Ethical and Legal Issues in Critical Care Nursing PDF

NCM 116 ETHICAL & LEGAL ISSUES IN CRITICAL CARE NURSING GINA S. CUENCA. RN, MN MARK ANTHONY G. ALCANTARA, RN, MAN CHIRADEE MAY R. PERALTA-MARQUEZ, RN, MAN LEARNING OBJECTIVES Identify and learn on the different ethical and legal issues in the practice of Critical Care Nursing....

NCM 116 ETHICAL & LEGAL ISSUES IN CRITICAL CARE NURSING GINA S. CUENCA. RN, MN MARK ANTHONY G. ALCANTARA, RN, MAN CHIRADEE MAY R. PERALTA-MARQUEZ, RN, MAN LEARNING OBJECTIVES Identify and learn on the different ethical and legal issues in the practice of Critical Care Nursing. ETHICAL AND LEGAL ISSUES: Critical care nurses are often confronted with ethical and legal dilemmas related to: informed consent withholding or withdrawing life-sustaining treatment organ and tissue transplantation confidentiality increasingly, justice in the distribution of healthcare resources MORALS AND ETHICS MORALS Are the “shoulds,” “should nots,” “oughts,” and “ought nots” of actions and behaviors. They are related closely to cultural and religious values and beliefs that govern our social interactions. Example: honesty, respect, compassion, responsibility, fairness, generosity, etc. MORALS AND ETHICS ETHICS Are concerned with the basis of the action rather than whether the action is right or wrong, good or bad. It refers to what rules are required to prevent harm to persons and to the collective beliefs and values of a community or profession. Example: confidentiality, integrity, accountability, etc. MORAL DISTRESS OF NURSES: Emergency situations. Tension from conflict with others. Complex clinical cases. New technologies. Increasing regulatory requirements. Acquisition of new skills/knowledge. Staffing issues. Financial constraints. Workplace violence. ETHICAL PRINCIPLES AUTONOMY BENEFICENCE NON-MALEFICENCE VERACITY FIDELITY CONFIDENTIALITY PRIVACY JUSTICE AUTONOMY Respect for the individual and the ability of individuals to make decisions with regard to their own health and future (the basis for the practice of informed consent), without coercion or interference from others. Example: Independent of doctors or other healthcare workers Own decision-making in health scenarios BENEFICENCE Doing good and preventing harm to patients is the sine qua non (without which, not) for the nursing profession. Example: providing comfort to a dying patient or assisting with tasks a patient cannot perform independently NON-MALEFICENCE Actions intended not to harm or bring harm to others. Example: holding a medication due to adverse reactions taking steps to ensure a safe work environment VERACITY The obligation to tell the truth is an important ethical principle that underlies the nurse-patient relationship. Example: if a patient was starting chemotherapy and asked about the side effects, a nurse practicing veracity would be honest about the side effects they could expect with chemotherapy CONFIDENTIALITY Respect for an individual’s autonomy and the right of individuals to control the information relating to their own health. Example: confidentiality will be respected, and information will only be shared with the consent of the patient PRIVACY Patient privacy encompasses a number of aspects, including personal space (physical privacy), personal data (informational privacy), personal choices including cultural and religious affiliations (decisional privacy), and personal relationships with family members and other intimates (associational privacy). (AMA Code of Ethics) Example: Not discussing confidential information in public areas, such as the cafeteria, hallways or other patient rooms, or in online forums, such as social media networks and websites. JUSTICE Being fair or just to the wider community in terms of the consequences of an action. In health care, justice is described as the fair allocation or distribution of healthcare resources. Example: impartiality when assigning clinical or prioritizing patient care the nurse, must focus on the patient's chief complaints and not their race, religion, age, socioeconomic status, sexual orientation, whether they have insurance, etc. THE NURSING CODE OF ETHICS American Nurses Association CODE OF ETHICS American Nurses Association The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community. CODE OF ETHICS American Nurses Association The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. CODE OF ETHICS American Nurses Association The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. The nurse participates in establishing, maintaining, and improving health care environments 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. CODE OF ETHICS American Nurses Association The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. CODE OF ETHICS American Nurses Association The profession of nursing, as represented by associations and other members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. THE ETHICAL DILLEMA WHAT IS AN ETHICAL DILLEMA? An ethical dilemma exists if there are two (or more) morally correct actions that cannot be followed. The result is that both something right and something wrong occur. In these situations, there are both ethical conflict and ethical conduct issues. Example: foregoing treatment and allocating the scarce resource of critical care EARLY INDICATORS FOR ETHICAL DILLEMA Signs of conflict among healthcare team members, family members, and healthcare team and family Signs of patient suffering Signs of nurse distress Signs of ethics violation Signs of unrealistic expectations Signs of poor communication STEPS IN ETHICAL DECISION MAKING Identify the health problem. Define the ethical issue. Gather additional information. Delineate the decision maker. Examine ethical and moral principles. Explore alternative options. Implement decisions. Evaluate and modify actions. INFORMED CONSENT INFORMED CONSENT 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. