NUR1 424 Class 1 Part 2 Nursing Ethics 1 2024 myCourses.pptx

Plan & Learning Outcomes Discuss the historical context relevant to bioethics broadly and nursing ethics specifically History Articulate the fields of ethics an...

Plan & Learning Outcomes Discuss the historical context relevant to bioethics broadly and nursing ethics specifically History Articulate the fields of ethics and the relevant nursing Ethics and Fields of Ethics questions that they discuss Reflect on nursing as a moral Nursing Ethics endeavor and the need for History and Codes of Ethics moral communities. Discuss nursing codes of Nursing as Moral Practice ethics and apply them to practice Recognize key questions and Organizational Ethics tools relevant to organizational ethics. Cultural Humility & Safety Discuss the relevance of the  NUR1 424 Fall 2024 History of Bioethics "History is for human self-knowledge... the only clue to what man can do is what man has done. ​The value of history, then, is that it teaches us what man has done and thus what man is.“​ R. G. Collingwood​ @Copyrighted Material – ISoN McGill Important Historical Events in Bioethics Nuremberg War Crime Tribunals (1945- 1949) – The Nuremberg Code of 1947 Nutrition Studies in Residential schools- pablum studies - 1942 to1952 Tuskegee Syphilis Study (1932-1972) US Studies in Guatemala (1946-1948) Radiation Studies (1944-1974) REBs in 60s Declaration of Helsinki (1964) Belmont Report (1979) Lerner BH, Caplan AL. Judging the past: how history should inform bioethics. Ann Intern Med. 2016;164(8):553-557, PMID: 27089070 Hoyt, 08:52S. PM (2010). Florence Nightingale’s contribution to contemporary nursing ethics. Journal of Holistic Nursing, 28(4), 331-332.. MacDonald, N. E., Stanwick, R., & Lynk, A. (2014). Canada’s shameful history of nutrition research on residential school children: the need for strong medical ethics in Aboriginal health research. Paediatrics & Child Health, 19(2), 64-64. History - These events will be referred to in other contexts - Bioethics in general - Research ethics 08:52 PM “Good history transports those studying and practicing bioethics to —Lerner & Caplan 2016 an earlier time, figuratively putting them in the shoes of their predecessors and teaching them how these past individuals rationalized the choices they made— choices that now seem clearly ethically dubious. Learning how societal values, scientific zeal, ideological beliefs, and the desire for personal achievement influenced these persons reveals how similar factors can and often still remain in play, even in our supposedly more “enlightened” era.’ Lerner BH, Caplan AL. Judging the past: how history should inform bioethics. Ann Intern Med. 2016;164(8):553- 557, PMID: 27089070. 08:52 PM  NUR1 424 Fields of Ethics @Copyrighted Material – ISoN McGill  VIDEO CUE What is the difference between Ethics, Morality and the Law? https://www.youtube.com/watch?v =Xki2fRA0bY8 What is Ethics? What should be done? What ought to happen? What is fair and just? (Walton, (Walton, 2019) 2019) Fields of Ethics (Rodney, Burgess, Phillips, McPherson & Brown,  Field of Description Ethics Metaethics: A field of ethics that looks at deep philosophical questions, defining moral terms and asking questions such as: “What is the meaning?” It focuses on the analysis of meaning, Metaethic creating justifications for actions, and making inferences from moral concepts. s Normative Ethics: A field of ethics that focuses on the formulation and defense of basic principles, values, virtues, and ideals governing moral behaviour. It seeks to answer questions such as: Normative “What makes an action right or wrong?”, “What situation is good or bad?”, and “What makes someone good or bad?” Descriptive Ethics: A field of ethics that focuses on factual descriptions and observations. It is an empirical analysis of what people actually do, and what they perceive as being the reasons Descriptiv for their actions. It does not try to answer what is good or how best to live, but rather describes the current reality. e Applied Ethics: A field of ethics that focuses on the practical Activity Reference: