Ethical Principles of Community Health Nursing Practice PDF

ETHICAL PRINCIPLES OF COMMUNITY HEALTH NURSING PRACTICE DR. JUANITO LEABRES JR. Ethics  Ethics is a system of moral principles and rules of conduct recognized in respect to a particular class of human actions or to a particular group of people. Ethical Consideration  Means consider...

ETHICAL PRINCIPLES OF COMMUNITY HEALTH NURSING PRACTICE DR. JUANITO LEABRES JR. Ethics  Ethics is a system of moral principles and rules of conduct recognized in respect to a particular class of human actions or to a particular group of people. Ethical Consideration  Means considering the morals or the principles of goodness.  The right and wrong of an action prior to doing the action.  It considers whether or not it is within the rules or standards of right conduct or practice, especially the standards of a profession, so in our case we are talking about the nursing profession. Ethical Consideration  The rightness or Example: wrongness of the  Selling of drugs and human behavior with toxins and other the motivation packages like family behind the planning supplies or behavior so there  Asking payment for are a lot of legal services rendered in and ethical issues barangay health in community health centers. nursing practice. According to George Washington Carver, once motives are wrong then nothing can be right or there's no right way to do the wrong thing. Application of all nursing principles to life and death is used in all clinical setting  The main duties and obligations of healthcare practitioners are preservation of life and health protection of bodily integrity from harm and respect for human dignity. Ethical Issues Occur when a given decision scenario or activity creates the conflict with the society’s moral principles - this conflicts or sometimes legally dangerous since some of the alternatives to solve the issue might breaks a particular law. Ethical Issues 1. MORAL DILEMMA  One example of a common ethical dilemma nurses deal with in community health nursing practice is establishing boundaries with clients.  In the community, the nurse can be very manipulative or vice versa. An assistant or colleague can tend to establish extra closeness to the community or the community to the health nurse. Ethical Issues  MORAL UNCERTAINTY OR MORAL CONFLICT  This happens when the nurse is unsure which moral principle to apply so common nurses particularly during the pandemic.  The nurses have a hard time making decisions how to be fair and unjust to all patients. Ethical Issues 3. MORAL DISTRESS  This happens when the nurse knows the right thing to do but organization constraints them from doing it so conflicts with other healthcare providers.  Excessive workload and working with colleagues believed to be incompetent are examples of clinical situations that cause moral distress to nurses. Ethical Issues 4. MORAL OUTRAGE  A nurse witnesses an immoral act by another but feels powerless to stop it.  It is also a behavioral response to a certain situation.  For example, in the context of COVID 19, moral outrage was manifested as frustration particularly in the context of treatment and the level of risk to help professionals like frontliners. ETHICAL VS LEGAL  As a nurse, you need  As a nurse, you need to practice within to be knowledgeable the moral standards enough, judicious & of the nursing considerate in profession and within discharging your the context as duties and governed by our legal responsibilities. laws. ETHICAL VS LEGAL  ETHICAL= OUGHT TO  PRUDENT = KNOWLEDGE  LEGAL= MUST ETHICAL PRINCIPLES  AUTONOMY  BENEFICENCE  NON-MALEFICENCE  JUSTICE  VERACITY  FIDELITY  Principle of Autonomy  Autonomy refers to freedom of action, as chosen by individual person who are autonomous and are capable of choosing and acting on plans they themselves have decided about it.  Application in community - the provision of informed consent ,freedom of choice including treatment refusal, Client should be given a choice in treatment plan. Principle of Autonomy  The nurse must be reminded of the rights of the community people to self determination.  The nurse has a responsibility to treat its individuals as autonomous objects and has the right to make decisions. Principle of Autonomy  There are instances that Paternalism is being utilized and restricts autonomy.  The nurse is duty bound to decide on behalf of the client in instances where developmental considerations and health related challenges restrict the autonomy of the client to decide for himself.  While the intentions may be to promote health and prevent harm, paternalistic approaches can sometimes limit personal autonomy or choice. Health Education and Promotion  Community health nurses often lead educational campaigns to promote healthy behaviors, such as vaccinations, safe sex practices, and smoking cessation.  