اخلاقيات التمريض الفرقة الاولى 2024-2025 PDF

Faculty of Nursing 2024\2025 List of content N. B Subject Page 1 Concept of ethics in nursing practice 1 2 Ethical decision making 8 3 Egyptian nursing l...

Faculty of Nursing 2024\2025 List of content N. B Subject Page 1 Concept of ethics in nursing practice 1 2 Ethical decision making 8 3 Egyptian nursing legislation 24 4 Ethical issues 32 5 Ethical principles 43 6 Informed consent 52 7 Patient and nurse rights and responsibility 63 8 Code of ethics 74 9 Legal issues and job related issues associated 81 to legal risk in nursing practice 10 Practice Issues Related to Technology 91 11 Ethics theories 100 12 References 113 1   Objectives At the end of lecture, the student will be able to 1. Define the basic ethical concepts (Bioethics, ethics , morals , value ) 2. Know the ethics in nursing practice 3. Discuss importance of ethics in nursing 4. Know types of ethics 5. Discuss ethical dilemma in nursing 6. Explain how to identify ethical dilemma  Outlines 1. Definition of the basic ethical concepts (values, morals, ethics,soihteoib ) 2. The ethics in nursing practice 3. Importance of ethics in nursing 4. Types of ethics 5. Ethical dilemma in nursing 6. Explain how to identify ethical dilemma 2   Introduction Ethics is concerned with ‗right and wrong‘, although agreeing what is ‗right‘ can be challenging. An understanding of ethics is essential to the delivery of skilled professional care. It is vital that nurses appreciate the value of ethics in their work. Ethics is relevant to clinical, practice-based issues and affects all areas of the professional nursing role. To apply ethics effectively, nurses must develop reasoning skills and understand the concepts and principles that assist ethical analysis  Definitions:  Values: - are attitudes, ideals, or beliefs that an individual or a group holds and uses to guide behavior. Values are freely chosen and indicate what the individual considers important, such as honesty and hard work.  Morals: - are established rules of conduct to be used in situations where a decision about right and wrong must be made.  Ethics: - is a term used to reflect what actions an individual should take and may be ―codified,‖ as in the ethical code of a profession.  Bioethics: - is the application of ethical theories and principles to moral issues or problems in health care.  Ethics in nursing practice Ethics are important to the nursing profession. They guide nurses in their practice on a daily basis. They help nurses distinguish between right and wrong when the correct path is unclear. At times, nurses may be asked to do 3 things by other health care providers or employers that are out of their comfort zone. Ethics can also come into play when a nurse is off-duty. Nurses may find themselves in a position to make an ethical choice to provide care to a stranger should they come upon a car wreck or should a fellow airplane passenger experience a heart attack. A nurse may not be legally bound to provide care, but may have an ethical obligation to help. These situations are times when nurses must employ their profession.  Importance of ethics in nursing 1. Using ethical principles as the foundation of practice assists nurses in making good judgment calls. 2. Ethical principles in nursing guide nurses in providing high-quality care within the laws that govern nursing practices. 3. Nurses who work within the guidelines of ethical principles support the emotional, physical, and mental health of each patient, acting with their best interest in mind. 4. Applying principles of ethics in nursing is beneficial to developing strong nurse-patient and interdisciplinary relationships, which is essential for collaboration and quality patient care. 5. Patients cared for by nurses with solid ethical standards are typically more compliant than those whose nurses disregard ethical principles. When patients are compliant with prescribed health and nursing care plans, they experience improved health outcomes. 6. Ethical nursing practices help reduce risks to patient and nursing safety. 4  7. Healthcare organizations that have nurses who exercise ethical nursing principles typically have higher patient satisfaction scores, higher employee satisfaction, and lower employee turnover rates.  Types of Ethics: 1- Normative Ethics : One way of understanding ethics is by looking at the norms, or rules, in society. Normative Ethics looks at what the right and wrong things to do are in a specific situation. 2- Applied Ethics: An example of applied ethics would be the ethics of recycling. This can be applied to our personal lives by ensuring we recycle as much as possible and teaching our children to do the same. 3- Meta-Ethics: Meta-ethics asks the question of what it means to do ethics. In other words, meta-ethics questions how we can justify ethical judgments, or how we can prove that one ethical theory is better than another 4- Virtue Ethics ; Ethics are about the virtues that a person should adopt to be a good person. Virtue ethics often focus on what we should do and not do in various situations, rather than on right and wrong. 5   Ethical Dilemma An ethical dilemma in nursing is a situation where a nurse must decide between competing values and know that no matter what choice they make, there are consequences. Main Reasons Why Nurses Face With Ethical Dilemmas In Nursing : 1. Patients or their loved ones must make life or death decisions 2. The patient refuses treatment 3. Nursing assignments may contradict cultural or religious beliefs 4. Nursing peers demonstrate incompetence 5. Inadequate staffing How to Identify and deal with Ethical Dilemmas In Nursing? 1. Consider how a situation makes you think and feel. 2. Understand the Uniqueness of the Dilemma...Every patient for whom you care comes to you surrounded by a unique set of circumstances. No two patients are alike and the moral dilemma you face is just as unique. 3. -Refer to the Code of Ethics. The Code of ethics supports nurses in providing respectful, humane, and dignified care to the individual patients. 6 4. -Seek Ethics Education. For further guidance beyond The Code, look to mentors, supervisors, or even the nurse educators you know from nursing school. Although no two ethical dilemmas are the same, you may find that your mentor faced a similar challenge. 5. -Speak Up. Some nurses may find themselves facing ethical dilemmas that can only be addressed by speaking up. However, the patient depend on nurses to be their voice. It is incumbent upon the nurse to alert those in charge. 6. -Seek Perspective. Request a family conference if possible. The family members may offer some influence and aid in addressing the moral dilemma. 7. -Reach Out to Professional Organizations/Associations. Professional nursing organizations typically have access to nurse ethicists who can help address ethical dilemmas. 8. Seek Counseling Sometimes; you cannot come to a resolution that does not bring emotional upheaval to you personally. Most large medical facilities provide counselors. Do not ignore any personal feelings brought to the surface by this moral dilemma. 7   Objectives: At the end of these presentation, every candidate will able to 1. Define some terms related to ethical decision making. 2. Identify purpose of decision-making. 3. Enumerate types of decision-making. 4. Identify steps of decision-making. 5. List factors affecting decision-making. 6. List Obstacles of decision-making. 7. Discuss Role of nurse in ethical decision-making.  Outlines: 1. Introduction. 2. Definitions of terms. 3. Purpose of ethical decision-making. 4. Types of ethical decision-making. 5. The steps of decision-making. 6. Factors influence ethical decision-making. 7. Obstacles of decision-making. 8. Role of nurse in ethical decision-making.   Introduction: Every organization or individuals has taken a lot of decision on daily basis Individual values, beliefs and personal philosophy play a major role in moral or ethical decision making Acting ethically is the right thing to do but it is not always easy  Definition of decision making: - Is a cognitive process resulting in the selection of a belief or a course of.action among several possible alternatives option  Definition of ethical decision making-: Is not a purely cognitive and liner process that follows clearly defined and predictable steps or The process of evaluating and choosing among alternatives in a manner consistent with ethical principles. Definition of ethical Decision-Making in Nursing refers to a framework that nurse professionals use in making informed decisions while evaluating the impacts of their actions  Purpose of ethical decision making-: 1. Ethical decisions generate and sustain trust. 2. Demonstrate and respect responsibility, fairness, and caring. 3. Consistent with good citizenship.   Types of ethical decision making: 1. Programmed &non-programmed 2. Active decision 3. Passive decision 4. Rational decision 5. Irreversible decision 6. Reversible decision 7. Quick decision 8. Delayed decision 9. Conditional decision  Programmed decisions: It involves situations that occur often enough to enable decision rules to be developed and applied in the future.  -Non-programmed decisions: Are made in response to situations that are unique, are poorly defined and largely unstructured.  Active decision: Involve a choice between at least two alternatives in making active decision; people consider their feelings, and their beliefs.   Passive decision-: Are those when the person has a choice, but allows someone else, or time or chance to decided.  Rational decision-: Has sequence of steps starts with identifying the situation at hand then compelling all the facts and information necessary to create a solution.  Irreversible decision: From the term itself, irreversible decision is permanent choices. People usually back for irreversible decision when there are very limited.  Reversible decision making-: This kind of decision is not finding and may be temporary. At any point reversible decision can be change. Ex: when the decision made is not right.  _Delayed decision- : It is termed as such because the decision maker set the decision aside until the right time comes for it to be implemented.  Quick decision-: Not everyone is able to make quick decision so only good decision makers arrive at instant and correct decision easily the long term outcome must be considered in making quick decision.   Conditional decision-: The person opens other possibilities or other alternatives, when the initial decision fails there are other option to choose from it.  Factors influence ethical decision making: 1. Ethical Issue Intensity 2. Individual factors 3. Situational factors (organizational factors) 4. Opportunity  Ethical Issue Intensity: Perception of ethical Issue Intensity can be influenced by: 1. -Management‘s use of rewards & punishments 2. -Corporate Policies 3. -Corporate Values  Individual factors-: There are personal factor about individual may sensitivity to ethical issues, judgment about such issues include:  Age: The older you are, the more ethical you are   Locus of control: External control versus internal control: relates to authority/power 1. -External control: see themselves as going with the flow because that‘s all they can do. 2. -Internal control: believe that they control the event in their lives by their own effort and skill.  