NCMA218 FINAL.pdf

Bachelor of Science in Nursing 2YC NCMA218: BSN 2ND YEAR SUMMER FINAL 2022 Coverage for Final: Modules 10-17 ating mga prejudices, biases, values na iimpose sa patient. The Nursing Roles and Responsibilities on Euthana...

Bachelor of Science in Nursing 2YC NCMA218: BSN 2ND YEAR SUMMER FINAL 2022 Coverage for Final: Modules 10-17 ating mga prejudices, biases, values na iimpose sa patient. The Nursing Roles and Responsibilities on Euthanasia, people who usually wish the end of life is. What ever it is that Advance Directives and DNR fall under the basic needs of the patient or ordinary measures Bioethics and Research and Guidelines in Documentation that are needed to sustain the life we still continue that) Ethical Consideration in Leadership Management 3. Prevention and alleviation of suffering. (if terminal cases we Meaning and Service Value of Medical Care need to accept the fact together with the patients that they will Ethical Issues Related to Technology in the Delivery of suffer. For example, emotionally, disfigurement, etc. we Health Care cannot prevent suffering because it is natural therefore, we can Continuing Education Program on Ethico-Moral Practice only comfort them through the process.) in Nursing Integration of all Ethical Theories and Principles Therefore, nurses should be clear about the: Ethical foundation of their own views on medical aid in dying (Place yourself in the position of the patient) ETHICO-MORAL RESPONSIBILITY OF NURSES Discussed by Prof. Ma. Diosul Roque Personal and professional values related to end-of-life Euthanasia options and care to help them recognize the conditions to - The delivery of high-quality, compassionate, holistic and which they may wish to conscientiously object (the time will patient-centered care, including end-of-life care, is central to come that they will ask you to do contrary to your conscience nursing practice. at nag pasabi kana na object ka at dpt malinaw ito sa umpisa - Means cutting the life of a person either aided by the person or pa lang. conscience expression advantage is you will not be the patient itself forced to do it.) - Euthanasia is inconsistent with the core commitments of the nursing profession and profoundly violates public trust. Therefore, the American Nurses Association supports - Nurses are ethically prohibited from administering medical aid recommendations that nurses: in dying medication. Yet they must be comfortable supporting - It is a shared responsibility of professional nursing patients with end-of-life conversations, assessing the context organizations to speak for nurses collectively in shaping health of a medical aid in dying request (hindi tayo snag bibigay ng care. Hence it supports recommendations that nurses: gamot para makapatay. How do you deal with the patient 1. Remain objective when discussing end-of-life options suffering too much that wants to die “nurse tanggalin mo na with patients who are exploring medical aid in dying. ung ventilator, bigyan mo nkong gamot na-nakaka overdose” 2. Have an ethical duty to be knowledgeable about this we have to have active listening to the patient means we don’t evolving issue. get easily distracted, we stay focused to the patient, and listen 3. Be aware of their personal values regarding medical aid in attentively) dying and how these values might affect the patient-nurse - Nurses should reflect on personal values related to medical aid relationship. in dying and be aware of how those values inform one’s ability 4. Have the right to conscientiously object to being involved to provide objective information in response to a patient’s in the aid in dying process. request. (magbibigay ka ng info pero sasalungatin mo, we 5. Never “abandon or refuse to provide comfort and safety should always remember the fact to be alert. In no manner measures to the patient” who has chosen medical aid in should our decision be subjectively base on our personal dying (Ersek, 2004, p. 55). Nurses who work in decision.) jurisdictions where medical aid in dying is legal have an 2 options of end-of-life obligation to inform their employers that they would 1. Medical aid in dying – patient with terminal illness, self- predictively exercise a conscience-based objection so that determination, voluntary choice and informed request to self- appropriate assignments could be made. administer medication to hasten death 6. Protect the confidentiality of the patient who chooses 2. Euthanasia – occurs when someone other than the patient medical aid in dying. (This is not something to talk in the administers medication in any form with the intention of group and not something to be shared who is not direct hastening the patient’s death provider of care to the patient) Hallmarks of end-of-life care 7. Remain objective and protect the confidentiality of health - include respect for patient self- determination, nonjudgmental care professionals who are present during the aid in dying support for patients’ end-of-life. Preferences and values and process, as well as the confidentiality of those who choose prevention and alleviation of suffering not to be present. 1. Respect for patient self-determination (end of life care is 8. Be involved in end-of-life policy discussions and just like any other matters that concern patient care, also development (Ersek, 2004) on local, state, and national allows patient to exercise his right to self-determination, the levels, including advocating for palliative and hospice right to decide for himself, exercise autonomy and give his full care services. consent) 9. Furthermore, research is needed to better understand the 2. Nonjudgmental support for patients’ end-of-life phenomenon. (Phenomenon kung bakit ung ibang tao preferences and values (as a nurse hindi dpat pumasok ung pinipili euthanasia. I-research ntin ung dpt na approach sa J.A.K.E 1 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 pt.para kung ano ung gusto mong gawin sayo sa ganung natuklasan pa alng makakapag pagaling na e kaso Nakagawa sitwasyon ganun dpt gawin mo sa ptient mo) na ng advance directive) 10. Important that nurses are clear about the ethical Uncertainty over who can/should be a health care agent, foundations of their own views on medical aid in dying. especially for individuals without available (or willing) family. 11. Clarity about personal and professional values related to end-of-life options and care can also help nurses Nursing Role and Responsibilities recognize the conditions to which they may wish to Whatever the work setting, nurses have a key role and conscientiously object responsibility in ensuring that patients have an opportunity to complete advance directives, and in interpreting and following Advance Directives through with patient’s wishes as expressed through these - Is a legal document in which a person specifies what actions directives. should be taken for their health if they are no longer able to As nurses, we need to know our state’s statutes that guide and make decisions for themselves because of illness or incapacity. govern advance directives. (What kind of medication should be given to the patient or We also need to be aware of the policies and procedures who is tasked to decide if something happens to the patient) regarding advance directives where we work. (court will - Advance directives are written, legally-recognized documents decide kung pwede pang baguhin ung ginawang advance that state your choices