Ethical Principles in Nursing PDF

ETHICAL PRINCIPLES IN NURSING Prepared by: Luigi M. Laurpn-Marco, RN, MSN  Class Brainstorm ETHICO-MORAL RESPONSIBILITY ETHICS moral philosophy. a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. Ethics is a system...

ETHICAL PRINCIPLES IN NURSING Prepared by: Luigi M. Laurpn-Marco, RN, MSN  Class Brainstorm ETHICO-MORAL RESPONSIBILITY ETHICS moral philosophy. a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. Ethics is a system of moral principles, they affect how people make decisions and lead their everyday lives. The term is derived from the Greek word “ethos”, which can mean custom, habit, character, or disposition ETHICS Ethics covers the following dilemmas: How to live a good life our rights and responsibilities the language of right and wrong moral decision on what is good and bad HUMAN RIGHTS these are standards that allow all people to live with dignity, freedom, equality, justice and peace. Every person has these rights simply because they are human beings. They are guaranteed to everyone without distinction of any kind, such as race, color, sex, language, religion, political or another opinion, national or social origin, property, birth, or another status. Human rights are essential to the full development of individuals and communities VALUES denote the degree of importance of some thing or action, with the aim of determining what actions are best to do or what way is best to live. MORAL relate to the standards of good or bad behavior, fairness, honesty, etc. that each person believes in rather than to the laws. CONDUCT is the manner in which a person behaves, especially on a particular occasion or in a particular context.. ADVOCACY is the act of speaking on behalf of or in support of another person’s rights and welfare.  PATIENT’S RIGHTS Right to Appropriate Right to Informed Right to Privacy and Medical Care and Consent Confidentiality Humane Treatment every person has a right The patient has the right to health and medical care to clear, truthful and corresponding to his state substantial explanation, of health, without any in a manner and language The privacy of the discrimination and within understandable to the patients must be the limits of it’s resources, patient, of all proposed assured at all stages manpower and procedures, whether of his/her treatment competence available for diagnostic, preventive, health and medical care at curative, rehabilitative or the relevant time therapeutic  PATIENT’S RIGHTS Right to Choose Right to Information Health Care Provider Right to Self- and Facility Determination The patient is free to choose the health care In the course of the provider to serve him/her The patient has the treatment, the patient as well as the facility, right to avail him or and the SO has a right to except when he/she is herself of any be informed of the result under the care of a recommended of the evaluation of the service facility or when diagnostic and nature and extent of the public health and safety treatment disease. so demands or when the patient expressly waives procedures. this right in writing  PATIENT’S RIGHTS Right to religious Right to Medical belief Records Right to Leave The patient has the right to refuse medical The patient has the treatment or procedures The patient is entitled to a right to leave the which may be contrary to summary of his/her hospital or any other his/her religious beliefs, medical history and health care institution subject to limitations condition regardless of his/her described in the preceding physical condition section  PATIENT’S RIGHTS Right to Refuse Right to participation in Correspondence and Right to Express Medical Research to receive Visitors Grievances The patient has the right The patient has the right The patient has the right to be advised if the health to communicate with to express complaints and care provider plans to relatives and other grievances about the care involve him/her in medical persons and to receive and services received research, including but not visitors subject to without fear of limited to human reasonable limits discrimination or reprisal experimentation which prescribed by the rules and to know about the may be performed only and regulations of the disposition of such with written consent health care institution. complaints PATIENT’S RIGHTS Right to be informed of his/her rights and obligations as a patient Every person has the right to be informed of his/her rights and obligations as a patient  NURSES CODE OF ETHICS The Code of Ethics for Nurses in the Philippines was devised as a guide for carrying out nursing responsibilities which would tackle difficult issues and decisions that a profession might be facing, and give clear instruction of what action would be considered ethical or right in the given circumstance.  NURSES CODE OF ETHICS The Code of Ethics for Registered Nurses in the Philippines is promulgated by the Board of Nursing (BON) and was consulted with accredited professional organizations like the Philippine Nurses Association. It also coincides with the ideals of the Republic Act No. 9173 or the "Philippine Nursing Act of 2002." Code of ethics for nurses assumes various versions depending on the organization. For instance, the “International Council for Nurses” have embraced a code of ethics since 1953. It was in 2006 that it was revised as people and the demands of nursing had changed. This serves as a guide for the right actions towards social values and needs. The Code has been the basis of worldwide practice for ethical practice in nursing.  NURSES CODE OF ETHICS The ICN Code of Ethics serves as the guiding light for professional nurses as they practice their skills whether in a hospital setting or community setting. This serves as a gauge of whether nurses have given ethical care, that encourage healing or prevents illness.  