Education: The more education that one has, the better he or she is at ethical decision making.  Culture: Appears to be significant in effect of ethical decision making.  Stress: Situation of extreme stress can have negative impact affect thinking and ability of decision making such as inadequate staffing, interpersonal conflict, lack of supportive resource & dealing with death.  Experience and knowledge: The more experienced person has the ability to rapidly identify the important facts, limits and all alternatives to help in ethical decision making.   Religious beliefs and morals: When an individual‘s intentions and behavior are inconsistence with his or her religious beliefs and morals the person may feel guilty.  Situational factors (organizational factors)-: 1. Corporate culture: The set of values, beliefs, norms, polices, overall organization culture and ways to solve problems that an organization‘s member‘s share. 2. Interpersonal conflict: Those who have influence in a work group including peers, managers, coworkers, and subordinates. As the ethical decision-making is a social activity involving health team member and the patient, so we need to identify fundamental communication pattern used by nurse & other health team. 3. Opportunity: Condition that limit or permit ethical or unethical behavior. Opportunity to engage in unethical behavior can be limited through formal codes of ethics, policies, and rules that are adequately enforced  The steps of decision-making: 1. Identify the problem 2. Apply code of ethics  3. Determine the nature and dimensions of the dilemma 4. Generate potential courses of action 5. Consider the potential consequences of all options and determine a courses of 6. Evaluate the selected courses of action 7. Implement the courses of action  Ethical decision making according to nursing process 1. Assessment: Collect، analyze, interpret the data and state the dilemma) Is the process of collecting information as much as possible about the particular ethical dilemma? Include (the problem itself actual or potential problem, identify the people involved in the problem, available resource, patient family)  Example: Whether or not to resuscitate a hospital patient with a terminal disease after physician‘s instructions not to code or resuscitate Questions as: How mentally competent the patient is to make a no resuscitation decision? Also, include the patient‘s wishes and the family‘s wishes.  2- -Planning- :  Consider the choices of action (all the possible courses of action that can resolve the dilemma without considering their consequences)  The process of idea development requires inputs from outside sources such as colleagues، supervisor or even experts in the ethical field.  Two approaches can be used in determining the choice: As previous example: Questions may be: 1. Resuscitating the patient despite the physician has requested. 2. Not resuscitating the patient at all. 3. Seeking another assignment to avoid dealing with the situation. 4. reporting the problem to supervisor 5. Confronting the physician about the question. 6. Clarifying the question with the family. o After considering all choices, the consequences of different actions are considered. o Analyze the advantages and disadvantages of each course of action help the decision maker to select the most realistic action. o As in the previous example: Course of action analysis is:  Discussing the decision with physician may lead to an angry physician and no longer trust in the nurse.  Disciplinary action if successful resuscitation despite orders to the contrary. Make the decision:  The most difficult part of the process is actually making the decision and then living with the consequences.  The best decision that we hoped for is one that is based on ethical decision-making process.  Collaborative decision making among patient, physician, nurses and family about resuscitation is the ideal and tends to produce fewer complication in the long-term resolution of such questions. 3- -Implementation- : To decide ethically is the moral ability and to act ethically is the physical ability. The decision must be done in a caring way. Would I like to be treated in this way? The most appropriate person should do it in the most appropriate way 4- -Evaluation: Evaluation of the action is crucial, but not easy *example: If the decision was that active treatment should be stopped for a dying person, then perhaps the person will die. Evaluation in this situation may be how the death took place and how the family reacted may be taken as an evaluation.  Obstacles of decision making-: 1. Poor moral awareness-: Can either result in a failure to perceive the problem as being an ethical problem at all 2- Failure to gather relevant facts-: Good practical decision requires that know important facts relevant to the decision. 3- Rationalizing ourselves out of good moral decision making-: 1. We can do what we like. 2. The following are poor, but unfortunately all too common. 3. It is just a part of the job. 4. It is legal, and then it‘s moral. 5. It does not hurt anyone.  4- -Slippery slope arguments (SSA)-: People are willing to do unethical things because they have already done smaller less extreme acts that make the bigger choice appear less unethical. 5- Confirmation bias-: Is the tendency to notice and remember evidence that supports our beliefs and to ignore evidence that contradicts them? So when we are making decision and problem solving, we have a tendency to make evidence fit our desired outcome. 6- Not weighing consequences-: Another obstacle to decision making is not weighing consequences. Sometimes we see a solution or decision making that we really like and we will committee and jump in before we consider how that solution or decision we impact others' lives.  Role of the nurse in ethical decision making: 1. -Facilitator: By utilization different frameworks and models as the ANA code of ethics which offers a statement of every nurse‘s ethical obligations and duties 2. -Advocator: For the rights of their patients (patient‘s access to care –refuse treatment – informed consent)  3. Promoting justice: Individuals should be treated the same, unless they differ in ways that are relevant to the situation in which they are involved 4. -Being accountable: From the nurse‘s responsibility in the process of decision making and caring process, accountability arises through information and to what extent she participates in the decisions. 5. -Maintaining privacy: The right to make decisions for oneself and right to control information about oneself also the right to control certain extremely personal decisions and information helps determine the kind of person we are and the person we become. 6. Clarifier and educator: Through giving information about disease process and translate medical terms and clarifying any meaningless information to the family. 7. Preserving dignity: By ensuring involvement of patient and family in any decision that affects their care. Egyptian nursing legislation  Objectives o At the end of lecture the student will be able to: 1) Define legislation 2) Discuss Egyptian nursing legislation. 3) Identify legal aspects of practicing nursing. 4) Identify of law 5) Discuss Functions of Law in Nursing Outlines: 1- Introduction 2- Definition of legislation 3-Definition of law 4- Functions of Law in Nursing 5- Egyptian nursing legislations 6- Legal safeguards for nurses Introduction As a nurse, it has become an important necessity to be aware of the legal aspects associated with caring and helping people in the health industry Definition of legislation The actual law enacted by a legislative body at the national, state, or local level Definition of law Those rules made by humans who regulated social conduct in a formally prescribed and legally binding manner. Laws are based upon concerns for fairness and justice Functions of Law in Nursing  The law serves a number of functions in nursing: 1) It provides a framework for establishing which nursing actions in the care of client are legal. 2) It differentiates the nurse's responsibilities from those of other health professional. 3) It helps establish the boundaries of independent nursing action. 4) It assists in maintaining a standard of nursing practice by making nurses accountable under the law. Egyptian nursing legislations  Article (1): It is not permissible to practice the profession of nursing except for those whose name was registered in the records prepared by the Ministry of Health and Population for this purpose and in the Nursing Syndicate in accordance with the provisions of Law No. 115 of 1976 and the license to practice the profession is renewed every five years  Article (2): The applicant for registration in the records referred to in Article (1) of this law is required to do the following: a- He must be an Egyptian or a national of an Arab country b- He must have a degree in the field of nursing from a college or Accredited institutes or schools. C- He must be of good reputation D- He has not been sentenced to a dishonorable punishment e- That he has proven health suitability to carry out the profession  Article (3): The practitioners of the profession of nursing registered in the records stipulated in Article (4) of this law shall be classified under the following professional levels: a- Specialist nursing specialist b- Nursing specialist c- Specialist technical nurse d- Technical nurse  Article (4): Registers shall be established at the Ministry of Health and Population to register the names of those who meet the conditions for practicing the profession of nursing  Article (5): The data that must be included in each of the records stipulated in Article 4 of this law shall be determined by a decision of the Minister of Health and Population and the Nursing Syndicate Council.  Article (6): The equivalence of foreign certificates to their Egyptian counterparts shall be by a decision of a committee to evaluate and equalize certificates at the Ministry of Health  Article (7): It is permissible for foreigners who have qualifications in the field of nursing to practice the profession after the approval of the Council of the Nursing Profession  Article (8): Students of the training year (internship year) in the nursing faculties of Egyptian universities are permitted to practice the profession of nursing on a temporary basis, in university hospitals, Ministry of Health hospitals and other health units under the supervision of the faculty  Article (9): The registration in the records stipulated in Article (4) of this law shall be canceled by a decision of the Minister of Health and Population in the following cases: A- If the nurse loses one of the conditions for registration. B- If it is proven that the registration was carried out by fraud, fraudulent means, or other illegal means, provided that the Nursing Syndicate is notified  Article (10): Enrollment in the records stipulated in Article (4) of this Article shall be suspended: A- Injury to illness or disability, for the period specified by the specialized medical council. B Suspension from work by a decision or disciplinary ruling for the period specified therein. The National Council for Nursing  Article (11): A National Council for Nursing shall be established in the Ministry of Health and Population headed by the Ministry of Health and Population, with membership, the medical field, the medical field, the field, the field, the field, and the office.  