about health- care treatment or name directive ng pt.) someone to make such choices for you if you are not able to do so (Reyes, 2010). - nurses have a key role and responsibility in ensuring that patients have an opportunity to complete advance directives, and in interpreting and following through with patient’s wishes as expressed through these directives. - As nurses, we need to know our state’s statutes that guide and govern advance directives - be aware of the policies and procedures regarding advance directives where we work Purposes Appointment of health care proxy Make decision and guide doctors about life sustaining procedures in the event of terminal condition, persistent vegetative state and end stage condition i.e DNR, Pain management, Organ Donation, Euthanasia. (Should be treated as regular basis or should be given higher doses? Does the patient decide for organ donation?) Ethical Decision-Making Process Forms Problem Analysis Living will - A problem is a discrepancy between the current situation and a Health care proxy desired state. Problems are usually unplanned and often Health care power of attorney – specific for health care only. unexpected. They may be simple or complex, routine or moral. Pero pag power of attorney lang it is for how patient will be Before you can begin to solve a problem, you must be able to taken care of and the finances identify and categorize it. Advantage Moral Uncertainty Unnecessarily prolonged painful hospitalization - occurs when we sense that there is a moral problem, but are Prevents unnecessary prolonged comatose or vegetative state not sure of the morally correct action; (pumapasok na ung kaisipan kung tatanggalin na ba or hindi Moral/ethical dilemma ung life support) - A dilemma is a problem that requires a choice between two Prevents burden of rising medical costs (meron kasing family options that are equally unfavorable and mutually exclusive. na inadequate sa budget) Releases responsibility of love ones of difficult decisions Pattern of decision making (meron nang sariling desisyon ung pasyente para ung maiiwan 1. Recognizing a problem nyng kamag anak hindi na mahihirapn mag decide for him) 2. Gathering data Disadvantage 3. Comparing options/action implies uncertainty – list of options Family or loved ones may disagree with your medical 4. Making a choice/implemented decision decisions. (dumating na ung time na nag aagaw buhay ung pt. kaya ung family sabi gawin lahat kaso bago ka mamatay Nursing Process and Ethical Decision Making sinabi mo ng wag ka ng buhayin) Ethical decision-making models are related to nursing care in Difficulty in predicting what treatments will be available and the ethical realm in the same way that the nursing process is preferred in a “future” crisis. (pag meron ka ng advance related to nursing care in the physical realm. directive bawal na siyang bawiin, baka bawiin kase may As nurses we commonly use the nursing process model for decision making. J.A.K.E 2 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Utilizing logical thinking and intuitive knowing, the nursing 3. Human experiments should be based on previous animal process is a deliberate activity that provides a systematic experimentations. method for nursing practice 4. Experiments should be conducted by avoiding physical/mental suffering and injury Attributes of an Effective Ethical Decision Maker 5. No experiments should be conducted if it is believed to cause 1. Moral integrity – binds all of a person’s moral virtues into a death /inquiry (kaya meron animals’ experiments muna) coherent package it creates a wholeness and stability of 6. The risks should never exceed the benefits character that leads to trustworthiness. (kabuuan ng buong 7. Adequate facilities should be used to protect subjects opag katao mo at walang pwedeng makasira nito dahil nabuo 8. Experiments should be conducted only by qualified scientists na ‘to simula nung pag ka bata mo) 9. Subjects should be able to end their participation at any time 2. Sensitivity, compassion, and caring - they hear what patients 10. The scientist in charge must be prepared to terminate the say and understand the meaning experiment when injury, disability or death is likely to occur 3. Responsibility. - has a sense of duty to the patient, an Declaration of Helsinki obligation to do whatever is necessary, within reason, to care - Statement of ethical principles for medical research involving for the patient or solve a problem human participants, including identifiable human material and 4. Empowerment - suggests that a person has self-confidence data; doctors doing medical research on patients (basis for that he or she can effect change. (paano ka na-eempower to do good clinical practice) things) For all involved in medical research 5. Patience and willingness to deliberate Basis for Good Clinical Practice (GCP) General Principles What will you do…? Purpose: understand disease, improve interventions (like covid 1. In the case of a terminally ill patient. While most would think vaccines) it is morally right to preserve life, many would believe it is Human participants necessary morally wrong to prolong suffering. Primacy of patient’s best interest: health, well-being, rights 2. In deciding who must have the priority to get a critical care bed. Should the decision be made relative to who is most Duty and responsibility of researcher even if with consent of deserving, who arrives first, who can pay, or who has the best participants (treat subject properly) chance of survival? Subject to ethical standards: International and national 3. Would you rather make your own life/death situation via A.D. guidelines cannot reduce Helsinki or let your loved ones do the decision making? Respect and protect participants 4. If you are the medical power of your comatose mother would Minimize harm to environment you have the strength to obey their advance directive if it Qualified researcher stated to turn of the respirator to ease their suffering? Fair access to research Risks, Burdens, and Benefits Thoughts to ponder Pre-assess then monitor “End of life decisions should not be made at the end of life” Importance of objectives outweigh R/B for participants. (mag desisyon kana habang kaya mo pa essence ng advance Benefits outweigh risks for participants and groups affected directives kase dk ana makakapag desisyon kapag mamamatay and managed kana) Measures to minimize implemented Just because you talk about death it doesn’t mean you are Once risks outweigh the benefits or if there is already a clear gonna die right now outcome: assess if research should be continued Be brave enough to start a conversation that matters Vulnerable Groups and Individuals Increased likelihood of wrong and harm – Special protection BIOETHICS AND RESEARCH AND GUIDELINES IN Responsive to their health needs DOCUMENTATION Cannot be done on non-vulnerable Discussed by Prof. Ma. Diosul Roque Stand to benefit from result Principles of Ethics and Research Scientific Requirements and Research Protocols Nuremberg code of 1947 Conform to accepted scientific principles - formulated 50 years ago, in august 1947 in Numberg Germany Respect animals by American judges sitting in judgement of Nazi doctors Complete protocol including addressed ethical considerations accused of conducting murderous and torturous human Post-trial provisions indicated experiments in the concentration camps (the so -called Doctors Research Ethics Committees