NCM103-THEORY: FUNDAMENTALS IN NURSING PRACTICE - FN_Midterms PDF

NCM103-THEORY: FUNDAMENTALS IN CLO#1 Define the following terms: NURSING PRACTICE 1. Health – Optimum level of wellness in an 1M- CONCEPT OF MAN: BIO-PSYCHO-SOCIAL...

NCM103-THEORY: FUNDAMENTALS IN CLO#1 Define the following terms: NURSING PRACTICE 1. Health – Optimum level of wellness in an 1M- CONCEPT OF MAN: BIO-PSYCHO-SOCIAL individual which allows him to function AND SPIRITUAL BEING adequately in daily life activities. 2. Disease – The interruption of health due to INTRODUCTION invasion of the body by microorganisms, to trauma, or to mal- or dysfunctions of the Man, a complexity of cells, is a remarkable member body parts due to age, nutritional deficiency, of the animal species. He reproduces his kind and or metabolic disorder. carries on daily life activities for his survival. He alone, the other animals, use language to 3. Behavior – The overt response of an communicate with others of his kind. Through individual toward stimuli in his environment. innate potentials, he adapts to his environment, growing and developing in the process through 4. Personality – The complex characteristics space and time, and finally dying old because his that distinguishes a particular individual time has come. He may even die young because of from another or characterizes him in his disease, trauma or other factors. relationship with others. 5. Family – A basic unit of society composed To understand him, one needs to view MAN in his of biological or sociological parents and totality: children born of or adopted by them.  A unified whole much greater than and different from the sum of all his parts. 6. Culture – The total pattern of human  A composite being of behavior and its products embodied in o Biological thought, speech, action and artifacts o Psychological transmitted to succeeding generations o Social through the use of tools, language and o Spiritual Systems abstract thought. He is born adequately equipped to cope with 7. Religion – A personal awareness or environmental stresses both within him and conviction of the existence of a Supreme outside. Being or of Supernatural Powers, as  This module is the first of all modules that you will study in expressed in feelings of reverence, worship the nursing course. All other modules will be based on the and faith. basic concepts that will learn here and they will help you understand man: the nature of his being. 8. Community – An aggregate of families To study man, it is necessary to understand living in a specific locality bound together by him as a total person with bodily needs and wants, common interests and goals. thoughts and feelings. However, the study of man cannot be understood, it is done out of context of 9. Society – An enduring and cooperating the supra systems called society in which he lives social group whose members have or without considering the vital life-support developed organized patterns of relationship of the various subsystems which relationship through interaction with one comprise himself and of his being. The student is, another. therefore, encouraged to view man as an organized whole with his biological, psychological, social and spiritual attributes intertwining and interlocking throughout his lifetime. MINGUITO, SHANIA D. | BSN1B 1 CLO#2 Compare the atomistic and holistic Byrne and Thompsons call this approach holistic approaches in the study of man as a bio-psycho- or total. It provides a fundamental framework on social and spiritual being. which one can base his perception or observation of the total behavior of man in relation to society. THE STUDY OF MAN Man has always been a fascinating organism. How The holistic view, therefore, traces the patterns of he came to being, how each part of his body works, man’s relationships with other beings in the and how it is related to other parts, what makes him suprasystem of society. Given varying situations, grow and acquire mechanisms which allow him how man acts and how he reacts to situational to recognize and overcome threats in his stimuli provide clues in understanding the nature of environment, how he communicates with others of his responses and the reason for them. Unlike the his kind are some of the questions which have atomistic study of man, the holistic approach views been carefully studied over the years. man as a whole organism with interrelated and interdependent parts functioning to produce behavior unacceptable or acceptable to him or A. THE ATOMISTIC APPROACH to society. In order to understand how man functions, one needs to know first the structure of the human body. The basic unit of the human body is the cell. The knowledge of the atomistic and holistic approaches of studying man is useful in planning Byrne and Thompson calls such detailed study his care during illness or preventing it. of man the atomists approach. It actually means studying the parts of man’s body singly or  When the nurse takes the patient’s temperature, pulse and respiration, she is gathering data to determine the internal independently. The atomistic study of man, condition of or changes in his body cells, organs and therefore views him as an organism composed of organ system. The urine specimen she collects and sends different organ system. Each system composted of to the laboratory will show the normal and/or abnormal organs and each organ made up of cells. constituents in his body fluid which can help greatly the doctor’s management of the patient’s disease condition. B. HOLISTIC APPROACH The holistic approach supplements the data  However, complete this atomistic data might be, it still collected by means of the atomistic study. leaves one feeling that something has been omitted. There are still unanswered questions and areas of man’s study  The nurse observes the nature and extent of relationships untouched. One may know the form and function of each existing within the patient’s family and between the patient cell, yet the question remains- what is man really liked? and other family members. She can also predetermine the What makes him fall or succeed? How does he cope with kind of relationships which the patient’s family have with stresses in his environment? There is a need, therefore, to the other families in the community. In this way, all aspects study man in all aspects of his behavior and his affecting the patient before, during and possibly after relationship with others in his environment. hospitalization are considered in his plan of care. Stimuli in the environment provide the necessary forces to enable man to demonstrate, consciously or unconsciously, the nature of his response and the subsequent quality of his relationship with his environment. MINGUITO, SHANIA D. | BSN1B 2 CLO#3 Identify elements in his biologic nature that CLO#4 Show examples that man’s whole is shows his response to environmental stimuli as a different from and more the sum of his component unified whole. parts. ORGANISMIC BEHAVIOR (Byrne and ORGANISMIC BEHAVIOR (Byrne and Thompson) Thompson) First Belief: That man normally responds as a Second Belief: That man as a whole is different unified whole. from and more than the sum of his component parts.  