Rodney, P., Burgess, M., McPherson, G., & Brown, H. (2004). Chapter 4: Our theoretical landscape: a brief history of health application care ethics. In J. L. Storch, P. Rodney, and Strazomski, R. (Eds.) of horizon: Toward a moral ethicsNursing to specific contexts. ethics for It poses leadership and questions practice (pp. 56-76). such Pearson Education Canada Inc. Update reference as: “In real life and specific contexts, what is the right thing to do?” Applied Ethics (Rodney, Burgess, Phillips, McPherson, & Brown, 2013; Tham, 2017; Health ethics (Rodney, Burgess, Phillips, McPherson & Brown,  NUR1 424 Historical Reflections Nursing Ethics Activity @ Copyrighted ISoN  Nursing Ethics ‘A single eye to the patient’ s good’ Hoyt, S. (2010). Florence Nightingale’s contribution to contemporary nursing 08:52 PM ethics. Journal of Holistic Nursing, 28(4), 331-332..  As we compare these two different pledges, what underlying values are highlighted? Reflect: As you read (reread) your Codes of Ethics, what themes overlap? 08:52 PM I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully. I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug. I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. I shall be loyal to my work and devoted towards the welfare of those committed to my care. 08:52 PM  Pledge Comparison Image: Pledge of Florence Nightingale. By Welcome Collection gallery (2018-04-01): https://wellcomecollection.org/works/n6ygau8w , Uniqueness of Nursing Ethics Image: A doctor with five nurses: studio portrait -1900. By Wellcome Library, CC-BY-4.0 via Wikimedia Commons. (Fowler, 2021) https://wellcomecollection.org/works/tk 7x49zq  Contrasts and Similarities Profession vs. Calling Nursing Moral Character, duties to self and Virtues Social Activism Image: Nurses & midwives are needed, WWll poster Wellcome L0025327. By Wellcome Collection Gallery. Wellcome Collection gallery (2018-03-31): https://wellcomecollection.org/works/zbm8eacf Duties to Self “For convenience sake, I will divide the duties of a nurse into seven classes: 1st. Those she owes to the family. 2nd. Those she owes to the doctor. 3rd. Those owing the family, friends, and servants of the patient. 4th To herself. 5th. To her own friends. 6th To her own hospital or school. 7th. To (Harriet other Camp, nurses.” 1889, as cited in Fowler, Social Activism within Patriarchy “The nurse should be able to trace the fact that her profession is a part of the whole “woman” movement, of the struggle of women down through the ages to free themselves from the domination of men and to take their places in the world as individuals, with the liberty and responsibility which that involves.”1938, as cited in Fowler, (Goodnow, 2021, p. 18) Image: Fight Patriarchy graffiti in Turin. By Prof.lumacorno, CC BY-SA 4.0, via Wikimedia Professional Trailblazers Nurse Bernice Redmon Nurse Marissa ScottMarissa Scott. By Grey County Museum, Owen Image: Sound, Ontario Bernice Redmon,  NUR1 424 Nursing as Moral Practice @Copyrighted Material – ISoN McGill  In what Edit Master text styles ways Second level Third level is nursing a Fourth level Fifth level moral practice? NUR1 - 424  Moral Agency A moral agent involves "an obligation to ensure integrity and ethical soundness in the care we provide and in the interactions with others" CNA. 2017 as cited with Walton 2018 Nursing as a Moral Practice Nursing strives to: maximize good: health & healing, comfort, dignity, quality of life, foster innate capacities & strengths minimize bad: pain, suffering Walton (2019)  How can Edit Master text styles nurses be moral Second level agents, practice Third level Fourth level ethically, and contribute to moral Fifth level communities? NUR1 - 424  NUR1 424 Fall 2024 Nursing Codes of Ethics A Quick Review @ Copyrighted ISoN  Codes of Ethics in Canada Images: Cover of Code of Ethics for Images: Cover of Code of Ethics of Nurses Registered Nurses (2017) and Logo of (2015) and Logo of Ordre des infiirmières et Ethical Standards or Rules of Conduct Ethical-codes tend to Conduct-codes tend be… to be… Titles Code of Ethics Code of Conduct Authorship Professional bodies Regulatory bodies Level Good nurse