Ethico-Legal and Moral Considerations in Nursing Management & Leadership PDF

IV. Ethico-Legal and Moral Considerations in Nursing Management and Leadership DR. ANNE ROSE L. CALIMLIM, MAN, RN  Values refers to However, the term Values provide a In nursing, values Some common the worth of an values refers to frame of reference are the...

IV. Ethico-Legal and Moral Considerations in Nursing Management and Leadership DR. ANNE ROSE L. CALIMLIM, MAN, RN  Values refers to However, the term Values provide a In nursing, values Some common the worth of an values refers to frame of reference are the values in nursing object or a thing. how individuals act as pilots to fundamental include feel about ideas, guide behaviors ethical and moral compassion, situations and and assist people standards that integrity, respect, concepts. in making underpin the and advocacy. Individuals choices. profession. They incorporate values form the as part of their foundation for the conscience and nurse's actions, worldview. interactions, and relationships with patients, families, and colleagues. Values Value Systems A value system is a set of related values. 1.Intrinsic values are those related to sustaining life, such as food and water. 2.Extrinsic values are not essential to life. They include the value of objects, both physical and abstract. Things, people, and material items are extrinsically valuable. 3.Personal values are qualities that people consider important in their lives. Concepts such as strong family ties and acceptance by others are personal values. 4.Professional values are qualities considered important by a professional group. Autonomy, integrity, and commitment are examples of professional values. Value Systems Values also generate the standards by which Often people adopt the people judge others. For values of other individuals People’s behaviors are example, someone who they admire. For example, motivated by values. values work more than a nursing student may Patients who have leisure activities will look begin to value humor after traumatic brain injuries down on a coworker who observing it used may overcome refuses to work throughout effectively with patients. tremendous barriers the weekend. A person Values provide a guide for because they value who believes health is decision-making and give independence. Race car more important than additional meaning to life. drivers may risk death or wealth would approve of Individuals develop a other serious injury spending money on a sense of satisfaction when because they value relaxing vacation or they work toward competition and winning. perhaps joining a health achieving values they club rather than investing believe are important. in money.  Values can be taught directly, incorporated through societal norms, and modeled through behavior. How Values are Children learn by watching their parents, friends, teachers, and religious leaders. Developed Through continuous reinforcement, children eventually learn about and adopt values as their own. Because of the values they hold dear, people often make great demands on themselves and others, ignoring the personal cost. For example: Sara grew up in a family where educational achievement was highly valued. Not surprisingly, she adopted this as one of her own values. Sara became a doctor, got married, and had a son Dino. She placed a great deal of effort on teaching her son the same values in order to get him into the best private school in the area. As he moved through the program, his grades did not reflect his mother’s great effort, and he felt that he had disappointed his mother as well as himself. By the time he was 13, he was so pressured that he turned to drugs to escape from reality. How Values are Developed Values can change with experience and maturity. For example, young children often value objects, such as their favorite blanket or toy. Older children are more likely to value a specific event, such as a family vacation. As children enter adolescence, they place more value on peer opinions than those of parents. Young adults often place value on certain ideals such as heroism. The values of adults are formed from all these experiences as well as from learning and thought. Choices are influenced by values. The way people use their own time and money, choose friends, and pursue a career are all influenced by values. Values Clarification Values Clarification Choosing 1. Choosing freely. After researching alternative career options, you 2. Choosing from alternatives. freely choose nursing school. This choice was 3. Deciding after considering the most likely influenced by such factors as consequences of each alternative. educational achievement and abilities, finances, support and encouragement from others, time, and feelings about people. Prizing 4. Being satisfied about the choice. Once the choice was made, you were satisfied 5. Being willing to declare the choice to with it and told your friends about it. others. Acting 6. Making the choice a part of one’s You entered the school and started the journey worldview and incorporating it into towards your new career. Later in your career, behavior. you decide to return to school for a master’s 7. Repeating the choice. degree in nursing.  Morals arise from an individual’s conscience. They act as a guide for individual behavior and are learned through family systems, instruction, and socialization. Morals Morals find their basis within individual values and have a larger social component than values. They focus more on “good” versus “bad” behaviors.  Although the terms morals and ethics are often used interchangeably, ethics usually refers to a standardized code as a guide to behaviors, whereas morals usually refers to an individual’s personal code for acceptable behavior. Ethics: Part of philosophy that deals with the rightness or wrongness of human behavior. It is Ethics also concerned with the motives behind that behavior. Bioethics: the application of ethics to issues that pertain to life and death. The implication is that judgements can be made about the rightness or goodness of health-care practices. Ethical Theories 1. Deontological theories Deon (Greek word) means duty. Originated from 18th century philosopher Immanuel Kant (1949). Deontological ethics, also known as duty-based ethics, is a theory that emphasizes the inherent rightness or wrongness of an action, regardless of its consequences. This means that an action is morally right if it is in line with a moral duty or obligation, and morally wrong if it violates that duty or obligation. Deontological ethics is based on the idea that there are certain moral rules or duties that individuals must follow, regardless of the outcome. These rules or duties are often derived from religious or philosophical principles and are considered to be universal and unchanging. Ethical Theories 2. Teleological theories Originated from David Hume (1978). Also known as consequentialist ethics, is a theory that emphasizes the consequences or outcomes of an action. In other words, teleological ethics judges the morality of an action based on the end result, rather than the action itself. This means that an action is morally right if it leads to a good outcome or consequence, and morally wrong if it leads to a bad outcome or consequence. Teleological ethics can be broken down into two main categories: egoism and utilitarianism. Egoism is the belief that individuals should act in their own self-interest, while utilitarianism is the belief that actions should be taken to promote the greatest happiness for the greatest number of people. Ethical Principles Ethical codes are based on principles that can be used to judge behavior. Ethical principles assist decision making because they are a standard for measuring actions. They may be the basis for laws, but they themselves are not laws. Laws are rules created by governing bodies. Laws operate because the government holds the power to enforce them. The following are several of the ethical principles that are most important to nursing: autonomy, nonmaleficence, beneficence, justice, fidelity, confidentiality, veracity and accountability. 