Not as a series of interrelated parts  His mind and body operates as a whole Analogy of Water and Its Component Parts:  His body structure conform to the  “Water not the same as its parts. Its elements, hydrogen purpose for which each part was made. and oxygen, have different sets of characteristics and  The mind operate in conjunction with the predictable responses. Each element alone will support body, what affects one affects the other. combustion but combined as water they are commonly used to extinguish fire.”  Neither one stands alone. Similarly, man, as a human organism composed of various system is something more than just Heart addition of his parts; Given any set of stimuli he responds as predicted, or becomes unpredictable because of other extraneous variables. His Blood Hormones Pressure responses are varied and numerous.  Man utilizes food as nutrients for his body in the Senses maintenance and repair of his cells and for the maintenance and regulation of his vital processes. If he takes in food which is contaminated during its preparation or in its storage, or if food is inadequate in amount or is Skin Breathing deficient in vitamins and minerals, man will become ill if failed to develop normally. Muscles Organismic behavior, therefore, refers to those observable features and actions that reflect man’s functioning as a unified whole within the environment in which he exists. It reflects the dynamic changes that occur in him as a result of alterations he has made or has met in his internal and external environments.  Behavioral features point out to the observable characteristics of the physical and external shell of man. This shell gives us clues to the internal state of the individual. Voice response, posture and color of the skin are tell-tale sign of what goes in a person’s body. Whether praised or censured, man reacts. MINGUITO, SHANIA D. | BSN1B 3 CLO#5 Identify the nature of man as a system and  To understand how a closed system works, image placing as an energy unit. a lighted candle inside a glass jar and then covering it tightly. When the oxygen in the jar is all used up, the flame CLO#6 Differentiate between an open and a closed dies. The unyielding glass does not allow oxygen from the atmosphere to penetrate its boundaries and nourish the system. flame. MAN AS A SYSTEM Byrne and Thompson uses Buckley’s definition of a system: → A whole which function as a whole by virtue Respiratory Circulatory ofthe interdependence of its parts. → A system has common or unifying boundaries with interrelated and interdependent parts. Musculo‐ Nervous Skeletal → A system may be composed of subsystems. Each is designed to carry out an activity, which in turn is necessary for achieving the general purpose of the system. The figure above shows how a closed system works. Note how the energy is only locked within the boundaries of the organism which does not TWO (2) TYPES OF SYSTEM: show observable behavioral change in response to 1. Closed System a stressor. 2. Open System There may be some wherein the stimuli received from the environment may penetrate the boundary CLOSED SYSTEM of the organism. They may produce changes in the sub-system of that organism but any response or change in any form to the stimuli is → Self-sufficient and totallyisolated from other not observed externally. The stimuli, unable to system. reinforce itself within the organism disintegrates o It does not allow outside stimuli in any form: and fades away.  Verbal  Non-verbal o Life-threatening or supportive, positive or negative – to penetrate its boundaries, nor does it allow anything from within it to go beyond its boundaries. o Life sustaining elements, either in the form of energy, matter or information, cannot enter the system to nourish it. → Thesystem uses upits reserves for energy. → In doing so, it eventually fails to function and disintegrates. MINGUITO, SHANIA D. | BSN1B 4 OPEN SYSTEM CLO#7 Cite examples that point out the nature of the energy-matter exchange between man and his → Exchanges matter, energy, orinformation wtih environment. the environment surrounding it. THE ENERGY-MATTER EXCHANGE OF MAN → It isdirectly affected byevents or changes inother systems. → Man, as a unified whole interacts constantly wtih his environment, while at the same time the This type of system views the person as a living different subsystems within him continuously behavioral system. The: interact with each other. o Metabolism → This on-going interaction within: o Growth o Total processes of living o man o between man Are involved in the interchange of energy, o his environment, matter or information among parts of the living organism, and between the living organism and its Enables him to grow, to overcome environment. environmental threats, and, as a result, to make adjustments within his body. In order to carry on processes which, the organisms need for its daily life activities, → As an energy unit, man’s energy is not limitless, but must be continuously replenished as o Continuous flow of energy soon as it is utilized. o Matter or Information (in & out of through its boundaries is necessary) → All life processes, such as: This way, the organism takes in new energy, o eating nourishing matter and fresh information into its o breathing and system at the same time giving us to the o working utilize energy environment the waste or by products or obsolete information which the organism no longer needs or When this energy supply is exhausted, man wants. dies. In order to function optimally he maintains a steady state of energy balance. What he uses, he must replace, while keeping some reserves in case of an emergency. → Emergencies may come in the form of increased volume of work, disease, or any bodily threat.  The interrelatedness and interdependence of man’s subsystem facilitate the energy-matter exchange. Food taken in is digested in the elementary tract (digestive system), is observed and carried by the blood (circulatory system) to the body cells (muscular system). Waste products of metabolism are excreted by the lungs (respiratory system), skin (integumentary system), urinary bladder (urinary system), and the bowels (digestive system). An input of matter results in an output of matter. In this instance, man has exchanged matter with his environment, utilizing energy in the process. MINGUITO, SHANIA D. | BSN1B 5 An input of energy need not result in an output of INPUT matter, and then the input be always energy. This ENERGY MATTER INFORMATION input-output relationship may result in any of Any form, May either be May be in form the following exchanges: such as food or of news and scolding or microorganisms. health o Energy-Energy a blow. teaching. o Matter-Matter o Matter-Energy & Matter-Matter Examples below demonstrate these various types OUTPUT of energy-matter exchange in patient care system: ENERGY MATTER INFORMATION Either be Can be loose Can be 1. A quarrel at bedtime may result in sleepless fever or stools or validating what night (energy-energy exchange) dyspnea vomitus. one has 2. Fear in anticipation of a test results in learned is frequent loose stools (energy-matter correct through exchange) feedback. 