Just-good-enough-nurse Disagreeme More subjective More objective nt Consequenc Disapproval, indignation Official sanction e of transgressio n Recreated from Table I. Suggested difference between ethics rules and conduct rules. Snelling (2016) Language Descriptive, implying Directive normative  ICN Values of the Nursing Profession Image: ICN Code of Ethics for Nurses, Professional Values. In International Council of 08:52 Nurses. (2021). ThePMICN code of ethics for nurses. International Council of Nurses. p. 21 Criticisms of Codes of Ethics How-to manage conflicting values and organizational factors Gaps with realities – need for more applicability More explicit commitment to human rights and equity (Snelling, 2016; Storch, 2013) NUR1 - 424  What are some barriers to practicing nursing in an ethical way? 08:52 PM  NUR1 424 Fall 2024 Organizational Ethics: A Quick Introduction Catherine-Anne Miller (adapted from Nicky Fraser’s Slides) @ Copyrighted ISoN Applied Ethics (Rodney, Burgess, Phillips, McPherson, & Brown, 2013; Tham, 2017; Applied Ethics: Bioethics ORGANIZATIONAL (Rodney, Burgess, Phillips, McPherson & Brown, Organizational Ethics Issues Resource Allocation Organizational Ethics Issues Business Development Organizational Ethics Issues Access to care for the uninsured Relating Organizational & Clinical Ethics Organizational Ethics (Meso/macro level) Clinical Ethics (micro level) 08:52 PM Defining Organizational Ethics Edit Master text styles “The organization’s efforts to define its own core Second level values and mission, identify areas in which Third level important values Fourth level come into conflict, seek the best Fifth level possible resolution of these conflicts and manage its own performance to ensure that it acts in accord with espoused values.” (Pearson, Sabin & Emmanuel, 2003)  Organizational Ethics in Practice There are different approaches: Organizational Ethics Committees Ethics Advisors Ethics Sub-Committees Frameworks to guide decision- making: Ex. Accountability for Reasonableness (A4R) What should we do? Why should we do it? How should it be done? You want to learn more: https://www.rvh.on.ca/wp-content/uploads/2020/11 /Accountability-for-Reasonableness-Framework-A4R 08:52 PM.pdf  Accountability for Reasonableness (A4R) 08:52 PM ved at https://www.rvh.on.ca/wp-content/uploads/2020/11/Accountability-for-Reasonableness-Framework-A  NUR1 424 Cultural Humility and Safety Catherine-Anne Miller, @Copyrighted Material – ISoN McGill  Relational Ethics: In- Between “In studies of excellent nursing practice, my colleagues and I have found relational and skillful attunement characterized by the virtues of openness and responsiveness. A care ethic is relational and focuses on meeting the other with respect characterized by recognition, support for growth or self- acceptance, and/or allowing the other ‘to be’.” mage: In Between HMM (33016693711). By Paul van de Velde, CC BY 2.0, via Wikimedia Commons Essential Nurse Qualities in SBNH Strengths of Mindset Strengths of Knowledge and Mindfulness Knowing Humility Curiosity Open-mindedness Self-reflection Nonjudgmental Loki Design. © 2020 Laurie Relationships and Culture Diverse perspectives and beliefs We are all holders of culture Importance of safety in partnership Power dynamics as healthcare provider Cultural Humility and Cultural Safety What do we mean? (Bauer, Scheim, Deutsch, & Massarella, 2014; Ruud, 2018)  Examples of Lack of Safety Brian Sinclair, 2008, Winnipeg Image: Cover of "Out of Sight" Report, Brian Sinclair Joyce Echaquan, 2020, Working Group https://www.dropbox.com/s/wxf3v5uh2pun0pf/Out%20 Joliette Image: Cover of "In Plain Sight" Summary Report. of%20Sight%20Final.pdf?dl=0 Image: Portrait of Joyce Echaquan, painted by Artwork by Eliot White-Hill (Kwulasultun) Eruoma Awashish, Cover of Joyce's https://engage.gov.bc.ca/app/uploads/sites/613/2020 Principle, Atikamekw leaders. /11/In-Plain-Sight-Summary-Report.pdf (Dryden & Nnorom, Image: Bradd, S. (2016). Leading a framework for Cultural Safety & Humility. First Nations Health Authority. Cultural Humility Lifelong Learning and Self-Reflection Acknowledging and