Trial). (kinukuha mga prisoners for trials at bawal silang tumanggi) Transparent, independent, and qualified Ethics principles for human experimentation resulting Follow norms from Nazi Approve protocol Focus on human rights and welfare Monitor study, approve amendments, and receive final report Privacy And Confidentiality – protect the privacy of research 10 Elements of The Numberg Code subjects (hindi identified ung taong kukuhanin mo) 1. Voluntary consent is essential Informed Consent – for capable: voluntary, informed. For not 2. The results of any experiment must be for the greater good of capable: legally authorized representative; society J.A.K.E 3 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Belmont Report 1976 Guidelines and Protocol in Documentation and Health Care - Emphasize netizens justice and respect for human person Records - One of the leading works concerning ethics and health care The NCCS Documentation Standard research - Documents are permanent legal records that provide a - Primary purpose: protection of subjects and participants in comprehensive sequential description of relevant facts, data, clinical trials or research studies and information about the patient’s health status. - Consists of three principles beneficence, justice and respect for - Documentation of nursing actions done to a patient is critical persons to determine if the expected standard of care was rendered to a - A report created by the national commission for the protection particular patient. of human subjects of biomedical and behavioral research Importance of documentation - summarizes ethical principles and guidelines for research 1. Facilitates interdisciplinary communication involving human subjects 2. Coordinates care - The Belmont Report is a report created by the National 3. Provides information Commission for the Protection of Human Subjects of 4. Serves as bases for reimbursement Biomedical and Behavioral Research 5. Reflects quality and timeliness of nursing care - Was written in response to the infamous Tuskegee syphilis 6. Is utilized as legal document during permissible courtroom study in w/c African American with syphilis were lied to and Characteristics Of Good Documentation denied treatment for more than 40 years. Many people died as 1. Factual result infected others with the disease and passed congenital 2. Complete syphilis onto their children 3. Current (Timely) - Also brought forth the creation of the national human 4. Organized investigation board as well as the request for the creation of 5. Compliant with standards institutional revive boards (IRBs) 6. Accurate The three fundamental ethical principles for using any human Guidelines In Documentation subjects for research are: 1. Objective/Factual Documentation Direct observations and 1. Respect for persons: protecting the autonomy of all people objective descriptions of interventions rendered to clients are and treating them with courtesy and respect and allowing for recorded informed consent. (Information, comprehension and 2. Timeliness Refers to completion of health care notes voluntariness) immediately within time specific care 2. Beneficence: the philosophy of "Do no harm" while 3. Use of Space Empty lines or spaces are avoided to prevent maximizing benefits for the research project late-entry of data. 3. Justice: ensuring reasonable, non-exploitative, and well- 4. Use of Abbreviations Abbreviations or acronyms that are considered procedures are administered fairly internationally/institutionally accepted 5. Follow-up All follow-up activities related to client care Ethical Issues Related to Evidenced Based Practice 6. Correcting Errors In isolated cases when errors in - Evidence-base practice is a systematic inter connecting documentation are committed it is advised that the SLIDE rule scientifically generated evidence with the tacit knowledge of (Baker, 2000) be utilized the expert practitioner 7. Recording Medication Administration Administration of Ethical issues involved in EBP medications are immediately documented after administration 1. Status of evidence 8. Recording Assistance with Care There are numerous 2. Client Autonomy circumstances that one nurse is assisted by another nurse in 3. Conflict of interest performing a specific nursing intervention Ethico-Moral Obligations of The Nurse In Evidence-Based 9. Designated Recorder in Emergency Situations During Practices emergency situations there must be a designated recorder 1. Golden Rule 10. Clarification of Orders Medical orders that are poorly written 2. The principle of Totality – The whole is greater than its parts require nurses to call the writer for clarification. 3. Epikia – There is always an exemption to the rule 11. Recording a Telephone Conversation with a Client Telephone 4. One who acts through as agent is herself responsible – conversation with a client does not give the nurse the benefit instrument to the crime, accessory or accomplice of verifying objective findings 5. No one is obliged to betray herself – You cannot betray 12. Interactions with other Health-care Professionals It is the yourself responsibility of the nurse when formulating nursing care 6. The end does not justify the means plans to include outcomes 7. Defects of nature maybe corrected 13. Client Education Educational interventions and related health 8. If one is willing to cooperate in the act, no justice is done to teachings that provide comprehensive information to clients him must be documented 9. A little more or a little less does not change the substance of 14. Documenting an Incident in the Health-care Record It is an act. imperative that all incidents that occured with its 10. No one is held to impossible corresponding pertinent data are documented in the client’s health record. J.A.K.E 4 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 ETHICAL CONSIDERATION IN LEADERSHIP - fails to see a sin when actually there is one, tends to minimize MANAGEMENT its seriousness. Discussed by Dean Maria Luisa Uayan Moral Decision – Making Degrees of Moral Certitude Right Certain Wring - the judgment about the goodness or evil of a particular action Forbidden that is made without fear of being mistaken Duty Doubtful/Probable Good - the suspension of judgment on the moral goodness or evil of Corrupt action because the intellect cannot see clearly whether it is - refers to the ability to discern what is morally right from good or bad (doing good but gone wrong) morally wrong that requires moral reflectiveness on the Perplexed meaning of good and bad, Olson (2002) - when one is compelled to choose between two evils. (Of two - It refers to ability to draw conclusions from the evils, choose the least.) discernment to develop convictions. - discernment – wisdom, clarification, study the facts Principles of Well – formed Conscience - Moral – is a discernment wherein deliberating the issue - Informed consent to medical treatment is fundamental in both existing hindi ka lang basta basta umoo or nag a-agree ethics and law. pero kinikilatis mo sya - Patients have the right to receive information and ask questions about recommended treatments so that they can Four Principles of Moral Discernment/Judgment make well-considered decisions about care. Principle of Formal Cooperation - it occurs when someone intentionally helps another person Strategies of Moral Decision – Making Process carry out a sinful act. Ethical Dilemma Principle of Material Cooperation - is a problem in the decision-making process between two - when a person's actions unintentionally help another person do possible options, neither of which is absolutely acceptable something wrong. from an ethical perspective; Principle of Lesser Evil - Ex. thief. Bakit ang mga magnanakaw hindi nahuhuli? Edi - The principle that when faced with selecting from two yung dilemma mo naman is “ay ok lang naman pala mag immoral options, the one which is least immoral should be nakaw eh kase sila hindi nga nahuhuli, edi ako din chosen. The gravity, the impact. Kahit maliit na aksyon even magnanakaw nalang” (mga teh wag nyo gagawin yun ah? less or great evil kapag nag participate ka evil pa din kahit kapit na tayo sa patalim HAHAHAHAHA) Principle of Double Effect Process of Ethical Decision Making - This principle aims to provide specific guidelines for 1) Gather data and identify conflicting moral claims determining when it is morally permissible to perform an 2) Identify key participants – wag isali ang mga dapat hindi na action in pursuit of a good end in full knowledge that the kasali. Focus on who will receive the big impact action will also bring about bad results. 3) Determine moral perspective and phase of moral development Conscience of key participants – 7 ethical principles - the act by which we apply to our own conduct our knowledge 4) Determine desired outcomes – something good of good and evil, whether our judgment be correct or incorrect. 5) dentify options – alternatives - to seek wisdom 6) Act on the choice - Ex. Yung sa Ateno. Doctor ang bumaril, think of this na ang 7) Evaluate outcomes of actions – masaya ka ba? Did God haba ng ginugol nya sap ag aaral to get that degree but look become happy with your decision? what he did to the ex-Mayor of basilan, he shoots the ex- mayor kase nga feeling nya grabe yung pang aapi sakanya, MEANING AND SERVICE VALUE OF MEDICAL CARE grabe yung suffering na binigay sakanya. Nagiging mali ang Discussed by Dean Maria Luisa Uayan pananaw natin sa suffering. Allocation of Health Resources Cost-effective Types of Moral Attitude - limited resources for health should be allocated to Callous maximize the health benefits for the population served - not feeling or showing any concern about the problems and - Quantititave ka pero quality ang nakuha mo suffering of other people - Sa kunting gastos nakakuha ka ng benefits Strict - one who chooses the hardest way to do something - Equity means giving more to the person who needed the Pharisaical most. - marked by insincere self-righteousness - Costs are measured in monetary terms; benefits are measured Scrupulous in health improvements. - involves one who is being overly critical of himself. Such a - Cost-effectiveness is not merely an economic concern, person always has a fear of sinning when there is no sin, or is because improving people's health and well-being is a moral in constant doubt, and/or is in fear of committing a mortal sin; concern, and an allocation of resources that is not cost- tends to see sins when there is none effective produces fewer benefits than would have been Lax possible with a different allocation J.A.K.E 5 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Equity Reducing Healthcare Costs - is concerned with the distribution of benefits and costs to - New technology is a great way to reduce costs, offer better distinct individuals or groups. patient care, and encourage innovation. With the right insights - Equity in health care distribution is complex and embodies and data, developers can give the healthcare industry much several distinct moral concerns or issues that this chapter more efficient, cheaper, and faster treatment options. delineates (Brock 2003a) Issues involving access to care 1) Access to Quality Care - Patients want to be able to access their healthcare when they want and need it. 2) Geographic and Manpower Shortage 3) Limited education 4) Poor infrastructures 5) Cost – kahit walang babayaran sa hospital pero yung mga cost sa byahe, pagkain ganun 6) Scientific evidence vs Cultural Practice ETHICAL ISSUES RELATED TO TECHNOLOGY IN THE DELIVERY OF HEALTH CARE Discussed by Dean Maria Luisa Uayan Predicting Epidemics - Various scientific fields, particularly medical science, have seen a lot of technological innovation in the last few decades. Such advancements include the use of natural language processing, medical image processing, and deep learning techniques. The influence of AI has added a lot of potential in the healthcare sector to predict diagnoses faster. Avoiding Preventable Deaths - According to healthcare and health industry leaders, using information technology enhances patient safety by preventing medical errors, assessment errors, and surveillance system with rapid response and reduces the risk of harm. - Information technology improves the healthcare system, regardless of the type of technology used, by one of the followings: documentation (test results, clinical reports, recommendations, and consultation), providing communication between the patient and each other providers, facilitating data entry, identification, and evaluation of risks. Improving quality of life/quality care - Health information technology presents numerous opportunities for improving the advancement of medical technology and is vital to the field's continued development. Modern medications, monitoring equipment, laboratory services, and imaging devices have all made significant contributions to medical progress in terms of improving quality care. Reducing Healthcare Waste - Health care facilities generate a tremendous amount of waste in the course of treating patients. They generate “regulated medical waste” or infectious waste, hazardous chemical waste, recyclable, reusable, and solid waste. J.A.K.E 6 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 - In order to fulfill the medical ethic to “do no harm,” it is the - As developers create AI systems to take on these tasks, several responsibility of the health care industry to create and risks and challenges emerge, including the risk of injuries to implement waste disposal policies. patients from AI system errors, the risk to patient privacy of - Fulfilling this ethic also calls for a cultural shift to consider data acquisition and AI inference, and more. disposal technologies and services as part of a total waste management system. Impersonal patient-healthcare provider relationships Improving Mobility/Access - Interpersonal relationships and information are intertwined - Health information technology (HIT) is an important tool to as essential cornerstones of health care. Although, improve the quality, safety, effectiveness, and delivery of information technology (IT) has begun to develop systems healthcare services in rural communities. HIT can connect that allow patients to enter their own clinical data directly rural patients and providers in remote locations to specialists into computer systems, using automation and integration in urban areas. tools. We are not even close to realizing its full potential. - Key components of HIT can include: Electronic health Indeed, issues related to mismanaging health information records (EHR), Electronic transmittal of medical test results, often undermine relationship-centered care. Information Telehealth applications to increase access to providers, technology must be implemented in ways that preserve and Telemonitoring applications that allow patients