3. Inhalation of pathogenic microorganisms produces fever (matter-matter exchange) 4. Ingestion of histamine-rich food produces Since man is an open system, acting as a unified hives (matter-matter exchange) whole and composed of subsystems what affects one subsystem easily affects the other subsystem/s within the set. This is how the subsystem work interdependently. Food is taken by mouth which is Respiratory part of the digestive system. The food provides energy for doing work which an output of the skeletomuscular system. Nervous Circulat ory Digestive (Fig. above) An open system which shows observable Behavior Change in Response to a Stressor Input → Energy, matter or information which istaken in by a system. Output→ Which passes from the organism into theenvironment. MINGUITO, SHANIA D. | BSN1B 6  MAN AS A BIOLOGICAL BEING → Man is not only a composite of isolated → Super-Ordinate System: Provides man with components, each part independent of the other thenecessary framework of relationships which but also a total being with parts interrelated and links to the family, the community and society. interdependent upon one another. Together with others in his family and community, he comes with elements in his environment; his Man is a living organism who from birth is destined behavior greatly influenced by his response to to die. Until he does, he has to content continually others in his environment. with forces in his environment; some of them friendly, others hostile. → In the micro and macrocosms of life, man The network of relationships, therefore, are just responds to environmental stimuli as a as important as the form and function of the particular unit—be it a solitary cell, a component different organ systems which comprise the organism or a member of a conglomerate of biological nature of man. individuals. → Cellular behavior: Simplest functional unit (Fig. below) How man enlarges these behavioral responses from a single family unit to the → Cell: Basic unit or building block of structure suprasystem of society and how these different ofall forms of plant and animallife. systems and subsystems all refer back to man as an individual.  Within the human body, there are approximately 60,000 billion cells. Each of these cells carry out precise and Cell highly specialized functions that interweave harmoniously with the activities and functions of other cells in the body. Organ MAN → As a result of coordinated cellular activities, it grows and develops into an integrated whole. Family Community → As man enlarges his interaction with his & Society environment his behavioral responses become more complex and variables.  Studying these different responses often requires the specialized services of other man; for example, the microbiologist for cellular behavior, the physiologist for the Man’s subordinate & super ordinate systems organ and organs system behavior and the psychologist influence his behavior as an individual. and sociologist for his relationship with his family, community, or society. → Behavior at the societal level is discussed by → Because the cells, organs and organ systems thesocial scientists and the anthropologists in the are found within the individual, they comprise the light of: subordinate system of man while the family, community and society which consists of bigger o Mores units of man are called his super ordinate system. o Value systems o Taboos → Subordinate System: Is important in carrying o Social intercourse out daily life activities which are vital to survival. Man’s feeling of well-being each day → Characteristic behavioral patterns toward current depends on the condition of the various organ or potential health crisis are identified by public systems in his body. health workers while deviant or anti-social behavioral become the concern of law-enforcing agencies. MINGUITO, SHANIA D. | BSN1B 7 CLO#8 Identify the psycho-social characteristics of Man, the psychosocial being that he is Travelbee, man which determine his nature as a human being. says, is a thinking being who is very capable of rational, logical thinking most of the time but MAN AS A PSYCHO-SOCIAL BEING who becomes irrational and illogical when Man (Travelbee) → “A unique, irreplaceable provoked. His rational side makes him merciful, individual, a one-time being in this world.” kind and compassionate while his irrational nature may make him commit criminal acts To be irreplaceable means that an entity cannot be exchanged against another man. for another. In this era of transplants, most parts of the human being can be replaced by organs taken from human or animal TRAVELBEE POINTS THAT: donors and are known as transplants or by plastic or steel parts which are called prosthesis. 1. Man is imprisoned within himself by his limited nature and how he enjoys freedom → Because man is a one-time being in this which other animals can never enjoy. world, when he dies, he ceases to exist. There is 2. Man retains a certain amount of immaturity not a reason chance for living. What may be left of well within an outer shell of maturity. him to indicated his temporal presence will be a few 3. Man as a social being who is capable of mementoes which some thoughtful person relating with others. remembered to collect in his memory, unlike a plant, he cannot wither away in times of drought only to CONCLUSION OF TRAVELBEE: sprout a new shoot when conditions later become o What wonderful with man is his capacity to more favorable. cope with stressful stimuli. Depending on  In spite, of this, he is often at odds with his own self his inherent qualities, in the environment he whether to give to others or to take from them instead. His grew up in, the experiences he has—he will unlimited nature requires him to share what he has manage to rise above the limitations of however, he is aware that to do so at all times and to any his human conditions. He tries all actions person may not be good at all! His limited nature tells him not to be so generous otherwise he may have little left to which can resolve conflict knowing that if he him. does not, he becomes a martyr of his core incommunicable loneliness. If man does not strive to strengthen his relationship → It is, therefore, not surprising to find man always with other fellow humans, he becomes restless and lonely, an embittered at the crossroads of indecision. Whether he has individual without friends until the day to do or not do something, he is forced to make a he dies. choice and he finds it difficult. The higher the position or responsibility, the greater the burden of making choices and bearing the consequences of these choices. He becomes aware although reluctantly that to be human, one cannot make a choice of an act without being responsible for the consequences that such an act may entail whether to himself, to his friends or to total strangers. MINGUITO, SHANIA D. | BSN1B 8 CLO#9 List examples that show aspects of man’s CLO#10 Identify the nature of the spiritual spiritual nature. relationship that exists between man and his Creator. MAN AS A SPIRITUAL BEING 1. BELIEF IN A SUPERIOR FORCE o The unity of Man in Body, Mind and Spirit. Man believes that his life is governed by a o Man is a being with complexities. great power greater than he. He pays o Man as a complex organism has special obeisance to this Supreme Power regularly abilities to transcend the limits of his animal or infrequently, the frequency dependent on nature. This ability to overcome the physical man’s whims, caprices or feelings of despair and social needs through transcendence whenever it by adversity. is descriptive of