redressing power differentials Institutional Cue to Organizational Ethics! accountability & collaborative (Tervalon & Murray-Garcia, 1998) partnerships Not an outcome, but a process 08:52 PM  Cultura l Humilit y 08:52 PM  Relationality & Ethics 5  Cultural https://www.youtube.com/watch?v=_Mbu8bvKb_U In Other Humility: People, Principle Words… s and Practices Supplementa - Part 1 of 4 l https://w ww.yout ube.com /watch?v =_Mbu8 08:52 PM bvKb_U Supplemental Resources In addition to today's content & readings:  Glenda Sandy offers reflections on Ethical nursing practice from an Indigenous Perspective – Video on myCourses  Historical Timeline – Review as it will inform next week  Mini-Assignment - Individual  Sept Mini-Assignment (5%) 10th before Individual – Own work 23:59 pm 1- SHORT VALUE 2- MULTI-MEDIA 3- REFLECTION ON REFLECTION (SBNH) RESOURCES (WITH ETHICAL NURSING TED-TALK + PODCAST) PRACTICE Objectives: Reflect on your core personal values, through the lens of Strengths-Based Nursing & Healthcare Reflect on prejudice, biases, power and privilege as it relates to ethical nursing practice Alternative available – If these themes touch too close to home 08:52 PM Some Practicalitie s Next week – Ethical Theories & tools! To review Make sure you are listed in Workshop Groups Door to enter Jeanne Contact me if interested in Student- Timmins Liaison Committee 08:52 PM  References Bauer, G. R., Scheim, A. I., Deutsch, M. B., & Massarella, C. (2014). Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Annals of emergency medicine, 63(6), 713-720. Benner, P. (1997). A dialogue between virtue ethics and care ethics. Theoretical Medicine, 18(1), 47-61. Canadian Nurses Association [CNA]. (2017). Code of ethics for registered nurses. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of- ethics-2017-edition-secure-interactive Dryden, O., & Nnorom, O. (2021). Time to dismantle systemic anti-Black racism in medicine in Canada. CMAJ, 193(2), E55-E57. Fowler, M. D. (2017). Why the history of nursing ethics matters. Nursing Ethics, 24(3), 292-304. Fowler, M. D. (2020). The Influence of the Social Location of Nurses-as-Women on the Early Development of Nursing Ethics. In Nursing ethics: feminist perspectives (pp. 3-21). Springer, Cham. Fowler, M.D., (April 7, 2021) "The Nightingale Still Sings: Ten Ethical Themes in Early Nursing in the United Kingdom, 1888-1989" OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 2. Goodnow, M. (1938). Nursing History in Brief. W.B. Saunders. P.18 As cited in Fowler, M. D. (2021). The Nightingale Still Sings: Ten Ethical Themes in Early Nursing in the United Kingdom, 1888-1989. OJIN: The Online Journal of Issues in Nursing, 26(2). International Council of Nurses. (2021). The ICN code of ethics for nurses. International Council of Nurses. Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757. Kidder, R. M. (2009). Overview: The ethics of right versus right. How good people make tough choices: Resolving the dilemmas of ethical living, 12-29. Ordre des Infirmières et Infirmiers du Québec (OIIQ) (2015) Code of ethics of nurses. Retrieved from https://www.oiiq.org/documents/20147/237836/8450_doc.pdf Pearson, S. D., Sabin, J., & Emanuel, E. J. (2003). No margin, no mission: health care organizations and the quest for ethical excellence. Oxford University Press. Ruud, M. (2018). Cultural humility in the care of individuals who are lesbian, gay, bisexual, transgender, or queer. Nursing for women's health, 22(3), 255-263. Schick-Makaroff, K., & Storch, J. L. (2019). Guidance for Ethical Leadership in Nursing Codes of Ethics: An Integrative Review. Nursing Leadership (Toronto, Ont.), 32(1), 60-73. Snelling, P. C. (2016). The metaethics of nursing codes of ethics and conduct. Nursing Philosophy, 17(4), 229-249. Storch, J.L. (2013). Nursing Ethics: The Moral Terrain. In Storch JL, Rodney P, Starzomski R, editors. Toward a moral horizon: nursing ethics for leadership and practice. 2nd ed. Toronto: Pearson Education; 2013. 08:52 PM Wright, D., & Brajtman, S. (2011). Relational and embodied knowing: Nursing ethics within the interprofessional team. Nursing ethics, 18(1), 20-30.