4 ELEMENTS OF ICN CODE OF ETHICS 1. Nurses and People – The primary responsibility of nurses to people is to provide nursing care. 2. Nurses and Practice – The nurse is personally accountable of the nursing practice and will hold the white uniform with dignity and pride 3. Nurses and the Profession – The nurse is responsible in improving the face of the profession in a form of research and practicing using evidenced-based nursing practice 4. Nurses and Co-workers - The nurse has a responsibility in encouraging a harmonious relationship among colleagues and members of the health care team NURSES AND PEOPLE 1. Values, customs, and spiritual beliefs held by individuals shall be represented. 2. Individual freedom to make rational and unconstrained decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence. Registered nurses must observe the following guidelines: Consider the individuality and totality of patients when they administer care; Respect the spiritual beliefs and practices of patients regarding diet and treatment; Uphold the rights of individuals; and Take into consideration the culture and values of patients in providing nursing care. However, in conflicts, their welfare and safety must take precedence. NURSES AND PRACTICE 1. Human life is inviolable. 2. Quality and excellence in the care of patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability NURSES AND PRACTICE Registered nurses must observe the following guidelines: Know the definition and scope of nursing practice which are in the provisions of R.A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act of 2002”, (the IRR); Be aware of their duties and responsibilities in the practice of their profession as defined in the "Philippine Nursing Act of 2002" and the IRR; Acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate nursing services through varied learning situations; NURSES AND PRACTICE If they are administrators, be responsible for providing favorable environment for the growth and development of Registered Nurses in their charge; Be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC); See to it that quality nursing care and practice meet the optimum standard of safe nursing practice; Ensure that patient's records shall be available only if they are to be issued to those who are professionally and directly involved in their care and when they are required by law; Ensure that modification of practice shall consider the principles of safe nursing practice; and If in the position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. NURSES AND PRACTICE 4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. Registered nurses must observe the following guidelines: Respect the “Patient’s Bill of Rights” in the delivery of Nursing Care; Provide the patients or their families with all pertinent information except those that may be deemed harmful to their well-being; and Uphold the patient’s rights when conflict arises regarding management if their care. NURSES AND CO-WORKERS The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient's best interest. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers. NURSES AND CO-WORKERS Registered nurses must observe the following guidelines: Maintain their professional role/identity while working with other members of the health team; Conform with the group activities as those of a health team should be based on acceptable, ethico-legal standards; Contribute to the professional growth and development of other members of the health team; Actively participate in a professional organization; Not act in any manner prejudicial to other professions; Honor and safeguard the reputation and dignity of the members of the nursing and other profession; refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and procedures; or not to do anything that will bring discredit to a colleague and to a member of another profession; and Respect the rights of their co-workers. REGISTERED NURSES, SOCIETY AND ENVIRONMENT The preservation of life, respect for human rights, and promotion of a healthy environment shall be a commitment of a Registered Nurse. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse. REGISTERED NURSES, SOCIETY AND ENVIRONMENT Registered nurses must observe the following guidelines: Be conscious of their obligations as citizens and, as such, be involved in community concerns; Be equipped with knowledge of health resources within the community, and take active roles in primary health care; Actively participate in programs, projects, and activities that respond to the problems of society; Leads their lives in conformity with the principles of right conduct and proper decorum; and Project an image that will uplift the nursing profession at all times. NURSES AND THE PROFESSION Maintenance of loyalty to the nursing profession and preservation of its integrity is ideal. Compliance with the by-laws of the accredited professional organization (PNA) and other professional organizations of which Registered Nurse is a member is a lofty duty. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations. Contribution to the improvement of the socio- economic conditions and general welfare of nurses through appropriate legislation is a practice and visionary mission. NURSES AND THE PROFESSION Registered nurses must observe the following guidelines: Be members of the accredited professional organization which is the PNA; Strictly adhere to the nursing standards; Participate actively in the growth and development of the nursing profession; Strive to secure equitable-economic and work conditions in nursing through appropriate legislation and other means; and Assert for the implementation of labor and work standards  ETHICAL PRINCIPLES IN NURSING Autonomy Deontology Fidelity Veracity Nonmaleficence Paternalism Distributive Beneficence Justice Double Effect Religions Utilitarianism Parents Confidentiality Books  AUTONOMY Means that patients are able to make independent decisions. This means that nurses should ensure that patients have all of the needed information required to make a decision about their medical care and are informed. Nurses do not influence patient's choices. Examples of nurses demonstrating this include obtaining informed consent from the patient for treatment, accepting the situation when the patient refuses medication, and maintaining confidentiality.  