man’s spiritual nature. Two components that assist man in the power of Religions differ in their beliefs as to the transcendence: nature of this Power, Force, or Being. Christians Believe that the Power 1. Intellect exists in a realm outside of 2. Will their own selves and that it wields an Omnipotent Intellect → Allows man to look for the truth. It gives Power over their lives, him the ability to perceive his surroundings or the called Supreme Being God. forces within our outside him or to understand the Muslims Recognize an outside all meaning of events as they relate to him and to his powerful force and worship loved ones. Allah in complicated religious rituals and in Will → Expresses man’s own wishes, desire or special places of worship longing to do what he has set his mind to do. It called Mosques. gives him power of conscious and deliberate action Buddhist Believe in the or self-control in initiating, sustaining or terminating Enlightenment of the Self human activity. as the embodiment of divine worship and virtue → Provides mantheenergy to overcome the and not in any outside forces working against him. Force or Power. They follow the teaching of Buddha to release the human body from earthly  Through firm resolution of mind, man accomplishes what he likes or fails to accomplish what he dislikes. This and bodily pain. demonstrates only too clearly that the mind and the body perform as one. Therefore, man the spiritual being, needs the essential freedom of the human spirit. To 2. MOTIVATION TO OVERCOME HARDSHIP achieve this freedom, he continuously for it and the a) Natural struggle is made doubly difficult when he is ill. → It comes naturally to man to suffer for those whom he loves and wishes to protect from pain and suffering. b) Supernatural Forces → Wherein one transcends pain and suffering to a higher place in the hope of non-material reward. MINGUITO, SHANIA D. | BSN1B 9  SPIRITUAL VIRTUES SUMMARY  Man is like all other men. Even if human reason makes man skeptical  Man needs the same vital processes and faithless his spiritual nature makes him to support life and uses identical overcome skepticism and sets him back to biological form and functions to carry the right oaths of thinking. out these processes.  Factors affecting man: VIRTUES o Heredity Faith → Unquestioning belief in o Environment someone or in something or the o Culture complete trust and confidence o Societal Experiences or elance one places in a person or thing.  He believes in a Supreme Power Hope → Closely related to faith.  People who live in close proximity While faith is the foundation on with each other develop identical which hope rests, hope ways which distinguish them from nourishes faith. other people who are separated from them geographically. → Vital factor in the health care  Through culture, man borrows and setting. assimilates different: Charity → Means love of man for o Thought hs i fellowman. o Speech → Enables to overcome  Behavior patterns of other countries frustration because of love for  Psychologically, man is like no another. other man. Every individual has his → This love makes one d o own personality make-up. things for another without  Two ways of studying man. complaint. o Atomistic Approach → Studies → Allows one to give up his the part of man’s body starting own pleasures while serving from the cell and moving towards another without even thinking of the different organ systems each the sacrifice it entails. part analyzed as individual entities. In conclusion, man’s spiritual nature forges with his physical and o Holistic Approach → Man’s psychological nature to make him a being relationship with others in the different from the sum of his individual parts. family, community and society are studied, each relationship taken within the context of the other or bigger systems surrounding man.  Man, the bio-psycho-social-spiritual being is a marvel of complexities. His biological nature arises from the form and function of the individual cells in each organ of his different organ systems.  Man’s ability to react to stimuli in his environment is greatly influenced by or dependent on his bio- psycho-social and spiritual nature. MINGUITO, SHANIA D. | BSN1B 10  NCM 103 – FUNDAMENTALS OF NURSING o Enduring beliefs (opinions, PRACTICE interpretations) or attitudes (mental MODULE 2M – ETHICS AND VALUES SYSTEM position) about the worth of a person, object, idea or action. Introduction o An important influence on (ethical) decision-making and choices In their daily work, nurses deal with intimate (personal and professional) and fundamental human events such as birth, death, and suffering. They must decide the morality of their 2. Value System – People organize their own actions when they face the many ethical issues values internally along a continuum from that most important to least important. surround such sensitive areas. Because of the o Value systems are basic to a way of special nurse–client relationship, nurses are the life, give direction to life, and form the ones who are there to support and advocate for basis of behavior – especially clients and families who are facing difficult choices, behavior that is based on decisions or choices. and for those who are living the results of choices that others make for and about them. o Molded by one’s virtues or vices. o Influence decision and actions o Ideas and principles by which man The present environment of cost containment lives. and the nursing shortage tends to emphasize o Organizations of a person’s values business values. This creates new moral problems along a continuum of relative and intensifies old ones, making it more critical than importance. ever for nurses to make sound moral decisions. o A coherent set of values adopted Therefore, nurses need to: and/or evolved by a person, organization, or society as a standard (a) develop sensitivity to the ethical to guide its behavior in preferences in dimensions of nursing practice, all situations. (b) examine their own and clients’ values, (c) understand how values influence their 3. Ethics – “ethos” It refers to decisions, and a) a method of inquiry that helps people (d) think ahead about the kinds of moral to understand the morality of human problems they are likely to face. behavior (i.e., it is the study of morality), CLO#1: Recognize the role of values, value system, b) the practices or beliefs of a certain ethics and morals in nursing practice. group (e.g., medical ethics, nursing ethics), and Definition of Terms: c) the expected standards of moral 1. Values – Are enduring beliefs or attitudes behavior of a particular group as about the worth of a person, object, idea, or described in the group’s formal code action. Can be learned through observation of professional ethics. and experience. o Custom or characteristics. o Values are important because they 4. Morals – Usually refers to private, personal influence decisions and actions, standards of what is right and wrong in including nurses’ ethical decision conduct, character, and attitude. making. o What individuals would do to live together o Comes from the Latin word “Valere” in society. – measure the worth of something. o Freely chosen 5. Bioethics – Ethics as applied to human life o Is a personal belief about the worth of or health. a given idea, attitude, custo, or object that sets standards that influence 6. Nursing Ethics – Refers to ethical issues behavior. that occur in nursing practice. MINGUITO, SHANIA D. | BSN1B 1  7. Value Set – Small group of values held by an CLO#3: Discuss the values necessary for individual. professional nurses as reflected in the Code of - Group of values a person holds Nurses. - People organize their set of values internally along a continuum from most CORE VALUES OF A NURSE important to least important forming a value Values Essential for a Nurse system. 