Article (12): The National Council of Nursing is responsible for proposing a policy related to nursing at the national level to ensure the advancement of the nursing profession in all fields  Article (13): The National Council for Nursing shall have a special account opened with the approval of the Minister of Finance and its resources shall consist of the following: A- The financial appropriations allocated by the Ministry of Health and Population in its budget. B - Donations and wills made by individuals or local or foreign bodies and accepted by the Council. The aforementioned resources shall be deposited in a special account in one of the licensed banks  Article (14): The National Council for Nursing may refer to the Council of the Syndicate of the Nursing Profession the professional violations committed by a practitioner of the profession that affect the honor or dignity of the profession  Article (15): Whoever practices the profession of nursing without registering his name in the stipulated records shall be punished with imprisonment for a period of no less than three years and a fine of no less than 5,000 pounds (five thousand pounds) and not more than 25,000 pounds (twenty five thousand pounds) or one of these two penalties.  Article (16): Every nurse who has been previously licensed to practice the profession prior to the date this law comes into effect must submit within one year from this date a request to the Medical Licensing Department at the Ministry of Health and Population together with the documents necessary to be registered in the Ministry‘s records in accordance with its provisions  Article (17): Those who are licensed to practice the profession of nursing will continue on the date this law comes into force from the aid of nurses whose educational system has been canceled for whom the educational qualification condition stipulated in Clause (b) of Article (2) of this law is not available to practice the profession  Article (18): The Minister of Health and Population issues the necessary decisions to implement the provisions of this law  Article (19): This law shall be published in the official gazette and shall be enforced from the day following its publication  Legal safeguards for nurses: 1-Informed consent Informed consent is a patient's agreement to allow something to happen, such as surgery based on a full disclosure of risks, benefits alternatives and consequences of refusal 2. Documentation. 3. Executing physicians order. 4. Good Samaritan law. 5. Patient education. 6. Privileged communication Ethical issues in nursing Out line: 1. Introduction. 2. Definition of ethics. 3. Definition of ethical issues in nursing. 4. Ethical issues between nurses and patients 5. Ethical issues between nurses and physician 6. Ethical issues between nurses and nurses 7. Ethical issues between nurses and employers 8. Ethical issues between nurses and the profession 9. Common ethical issues 10. Ethical dilemma 11. How to deal with ethical dilemma   Introduction The Consumers are patients with complex needs. With increased awareness of health care, health care facilities and Consumer Protection Act, patients are getting aware about their rights. Nurses also have now the expanded role. Issues which seem not feasible, and ideal, may become practice with the change of time. These issues are base for the future trends in care  Definition of Ethical issue: A problem or situation requires a person or organization to choose between.)alternatives that must be evaluated as right (ethical) or wrong (unethical Example: Abortion, stem cells researches  Nursing Ethics It is the branch of ethics that provide professional standards for nursing activities; these standards protect both the nurse and the patient.  Ethical issues between nurses and patients There are many ethical issues in the relationship between nurses and patients because this relation includes giving care but the most important ethical issues are:  Confidentiality and advocacy.  Confidentiality It means a moral obligation of individual or organization to protect entrusted information of another`s ownership.  Advocacy  It means provide help and assistance to someone in which the advocate fight to get other`s right   Ethical issues between nurses and physicians  The relationship between nurses and physicians is a working relationship and this relation been characterized by social and professional inequality  The most important ethical issue between nurses and physician is nursing autonomy.  Nursing autonomy: It refers to the ability of nurse to make independent decisions and the freedom to act in accordance with her professional knowledge base.  How does autonomy impact the nursing practice?  Increase nurse satisfaction  Improve patient outcomes.  Ethical issues between nurses and nurses: The most important ethical issue between nurses is  Tension between nurses. Causes of tension occurrence among nurses:  In the practice, nurses work closely with other nurses so, normally a nurse‘s activities will overlap with other nurses which her practice affects and is affected by the practices of others  Most nurses either supervise or are supervised by other nurses. So, it gives a great chance to tension among nurses to occur.  Ethical issues between nurses and employers The most important ethical issues between nurses and employers are: 1. Standards of Care 2. Accountability 3. Responsibility 4. Strikes 1. Standards of Care These are general guidelines that provide a foundation about how a nurse should act and what he/she should and should not do in his/her professional capacity. Importance of standards of care:  Solve problems  Ensure that practice moves forward and does not stagnate  Guide and evaluate nursing care. 2. Accountability It means that the person is being responsible for his/her actions `and the outcomes of these actions. Purpose of accountability:  To provide good quality health care  Result in cost-effective care. 3. Responsibility Is a duty or task that you should do because it is morally right and legally required. Note: Whoever has responsibility has accountability. 4. Strikes Strikes are collective and organized stopping or slowdown of work by employees, to force acceptance of their demands by the employer Causes of strikes:  Nurses start to negotiate about conditions of employment like; wages and salaries. Legality of strikes:  When nurses do vote to strike, they create mechanisms to ensure the well-being of their patients and the community and the same time take their rights without affect quality of patients` care.  Ethical issues between nurses and the profession To practice any job/profession you must give the best service within certain frameworks. When a person goes outside these frameworks, this may be harmful to the client and the profession. -The most important ethical issues between nurses and the profession is :  Professionalism It is a collection of qualities that linked with well trained and skilled person who concern certain profession.  Principles for professionalism: 1. Appearance. The nurse`s uniform must be clean, neat and contains the following:  Put nametag on uniform.  Keep it in a good odor.  Clean short nails. 2. Behavior.  Treat all people as a part of your profession.  Be polite and good speaker when interact with client, relatives, visitors,seniors.   All of the times tell truth.  Respect others and deal with others by optimistic attitude 3. Organizational activities.  Nurse must organize her/his daily activities by using certain agenda and plan at the beginning of each day.  Be ready with all equipment.  Try to found quickly responses and solutions to problems at work. 4. Ethics.  Nurses must deal with others by moral and ethical behavior all of the times. 5. Patient and families caring.  Be advocate for patients` rights.  Deal with all patients regardless their sex, race, color and religion.  Protect patient from any harm or injury 6. Education.  The nurse must be research wise.  Nurse must keep her/his self in continues training and educational courses to connect with the most updated knowledge and skills.  Benefits of professionalism in nursing: 1. Improve reputation of staff and organization 2. Improve dignity and self-worth of employees 3. Make nurses be respected from other health team members 4. Increase nurses` chance for promotion   Common ethical issues 1.. Honesty vs. withholding information. Family members may want to withhold medical information from sick patients to protect their emotions. However, patients have the right to know about their medical conditions. Deciding how to share this information, especially if it goes against the family‘s beliefs, can be a touchy situation 2. Science vs. spirituality. Healthcare, which is science-based and results driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guideline 3. Healthcare needs vs. resource allocation. The rising cost of healthcare is increasingly putting nurse managers at odds with budgeting constraints and patient needs. A large number of medical facilities have scarce resources, which puts patients at risk for not getting the care they need. These resources range from medical equipment to healthcare staff. Research suggests that nurse leaders must include staff in the budgeting process so that they can better understand the needs and demands 4. Autonomy vs. beneficence. Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care ANA explains: ―Using ethical principles to arrive at a solution should be done in an atmosphere of caring, respect, openness, and honesty"   Ethical Dilemma o A dilemma is defined as a situation requiring a choice between two equally desirable or undesirable alternatives  Common Ethical Dilemma Situations Ethical dilemmas present themselves frequently via patient interaction, but can sometimes occur through the nurse‘s relationship with coworkers and other healthcare professionals. The most common ethical issues in nursing :will involve 1) Refusal of Medication or Life-Sustaining Treatment Many patients who observe certain religions or ideologies will refuse a particular medical intervention or life-saving treatment. In this scenario, the RN should concentrate on educating patients to ensure a good understanding of the consequences of either rejecting or accepting treatment, while allowing them to practice self-care on their own terms, without judgment. Nurses can also advocate for their patients by encouraging the healthcare team to explore alternative treatment options that align with a patient‘s beliefs 2) Surrogate Decision-Making Patients must be empowered to be able to make their own educated healthcare decisions. However, if the patient is unable to make an informed decision regarding the course of their treatment, a surrogate is required to use their personal knowledge of the patient‘s values and perspectives to determine the decision they would have made.  3) Advance Directive Planning and Do Not Resuscitate (DNR) Orders In fact, patients have a right to refuse any and all medical care. Thus, it is crucial for RNs to have a broad understanding of cultural differences, with insight into the particular patient‘s situation, in order to effectively educate the patient on any medical necessity or course of treatment 4) Patient Privacy RNs are obligated to treat the patient with the goal of achieving the best health outcome, which includes keeping patient medical and personal information private. 