AUTONOMY Autonomy allows healthcare teams to respect and support patients' decision to accept or refuse life-sustaining treatments. As patient advocates, it is our duty to ensure that patients receive all of the necessary information, potential risks, benefits, and complications, to make well-informed decisions. The healthcare team can formulate care in compliance with the patients' wishes. Family members should refrain from making decisions for the patient or inflicting undue pressure to alter his or her decisions unless the patient is incapacitated or found to be legally incompetent. Many factors influence a patient's acceptance or refusal of medical treatment, such as culture, age, general health, social support system and previous exposure to individuals who receieved a similar treatment modality with negative clinical outcomes.  VERACITY Defined as being honest and telling the truth. It is the basis of the trusting relationship established between a patient and a health care provider. When nurses and doctors communicate with patients, being honest is an important way to foster trust and show respect for the patient. Patients place a great deal of trust in their nurses, and may feel that trust is misplaced if they discover or perceive a lack of honesty and can disconnect from his/her own health care provider.  VERACITY There are few studies about nurses and truth- telling because communicating about new medical diagnoses and their prognosis is traditionally a physician's responsibility. According to some authorities, the person delivering the bad news should be someone whom the patient trusts and can feel most comfortable with. Even though for many patients this person is their nurse, breaking bad news is not a common practice for nurses.  BENEFICENCE An ethical principle that addresses the idea that a nurse's actions should promote good. Doing good is thought of as doing what is best for the patient. Should not be confused with the closely related ethical principle of nonmaleficence, which states that one should not do harm to patients. Defined as kindness and charity, requires action on the part of the nurse to benefit others. An example of a nurse demonstrating this ethical principle is by holding a dying patient's hand.  BENEFICENCE In the practice of nursing, examples of beneficence may include the following: Resuscitating a drowning victim; Providing pain medication as soon as possible to an injured patient in the emergency room; Lifting a meal tray for a weak patient; Providing vaccinations; or Performing daily tasks for patients who are unable to carry them out alone. Beneficence is valuable because it encourages a superior standard of nursing performance. It also emphasizes compassionate care and advocates for continual striving toward excellence.  UTILITARIANISM An approach where decisions are chosen based on the greatest amount of benefit obtained for the greatest number of individuals. This subscribes to the principle that the "end justifies the means". This is also known as the consequentialist approach since the outcomes determine the morality of the intervention. This approach could lead to harm to some individuals while the net outcome is the maximum benefit. This approach is usually guided by the calculated benefits or harms for action or intervention based on evidence.  DEONTOLOGY Is ethics of duty where the morality of an action depends on the nature of action, hence harm is unacceptable, irrespective of its consequences. “Kahit anong mangyari, gawin niyo ang lahat!!” This concept was introduced by a philosopher, Immanuel Kant and widely referred to as Kantian's Deontology. The decisions of deontology may be appropriate for an individual but do not necessarily produce a good outcome for society.  DEONTOLOGY The decisions or the rightful actions that must be preferred by the nurse or the physician must be based on existing laws, rules, policies, and regulations as determinants for its validity. The nurse-patient relationship is, by nature, deontological since nursing practices inculcate this tradition, and when this deontological practice is breached, the context of malpractice and negligence arises. This tradition drives nurses to do good to patients, strengthening the nurse-patient bond.  NONMALEFICENCE Means that nurses must do no harm intentionally. Nurses must provide a standard of care which avoids risk or minimizes it, as it relates to medical competence. An example of nurses demonstrating this principle includes avoiding negligent care of a patient to avoid unnecessary harm.  DISTRIBUTIVE JUSTICE A key ethical principle that applies to the provision of social good including public health services. The principle of distributive justice requires that health services be accessible to individuals according to need and within the context of resource availability. Within the health care system, "justice" can be considered that persons with the same medical conditions should have the availability of the same treatment options. “Social justice” refers to the distribution of goods or services within a societal context. It focuses on the persons or groups that influence the distribution of services or merchandise. This includes health care treatment accessibility and availability.  CONFIDENTIALITY Refers to the privacy of information or patient's data. This principle legally limits access to medical records and information to only those who have a need to know. Those who have the need to know have this need because they need some data and information about the patient so that they can perform some indirect or direct patient care.  