1. Altruism – A concern for the welfare and 8. Beliefs or Opinions – Interpretation or well-being of others. In professional practice, conclusion that people accept as true. Based altruism is reflected by the nurse’s concern on faith. Something accepted as true by a for the welfare of patients, other nurses, and judge. Are interpretations or conclusions that other health care providers. people accept as true. 2. Autonomy – is the right to self- 9. Attitudes – Are mental positions of feeling determination. Professional practice reflects toward a person, object, or ideas (e.g. autonomy when the nurse respects patients’ acceptance, compassion, openness) rights to make decisions about their health - Are often judged as bad or good, positive or care. negative, whereas beliefs are judged as correct or incorrect. 3. Human Dignity – Is respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human CLO#2: Explain values as foundation of ethical dignity is reflected when the nurse values principles. and respects all patients and colleagues. IMPORTANCE OF VALUES 4. Integrity – Is acting in accordance with an o Giving directions in life. appropriate code of ethics and accepted o Forms the basis of behavior (decisions standards of practice. Integrity is reflected in and choices). professional practice when the nurse is o Serves as “guiding stars” which honest and provides care based on an navigates our life. ethical framework that is accepted within the o Gives definite directions to one’s life. profession. o Reflects a person’s identity. o Motivates behavior. 5. Social Justice – Is acting in accordance with o Gives meaning in life in fulfilling self- fair treatment regardless of economic status, esteem and promotes self-actualization. race, ethnicity, age, citizenship, disability, or o Basis for individual’s position on sexual orientation. personal, professional, social, and philosophical issues. o Shapes and determines an individual or group decision to like or dislike, favor or CLO#4: Project the positive professional image disfavor, change or not change. of a Filipino Nurse. THE FILIPINO NURSE o As affected in the promulgation of the code of ethics for registered nurse; BON resolution #220 series of 2004. o Article II. Registered Nurses and People o Section 4. Ethical Principles  Values, customs and spiritual beliefs  Individual Freedom MINGUITO, SHANIA D. | BSN1B 2 CLO#5: Exemplify compassion, courtesy, 12. Human Dignity – Provides culturally dedication, discipline, uprightness, commitment, and competent and sensitive care. neatness in the practice of nursing. 13. Human Dignity – Design care with sensitivity to individual patient needs.  Compassion and Courtesy 14. Social Justice, Human Dignity – Provides o Holistic caring care honest information to patients and the public. o Good manners 15. Promotes universality access to health care. PHILIPPINES NURSING ACT OF 2002  Dedication and Discipline o Lifelong learner o Social involvement o Research productive CLO#7: Explain the importance of ethico-moral- spiritual values in daily living and in the promotion of  Uprightness health and prevention of illness. o Ethically responsible  Competence and Commitment MORAL DEVELOPMENT o Professional competence  The process of learning to tell the difference o Global mindset between right and wrong and of learning what o Technically experienced ought and ought not to be done. o Team collaborator  Complex process that begins in childhood and o Effective communicator continues throughout life. o Critical thinker  Ethical decisions require persons to think and reason.  Neatness  Reasoning is a cognitive function and is, o Personal cleanliness therefore, developmental. CLO#6: Discuss how values influence: nurse’s and MORAL FRAMEWORKS student nurse’s activities, decision-making and rights of a person.  Moral theories provide different frameworks through which nurses can view and clarify PROFESSIONAL BEHAVIOR OF A NURSE disturbing client care situations. 1. Altruism – Demonstrates understanding of  Nurses can use moral theories in developing cultures, beliefs and perspective of others. explanations for their ethical decisions and 2. Altruism – Advocates for patients, particularly actions and in discussing problem situations with the most vulnerable. others. 3. Altruism – Takes risks on behalf of patients  Three types of moral theories are widely used, and colleagues. 1. Consequences 4. Integrity – Mentors other professionals. 2. Principles and Duties 5. Integrity – Protects the patient’s privacy. 3. Relationships 6. Integrity – Presents the confidentiality of patients and health care providers. 7. Integrity – Documents care accurately and Consequence-based (teleological) theories – honestly. look to the outcomes (consequences) of an action in 8. Integrity – Demonstrate accountability for judging whether that action is right or wrong. own actions. 9. Autonomy – Plans care in partnership with  Utilitarianism – One form of patients. consequentialist theory, views a good act as 10. Autonomy – Honors the right of patients and one that is most useful – that is, one that families to make decisions and health. brings the most good and the least harm to 11. Autonomy – Provides information so patients the greatest number of people. This is called can make informed choices the principle of utility. MINGUITO, SHANIA D. | BSN1B 3   Principle of Utility – The approach is often 6. Justice – Frequently referred to as fairness. used in making decisions about the funding Nurses often face decisions in which a sense and delivery of health care. of justice should prevail.  Teleological theories focus on issues of fairness. 7. Fidelity – Means to be faithful to agreements and promises. By virtue of their standing as professional caregivers, nurses have Principles-based (deontological) theories – responsibilities to clients, employers, Involve logical and formal processes and emphasize government, and society, as well as to individual rights, duties, and obligations. The themselves. morality of an action is determined not by its consequences but by whether it is done according to 8. Veracity – Refers to telling the truth. Nurses an impartial, objective principle. must also have professional accountability and responsibility. According to the Code of Ethics for Nurses (Fowler, 2010) Relationships-based (caring) theories – Stress 9. Accountability – Answerable to oneself and courage, generosity, commitment, and the need to others for one’s own actions. nurture and maintain relationships. Caring theories - Refers to the ability to answer for one’s promote the common good or the welfare of the actions. group. A moral framework guides moral decisions, - It means that the nurse is responsible, but it does not determine the outcome. professionally and legally, for the type and quality of nursing provided. MORAL PRINCIPLES 10. Responsibility – Refers to the specific accountability or liability associated with the  Are statements about broad, general, performance of duties of a particular role. philosophical concepts such as autonomy and justice. They provide the foundation for 11. Confidentiality – Safeguarding the clients moral rules, which are specific prescriptions right to privacy by protecting one’s for actions. information.  