5) Inadequate Staffing, Education, or Resources Sometimes, RNs may be asked to take a patient or complete a task that they do not have the appropriate education, training, or resources to properly complete. Team leaders should also organize and provide training sessions.for their staff to reduce inappropriate or unsafe nursing assignments Some facilities or units may face staffing shortages or have outdated equipment, which can impact the quality of patient care. Nurse managers are encouraged to include staff in the shift planning and unit budgeting processes to empower nurses to suggest changes and understand demands  How to Deal With Ethical Dilemmas in Nursing 1. Nurses undergo many years of education and clinical training before they can become certified nurses, and yet, dealing with real ethical issues in nursing can be far more complex than solving hypothetical issues in textbooks. 2. Nurses can learn how to deal with ethical dilemmas in the workplace through gaining experience and interacting with patients over time. 3. Nurses struggle to identify whether something is ethical, they can review the ANA Code of Ethics. 4. Nurse Managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges.  Ethical principles Objectives At the end of lecture the student will be able to: 1) Define ethical principles. 2) Apply ethical principles in nursing. 3) Discuss importance ethical principles Out line 1) introduction 2) Definition Ethical principles 3) The basic ethical principles  Introduction: Ethical principles do not provide a straightforward guide that guarantees the making of an ethically correct decision, nor can they offer guidance about ranking when the principles appear to conflict with one another. Instead, they point only to considerations that should be weighed when making decisions. Definition of Ethical principles:- refers to those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of human actions.  Other definition - It refers to codes that direct or manage actions Importance of ethical principles 1. Establish common ground among nurse patient, family, other health care professions and society for discussion of ethical questions and ethical decision making 2. Permit people to take a consistent position on specific or related issues 3. Provide an analytical framework by which moral problems can be evaluated The basic ethical principles: -- 1. Autonomy- 2. Beneficence. 3. Non-maleficence 4. Justice  5. Fidelity 6. Veracity 7. Confidentiality 8. privacy 1- Autonomy- autonomy is a fundamental ethical and political concept. The world autonomy means self-rule. this principle reflects our belief that patients have a right to make decision about things that will affect their own lives. the autonomy is important part in ethical principles.  Definition of autonomy: Refer to Duty to respect patient s rights of self governance  Application of autonomy (examples): 1. Informed consent 2. Treatment options  The autonomous person is able to--: 1- Determine goals 2- Decide plan of actions 3- Choose from various options with understanding of possible outcomes 2- Beneficence.(doing good)  Definition of beneficence:  It Is duty to maximize benefits and enhance patient‘ s well being  importance of beneficence- : 1- Beneficence actions can be taken to prevent or remove harms or improve the situation of others. 2- To supply patients with information that will enable them to reduce of harm or prevent harm from occurring  Examples: 1. Providing patients with emotional support 2. Educating patient about healthy lifestyle 3- Non-maleficence (do no harm):  Definition of non-maleficence: The duty to avoid causing harm and minimize harm to the patient.  Importance of non malefinece-: - Avoiding harm as benefience -Harm may be; physiological, psychological, social, spiritual.  Example of non- maleficence: 1. preventing patient from taking a harmful medication. 2. The nurse check the side rails of patient`s bed to protect him from fall down.  3. Justice:  Definition of justice: duty to treat patients fairly and equitably.  Eexample of justice:- Providing nursing care according to the patient s condition without discrimination in religion or nationality  Element of justice: - 1- Justice is based on the concept of fairness 2- Nurses face justice every day as they organize care for their clients; like she must decide how much time have to spend with each client by taking patient`s needs into consideration, and then fairly distributing the resources accordingly.  Types of justice: 1. -equitability justice: this type of justice that involves distributing rights and obligations fairly and equally among individuals 2. -distributive justice: A type of justice that deals with the fair distribution of resources and opportunities in society 4. Fidelity: Fidelity means that be obligates to carry out patients promises to care with faithfulness   Example of fidelity: If you tell a patient you will be back to check on them, follow through by doing so.  Elements of fidelity- 1- Fidelity requires loyalty, fairness, truthfulness, advocacy, and commitment to our patients and an agreement to keep our promises 2- By using fidelity as a principle; nurses are encouraged to keep their commitments to patients in a good quality of caring 5. Veracity- It refers to telling the truth, neither lying nor deceiving others  Elements of veracity: 1- Veracity is difficult to achieve because it may not be hard to tell the truth, but it can be very hard to decide how much truth can be told 2- Truth will be telling in respect, honest, open communication, trust, and share responsibility 3- Patients must be provided with the complete truth about medical problem 6. Confidentiality The nurse has a duty to maintain confidentiality of all patient information the rights well- being and safety of the individual patient shoud be the primary factors in arriving at any professional judgment concerning the disposition of confidential information received from or about the patient whether oral written or electronic.  Definition of Confidentiality: refers to moral obligation of individual or organization to protect entrusted information of anther ‗s ownership.  Element of Confidentiality–  1- Confidentiality is a principle by which an individual has the right to control the personal information 2- Nurses must keep patient`s information confidential and not shared only if necessary  Important of confidentiality: 1- It helps to maintain privacy and confidentiality expectations., 2- It allows for the opportunity to ethically disclose personal information and provide critical information to health professionals, 3- Often in times of significant need within an individual's life or in order to protect public health  Examples: The hospital starts to apply new electronic documentation system to protect health data of patient. 7. Privacy: - Privacy the nurse safeguards the patients right to privacy the need for health care does not justify unwanted intrusion into the patient‘s life the nurse advocates for an environment that provides for sufficient physical privacy including auditory privacy for discussions of a personal nature and policies that protect the confidentiality of information.  Examples: The nurse is keen to put curtains to protect the privacy of the patient during performing wound care for him The difference between confidentiality and privacy? 1. Confidentiality: Clause places an obligation on one party or both parties to keep specific information confidential. 2. Privacy: Clause generally requires tht one or both parties comply with the act whether you are already under an obligation to do so or not. Informed consent Outlines 1- Introduction 2- Definition of Informed consent 3- Components of informed consent 4- Types of informed consent 5- Aspects of informed consent 6- Elements of informed Consent 7-Principles of informed consent 8- When is informed consent not required ? 9- Barriers for effective informed consent 10- Role of informed consent   Introduction Informed consent is a process for getting permission before conducting a healthcare intervention on a person, or for conducting some form of research on a person. A health care provider may ask a patient to consent to receive therapy before providing it.  Definition Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. Informed consent is the patient's choice to have a treatment or procedure, which is based on their full understanding of the treatment or procedure, its benefits, its risks, and any alternatives to the particular treatment or procedure. Is an agreement by a client to accept a course of treatment or a procedure after being fully informed of it.  What should it include? 1- Nature of the procedures 2- Benefits, risks, and alternative procedures 3- Benefits and risks of each alternative 4- Assement of patient understanding   Types of Informed Consent: 1- Implied consent: Implied consent refers to when a patient passively cooperates in a process without discussion or formal consent. The principles of good communication apply in these circumstances and health professionals need to provide the patient with enough information to understand the procedure and why it is being done. Implied consent does not need to be documented in the clinical record.  There are several situations where implied consent may apply: 1. When a patient is unable to communicate for some reason, such as if they are unconscious or in shock. 2. When a patient‘s ability to communicate is limited by their age, mental state or physical condition. 3. If a patient has been injured or has an illness that makes it difficult for them to express their wishes. 2- Verbal consent: A verbal consent is where a patient states their consent to a procedure verbally but does not sign any written form. This is adequate for routine treatment such for diagnostic procedures and prophylaxis. Examples of verbal consent: 1-X-ray 2- Catheterization 3- Written consent A written consent is necessary in case of extensive intervention involving risks where anesthesia or sedation is used, any invasive or surgical procedures, and administration of medications with known high risks  Examples of written consent 1. Most surgeries, even when they are not done in the hospital. 2. -Advanced or complex medical tests and procedures. 3. Examples are an endoscopy (placing a tube down throat to look at the inside of stomach) or a needle biopsy of the liver. -Most vaccines. -Radiation or chemotherapy to treat cancer. -Some blood tests, such as HIV testing (need for written consent varies by countries.  The following components should be discussed and included in the written consent form : a) -An explanation of the medical condition that warrants the test, procedure, or treatment. b) -An explanation of the purpose and benefits of the proposed test, procedure, or treatment. c) -An explanation of the proposed test, procedure, or treatment, including possible complications. d) -A description of alternative treatments, procedures, or tests.  