FIDELITY Fidelity in nursing means that nurses must be loyal and faithful to the promises they made as professionals to provide competent, quality care to their patients. In health care, fidelity is the most important of the ethical principles because it governs the other six. Nurses promise to provide competent care to patients and to do so in a way that is honest, responsible, and fair. Fidelity is considered by many nurses to be the most common source of ethical conflict. Health care professionals may find themselves caught between what they believe is right, what the patient wants, what other members of the health care team expect, and what is required by organizational policy and the law.  FIDELITY Fidelity requires that nurses treat all patients with respect. It's not always easy, especially if a patient is disagreeable, uncooperative, or rude. Nurses need to put aside any negative feelings they might have about such patients and adhere to the standard of care. Nurses should talk with their team members if they believe their feelings toward a patient could compromise care.  PATERNALISM Paternalism occurs when someone acts to make a decision for another or acts to prevent another from carrying out a decision on the premise that such an action is for that person's own good. In healthcare, paternalistic measures are often used when dealing with those who are mentally unstable, or are otherwise incapacitated from making fully rational choices for themselves.  DOUBLE EFFECT Double Effect the doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause harm as a side effect (or "double effect") of bringing about a good result even though it would not be permissible to cause such harm as means to bringing about the same good end.  DOUBLE EFFECT The double effect principle emphasizes the distinction between causing morally grave harm as a side effect of pursuing a good end and causing morally grave harm as a means of pursuing a good end. An example is when a pregnant woman due on labor, but is suffering from high-risk pregnancy, is made to choose between her life and the life of her baby.  Class Brainstorm LEGAL RESPONSIBILITIES  PHILIPPINE NURSING LAW Law is defined as the “sum total of rules and regulations by which society is governed rule of conduct pronounced by controlling authority ad which may be enforced the first essential to a pronounced law is that it must be declared in writing  PHILIPPINE NURSING LAW The first law that had to do with the practice of nursing was contained in Act No. 2493 of 1915, which regulated the practice of medicine in 1919, Act 2808 was passed. This was known as the First True Nursing Law. Congress enacted The Philippine Nursing Law , otherwise known as Republic Act 877, on June 19, 1953. provisions include the organization of the Board Examiners for nurses, provisions regarding nursing schools and college, examinations, registration of nurses including sundry provisions relative to the practice of nursing LEGAL ASPECTS AND THE NURSE  PROFESSIONAL NEGLIGENCE Negligence refers to the commission or omission of an act, pursuant to a duty, that are reasonably prudent person in the same or similar circumstances would or would not do. elements of professional negligence: existence of a duty on the part of the person charged to use due care under circumstances failure to meet the standard of due care the foreseeability of harm resulting from failure to meet standard the fact that the breech of standard resulted in an injury to the plaintiff  PROFESSIONAL NEGLIGENCE Examples of negligence failure to report observations to attending physician failure to exercise the degree of diligence which the circumstances of the particular case demands mistaken identity wrong medicine, wrong concentration, wrong route, wrong dose defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients errors due to family assistance administration of medicine without a doctor’s prescription  PROFESSIONAL NEGLIGENCE RES IPSA LOQUITUR Three conditions are required to establish a defendant’s negligence without proving specific conduct 1. That the injury was of such nature that ot would normally occur unless there was a negligent act on the part of someone 2. that the injury was caused by an agency within control of the defendant 3. That the plaintiff himself did not engage in any manner that would tend to bring about the injury‘ h  MALPRACTICE is the usual sense implies the idea of improper or unskillful care of patient by a nurse denotes stepping beyond one’s authority with serious consequences. h  INCOMPETENCE the lack of ability, legal qualifications or fitness to discharge the required duty h  IV THERAPY AND LEGAL IMPLICATIONS Nurses now participate in complex IV Therapy procedures that were once performed only by doctors. because of this change, nurses must remember that their legal right to give IVT injection is based in the Philippine Nursing Act of 1991, Section 28, which states that in the administration of intravenous injections, special training shall be required according to protocol established h  CONSENT TO MEDICAL AND SURGICAL PROCEDURES Consent is defines as a “free and rational act that presupposes knowledge of the thing which consent is being given by a person who is legally capable to give consent”. Nature of consent informed consent Proof of consent who must consent Consent of minors consent of mentally Ill Emergency situation Refusal to consent consent for sterilization h  CRIMES, MISDEMEANOR, AND FELONIES Moral Turpitude - is an act of baseness, vileness or depravity in social or private duties Murder - unlawful killing of a huma being with intent to kill Homicide - killing of a human being by another abortion - expulsion of the product of conception before the age of viability infanticide - killing of a child less than 3 days of age parricide - a crime committed by one who kills his/her father, mother or child whether legitimate or illegitimate Robbery - crime against a person or property h  Thanks for listening! ANY QUESTIONS?