Principles are useful in ethical discussions - Federal legislation known as the Health because even if people disagree about which Insurance Protocol and Accountability Act of action is right in a situation, they may be able 1996 (HIPAA) mandates confidentiality to agree on the principles that apply. Such about the protection of patients’ personal agreement can serve as the basis for a health information. solution that is acceptable to all parties. - This legislation defines the rights and privileges of patients for protection and privacy. 1. Autonomy – Refers to the right to make one’s own decisions. 12. Social Networking – The online presence of social networks presents ethical challenges 2. Inward Autonomy – People have the ability for nurses. to make choices. - On one hand social networks can be a supportive source of information about 3. Outward Autonomy – Choices are not patient care or professional nursing activities. limited or imposed by others. 4. Nonmaleficence – The duty to “do no harm”. Moral issues are those that arouse the conscience or awareness of feelings such as guilt, hope, or 5. Beneficence – Means “doing good”. Nurses shame; are concerned with important social values are obligated to do good, that is, to and norms; and evoke words such as good, bad, implement actions that benefit clients and right, wrong, should, and ought. their support persons. MINGUITO, SHANIA D. | BSN1B 4  ETHICS AND PHILOSOPHY CLO#8: Utilize the values clarification process to identify one’s values and goals in life. o Deontology - looks to the presence of principles GENERAL VALUES regardless of outcome Types of Values: - Proposes a system of ethics that is perhaps most familiar to health care a) Intrinsic – Maintenance of life/concerned practitioners with life (e.g. food or water) - Actions as right or wrong on the basis of their “right making characteristics” b) Extrinsic – Originates outside the individual such as fidelity to premises, (E.G. Health & Humanism) truthfulness, and justice Other Types: - Examines a situation for the existence of essential right or wrong Religion - A person obtains strength from religious belief o Utilitarianism - System of ethics proposes that the Theoretical - Holds the truth, rationality, empiricism value of something is determined by in high esteem its usefulness Political - Values that are place in power - This philosophy is also known as consequentialism because its main Economic - Values that focus on usefulness & emphasis is on the outcome or practicality consequence of action - Measure the effect that action will Aesthetic - Values on beauty, harmony and form have Social - Values on human interactions, o Feminist of Ethics blindness sympathy and unselfishness - Focused on differences between VALUES CLARIFICATION genders, especially women’s point of view, developed a critique of ethical o A process by which people identify philosophies called feminist ethics. (choosing), examine (prizing), and develop (acting) their own individual o Ethics of Care values. - Strives to address issues beyond individual o Promotes personal growth by caring occurs-structures such as hospitals or fostering awareness, empathy, and universities insight. - Closely related to feminist ethics, both o An internal process not apparent to promote a philosophy that focuses on the person. understanding relationships, especially o Important step for nurses to take in personal narratives. dealing with ethical problems. VALUES CLARIFICATION o Casuistry (case-based reasoning) - Turns away from conventional Choosing Beliefs are chosen principles of ethics as a way to (Cognitive)  Freely, without outside determine best actions and focuses pressure. instead on an “intimate  From among alternatives. understanding of a particular  After reflecting and considering situation” consequences. - This approach to ethical discourses Example: A person learns about energy depends on finding consensus more resources, production, and consumption; the than an appeal to philosophical greenhouse effect; and other environmental principle issues, including ways to minimize use of and to recycle limited resources. MINGUITO, SHANIA D. | BSN1B 5  VALUES CLARIFICATION VALUES TRANSMITTED Prizing  Chosen beliefs are prized and Values are learned through observation and (Affective) cherished. experience. As a result, they are heavily influenced Example: The person is proud of the belief that he by a person’s sociocultural environment – that is, by or she has an obligation to participate in some way in reducing environmental waste. societal tradition; by culture, ethnic, and religious group; and by family and peer groups. o Personal Values – Although people derive VALUES CLARIFICATION values from society and their individual Acting Chosen beliefs are subgroups, they internalize some or all of (Behavioral)  Affirmed to others these values as personal values. People  Incorporated into one’s need societal values to feel accepted, and behavior. they need personal values to have a sense  Repeated consistently in one’s of individuality. life. (e.g. self-respect, religion, honesty and Example: The person participates in the city fairness, love) recycling program for household waste, uses public transportation rather than driving a personal o Professional Values – Nurses’ professional car when possible, helps organize recycling in the values are acquired during socialization into workplace, and is active in legislative and political nursing from code of ethics, nursing activities related to environmental issues. experiences, teachers, and peers. (e.g. beneficence, nonmaleficence, justice, veracity) PROFESSIONAL VALUES o Nurses’ professional values are acquired 1. Purposive Behavior – Actions that are during socialization into nursing from code of performed on purpose with the intention of ethics, nursing experiences, teachers and reaching a goal or to bring an important peers. Watson (1981, pp. 20-21) result. 2. Value-Belief Pattern – Pattern of values, Outlined Four Important Values in Nursing: beliefs, and goals that guides the client’s 1. Strong commitment to serve. choice/decision. 2. Belief in the dignity and worth of each person. 3. Value Formation – Ability to identify strong 3. Commitment to education. feelings and act to them. 4. Professional autonomy. - Parental influence, religions, cultural, and individual. American Association of Colleges of Nursing (AACN,1998) Identified five (5) values essential 4. Value Clarification – Analyzing one’s own for professional nurse: values to better understand these things that are truly important in life. 1. Altruism 2. Autonomy 5. Value Transmission – Acquiring values 3. Human Dignity which usually occur in an unconscious level. 4. Integrity 5. Social Justice How Are Values Transmitted: - Culture - Society - Institutions - Personality MINGUITO, SHANIA D. | BSN1B 6 CLO#9: Discuss the process of ethical problems and CLO#10: Apply ethical reasoning and decision- dilemmas. making processes to address situations of ethical distress and dilemma.  