e) -A discussion of the consequences of not accepted test, procedure, or treatment. f) The consent form should be signed and dated by both the doctor and nurse.  Aspects of informed consent Informed consent is required for many aspects of health care.These include consent for: 1- Treatment 2- Dissemination of patient information 3-Discussion of HIPPA laws 4-Specific procedures 5-Surgery 6-Blood transfusions 7-Anethesia  Elements of informed consent 1- Know what is going to happen An informed consent document must state the exact procedures or treatments that are going to be performed or being considered. Some forms give a doctor the option to perform other procedures at their discretion. Review these carefully so that you understand. What these procedures are. You can withhold your consent. 2- Know what part of body will be affected The location on body where a procedure is going to be performed should be listed on the form. Giving the doctor a chance to confirm understanding what will be happening physically. 3- Know the risks and alternatives the risks and potential complications should be clearly listed and identified. This allows the chance for discussing the negative outcomes through the procedure. Nurse should also be aware of any reasonable alternatives to the proposed treatment 4- Know who will be involved the consent form should list exactly who will be performing the different aspects of procedure. It is a good idea for asking how much experience the medical staff involved with the procedure. If anesthesia will be administered, the consent form should clearly list who will be administering the anesthesia and with this information, nurse should look to see if the form indicates that there will be observers or photography during the procedure. 5- Have the forms in advance Nurse ask doctor to provide the consent forms before the procedure. Nurse should have a reasonable amount of time to review the forms. Nurse Keep the forms in her possession until being satisfied for having all the information needed to make a decision on treatment. That is real informed consent. 6- Have a medical representative Bring a family member or someone who can act as a medical representative. Dealing with medical condition and the impact of surgery may make distracting through the process. This person can help in understanding the document and what was discussed and agreed in the consent. 7- Have Copies - Make sure of getting a copy of every consent form signed  Principles of informed consent There are 4 principles of informed consent including : 1-Decision capacity 2-Disclosure 3-Documentation of consent 4- Competency 1. Decision capacity 1. -Nurse must have the ability to make the decision. 2. The medical provider must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the probability that the benefits and risks will occur. 3. -Nurse must understand the relevant information. 4. Must voluntarily grant consent, without coercion. 2. Disclosure To give informed consent for treatment or tests, the doctor or health care provider must give enough information for making an informed decision. It is not necessary to receive every detail of the test, treatment, or procedure. Nurse need only the information that would be expected by a reasonable person to make an intelligent decision. This information should include the risks and probability of each of the risks and the benefits. Any questions should be explained in understandable language. 3. Documentation of Consent For many tests and procedures, such as routine blood tests, X-rays, and splints or casts, written documentation of the consent process is obtained. For many invasive tests or for treatments with significant risk, nurse should be given a written consent form. 4. Competency Decision-making capacity is often referred to the legal term competency. It is one of the most important components of informed consent. To have decision-making capacity does not mean that the patient will always make "good" decisions, or decisions that doctor agrees with. Likewise, making a "bad" decision does not mean that the patient is "incompetent" or does not have decision-making capacity. Decision-making capacity, or competency, simply means that understanding and explaining the options, their implications, and give a rational reason why deciding on a particular option instead of the others.  When is informed consent not required? In an emergency, Informed consent isn‘t always required in emergencies. provider may look for your closest blood relatives for consent. But if your relatives aren‘t available, or if you‘re in a life-threatening situation, a healthcare provider can perform the necessary life-saving procedures without consent.  Barriers for effective informed consent : Patient-centered barriers to informed consent such as: 1- Age e.g child 2- Impaired cognitive condition 3- Illness process centered barriers such as a. Content e.g comatosed patient , brain stem death b. Readability of the consent form c. Timing of discussion, amount of time allotted to the process can affect an individual's ability to provide substantial informed consent. 4- nurses must be aware and knowledgeable of the various barriers to informed consent to minimize these barriers and to improve and facilitate the informed consent process.  Role of nursing in informed consent : 1- Support of patients' decision making. 2- Promotion of patients' understanding of their own situation by active listening, information disclosure, psychological support. 3-Advocation. 4- Assisting patients understanding of doctor's explanations. 5- Promotion of good relationships between patients and professional Patient and nurse rights and responsibility  Objectives At the end of lecture the student will be able to : 1. List characteristics of responsibility 2. Determine Nurse responsibilities 3. Identify Nurse rights 4. Apply Nurse strategic to promote their rights 5. Discuss patient's rights. 6. Discuss patient's responsibilities. 7. Discuss Nursing manager role in maintaining of ethical consideration for patient and nurse  Outlines 1. Introduction. 2. Characteristics of responsibility. 3. Nurse‘s responsibilities. 4. Nurse rights. 5. Nurses‘ strategies to promote their rights. 6. Patient‘s rights.   Introduction Everyone has rights responsibilities to each other. Responsibility Means to be answerable to someone or something specific. Rights: - Are mutual recognitions & expectations that arise among people. *Responsibility: -refers to duty or obligation to satisfactory or complete a task (assigned by someone) that one must fulfill, and which has a consequent penalty for failure.  Characteristics of responsibility: - 1. The responsibility is the obligation of a subordinate to perform the duty assigned. 2. It always originates from the superior-subordinate relationship. 3. Normally, responsibility moves upwards. 4. Responsibility is in the form of a continuing obligation. 5. Responsibility cannot be delegated. 6. The person accepting responsibility is accountable.  Essential responsibilities for nurse 1. Record medical history and symptoms. Nurse‘s record and maintain accurate documentation of their patients' health to ensure they receive the proper treatment. Most nurses begin this process by asking patients questions about their medical history to gather information about previous diagnoses and surgeries, current medications, allergies and relevant family medical information. 2. Administer medications and treatments. Most nurses can administer medications and treatments to their patients with a physician's order. Nurses may also assist doctors with more advanced procedures or administer emergency care to patients in critical condition. 3. Collaborate with teams for patient care. Nurses play a vital role in collecting information from patients and sharing it with the rest of their medical team 4. Perform diagnostic tests. Nurses may perform a wide variety of diagnostic tests, including checking vitals and collecting tissue, blood, stool or urine samples for analysis. Nurses may also be responsible for analyzing the results and sharing what they find with the rest of their medical team. 5. Conduct physical examinations. Nurses often conduct a physical examination of patients at the beginning of their visit to assess their overall health. This may involve taking the patient's temperature, recording their weight, monitoring their heartbeat and checking their blood pressure. 6. Monitor patients' health. Nurses must carefully monitor and observe their patients to record any symptoms or relevant information that could lead to a diagnosis or a change in their treatment plan. 7. Provide support and advice to patients. It is important to make sure patients feel cared for, listened to and understood, especially when nurses need to deliver challenging medical news. Patients often look to nurses for support and advice to help them process their diagnoses and determine what steps they should take next. 8. Operate medical equipment. Nurses use a wide variety of diagnostic tools to care for their patients, including stethoscopes, glucometers, pulse ox meters, thermometers and blood pressure machines. 9. Educate patients about how to manage an illness. Part of a nurse's role is to educate their patients about various medical conditions and provide clear instructions on how they can manage their symptoms. This could include explaining what medications the patient needs to take, when the patient should schedule a follow-up appointment and instructions for rehabilitative exercises or practices 10. Advocate for the health and well-being of patients. In order to properly care for their patients and ensure their safety, nurses may often act as advocates for their health and overall well-being. This can involve translating the medical information or diagnosis a doctor provides to ensure the patient understands the important details, encouraging patients to ask questions or connecting patients with resources at another facility that's better suited for their needs. 11. Provide basic bedside care. Nurses may be responsible for a wide range of basic bedside care tasks, depending on their particular working environment. These tasks can include helping patients bathe, use the bathroom and perform other hygiene-related activities. 12. Train and educate staff. In addition to the clinical work, they do to take care of patients, qualified nurses with an appropriate amount of experience may help train and supervise newer members of their medical team, including practical nurses and nurses' aides. 13. Maintain inventory. Experienced nurses may take on extra job roles, such as maintaining inventory and ordering supplies. This is often a shared responsibility, but tenured nurses may supervise entire departments.   Nurse rights: 1. Nurses have the right to freely and openly advocate for themselves and their patients, without fear. 2. Compensate for their work, consistent with their knowledge, experience, and professional responsibilities. 3. Work in environment that is safe for themselves and their patients. 4. Negotiate the conditions of their employment, either as individuals or collectively, in all practice settings. 