In some cases, they may use paternalistic approaches by insisting on certain behaviors or interventions, believing that these actions are in the community’s best interest, even if individuals resist.  Examples: Health Education and Promotion  Vaccination campaigns: Nurses might advocate strongly for mandatory vaccinations for all, especially in the face of vaccine hesitancy, believing it will prevent public health crises despite resistance from some community members.  Smoking cessation: Nurses might limit a smoker’s choices by only offering information about the benefits of quitting, without acknowledging their right to continue smoking if they wish, framing it as harmful and unacceptable behavior. Principle of Autonomy  The nurse makes decisions on behalf of the client. - considered acceptable when a client does not have decision making capacity. BENEFICENCE  This refers to actions that benefit others based on the hypothetical to apply measures that will benefit the sick.  An ethical principle that addresses the idea that the nurse's actions should promote good or doing good is taught of doing what is best for the clients.  “centerpiece if caring”. Principle of Beneficence  Prevent or avoid doing harm during community practices.  It includes the idea that beneficence is a duty to help others by providing health care services to community people.  Application in community: To measures the benefits and costs of alternative approaches to problem or to decide how to distribute health programmed funds. Principle of Nonmaleficence  State that a person should do not harm  Health care providers often use the concept of a detrimental benefit analysis when the issue of nonmaleficence is raised.  Application in community: Non- maleficence requires that nurses avoid causing harm to patients. Principle of Nonmaleficence  The nurse is trying to prevent harm or totally remove harm  More binding than beneficence because the nurse is going beyond just to do good or prevent harm to the patient.  Example: The nurse is carefully dressing a wound of an injured child. Principle of Justice  The formal principle of justice claims that equals should be treated equally and that those who are unequal should be treated differently.  Application in community: Equitable Health care services to community people. Fidelity  The nurse is duty bound to be faithful and loyal to commitments.  Fidelity in nursing means that nurses must be faithful to the promises they made as professionals to provide competent and quality care to their patients. Fidelity  2 types of promises associated in this principle 1. Explicit promises 2. Implicit promises.  3 ASPECTS AS THE MODEL FOR FIDELITY 1. Keeping one’s word of honor 2. Loyalty to commitment and oaths 3. Reliability  By fidelity we mean the obligation to act in good faith and to keep vows and promises, fulfill agreement, maintain relationships and fiduciary responsibilities Fiduciary Responsibilities  It refers to the contract of relationship the nurse enters into with the patient. So with the fiduciary relationship it backs on trust and confidence which means once that physician or nurse enter into a relationship with the patient this professionals become the trustees of the patients health and welfare. VERACITY  In here the community nurse is bound to be truthful and honest in all their dealings with the community people so this is an obligations to tell the truth and not to lie or deceive others. Confidentiality  In here the nurse is duty bound to keep privilege information private, meaning anything stated to the nurse or health care providers by the patient must remain confidential.  So in instances wherein patients indicate harm to themselves or others it can be violated or in instances where patients need permission for the information to be shared. Confidentiality  Health care professionals did not follow rule of confidentiality, clients might not sought help when needed it.  Example - The family planning services Principle of double effect  Meaning some actions can be morally justified even those consequences may be a mixture of good and evil. So this principle must meet the four criteria.  Four Criteria 1. The action itself is morally good or neutral 2. The agent intends the good effect and not the evil ( the evil may not foreseen but not intended) 3. The good is not achieved by the evil 4. There is favorable balance of good over evil Principle of Accountability  The application of this principle indicates that how a community health nurses morally provide health services so as to provide maximize total net health of population. Principle of Advocacy  Advocacy in the care of safety of clients is concerned.  The nurse must be alert to take appropriate action regarding any instance of incompetent. DUTY-BASED (DEONTOLOGY)  Duty to do or to refrain from doing something.  Decisions are made because there is duty!  