Values & Ethics PDF

LECTURE OF VALUES & ETHICS Common Modes of Value Transmission: - Modeling: observation - Moralizing: instilled value system - Laissez-faire: child develops on their own, little or no guidance → possible confusion - Rewarding & Punishing: (just what it is) - Responsible choice: encoura...

LECTURE OF VALUES & ETHICS Common Modes of Value Transmission: - Modeling: observation - Moralizing: instilled value system - Laissez-faire: child develops on their own, little or no guidance → possible confusion - Rewarding & Punishing: (just what it is) - Responsible choice: encourages child to explore Process of Developing Values: - Choosing: Choosing freely from alternatives after careful consideration of the consequences of each alternatives - Prizing (treasuring): Involves pride happiness, and public affirmation - Acting: Combining choice into one’s behavior with consistency and regularity on the value Ethics & Morals: - Ethics: study of rights & wrong principles, virtue, good vs evil as they relate to conduct and human flourishing (what’s right and what's wrong) - Bioethics (Medicine/science): Ask questions such as what kind of person should I be; what are my duties and obligations to other people; what do I owe the common good or the public? - Nursing Ethics (subset of bioethics): formal study of ethical issues that arise in the practice of nursing - Morals: personal/ communal standards of right & wrong 2 principles of Bioethics: - Utilitarian: (Personalized; evaluating what's going to happen to this patient) - Rightness or wrongness of an action depends on the consequences of the action - → Action promotes greater good - Deontologic: (Across the board we can’t do that) - An action is right or wrong independent of its consequences Beauchamp & Childress Principle Based Approach to Bioethics - Autonomy: respect rights of patients to make health care decisions, provide education - Nonmaleficence: Avoid causing/prevent harm; Intervention will NOT cause more harm than good - Beneficence: Benefit the patient, harms vs risk, prior research studies, “Do good” (requires a nurse to act in ways that promote patients well-being) EX: emotional support, ensuring medical needs are met: comforting dying pt; assisting with tasks they cannot perform independently. Beneficial course of action might involve some risk of harm such as pain & scarring from a surgical wound to remove a ruptured appendix. However, the overall expected outcomes should still be positive & outweigh any risks - Justice: Give each their due and act fairly - Nurses add FIDELITY (Keep promises, non abandonment, upholding RN standards), VERACITY (tell the truth), ACCOUNTABILITY, PRIVACY (HIPPA law- maintain patient privacy), CONFIDENTIALITY Non-Maleficence Principles: (Avoid causing harm or minimize harm → Avoiding ACTUAL injury) EX: Holding a medication due to adverse effects,/Ensuring a safe work environment,/ Selecting interventions that cause the LEAST amount of harm to a pt,/ Reporting suicidal or homicidal ideations). 1. An intervention should not be inherently negative 2. The action must be meant to have a beneficial impact 3. A positive result cannot be a consequence of an adverse effect 4. If an action has negative consequences, the potential benefits must outweigh the negative repercussions (Beneficence entails taking actions to help others, whereas non-maleficence entails avoiding behaviors that injure others.) Characteristics of the care-based approach to bioethics: - Centrality of the caring relationship - Promotion of dignity and respect as people - Attention to the particulars of individual patients - Cultivation of responsiveness to others - Redefinition of fundamental moral skills to include virtues Ethical Conduct: Practice based on professional standards of ethical conduct + professional values Nurse should: - Cultivate the virtues of nursing - Understand ethical theories that dictate and justify professional conduct - Be familiar with codes of ethics for nurses and standards for professional nursing conduct - Moral agency: the capacity to be ethical and do the ethically right thing for the right reasons. Professional Values Fox stated “a lot of times you will be given a patient scenario and you have to identify which professional value it is or you have to identify which response will reflect eligibly” MIGHT BE ON EXAM IN THIS FORMAT - Altruism: concern for the welfare and well-being being of others - Autonomy: right to self-determination (in order to make an informed decision you have to be able to educate the pt & educate them on alternative treatments in addition to what the possible outcome) - Human Dignity: Respect for inherent worth and uniqueness of individuals and populations (we understand that certain populations would not like a blood transfusion because it is not their standard of care that they would like to proceed with → as the nurse, you need to educate the pt what could happen by providing that care for them but also provide alternative options.) - Integrity: Acting according to the code of ethics and standards of practice (standards are set by “ANA” American Nursing Association) - Social Justice: upholding moral, legal, and humanistic rights (legal issues, advocating for human rights) Nurse Virtues (what is needed to perform competently and not harm the pt): - Competence: (need to know your individual skills and why are you performing the individual skills) - Compassionate Caring: (Never make the situation about yourself but about the pt) - Subordination of Self-Interest to Patient Interest: (Address the the patient what you are doing and why, make it about them regardless of the circumstances) - Self-Effacement: (you need to be humble & modest, always put the patient first PT centered care) - Trustworthiness: (never lie to the pt and need to have honesty)  - Conscientiousness: (being aware of how you present yourself to a pt & how you communicate with the pt) - Intelligence: (need to know why you are doing the treatment, what other alternatives there are and possible side effects so that you can assess if the benefit of the treatment will outweigh the rest) - Practical Wisdom: (why are you doing things? Need to be confidently spike an IV bag, know what type of fluid you’re supposed to give, know what that fluid can do for you patient) - Humility: (you can’t take things personal in healthcare, you have to be empathetic and put yourself in your pt’s shoes to better understand what their needs are) - Courage: (you will encounter experiences that you neve thought you would, you have to be able to advocate for you pt even if it would benefit you) - Integrity: (You need to be sure you are doing things & in the field for the right reason) *Everything in Red came out of Fox’s mouth* Moral Distress and Resiliency - Moral Dilemma: (both things are correct but which one do I choose?) - Moral Distress: you know the right thing to do, but either personal or institutional factors make it difficult to follow the correct course of action - Moral Resilience: the developed capacity to respond well and morally distressing experiences and to emerge strong Ways to Build Resilience - Cultivating good relationships - Accepting that changes is a part of living - Refusing to view crises as insurmountable - Nurturing a positive view of self and taking care of self - Keeping things in perspective Ethically Relevant Considerations: - Balance between benefits and harms in the care of patients - Disclosure, informed consent (educating consent to pt) and shared decision making - Norms of family life (if pt consents to it, allow other family member to make decisions for pt and be present) → be considerate of their family dynamics - Relationship between clinicians and patients (need to build relationship so that trust is built) - Professional integrity of clinicians  - Cost effectiveness and allocation - Issues of cultural and/or religious variations - Considerations of power (who is delegating treatments to prevent ethical dilemma) Examples of Ethical Problems #1 - Paternalism: Clinicians decide what's to be done to benefit pt → inform pt, patient’s role is to comply (provider decides what type of tx is being done for the pt and bypassing autonomy) - Deception: (lying to a pt is a no, you must tell the the truth but still make them feel comfortable) EX: when you are in clinical and are about to give pt a shot & they ask you if this is your first time giving a shot, you must be honest and reply “yes it is my first time but in order for us to be in clinical we must practice in a lab multiple times to be proficient” - Privacy & Social Media: (never post about a patient and close curtain) - Confidentiality: (think about HIPPA, never share passwords nor print out things and taking home pt’s stuff) - Allocation of Scarce Nursing Resources: (knowing why you are using resources, what resources are available and prioritizing pt use) - Valid Consent or Refusal: (pt has to be educated before signing consent, what they are getting and why, and alternative tx. - Conflicts Concerning New Technologies: (know when it is appropriate to use technology and when it is not.) Functions of Ethics Committees - Education - Policy Making - Case Review - Consultation - Occasionally Research *When making ethical decisions you must use ADPIE guidelines*