1. Autonomy Freedom to make decisions for oneself. Nurses need to respect patients’ rights to make their own choices about treatments. Closely linked to the ethical principle of autonomy is the legal issue of competence. A patient needs to be deemed competent in order to make a decision regarding treatment options. When patients refuse treatment, health-care personnel and family members who think differently often question the patient’s “competence” in making the decision. 2. Nonmaleficence Nonmaleficence requires that no harm be done, either deliberately or non- deliberately. The principle of nonmaleficence also requires nurses to protect individuals who lack the ability to protect themselves because of their physical or mental condition. Often, treatments meant to improve patient health may lead to harm. This is not the intention of the nurse or of other health-care personnel, but it is a direct result of treatment. The obligation to do no harm extends to the nurse who for some reason is not functioning at an optimal level. 3. Beneficence The principle of beneficence demands that good be done for the benefit of others. Beneficence is caring in the truest sense, and caring fuses thought, feeling and action. It requires knowing and being truly understanding of the situation and the thoughts and ideas of the individual. 4. Justice The principle of justice obliges nurses and other healthcare professionals to treat every person equally regardless of gender, sexual orientation, religion, ethnicity, disease or social standing. Based on this principle, all individuals should be treated and judged by the same criteria. 5. Fidelity The principle of fidelity requires loyalty. It is a promise that the individual will fulfill all commitments made to themselves and to others. For nurses, fidelity includes the professional’s loyalty to fulfill all responsibilities and agreement expected as part of professional practice. Fidelity is the basis for accountability-taking responsibility for one’s own actions. 6. Confidentiality The principle of confidentiality states that anything patients say to nurses and other healthcare providers must be held in strictest confidence. Confidentiality presents both an ethical and legal issue. Exceptions only exist when patients give permission for the sharing of information or when the law requires the release of specific information. Sometimes simply sharing information without revealing an individual’s name can be a breach of confidentiality if the situation and the individual are identifiable. 7. Veracity Veracity requires nurses to be truthful. Truth is fundamental to building a trusting relationship. Intentionally deceiving or misleading a patient is a violation of this principle. 8. Accountability Accountability is linked to fidelity and means accepting responsibility for one’s own actions. Nurses are accountable to their patients and to their colleagues. If something was not done, do not chart it and tell a a colleague that it was competed. Case Analysis Mrs. Liu was admitted to the oncology unit with ovarian cancer. She is scheduled to begin chemotherapy treatments. Her two children and her husband have requested that the physician ensure that Mrs. Liu not be told her diagnosis because they believe she would not be able to cope with it. The physician communicated this information to the nursing staff and placed an order in the patient’s electronic medical record. After the first treatment, Mrs. Liu became very ill. She refused the next treatment, stating that she did not feel sick until she came to the hospital. She asked the nurse what could possibly be wrong with her that needed a medicine that made her sick when she did not feel sick before. She then said, “Only people who get cancer medicine get this sick! Do I have cancer?” Case Analysis Mr. Smith was found on the street by the police, who brought him to the emergency department. Mr. smith was dirty, unshaven and covered with blood. His diagnosis was chronic alcoholism, complicated by end- stage liver disease. Several nursing students overheard the staff discussing Mr. Smith and that no one wanted to care for him because he was dirty and smelly, and that he brought this condition on himself. Case Analysis Ms. Allen has been told that her father suffers from Alzheimer’s disease. The nurse wants to come in the home to discuss treatment options. Ms. Allen refuses, telling the nurse that they should not tell her father the diagnosis. Ms. Allen bases her concern on past statements made by her father. She explains to the nurse that if her father finds out his diagnosis, he will take his own life. The nurse provides information on the newest treatments and medications that might help. However, these treatments and medications are only available through a research study. To participate in the study, the patient needs to be aware of the benefits and the risks. Case Analysis Ali and Dave attended nursing school together and developed a strong friendship. They work together on the pediatric ward in PRMMH. Ali made a medication error that she decided not to report, which resulted in the child being transferred to the intensive care unit. Dave realized what happened and confronted Ali, who begged him not to say anything. Dave knew the error had to be reported, but how would this affect his friendship with Ali? What would you do in this situation? Resolving Ethical Dilemmas Assessment What are the medical facts? What are the psychosocial facts? What are the cultural beliefs? What are the patient’s wishes? What values are in conflict? Resolving Ethical Dilemmas Planning Determine the goals of treatment. Identify the decision makers. List and rank all options. Resolving Ethical Dilemmas Implementation During the implementation phase, the patient or decision maker and members of the health care team reach a mutually acceptable decision. The role of nurse during the implementation phase is to ensure the communication remains open. Once an agreement is reached, the decision makers must accept it. Sometimes an agreement cannot be reached because parties are unable to reconcile their conflicting belief patterns or values. Sometimes, caregivers are unable to recognize the worth of the patient’s point of view. Occasionally, the patient or surrogate may make a request that is not institutionally or legally possible. Resolving Ethical Dilemmas Evaluation The purpose of evaluation in resolving ethical dilemmas is to determine whether the desired outcomes have occurred.