to transmit uplift relationships in care. vitals or diagnostic information to providers remotely, Connectivity Electronic communication between healthcare providers, as - The digital revolution has also resulted in the development of well as patients, Electronic prescribing, Mobile devices and hundreds of health apps. These apps enable patients to monitor tablets to update patient records in real-time and document at their health and disease, provide them with medical the point of care information, allow them access to test results, and prompt Developing New Drugs and Treatments them when it is time to get their check-ups. Also, healthcare - Technologies are helping drug manufacturers go further and apps enable healthcare workers to quickly check on test faster in monitoring patient safety. They’re also helping to results, drug dosing recommendations, and other information reduce costs and promote efficiencies by reducing manual they need urgently. input. - With increased demands placed on home internet connections - Technology that reports back on how patients are faring may and the nation's internet infrastructure, users focused on the help drug manufacturers understand the real effectiveness of quality and affordability of home internet connections. their products and help spot side effects that might otherwise Cost have been missed. It could even help identify emerging - New technology is a great way to reduce costs, offer better problems and help catch them before they escalate. patient care, and encourage innovation. With the right insights Security E.G. Data Hacking/Phishing and data, developers can give the healthcare industry much - One of the biggest advantages to using technology in more efficient, cheaper, and faster treatment options. healthcare is the ease in how data is generated, stored, and Structured methodologies, strong innovation, multidisciplinary transferred between systems and parties. When it works well perspective, and an eye for how to adopt and use these this proliferation in data allows for better healthcare technologies in a clever way can go a long way in making management: from diagnosis to treatment. healthcare better and accessible for all. - But It opens up the potential risk for data to be accessed by Fast and Numerous Changes third parties. Whether intentionally breached by malicious - Healthcare Technology Trends and Innovations have enhanced actors or accidentally exposed, cases abound of patient data the entire experience for both patients and medical making its way into the wrong hands. professionals. - Those who lack advanced cybersecurity expertise may be - healthcare technology will continue to improve in every area. putting the patients who use their systems at risk. Although security will improve across the industry, threats are Volume of Data In Icloud always evolving that must be dealt with through prevention - Cloud computing makes medical record-sharing easier and rather than response. Quality and efficiency of care will safer, automates backend operations, and even facilitates the continue to improve due to groundbreaking and evolving creation, and maintenance of, telehealth apps. technologies like artificial intelligence, machine learning, and - Another great benefit of digital technology is that it allows extended reality. clinicians to gather big data in minimal time. For those Current technology: Issues and dilemma conducting epidemiological studies, research, or clinical trials, digital technology allows for the instant collection of data from a much more diverse and larger population than ever before. - Such data collection allows for meta-analysis and permits healthcare professionals to stay on top of cutting-edge techniques and trends. Dangers with AI central data point - Artificial intelligence (AI) is rapidly entering health care and serving major roles, from automating drudgery and routine tasks in medical practice to managing patients and medical resources. J.A.K.E 7 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Security Justice - The privacy and security of patient health information is a top - Worldwide, digital health is transforming healthcare priority for patients and their families, health care providers systems. It promises to improve population health but may and professionals, and the government. Security breaches also result in health disparities. Adopting a fair approach is threaten patient privacy when confidential health information thus crucial from an ethical standpoint. Among them are is made available to others without the individual's consent or challenges related to digital illiteracy, which leads to authorization. inequities in access to healthcare, truthful information - Without the correct security protocols, patients’ connected sharing to end-users, fully informed consent, and dignity and medical devices may be accessed with the intention of altering fairness in data storage, access, sharing, and ownership. All functionality. In the worst-case scenario resulting in serious stakeholders are responsible for shaping digital health in an device malfunction in life and death situations. ethical and equitable manner. - Cybersecurity risk doesn’t just pertain to the exposure of private data or the ransoms that are sometimes associated with CONTINUING EDUCATION PROGRAM ON ETHICO- data breaches. The risks related to altered data can have MORAL PRACTICE IN NURSING serious consequences. Patients and healthcare professionals Discussed by Dean Maria Luisa Uayan that are relying on data to make treatment decisions depend on - The health care system in a country is often affected by new correct and accurate datasets. If data is deleted or altered it can legislation and regulations. lead to a wrong diagnosis or treatment plan, or other adverse - In the Philippines, the legislative branch of the government events. influences the health system by passing laws to improve the Portability financing, delivery and regulation of the health system, - The ability of software to be transferred from one machine including approval of the annual budget of the Department of or system to another may endanger personal information of Health (DOH) and health facilities under the management of the client. other government agencies. - Even with the most advanced technology, human error can’t - Often, lawmakers create these laws in a vacuum, without ever be erased completely. Mobile devices can be easily lost or having had hands-on experience in a health care facility. stolen, and they’re also vulnerable to hacking, malware, and - As a result, the laws that they create may not operate as viruses (especially if the devices are used on unsecured effectively in health care facilities internet connections). - Nurses can take an active role in the legislative and political Cost process to affect change. - Medical technology has contributed to rising health care - Nurses have an obligation to patients and to the profession to costs. One of the disadvantages of medical technology is the take an interest and take part in the formulation of the legal increased cost of treatment. Almost all treatments and and political infrastructure in which they operate. surgeries involving technology are extremely costly, such as - Keep in mind when lobbying for issues affecting nursing robotic surgery. Other kinds of surgeries using technological practice, any appearance of impropriety must be avoided, or it machinery can be very