issues in Critical Care Nursing  Prepared by Sahar Ahmed Ali Sayed Lecturer of Critical Care and Emergency Nursing  Outlines q Introduction q Definition q Ethical principles q Nursing code of ethics q Causes of ethical problems in critic...

Ethical issues in Critical Care Nursing  Prepared by Sahar Ahmed Ali Sayed Lecturer of Critical Care and Emergency Nursing  Outlines q Introduction q Definition q Ethical principles q Nursing code of ethics q Causes of ethical problems in critical care q Ethics and the nursing process q SFNO model  Introduction Critical care nurses need a strong understanding of professional nursing ethics and ethical principles and the ability to use a decision making model to guide.nursing actions Definitions  Morals: are traditions of belief about right or wrong human behavior. Informed by individual and group values, morality consists of standards of conduct that include moral principles, rules, virtues, rights, and responsibilities. Ethics: is a generic term for the reasoned inquiry and understanding of a moral life, in other words, a systematic examination of morality.  Ethical problems: (also called ethical or moral dilemmas) occur only when there is some conflict surrounding an ethical decision. Ethical Principles  Ethical Principles ✔ Respect for persons\autonomy Definition: Respect for the inherent and unconditional dignity of persons and to freely exercise choice about what happens to them. ✔ Beneficence efinition: Promoting and maximizing benefit. ✔ Non-maleficence nition: Avoiding and minimizing harm ✔ Justice on: Equitable distribution of benefits and burdens and scarce resources Ethical Principles Nursing code of Ethics  Nursing code of Ethics The nursing code of ethics contains statements and directives for ethical nursing behavior. The American Nurses Association (ANA) Code of Ethics for Nurses, updated in 2015, provides the major source of ethical guidance for the nursing profession. The nine statements of the code are presented in this box. Causes of ethical problems in critical care  Causes of ethical problems in critical care The critical care nurse encounters ethical issues on a daily basis that occur when there is , Conflict between the right action and the ability to take it ) 1( Uncertainty about the right action, or ) 2(. Conflict about which of several right actions is most ethical ) 3( Ethics and the Nursing Process  Ethics and the Nursing Process ✔Initial Steps: Clarify and Define Nature of the Problem What is the crisis (or dilemma) requiring a decision? Assessment: ✔ Identify Key Facts and Values That Are Applicable What are the crucial facts of the case? What moral principles are at issue here? What decision-making procedure is appropriate?  Ethics and the Nursing Process ✔Planning: Explore Available and Best Means to Reach Our Goal What is the primary aim or good for which we are acting? What objectives, benefits, and moral goals are achievable? What previous cases or contingencies should we take into account? Implementation: ✔ Take Decisive and Effective Action to Implement Plan How do we begin, continue, and finish the process of intervention? How do we assess costs/benefits of the intervention? How do we monitor success/failure in the overall process?  Ethics and the Nursing Process ✔ Evaluation: Evaluate Progress and Outcomes with Planned Objectives What means have we set up for debriefing and feedback? Have we used the “right” means to a “good” end? How do we review the pros/cons for the action taken? Final ✔Steps: In Retrospect, Apply the Following Te sts Could I/we provide a reasonable ethical justification for the course of action taken? Can I/we identify what we have learned from applying this model to decision making? How do we integrate this learning into the next decision-making cycle?  SFNO model for deliberation of ethical problems SFNO is an easily memorized acronym that stands for S: Stakeholders, F: Facts, N: Norms, O: Options. To illustrate the use of this model, consider the following straightforward Example. An older-adult woman with chronic obstructive pulmonary disease (COPD) is on a ventilator, receiving artificial nutrition through a gastric tube, intravenous fluids, and antibiotics for pneumonia. The patient does not have capacity and does not have an advance directive. The patient’s only child, an adult daughter, approaches the team and says the patient would not want to remain on the ventilator and requests that it be withdrawn. The treating physician believes that after the pneumonia is treated, it may be possible to wean the patient from the ventilator. The initial question is whether withdrawing the ventilator is ethically appropriate.  Stakeholders: ✔ The patient, the patient’s adult daughter, and extended family all are stakeholders. The nurses, other health care team members, and the health system are also stakeholders  Facts : ✔ The underlying severity of the COPD. ✔ The patient’s prognosis if the pneumonia is treated. ✔ The degree to which the patient is in pain or is suffering. ✔ The likelihood of suffering both with continued ventilation and if the ventilation is withdrawn. ✔ The time in which evidence of improvement from the pneumonia is expected. ✔ The anticipated likelihood of successfully weaning the patient from the ventilator  Norms: ✔ Respect for persons means that the patient’s autonomous decisions should be honored. ✔ Beneficence requires the caregivers to maximize benefit. ✔ Nonmaleficence requires the caregivers to minimize harm  Options: ✔ The team could do nothing (i.e., maintain the ventilation). ✔ The team could also begin weaning the ventilator but continue the other treatments. For example, if improvement from the pneumonia is expected after a few additional days of intravenous antibiotics, ✔ The team could work with the daughter to reach agreement to postpone removal for a few days and reassess the situation in light of the facts at that time.