A professional code of ethics is a formal statement of a group’s ideals and values that  The goal of ethical reasoning, in the context of serves as a standard and guideline for the nursing, is to reach a mutual, peaceful group’s professional actions and informs the agreement that is in the best interests of the public of its commitment. client; reaching the agreement may require compromise.  Ethical problems are created as a result of changes in society, advances in technology,  Nurses are responsible for determining their own conflicts within nursing itself, and nurses’ actions and for supporting clients who are conflicting loyalties and obligations (e.g., to making moral decisions or for whom decisions clients, families, employers, primary care are being made by others. providers, and other nurses).  Nurses can enhance their ethical practice and BASIC VALUES FROM CODE OF ETHICS client advocacy by clarifying their own values,  Accountability understanding the values of other health care  Confidentiality professionals, becoming familiar with nursing  Veracity codes of ethics, and participating in ethics  Fidelity committees and rounds.  Autonomy  Beneficence  Nonmaleficence  Altruism CLO#11: Discuss the different roles of the nurse in  Integrity helping clients confronted with issues utilizing  Responsibility personal, family and community resources.  Respect for Person  Client advocacy involves concern for and actions on behalf of another person or organization in order to bring about change. CODE OF ETHICS FOR NURSES: FOUR PRINCIPAL ELEMENTS  The functions of the advocacy role are to inform, 1. Nurses and People support, and mediate. 2. Nurses and Practice 3. Nurses and Profession THE ROLE OF THE NURSE IN VALUES 4. Nurses and Co-workers FORMATION AND ETHICAL ISSUES IN THE FAMILY AND COMMUNITY  The Surrogate Mother  The Nurse as an Advocate Advocate – Is one who expresses and defends the cause of another. The overall goal of the client advocate is to protect clients’ rights. An advocate informs clients about their rights and provides them with the information they need to make informed decisions. An advocate supports clients in their decisions, giving them full or at least mutual responsibility in decision making when they are capable of it. The advocate must be careful to remain objective and not convey approval or disapproval of the client’s choices. Advocacy requires accepting and respecting the client’s right to decide, even if the nurse believes the decision to be wrong. MINGUITO, SHANIA D. | BSN1B 7 Being an effective client advocate involves the Ways on How to Help Clients Identify Values: following: 1. List Alternatives Being assertive Ex: “are you considering other courses of Recognizing that the rights and values of actions?” clients and families must take precedence when they conflict with those of health care 2. Examine possible consequences of providers choices Being aware that conflicts may arise over Ex: “what do u think u will gain by doing that?” issues that require consultation, confrontation, or negotiation between the 3. Choose freely nurse and administrative personnel or Ex: “did you have a choice?” between the nurse and a primary care provider 4. Feel good about the choice Working with community agencies and lay Ex: “how do u feel about the decision?” practitioners 5. Affirm the choice Knowing that advocacy may require political action—communicating a client’s Ex: “what will you say to others about the health care needs to government and other decision?” officials who have the authority to do 6. Act on the choice something about these needs. Ex: “will it be difficult to do it?”  Professional Issues in clinical ethics. 7. Act with a pattern Ethical Issues in the Family & Community: Ex: “would you act that way again?” - As a nurse, one should explore the values and beliefs regarding the following: 1. Individual’s Rights To Make Decision For Self 2. Abortion 3. Passive And Active Euthanasia 4. Blood Transfusion 5. AIDS 6. Cultural Differences 7. Spiritual And Religious Difference MINGUITO, SHANIA D. | BSN1B 8  NCM103 – FUNDAMENTALS OF NURSING BELIEF PRACTICE MODULE 2M – ETHICS AND VALUES SYSTEM o Something accepted as true by a judgement of probability rather than actuality. Notes are based from the Pre-Recorded Lecture. Objectives: ETHICS o Definition of Terms o Importance of Values o “Ethos” means custom or character. o Core Values of a Nurse o Method of inquiry that help people to o The Filipino Nurse understand the morality of human behavior. o CDU-CN Values and the graduate attributes o Practices or beliefs of a certain group. o Values Clarification Process o Expected standards of behavior of a group. o Role of the Nurse in Values Formation and Ethical Issues BIOETHICS o Ethics applied to life. DEFINITION OF TERMS VALUE SYSTEM MORALITY o Organization of a person’s values along a continuum of relative importance. o Denotes what is right or wrong in conduct, character, attitude, and what individuals would do to live together in a society. VALUE SET o Group of values a person holds. VALUE BELIEF PATTERN VALUES o Pattern of values, beliefs and goals that guides the client’s choices or decisions. o Comes from the Latin word “Valere” which means to measure the worth of something. o Set of personal beliefs, attitudes about truth and beauty. VALUE FORMATION o Worth of any thought, object or behavior. o The ability to identify strong feelings and act o Freely chosen enduring beliefs or attitudes on them. about the worth of a person, object, idea, or action. VALUES CLARIFICATION PURPOSIVE BEHAVIOR o The process of analyzing one’s own values to better understand these things that are o Actions that are performed on purpose with truly important in life. the intention of reaching a goal or to bring an important result. VALUE TRANSMISSION o Process of acquiring values which usually occur in an unconscious level. MINGUITO, SHANIA D. | BSN1B 1 PERSONAL VALUES GENERAL TYPES OF VALUES o Internalization and perception of values o Intrinsic – Relates to the maintenance of life acquired. (e.g. food and water) o Extrinsic – It originates outside the Examples of Personal Values: individual (e.g. health and humanism) 1. Family unity 2. Self-worth OTHER TYPES OF VALUES 3. Religion 4. Honesty o Religion – A person obtains strength from 5. Fairness religious belief. 6. Love o Theoretical – Holds the truth, rationality, and empiricism in high esteem. o Political – Values that are placed in power. o Economic – Values that focus on usefulness IMPORTANCE OF VALUES and practicality. o Serves as “guiding star” which navigates our o Aesthetic – Values on beauty, harmony, and lives. form. o Social – Values on human interactions, o Gives definite directions to one’s life. kindness, sympathy, and unselfishness. o It reflects a person’s identity. HOW ARE VALUES TRANSMITTED o Motivates behavior. 1. Culture o Gives meaning to life in fulfilling self-esteem 2. Society and promotes self-actualization. 