expensive too.. can endanger your license. - A new technology may bring benefits such as improvements - Payoffs, kickbacks, and gifts of persuasion are illegal, in service delivery or transparency that are worth extra unethical, and certainly unprofessional. expenses. An assessment of the cost-effectiveness and - Political issues of particular interest to nurses fall into four potential benefits should be made before committing to a distinct categories involving moral values, professional new technology. regulation, the health of individuals in society, and distributive Real-Time Events justice. - Utilizing technology can help keep healthcare professionals - Nurses’ opinions on these issues are based upon personal and patients connected, even when they are not physically experience, ethical orientation, religion, cultural bias, and present together. several other factors. - However, the way in which technology has become the Selected Samples of Political Issues interface between patients and providers has the potential to cause issues. - Dealing with dashboards on connected medical devices and computers removes the human touch of treatment, resulting in a lack of empathy towards patient care. Equity - Although there has been significant growth worldwide in access to computers and the Internet, the “digital divide” continues to be a major form of social and economic exclusion for many peoples who are struggling with the use of technology across the globe. - The phrase “digital divide” is everywhere in healthcare IT. It’s typically described as a situation in which economic, educational, and social inequities exist between those who have computers and online access and those who do not. J.A.K.E 8 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Nursing, Policy, and Politics - Informed voting is necessary to enhance nurses’ political - Nurses are in the unique position to bring insight and power to ultimately improve the health of patients and the balance to the policy-making process through knowledge, nursing care that they receive. experience, and intimacy with the health care needs of - Becoming informed involves reading legislative people that newsletters and finding out about policymakers’ - Professional codes of ethics identify the goals and values of backgrounds, voting records, and current party and the profession, and explicitly call for nurses to be involved in candidate platforms. policy formulation. - Discussing your findings with nurse colleagues and others in the community enhances everyone’s understand ding of Nurses’ Roles and Responsibilities in candidates and their positions and facilitates informed Health Policy Formulation voting. - Develop the ability to think, teach, research, and act in ways Joining professional nursing organizations with policy, that are relative to policy advocacy agendas - Be aware of the impact that policies have on health and on - The value of a professional nursing organization is that, clinical practice together, the nursing profession is much mire powerful - Conduct research on health policy issues and find strategic than any individual RN speaking alone ways to influence national policy agendas - Joining a professional nursing organization that has a - Recognize health problems as policy issues as the first step political action committee (PAC) can help develop the toward policy formulation necessary skills to understand and participate in political issues and provide increased access to policymakers. Nursing Political Strengths Working in political candidates’ campaigns - The nursing profession boasts an extremely large number of - Most political candidates are not health professionals and political constituents as it is the most sizable group of health do not fully-understand health-related issues. care providers. Acting together, nurses have the potential to be - By becoming involved in political campaigns, nurses can a formidable political force. (and should) educate and inform candidates about health - Nurses have traditionally been perceived favorably by the care issues. public. Public views nurses with respect, trust, and admiration. - Nurse supporters may also write letters/e-mails to and/or - Once nurses become involved in health policy, they usually call other nurses to tell them about their support of the continue to become active. candidate and to ask for their vote. - Nursing Political Weakness Meeting with policymakers or their staff members - Being relatively new to the political arena, many nurses are - Face-to-face meetings provide a great opportunity for not astute or comfortable in policymaking or lobbyist roles. nurses to educate policymakers about health care issues. - There has historically been a lack of ideological and political - Policymakers are very interested in information that will unity within the profession, a weakness Hadley (1996) increase their knowledge about health care and help them believes stems from the lack of uniform educational develop options for future health care policy. requirements and titles (Western countries). Attending “meet the candidates” meetings - Though nurses comprise the largest number of professionals, - A strategy that nursing association can use to determine they have fewer funds specifically earmarked for intense which candidate(s) to endorse is to invite all candidates lobbying than many other special-interest groups. running for a particular office to a town hall meeting to Lobbying discuss their positions and platforms directly with nurses. - Attempts to influence the passage or defeat of legislation or - This activity will allow the candidates to talk about their attempts to create a favorable climate toward legislation platform to a group of interested likely voters and afford affecting goals or sides of various parties, special interest nurses an opportunity to voice their experiences, opinions, groups, individuals or organizations. and concerns about health care issues and assess the Lobbyist candidates’ view. - An individual who attempts to influence legislation on behalf Communicating with policymakers by e-mail, fax, and of others, such as professional organizations or industries telephone Grassroots Lobbying - Contacting policymakers through letters, e-mail, fax, and - These are actions taken at the local level to influence telephone can be effective if properly planned and policymakers. implemented. - Timing of the communication is important: it should be Effective Grassroots Methods for Nurses made early before policymakers publicly commit to a 1. Registering to vote and voting in all elections certain policy option and to send a follow-up 2. Joining professional nursing organizations with policy, communication immediately before the vote on a advocacy agendas particular bill is scheduled. 