5. Refuse any assignment that they feel is unsafe. Such as when a nurse is assigned a patient load the feels is unsafe 6.. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. 7. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 8. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements.  Nurses strategies to promote their rights There are many strategies that nurses could pursue to assert, promote, and advance their rights. 1. -protect and promote patients' rights. 2. -Know and stand up for nurses' human rights. 3. Adopt a philosophy of life-long learning. 4. -join a professional organization.   Patient’s Bill of Rights: 1. The patient has the right to considerate and respectful care. 2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment. 3. The patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the medically reasonable alternatives and their accompanying risks and benefits. 4. Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees. 5. The patient has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known. 6. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment. 7. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision- maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. 8. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient‘s privacy. 9. The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, 10. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient‘s treatment and care. 11. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment. 12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. 13. The patient has the right to be informed of the hospital‘s charges for services and available payment methods.  Patient's responsibility 1. Give correct and complete information about current symptoms, including pain and medication. 2. Give information about medical and health history. 3. Ask questions if treatment being given or planned treatment by a Health Provider is not understood or part to be played in the plan is not understood. 4. Follow recommended treatment plan agreed to by Health Provider. 5. Keep appointments or notify Health Providers within reasonable time frame if there is a need to cancel visit. 6. Follow health facility rules regarding smoking, noise and use of electrical and electronic equipment as well as limit the use of mobile devises within health facility. 7. Pay for care including emergency treatment. 8. Treat service provider staff with courtesy and respect, free from discrimination and harassment. 9. Comply with directives, instructions and advice of attending professionals. 10. Comply with operational rules and regulations of the facility for the safety and security of all. 11. Respect the rights of other patients. 12. To disclose all prior medical history relevant to your care. 13. To be considerate of the rights of other patients and medical personnel, to assist in the control of noise, and to follow the Adventist HealthCare non-smoking, visitor, and other rules 14. To be cooperative and considerate during the treatment and care prescribed. 15. To respect the privacy of other patients 16. To accept your financial obligations associated with your care 17. To advise your nurse/physician and/or Patient Representative of any dissatisfaction you may have regarding your care at the hospital.  Nurse managers roles in maintaining of ethical consideration for patients and nurses For Patient. 1. Patient safety. 2. Informed Consent ‫ز‬Protection of personal information. 3. Construction of mutual trust. 4. Improve quality of psychiatric services. 5. Shorten Average length of hospitalization. 6. Improve satisfaction level. 7. Improve health. 8. Educate patients about how to manage an illness. and provide clear instructions on how they can manage their symptoms. For Nurses. 1. Education for staff and improvement of technique 2. Interdisciplinary collaboration 3. Improve knowledge and health behaviors. 4. Participating in various continuing education programs and encouraging other groups will raise the scientific and practical level of nurses and familiarize them with what is new and how to apply it. 5. Working to provide a sound working environment, whether in hospitals or other heath institutions. Objectives *At the end of lecture the student will be able to: 1- Define of code of ethics. 2- Identify purpose of code of ethics. 3- Identify American nurse's association's code of ethics for nurses with interpretive statements contents 4- Identify Disadvtages of code of ethics Out line 1. Introduction 2. Definition 3. Purpose of Code of Ethics Principle of code of ethics 4. American nurses associations code of ethics for nurses with interpretive statements contents 5. Disadvtages of code of ethics   Introduction Ethics is concerned with ‗right and wrong‘, although agreeing what is ‗right ‘can be challenging. An understanding of ethics is essential to the delivery of skilled professional care. It is vital that nurses appreciate the value of ethics in their work. Ethics is relevant to clinical, practice-based issues and affects all areas of the professional nursing role. To apply ethics effectively Ethics is an integral part of the foundation of nursing.Nursing has concern for the welfare of the sick; injured ;and vulnerable and for social justice.  Definition  A code of ethics is a guide of principles designed to help professionals conduct business honestly and with integrity  Code of ethics could also refer to an individual‘s personal values or sense of right and wrong.  Purpose of Code of Ethics 1. -Help in assessing the complex situations 2. -Better decision making and problem solving 3. -Enhances interaction between the health professionals and with the community 4. -Unethical practices will be minimized. 5. -Reflect the good image of the nurses and the organization they work.   American nurses associations code of ethics for nurses with interpretive statements contents o Provision 1 The nurse in all professional relationships practices with compassion [and respect for the inherent diginity ,worth, and uniqueness of every individual, unrestricted by considerations of social or economic status personal attributes, or the nature of health problems 1-Respect for human dignity 2-Relationships to patient 3- The nature of health problems 4- The right to self- determination 5- Relationships with colleagues and others o Provision 2, the nurses primary commitment is to the patients, whether an individuals ,family,group,or community 1-primary of the patient‘s interests 3-collaboration 4-professional boundaries o Provision 3 , The nurse promotes, advocates for,and strives to protect the health ,safety ,and the rights of the patient. 1- privacy 2- confidentiality 3- protection of participants in research o Provision 4. the nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care 1- acceptance of accountability and responsibility 2-delegation of nursing activities o Provision 5 The nurse participates in establishing,maintaining and improving health care environment and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action 1-influence of the environment on moral virtues and values 2-influence of the environment on ethical obligations 3-responsibility for the health care environment  o Provision 6, The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development 1- Advancing the profession through active involvement in nursing and in health and in health care policy 2- Advancing the profession by developing, maintaining professional standards in clinical, administrative, and educational practice o Provision 7 The nurse collaborates with other health professionals and the puplic in promoting community, national and international efforts to meet health needs 1- health needs and concerns 2- responsibilities to the public o Provision 8 The profession of nursing as represented by associations and their members, is responsible for articulating nursing values 1- intra-professional integrity 2-social reform   Disadvtages of code of ethics 1. -Codes of Ethics only work if all members of an organization adhere to them, which is not always the case. 2. Codes of Ethics cannot stop unethical behaviour before it starts- 3. -Although most codes are designed to promote ethical behaviour, they will never achieve this goal 100% of the time  objective: 1. definition Ethical issue, legal issues , legal risk 2. mention Purpose of legal issues 3. Mention some legal rights and responsibility for nursing practice 4. Identify legal issues may be influence about the Patient and nursing 5. Legal issues that influence clinical decision 6. legal risks in nursing  Out Line : 1. definition Ethical issue, legal issues , legal risk 2. Purpose of legal issues 3. legal rights and responsibility for nursing practice 4. legal issues may be influence about the Patient and nursing 5. Legal issues that influence clinical decision 6. legal risks in nursing   Introduction Nurses as health service providers and members in health systems are responsible for giving care to the clients and patients based on ethical issues. Nurses need ethical knowledge to conduct their appropriate function to manage situations and to give safe and proper legal and ethical care in today's changing world.The health care climate is regularly changing like our society. So it is vital that nurses have a grounded understanding of ethics. In addition, the nurse finds herself constrained in various and conflicting ways by the hospital (which employs her), the physician (with whom she works), and the client (for whom she provides care.  Definition o Ethical issue: a problem or situation that requires a person to choose between two options, where both options are morally wrong. Ethical issues can be divided into three categories: personal, professional, and social. o Legal risk: Legal risk is the likelihood of financial or reputational loss resulting from a lack of knowledge (or misunderstanding) of how the law applies to your business, or operating with a reckless indifference to the law and how it applies. o Legal issues: A legal issue is something that happens that has legal implications and may need the help of a lawyer to sort out. It is a question or problem that is answered or resolved by the law.  o Law: means Rules of court, Decrees, Judgment, Orders of courts, and Injunctions from the point of view of Judges.  