So if utilitarianism is society centered, deontology is patient centered so it is defend as an ethical theory that the morality of action should be based either that action itself is right or wrong under a series of roles rather than based on the consequence of action.  Example: To respond or to refuse a house delivery in the middle of the night Virtue ethics  Action consistent with certain ideal virtues.  Decisions are directed at maintaining virtues.  Example: (honesty, courage, compassion, and service). PRINCIPLISM  Use of ethical principles instead of theories to evaluate actions.  More likely to be used by nurses in practice.  Requirements knowledge of principles, rather than knowledge of theories ETHICS IN PROFESSIONAL PRACTICE  Nursing practice is governed by International Council of Nurses or the ICN.  ICN Code of Ethics for Nurses is a guide for action based on social values and needs. So, the code correlates the four fundamental nursing responsibilities.  FUNDAMENTAL RESPONSIBILITIES OF NURSES 1. Promote health 2. Prevent illness 3. Restore health 4. Alleviate suffering  AMERICAN NURSES ASSOCIATION (ANA) Code of Ethics  Applies to all nurses in all healthcare setting. Ethical principle agreed upon by member of the profession.  Set standard of conduct and behaviors for nurses.  The ANA code of ethics for nurses is concise statement of the ethical classifications and duties of every individual who enters the nursing profession.  It is a profession's negotiable ethical standards and it is an expression of nursing on understanding of its commitments to the community or to the people.  AMERICAN NURSES ASSOCIATION (ANA) Code of Ethics Key Points: 1. Primary commitment is to patient (individual, family or community). 2. Demonstrate compassion and respect for all patients regardless of patients states. 3. Promotes the health welfare of patients. 4. Accountable for individual practice 5. Maintains and increase own knowledge base 6. Works to improve healthcare environment for providers and patients In every professional practice, there should also be Professional Boundaries.  What is Professional Boundary? It means that a nurse abstains from obtaining personal gain at the patient’s expense and refrains from jeopardizing the therapeutic nurse-patient relationship.  How do we describe boundary violations? Refers to unethical acts that are ?? used in therapeutic relations or harmful to the clients Examples are exploitation or personal gain. KEY TERMS:  Boundaries  Spaces between nurse’s power and client’s vulnerability.  Crossings  Brief excursions among boundaries that may be inadvertent, thoughtless, or even purposeful if done to meet a specific therapeutic need.  Violations  Results when there is a confusion between the needs of the nurse and those of the client  Sexual Misconduct  Extreme form of violation that is seductive, sexually demeaning, harassing, or interpreted as sexual by the client. Boundary Crossing examples: Excessive Self-Disclosure The nurse discusses her personal feelings or aspects of personal life in front of the patient. Boundary Crossing examples: Secretive Behaviors The nurse keeps secrets with the client or becomes guarded when someone questions their interaction. Boundary Crossing examples: Selective Communication The nurse fails to explain actions or actions of care. Boundary Crossing examples: “Super nurse” The nurse believes that only she/he can meet the needs of the client. Boundary Crossing examples: Singled out client treatment/client attention to the nurse Nurse spends inappropriate amounts of time with the client, client may give gifts to the nurse. Boundary Crossing examples: Failure to protect the client Nurse doesn’t recognize sexual feelings towards the client. In psychiatric nursing, this is called countertransference, so the nurse falls in love with the client. Boundary Crossing examples: “You and me against the world” behavior Nurse views client in a protective manner. Boundary Crossing examples: Flirtations Never, ever demonstrate inappropriate behavior of the nurse towards a client. How to set Professional Boundaries? Not discussing a client’s private health information with others. Meaning, we need to emphasize the principle of confidentiality. Keeping work contact numbers separate to your personal contact numbers. Not performing additional favors for clients outside the scope of your role. How to navigate nurse’s challenges in setting professional boundaries: Be aware of her own and her own feelings, biases and beliefs. Be cognizant of her own and patient’s culturally negotiated behaviors. Be observant of the behavior of other professionals. Always act in the best interest of the client. As a nurse: Know yourself and your values. Protect your patient by intervening if you identify an ethical question/dilemma. Know your facility policy for access to the ethics committee. Know your responsibilities with regard to informed consent. Respect the patient’s advance directives.