3. Working in political candidates’ campaigns 4. Meeting with policymakers or their staff members The ICN Code of Ethics for Nurses 5. Attending “meet the candidates” meetings International Council for Nurses 6. Communicating with policymakers by e-mail, fax, and - The International Council of Nurses is a federation of more telephone than 130 national nurses' associations, representing the more Registering to vote and voting in all elections than 28 million nurses worldwide. J.A.K.E 9 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 - ICN works directly with these member associations on issues - The nurse uses judgement regarding individual competence of importance to the nursing profession. There is no individual when accepting and delegating responsibility. membership to ICN. - The nurse at all times maintains standards of personal conduct - Operated by nurses for nurses, ICN works in the following which reflect well on the profession and enhance its image and areas: public confidence. - Professional nursing practice (e.g., advancing nursing - The nurse, in providing care, ensures that use of technology knowledge to ensure quality nursing care for all and advocacy and scientific advances are compatible with the safety, dignity for sound health policies globally) and rights of people. - Nursing regulation (e.g., credentialing, code of ethics, - The nurse strives to foster and maintain a practice culture standards and competencies) promoting ethical behaviour and open dialogue. - Socio-economic welfare for nurses (e.g., occupational health Nurses and the Profession and safety, human resources planning and policy, - The nurse assumes the major role in determining and remuneration, career development) implementing acceptable standards of clinical nursing practice, - Philippine Nurses Association, with its then-name Filipino management, research and education. Nurses Association was accepted by the International Council - The nurse is active in developing a core of research-based of Nurses as one of the member organizations during the professional knowledge that supports evidence-based practice. congress held in Montreal, Quebec, Canada on July 8–13, - The nurse is active in developing and sustaining a core of 1929. professional values. - The nurse, acting through the professional organisation, ICN Code of Ethics for Nurses 2012 Preamble participates in creating a positive practice environment and - Nurses have four fundamental responsibilities: to promote maintaining safe, equitable social and economic working health, to prevent illness, to restore health and to alleviate conditions in nursing. suffering. The need for nursing is universal. - The nurse practices to sustain and protect the natural - Inherent in nursing is a respect for human rights, including environment and is aware of its consequences on health. cultural rights, the right to life and choice, to dignity and to be - The nurse contributes to an ethical organisational environment treated with respect. Nursing care is respectful of and and challenges unethical practices and settings. unrestricted by considerations of age, colour, creed, culture, Nurses and Co-Workers disability or illness, gender, sexual orientation, nationality, - The nurse sustains a collaborative and respectful relationship politics, race or social status. with co-workers in nursing and other fields. - Nurses render health services to the individual, the family and - The nurse takes appropriate action to safeguard individuals, the community and coordinate their services with those of families and communities when their health is endangered related groups. by a co-worker or any other person. - The nurse takes appropriate action to support and guide co- Four Principal Elements of The ICN Code workers to advance ethical conduct. Nurses and people - The nurse’s primary professional responsibility is to people INTEGRATION OF ALL ETHICAL THEORIES AND requiring nursing care. PRINCIPLES - In providing care, the nurse promotes an environment in which Discussed by Dean Maria Luisa Uayan the human rights, values, customs and spiritual beliefs of the Code of Ethics for Filipino Nurses individual, family and community are respected. - The Health Care Profession - The nurse ensures that the individual receives accurate, - A special calling characterized by a trusting and caring sufficient and timely information in a culturally appropriate relationship which cannot be measured in monetary terms manner on which to base consent for care and related - Health professionals provide essential services that promote treatment. health, prevent diseases and deliver health care services to - The nurse holds in confidence personal information and uses individuals, families and communities. judgement in sharing this information. - The Patient - The nurse shares with society the responsibility for initiating - A person who is waiting for or undergoing medical treatment and supporting action to meet the health and social needs of or care. the public, in particular those of vulnerable populations. - People become patients when they seek assistance because of - The nurse advocates for equity and social justice in resource illness or for surgery. allocation, access to health care and other social and economic Patient’s Individual Rights (15) services. 1) Right to Good Quality Health Care and Humane Treatment - The nurse demonstrates professional values such as 2) Right to Dignity respectfulness, responsiveness, compassion, trustworthiness 3) Right to be Informed of His Rights and Obligations as a and integrity. Patient Nurses and Practice 4) Right to Choose His Physician / Health Institution - The nurse carries personal responsibility and accountability for 5) Right to Informed Consent nursing practice, and for maintaining competence by continual 6) Right to Refuse Diagnostic and Medical Treatment learning. 7) Right to Refuse Participation in Medical Research - The nurse maintains a standard of personal health such that the 8) Right to Religious Belief and Assistance ability to provide care is not compromised. 9) Right to Privacy and Confidentiality J.A.K.E 10 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 10) Right to Disclosure of, and Access to. Information - Repeat back to patient what professional heard that seems 11) Right to Correspondence and to Receive Visitors significant and to ask whether it is what the patient meant 12) Right to Medical Records - Confidentiality –maintain and protect patient’s information 13) Right to Health Education 14) Right to Leave Against Medical Advice Nurses as Professionals 15) Right to Express Grievances Beletz (1990) describes a professional as “one bound by values and standards other than those of his or her employing Patient’s Societal Rights (9) organization, setting one’s own rules, seeking to promote 1) Right to Health standards of excellence, and being evaluated and looing for 2) Right to Access to Quality Public Health Care approval from one’s own professional peers. 3) Right to a Healthy and Safe Workplace Jameton (1984) suggests that being a professional as similar to 4) Right to Medical Information and Education Programs having a calling – “something one feels called upon to do, 5) Right to Participate in Policy Decisions perhaps by God, by some deep need in one’s being, or by the 6) Right to Access to Health Facilities demands of historical circumstance. A calling is central to 7) Right to an Equitable and Economical Use of Resources one’s life and gives it meaning.” 