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention. Consent problems arise because patients are experiencing acute, life-threatening illnesses that interfere with their ability to make decisions about treatment or participation in a clinical research study. ELEMENTS OF INFORMED CONSENT Three primary elements must be present for a person’s consent or decline of medical treatment or research participation to be considered valid: competence voluntariness disclosure of information COMPETENCE refers to a person’s ability to understand information regarding a proposed medical or nursing treatment. The ability of patients to understand relevant information is an essential prerequisite to their participation in the decision-making process and should be carefully evaluated as part of the informed consent process. Patients providing informed consent should be free from severe pain and depression. VOLUNTARINESS Consent must be given voluntarily, without coercion or fraud, for the consent to be legally binding. This includes freedom from pressure from family members, healthcare providers, and payers. DISCLOSURE OF INFORMATION The function of disclosure is to provide information so that the person giving consent can make a decision about whether to consent. If he/she does not adequately understand that information, then it does not help her make a decision, and disclosure has not fulfilled its function. Persons who consent should base their decision on sufficient knowledge. WHAT DOES THE PATIENT NEEDS TO KNOW: Basic information considered necessary for decision making includes the following: A diagnosis of the patient’s specific health problem and condition The nature, duration, and purpose of the proposed treatment or procedures The probable outcome of any medical or nursing intervention WHAT DOES THE PATIENT NEEDS TO KNOW: The benefits of medical or nursing interventions The potential risks that are generally considered common or hazardous Alternative treatments and their feasibility Short-term and long-term prognoses if the proposed treatment or treatments are not provided ELEMENTS OF GOOD ETHICAL PRACTICE IN MEDICAL DECISIONS IN THE ICU Careful assessment of the patient’s condition. Evaluation of the risks and benefits of therapeutic options. Clear communication with the patient or proxy to inform about options and identify plan of care. Identification and respect for a competent patient’s or proxy’s preferences. Plan of care based on clinical assessment and mutually identified goals. ELEMENTS OF GOOD ETHICAL PRACTICE IN MEDICAL DECISIONS IN THE ICU Toleration of uncertainty when making decisions. Toleration of disagreement between parties. Ongoing dialogue to resolve difficult situations. CRITICAL CARE NURSING PRACTICE CRITICAL CARE NURSING PRACTICE Critical care nursing is the specialty within nursing that deals specifically with human responses to life- threatening problems. (www.ccnapi.org-critical-care-nursing-practice) CCNs needs to understand better judgment between thought and action and the categories of practice that illustrate clinical judgment and the clinical knowledge development of critical care nurses. THOUGHT AND ACTION Clinical grasp and clinical inquiry: problem identification and clinical problem solving. Clinical forethought: anticipating and preventing potential problems. 9 CATEGORIES OF PRACTICE Diagnosing and managing life-sustaining physiologic functions in unstable patients. Managing a crisis by using skilled know-how. Providing comfort measures for the critically ill. Caring for patients’ families. Preventing hazards in a technologic environment. Facing death: end-of-life care and decision making. 9 CATEGORIES OF PRACTICE Communicating and negotiating multiple perspectives. Monitoring quality and managing breakdown. Exhibiting the skilled know-how of clinical leadership and the coaching and mentoring of others. COMMUNICATIONS WITH PATIENTS COMMUNICATION IN THE ICU Communication is an important component of respect for patients; it is an indispensable ingredient for learning about patients’ needs, values, and preferences. Effective communication provides the basis for a good working relationship be- tween doctor and patient which will facilitate on-going patient care. FACTORS AFFECTING COMMUNICATION IN THE ICU insufficient time for staff members and patients to get to know one another and develop a trusting relationship discomfort or fear of talking about illness and death, focus on the patient’s physiologic function lack of a conducive setting for communication HOW DO YOU COMMUNICATE WITH PATIENTS IN THE ICU? gestures sign language writing incomprehensible words touch ACTIVITY: Answer the following questions. Explain and elaborate. Minimum of 250 words, maximum of 500 words. A. Why do Nurses need to understand Ethics? B. What is the process a Nurse should use to resolve a Moral Dilemma? (Cite a personal experience) C. When do you think Euthanasia is valid? How do you see its acceptance in our country? What ethical principles should or should not be practiced? THANK YOU!