Some legal rights and responsibility for nursing practice: 1. Identify legal issues affecting the client (e.g., refusing treatment) 2. Identify and manage the client's valuables according to facility/agency policy 3. Recognize limitations of self/others and seek assistance 4. Review facility policy and state mandates prior to agreeing to serve as an interpreter for staff or primary health care provider 5. Educate client/staff on legal issues 6. Report client conditions as required by law (e.g., abuse/neglect, communicable disease, gunshot wound) 7. Report unsafe practice of health care personnel and intervene as appropriate (e.g. substance abuse, improper care, staffing practices) 8. Provide care within the legal scope of practice  Legal issues may be influence on the patient and nursing: 1) Torts: A tort is a civil wrong committed against a person or property (real or personal) and is punishable by damages (i.e., monetary compensation) rather than imprisonment. There are three basic categories of torts: intentional torts, negligent torts a) Intentional Torts Several of the more common types of intentional torts are: assault, battery, false imprisonment, invasion of privacy, disclosure of information, defamation of character, misrepresentation and fraud and infliction of mental distress. Common types of intentional torts include but are not limited to: b) Assault: This is the causing of an apprehension of an immediate harmful, offensive or unauthorized contact to a person and a willful attempt or threat to injure. The plaintiff must be conscious and aware of experiencing apprehension as defined by assault. c) Battery: Is the harmful, offensive or unauthorized touching of another person. A person may be a receiver of the battery and not be aware that the battery has occurred, as in the case of an unconscious client who undergoes surgery without consent, either implied or expressed Legally, any adult client who is alert and oriented has the right to refuse any aspect of his treatment. A client also has the right to choose which physician will perform a certain procedure. d) Defamation of Character: Defamation is an act of communication that causes someone to be shamed, ridiculed, held in contempt, lowered in the estimation of the community, or to lose employment status or earnings or otherwise suffer a damaged reputation. Such defamation is couched in 'defamatory language'. Libel and slander are subcategories of defamation. Defamation is primarily covered under state law, but is subject to First Amendment guarantees of free speech. e) Misrepresentation and Fraud: Misrepresentation and fraud can occur when a health professional misleads a client to prevent the  discovery of a mistake in treatment. The plaintiff must prove not only that there was a wrongful misstatement, but also that it was relied on in making a decision. B) Negligent Torts: Although the terms negligence and malpractice are often used interchangeably, some differences are noted. Negligent tort means a tort committed by failure to act as a reasonable person to someone to whom s/he owes a duty, as required by law under the circumstances. Further, negligent torts are not deliberate, and there must be an injury resulting from the breach of the duty. Examples of negligent torts are car accidents, slip and fall accidents, and most medical malpractice cases. There are two degrees of negligence: ordinary and gross. Ordinary negligence is the failure to do (or not do) what a reasonable and prudent person would do (or not do) under the same circumstances in the situation in question. Gross negligence is more severe and includes the intentional omission of proper care or the commission of an act constituting the improper delivery of care. Malpractice: a) is very similar to negligence, but it is more specific. Medical malpractice is the failure of a medical professional to follow the accepted standards of practice of his or her profession, resulting in harm to the patient. Usually, proof of failure to comply with accepted standards of medical practice requires the testimony of someone with expertise in the area of medical practice. Some states have special evidentiary rules applicable to malpractice claims.  Types of law: a) Administrative law is an area of law that you will need to rely on if you wish to challenge a decision or action of a government official, department or authority. Administrative law may also apply when the person whose decision you wish to challenge is not a government officer but is exercising "public power" (e.g. a power granted to a person by a statute). Decisions or actions governed by administrative law are called (in this chapter) "administrative decisions b) Constitutional law is the body of law which defines the relationship of different entities within a state, namely, the executive, the legislature and the judiciary. c) Consumer law covers national laws guaranteeing consumer rights when buying goods and services. d) Contract law is primarily regulated by the 'common law', but increasingly statutes are supplementing the common law of contract - particularly in relation to consumer protection. e) Criminal law of Australia is generally administered by individual jurisdictions in the Commonwealth of Australia. These jurisdictions include the six states, the Commonwealth, and the self-governing territories. It is in large part a matter for the states, with only a small subset of criminal activities reserved for Commonwealth government to prosecute. f) Family Law is the branch of law that deals with matters relating to the family, such as divorce and child custody. g) Tort law "A civil right of action arising independently of contract, restitution, crime or equity. Torts serve to protect a person‘s interest in his or her bodily security, tangible property, financial resources, or reputation. Unlawful interference with one of these interests is redressable by an action for damages and potential interference may be prevented by injunction. The law of torts aims to restore the injured person to the position he or she was in before the tort was committed."  Legal Issues Affecting Staff and Clients 1. Licensure All registered and licensed practical, or vocational, nurses must be currently licensed to practice nursing in their state of practice. Licensure protects the consuming public and insures that the nurse has completed a state approved nursing school 2. The Safeguarding of Clients' Personal Possessions and Valuables Nurses are responsible for the safeguarding and respecting the clients' personal possessions and valuables; they must also NOT, under any circumstances, borrow or steal their personal possessions and valuables. 3. Malpractice Malpractice is an act of omission or commission that does not meet established standards of care and causes some injury. Nurses, therefore, must provide all aspects of nursing care according to established standards of care 4. Mandatory Reporting Nurses are legally mandated to report abuse, neglect, gunshot wounds, dog bites, some communicable diseases and any unsafe and/or illegal practices done by another health care provider. 5. Documentation All documentation and all forms of documentation are considered legal documents. 6. The Acceptance of an Assignment Nurse are legally accountable to accept only those assignments that are appropriate in terms of their nurse practice act  legal risks in nursing: 1. Failure to operate according to standard procedures, 2. Insufficient nursing sensitivity and negligent care, 3. Failure to communicate and deal with issues promptly and appropriately, 4. Beyond the scope of nursing practice, 5. Falsification or alteration of nursing records. 6. Patient falls 7. Patient burns 8. forced medication administration 9. suicide assessments 10. substance withdrawal 11. evaluation for use of force and body cavity searches Out line: 1. Introduction 2. Some of the major ethical issues faced by Information Technology (IT) 3. Most Important Ethical Issues in Technology 4. Ethical Principles in Technology 5. Ways to manage ethical issues in technology   Introduction: Information Technology specifies to the components that are used to store, fetch and manipulate the information at the minimum level with the server having an operating system. Information Technology have a wide area of applications in education, business, health, industries, banking sector and scientific r..esearch at a large level. With the leading advancement in information technology, it is necessary to have the knowledge of security issues, privacy issues and main negative impacts of IT. To deal with these issues in IT society it is important to find out the ethical issues  Some of the major ethical issues faced by T echnology 1. Personal Privacy 2. Access Right 3. Harmful Actions 4. Patents 5. Copyright 6. Trade Secrets 7. Liability 8. Piracy 1. Personal Privacy: It is an important aspect of ethical issues in information technology. IT facilitates the users having their own hardware, operating system and software tools to access the servers that are connected to each other and to the users by a network. Due to the distribution of the network on a large scale, data or information transfer in a big amount  takes place, which leads to the hidden chances of disclosing information and violating the privacy of any individuals or a group. It is a major challenge for IT society and organizations to maintain the privacy and integrity of data. Accidental disclosure to inappropriate individuals and provisions to protect the accuracy of data also comes in the privacy issue. 2. Access Right: The second aspect of ethical issues in information technology is access right. Access right becomes a high priority issue for the IT and cyberspace with the great advancement in technology. E-commerce and Electronic payment systems evolution on the internet heightened this issue for various corporate organizations and government agencies. 3. Harmful Actions: Harmful actions in the computer ethics refers to the damage or negative consequences to the IT such as loss of important information, loss of property, loss of ownership, destruction of property and undesirable substantial impacts. This principle of ethical conduct restricts any outsiders from the use of information technology in manner, which leads to any loss to any of the users, employees, employers and the public. To recover from the harmful actions extra time and efforts are required to remove the viruses from the computer systems. 4. Patents: It is more difficult to deal with these types of ethical issues. A patent can preserve the unique and secret aspect of an idea. Obtaining a patent is very difficult as compared with obtaining a copyright. A  thorough disclosure is required with the software. The patent holder has to reveal the full details of a program to a proficient programmer for building a program. 5. Copyright: The information security specialists are to be familiar with necessary concept of the copyright law. Copyright law works as a very powerful legal tool in protecting computer software, both before a security breach and surely after a security breach. This type of breach could be the mishandling and misuse of data, computer programs, documentation and similar material. In many countries, copyright legislation is amended or revised to provide explicit laws to protect computer programs. 6. Trade Secrets: Trade secrets is also a significant ethical issue in information technology. A trade secret secures something of value and usefulness. This law protects the private aspects of ideas which is known only to the discover or his confidants. Once disclosed, trade secret is lost as such and is only protected by the law for trade secrets. The application of trade secret law is very broad in the computer range, where even a slight head start in the advancement of software or hardware can provide a significant competitive influence. 7. Liability: One should be aware of the liability issue in making ethical decisions. Software developer makes promises and assertions to the user about the nature and quality of the product that can be restricted as an express warranty. Programmers or retailers possess the legitimate to determine the express warranties. Thus they have to be practical when  they define any claims and predictions about the capacities, quality and nature of their software or hardware. Every word they say about their product may be as legally valid as stated in written. All agreements should be in writing to protect against liability. 