8) Right to Continuing Health Care Reed (2000) proposes that nursing is a spiritual discipline, 9) Right to Be Provided Quality Health Care in Times of “one in which the person is said to be “called” or “launched Insolvency towards others. Patient’s Obligations (16) Ethical Codes 1) Know Rights - Systematic guides for developing ethical behavior 2) Provide Adequate, Accurate and Complete Information - Answer normative questions of what beliefs and values should 3) Report Unexpected Health Changes be morally accepted 4) Understand the Purpose and Cost of Treatment - No code could possibly provide absolute or complete rules that 5) Accept the Consequences of Own Informed Consent are free from conflict and ambiguity 6) Settle Financial Obligations 7) Respect the Rights of Health Care Providers, Health Care Codes of Nursing Ethics Institutions and Other Patients - An explicit, written articulation of the primary goals and 8) Obligation to Self values of the profession 9) Provide Adequate Health Information and Actively Participate - A means by which a discipline articulates the values that in his/her Treatment regulate the conduct of members 10) Respect the Right to Privacy of Health Care Providers and - Direct nurses to base professional judgment upon Institutions consideration of consequences and the universal moral 11) Exercise Fidelity on Privileged Communication principles of respect for persons, autonomy, beneficence, non- 12) Respect a Physician's Refusal to Treat Him maleficence, veracity, confidentiality, fidelity, and justice. 13) Respect the Physician's Decision on Medical Reasons based on his/her Religious Beliefs Themes of Nursing Ethics 14) Ensure Integrity and Authenticity of Medical Records Caring 15) Participate in the Training of Competent Future Physicians Care is the root of ethics (May, 1969). 16) Report Infractions and Exhaust Grievance Mechanism The origins of caring in nursing can be traced to the work and writing of Nightingale. Health Care Provider Leininger (1984) – “care is the essence and the central, - any physician, dentist, nurse, pharmacist or paramedic and unifying, and dominant domain to characterize nursing other supporting health personnel, including, but not limited Corcoran-Perry (1991) – nursing as the “study of caring in the to, dental and medical technicians and technologists, nursing human health experience” aides, therapists, nutritionists trained in Health Care and/or Watson (2010) – “caring is a professional and ethical covenant duly registered and licensed to practice in the Philippines as that nursing has with society” well as traditional and alternative Health Care practitioner Martha Rogers (1966) – “Nursing is the compassionate - any physician, dentist, nurse, pharmacist or paramedic and concern for human beings. It is the heart that understands and other supporting health personnel, including, but not limited the hand that soothes.” to, dental and medical technicians and technologists, nursing Expertise aides, therapists, nutritionists trained in Health Care and/or duly registered and licensed to practice in the Philippines as Relates to the characteristics of having a high level of well as traditional and alternative Health Care practitioner specialized skill and knowledge. Nightingale recognized the importance of an education Health Care Provider-Client Relationship consisting of depth and breadth of general knowledge, - Patient advocate (keep patient’s best interest) combined with a very specific nursing focus. - Concern for patient’s well-being Professionals must have the knowledge and functional skills - Knowledge and skill of his/her profession required to meet the needs of society and thereby fulfill the - Listen to patient purpose of the profession. J.A.K.E 11 of 12  BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022 Expertise allows professions to maintain autonomy because strive to perform their work in the best interest of all society trusts that professionals are the only ones who fully concerned. understand the work of the profession. Long years of study, minimum level of competence through Article IV. Registered Nurses and Co-workers licensure exam, and continuing education programs 1. The Registered Nurse is in solidarity with other members Autonomy of the healthcare team in working for the patient’s best To maintain integrity and fully exercise ethical practice, we interest. must be autonomous. 2. The Registered Nurse maintains collegial and 2 levels of nursing autonomy: (1) autonomy of the profession collaborative working relationship with colleagues and and (2) autonomy of the individual practitioner other health care providers Self-regulation is the mark of collective professional autonomy; credentialing such as licensure, educational Article V. Registered Nurses, Society, and Environment requirements, certification are the means by which nurses 1. The preservation of life, respect for human rights, and restrict others from doing the same work. promotion of healthy environment shall be a commitment Autonomous practice serves as a safeguard for the patient, of a Registered Nurse. nurse, physician, and institution. 2. The establishment of linkages with the public in Nursing codes of ethics support the nurse’s autonomous promoting local, national, and international efforts to meet decision making and responsibility. health and social needs of the people as a contributing Accountability member of society is a noble concern of a Registered Nurse. Means that a person has an obligation to accept responsibility and to account for his or her actions. Article VI. Registered Nurses and the Profession Because society places trust in nurses (gained through 1. Maintenance of loyalty to the nursing profession and recognition of nurses’ expertise), and because society gives the preservation of its integrity are ideal. profession the right to regulate practice, individual 2. Compliance with the by-laws of the accredited practitioners and the profession itself must be both responsible professional organization (PNA),and other professional and accountable. organizations of which the Registered Nurse is a member The Code of Ethics for Filipino Nurses state that a registered is a lofty duty. nurse is responsible for all individual actions. 3. Commitment to continual learning and active participation Article I. Preamble in the development and growth of the profession are The Filipino registered nurse believing in the worth and commendable obligations. dignity of each human being, recognizes the primary 4. Contribution to the improvement of the socio-economic responsibility to preserve health at all cost. conditions and general welfare of nurses through This encompasses promotion of health, prevention of illness, appropriate legislation is a practice and a visionary alleviation of suffering, and restoration of health. If restoration mission. of health is not possible, assistance towards a peaceful death shall be his/her obligation. Article VII. Administrative Penalties, Repealing Clause and To assume this responsibility, registered nurses must utilize Effectivity the therapeutic process to gain knowledge and understanding 1. The Certification and Registration of the Registered Nurse of man’s cultural, social, spiritual, psychological, and shall either be revoked or suspended for violation of any ecological aspects of illness. provisions of this Code. Article II. Registered Nurses and People 1. Values, customs, and spiritual beliefs held by individuals shall be respected. 2. Individual freedom to make rational and unconstrained decisions shall be respected. Good luck sa Final exam guys, after nito 3rd yr na us yey – Aki 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence. Article III. Registered Nurses and Practice 1. Human life is inviolable. 2. Quality and excellence in the care of the patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability. 4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. 5. Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions. They J.A.K.E 12 of 12