3. Institutions 4. Personality o Basis for individual’s position on personal, professional, social, and philosophical issues. CORE VALUES OF A NURSE o Shapes and determines an individual or o Altruism – Welfare and well-being ofothers. group decision to like or dislike, favor, or o Autonomy – Right to self-determination. disfavor, change or not change. Being “assertive”. o Human Dignity – Respect for the inherent worth and uniqueness of individuals and population. Belief in the dignity and worth of PROFESSIONAL VALUES each person. o Values that are acquired during socialization o Integrity – Acting in accordance with an in their respective professions. appropriate code of ethics and accepted standards of practice.  Beneficence – “Doing good” o Social Justice – Upholding moral, legal, and  Non-maleficence – “Duty to do no harm” humanistic principles.  Justice – “fairness” ; “equality”  Veracity – “telling the truth” MINGUITO, SHANIA D. | BSN1B 2 VALUES NECESSARY FOR FUTURE NURSES VALUES CLARIFICATION PROCESS (Based on Code of Ethics for Nurses) o A process by which people identify, examine, 1. Accountability – Refers to the ability to own and develop their own individual values. one’s action. The Three (3) Processes: 2. Confidentiality – Safeguarding the client’s right to privacy by protecting one’s 1. Choosing (Cognitive) information. o Beliefs are chosen freely among 3. Veracity – Telling the truth. alternatives without pressure after 4. Fidelity – Faithful to agreements and reflecting and considering responsibilities one has undertaken. consequences. 2. Prizing (Affective) CDU-CN VALUES AND GRADUATE o Chosen beliefs are cherished and ATTRIBUTES prized. o Compassion and Courtesy (Holistic Caring 3. Acting (Behavioral) Care and Good Manners) o Chosen beliefs of a person are affirmed to others and incorporated, o Dedication and Discipline (Lifelong learner, demonstrated consistently in one’s Social Involvement, Research and life. Productivity) o Uprightness (Ethically Responsible) ETHICAL ISSUES IN THE FAMILY AND o Competent and Committed (Professional COMMUNITY Competence, Global Mindset, Technically o As a nurse, one should explore the values Experienced, Critical Thinker, Effective and beliefs regarding the following: Communicator, Team Collaborator) 1. Individual’s right to make decision for o Neat (Cleanliness) self. 2. Abortion 3. Passive and Active Euthanasia 4. Blood Transfusion 5. AIDS 6. Cultural Differences 7. Spiritual and Religious Differences MINGUITO, SHANIA D. | BSN1B 3  NCM103 – FUNDAMENTALS OF NURSING 3. Nursing Law – Governed by legal law or PRACTICE concepts. Define entry requirements for the profession (such as graduation from an MODULE 3M – RIGHTS, RESPONSIBILITIES approved educational program for nursing) AND REGULATION OF NURSING PRACTICE duties and composition of the (state) board of Introduction nursing, scope of practice. In the Philippines, it is evident on Republic Act 9173 or the Nursing practice is governed by many legal Philippine Nursing Act of 2002. concepts. It is important for nurse to know the basics of legal concepts, because nurses are a) Regulatory or Administrative Law – accountable for their professional nursing practice When a state legislature passes a and the law. Knowledge of laws that regulate and statute, an administrative agency is affect nursing practice is needed for two reasons: given the authority to create rules and 1. To ensure that the nurse’s decisions and regulations to enforce the statutory laws. actions are consistent with current legal  Administrative bodies when rules principles. and regulations are passed. 2. To protect the nurse from liability. b) Common Law – Laws evolving from court decisions. Common Law is CLO#1: Define the following terms related to rights, continually being adapted and expanded. responsibilities and regulation of nursing practice.  Judicial decisions made in court.  stare decisis – “To stand by things decided” – usually DEFINTION OF TERMS referred to as “following precedent”. 1. Rights – Is a privilege or fundamental power to which an individual is entitled unless it is c) Statutory Law – Laws enacted by any revoked by law or given up voluntarily. legislative body. These acts, however,  Every human being is created in the must be consistent with constitutional image and likeness of God vested with and federal provisions. inherent human rights.  Created by legislative bodies.  A moral power of profounded claimed to do, to hold or to receive something from d) Public Law – Refers to the body of law others. that deals with relationships between  One is entitled to have or to do. individuals and the government and governmental agencies. 2. Responsibility – Is the obligation associated with a right. Involves accountability to a certain e) Criminal Law – Deals with actions task and is associated with a right. against the safety and welfare of the  Social future that binds your obligation. public.  State of being accountable  Present harm to society. MINGUITO, SHANIA D. | BSN1B 1  f) Private Law or Civil Law – The body of client, the greater the need for law that deals with relationships among written permission. private individuals. Types of Specialties: c) Implied Contract – Exists when the  Contract Law – Involves the individual’s nonverbal behavior enforcement of agreements indicates agreement. among private individuals or the  Not written. payment of compensation for failure to fulfill agreements. 8. Res ipsa loquitor – Latin, “The thing speaks  Tort Law – Defines and enforces for itself”, that the injury could not have happened if someone was not negligent that no It is important for nurses to keep their legislators informed about nursing because it is the legislature that passes laws that further proof is required. In some cases, the affect nursing practice. harm cannot be traced to a specific health care provider or standard but does not normally occur unless there has been a negligent act. An example is harm that results when surgical 4. Privilege – A special right to a person. instruments or bandages are accidentally left in  An immunity attached to a person. a client during surgery.  Something you cannot have or do  A rule of evidence that allows that proof unless you first granted permission. that injury cured established a presumption of negligence at the party 5. Power – An entity’s or individual’s ability to of the defendant. control or direct others.  Possession or control, authority or legal 9. Nursing Jurisprudence – A branch of law power. which deals with the study of nursing law. Law  Able to command individuals. affecting nursing practice. The application of the  To grant authority or legal powers. principles of law as they relate to the nursing practice. 6. Empowerment – Process by which we facilitate the participation of others in decision making 10. Professional Adjustment – The growth of the and take action within an environment where whole individual and the developmental of his there is an equitable distribution of power. physical, mental, emotional, social and spiritual Delegated authority or power given to an capabilities. individual.  Growth of an individual development in his or her capabilities. 7. Contracts – Written or exchange of services or will give you services. It is a promise or a set of promises which the law recognizes as a duty 11. Duties – It is the obligatory tasks, conduct, and when that duty is not performed, the law service or function that arise from one’s position. provides a remedy. The nurse must have (or should have ha