8. Piracy: Piracy is an activity in which the creation of illegal copy of the software is made. It is entirely up to the owner of the software as to whether or not users can make backup copies of their software. As laws made for copyright protection are evolving, also legislation that would stop unauthorized duplication of software is in consideration.  Most Important Ethical Issues in Technology  The most prominent of them are scientific researchers. The goals of wide-ranging research with knowledge are to identify the truth and responsibility, and committing any mistake from time to time may lead to searching for its value, credibility, and suitability for publication and generalization in the scientific community, and may lead the researcher to human accountability to humanity, especially in the case of forgery. And plagiarism  Collaboration is an essential element in scientific research and benefits the researcher a lot. Following the ethics of scientific research enhances the important and necessary values of cooperative work between the researcher and some individuals and institutions.  Following scientific research ethics makes the researcher morally accountable to the public, ensuring scientific integrity and providing fair, transparent research and highly credible information.   When researchers follow the ethics of scientific research while writing their research and studies, they will contribute to increasing and strengthening public support. When the researcher gains public trust in his honest and highly credible research, he will ensure obtaining more support and funding to carry out other projects and research, which supports the scientific community in general and enhances knowledge. in it.  Ethical principles in Technology 1. Respect for Employees and Customers Businesses that engage in ethical technology have a firm moral sense of employee rights and customer protections. Data is valuable, but the employees and customers who power your business are undoubtedly your greatest asset. Take care to always observe responsible protections for employees and customers to practice ethical technology. 2. Moral Use of Data and Resources Data is undoubtedly something of value for businesses. It allows companies to target their marketing strategies and refine product offerings,. Data protection measures and compliance procedures can help ensure that data isn‘t leaked or used inappropriately. 3. Responsible Adoption of Disruptive Tech Digital growth is a business reality. Disruptive tech often isn‘t just a way to outpace the competition—it‘s the only way to break even. But embracing new technologies doesn‘t have to coincide with an ethical challenge. Do your due diligence to ensure that the technology you  adopt has protections in place and you‘ll be well on your way to practicing ethical tech. 4. Create a Culture of Responsibility Ultimately, we need to create a culture of responsibility within technology. If the information technology workforce and industry giants believe they are responsible for the safe and ethical usage of technology, then we will see more governance and fair use of data.  Ways to manage ethical issues in technology (a) Identify ethical issues Companies can carry out ethical assessments and identify potential ethical risks while implementing any new technology. This way they can mitigate risks and address ethical concerns proactively. (b) Develop ethical guidelines Organizations that develop and use technology can establish certain guidelines to maintain the ethical standards while using that technology. Main areas that need to be covered while creating these guidelines are data security, privacy, and transparency. (c) Work on creating an ethical culture Companies can work towards creating an ethical culture by focusing on values that encourage ethical use of technology. They should work on educating and training employees on promoting transparency.Apart from these basic steps, encouraging discussions involving employees, developers, and users can help promote ethical decision-making. Additionally, it is important to regularly review and evaluate technology, conduct audits, take feedback from users, thereby helping organizations keep track of usage of technology. Therefore, ethical issues in technology can be successfully managed to an extent via a multifaceted approach. Outlines: 1. Introduction. 2. Definitions. 3. Ethical Theories: a. Definition. b. Major Ethical Theories and Theorists. 4. Specific Ethical Issues Related To the Profession of Nursing: a. Commitment to the Patient. b. Commitment to Your Employer. c. Commitment to Your Colleagues. d. Commitment to Personal Excellence. e. Commitment to the Nursing Profession   Introduction: ethical theories that provide perspective on how to approach finding the better answer in a case. Each theory has a different notion of on what a person should base the decision. Some theories say follow the up, others say choose what makes the best outcome  Definition: An ethical theory is a moral principle or a set of ethical concepts and moral principles that can be used to assess what is morally right or morally wrong in a given situation. Over the years, many people have called on the theories of philosophers to guide in decision making.  Types of theories of ethics:- THEORY WHAT IS GOOD Ethics of care Caring and nurturing Deontology Following the moral law, rules, and principles Utilitarianism Best outcome; greatest good for the greatest number Principlism Autonomy, beneficence, nonmaleficence, and justice 1. Deontology  This theory is ―duty-based ethics‖ since it is a belief that one has an obligation to act according to the rules. If you know the rule, then you should act to follow it. . In this theory what is right is always right and what is wrong is always wrong. For example, suicide is always wrong and lying is always wrong.  This theory believed in the idea of autonomy that an individual who has the ability to make his or her own decisions should be permitted to do so. Autonomy means self-governance or a person gets to decide what happens to himself or herself. 2. Utilitarianism  Utility is an action that increases happiness and decreases pain. In order to determine if an action will indeed serve this purpose, one must look at the potential outcome.  Utilitarianism requires one to look at the likely outcomes of an action and choose the one that is most likely to increase pleasure and decrease pain.  In modern ethics, utilitarianism is often used to mean the best choice is the one that leads to the best outcome for both groups, and, in a clinical setting, for individuals. 3. Principlism  In this volume, they presented four principles to serve as guidelines for moral deliberation: autonomy, nonmaleficence, beneficence, and justice.  Autonomy means that a choice must be intentionally made by a person who has an understanding of the risks, benefits, and alternatives.  Nonmaleficence is the idea that through one‘s actions, one should do no harm or at the very least, not make things worse.  Beneficence is an obligation to promote the welfare of another.  Justice also states that treat people fairly. People not communicated according to sex, ethnicity, religion, or age. 4. Naturalism  Moral judgment that regards Ethics as dependent on human Nature and psychology.  Value differences among cultures.  Maintain pleasure and avoid pain to be happy. 5. Sympathy  A motivating factor, is the sharing,  Tendency to warm towards others. 6. Rationalism :  Feelings and perceptions seems Similar Are not actually or may not be same.  Absolute truths that are not dependent on human nature.  Ethical value have an Independent origin, 7. Social Justice Theory  Members of society should be given goods to according to their needs. But this redistribution would require a governing power to decide who gets what and when. 8. Core Values Analysis  There are ethical and nonethical qualities among people.  People admire in others or in themselves, they may say wealth, power, fitness, sense of humor, good looks, intelligence, musical ability, or some other quality.  They may also value honesty, caring, fairness, courage, perseverance, diligence, trustworthiness, or integrity. 9. Ethics of Care  Also known as feminist ethics, ethics of care is primarily concerned with caring for others. This has evolved from the need to care for those who cannot care for themselves, such as infants.  It is a system that assists us in our relations with other people and thereby strengthens how we positively interact with people. 10. Egoism  Unlike other theories that prescribe how we ought to behave.  Egoism is a descriptive principle that does not tell us necessarily how we ought to behave, but rather why we behave the way we do.  According to the tenets of egoism, the core reason that someone does any action is self-serving by bringing happiness or some other benefit to him- or herself. 11. Religion or Divine Command Theory  Religion is often considered the most widely used system to make ethical decisions and to conduct moral reasoning  Throughout the world, people rely on a variety of religions to help them determine the most ethical action to take.  While divine command theory is widely used throughout the world, there are differences: the application of the theory may differ from religion to religion, and it may differ within each religion. 12. Moral Relativism  Moral relativism refers to the differences in morality from culture to culture.  A moral relativist‘s perspective would state that what is moral in one culture may not be moral in another culture, depending upon the culture.  This is important for police officers to understand in a pluralistic society in which many cultures and religions make up the community where the police officer works.  Specific Ethical Issues Related To the Profession of Nursing: We feel strongly about the individual nurse responsibility for nursing practice and place high value on personal integrity in professional relationships. Commitment to the Patient: 1. Nursing has a strong history of being committed to the well-being of patients who need care. 2. Nursing is focused on providing patients and their families with support for growth toward maximum health and wellbeing. 3. Patients can never become the objects of nursing care, but must be approached as unique individuals who deserve concern, respect, and culturally competent care.  Commitment to Your Employer: Once you have accepted a position in a health care organization, you also‘ have accepted the responsibilities that the position encompasses. Some of these responsibilities may be spelled out in the contract, if a formal contract exists between the employer and the employee. Others are more or less taken for granted. It is these latter responsibilities than can present problems. 1. Responsible Work Ethic: A. First, it is understood that you will arrive at work on time. When you arrive late, you obligate others to remain overtime to ensure continuous patient care. If you find yourself in an emergency situation that is going to cause you to be delayed, it