NURS24998 Issues and Trends Module 2 Ethical Domain Student 2022 PDF

NURS24998 Issues and Trends in Nursing & Health Care Fall 2022 Module 2 Ethical Domain Learning Outcomes - Identify what values are and how they are relative to ethics. - Identify ethical theories and principles to use when experiencing moral/ethical dilemmas. - Describe ethical decision-making proc...

NURS24998 Issues and Trends in Nursing & Health Care Fall 2022 Module 2 Ethical Domain Learning Outcomes - Identify what values are and how they are relative to ethics. - Identify ethical theories and principles to use when experiencing moral/ethical dilemmas. - Describe ethical decision-making processes. - Understand the importance of a professional code of conduct. 2 How Do You Behave When No One is Looking? 3 Values Review-The Core of Ethics §What are values? üA personal belief that is strong (may also be a shared belief in a profession). üOur values influence our behavior. They vary among people and they can develop and change over time. §How do values develop? üFrom socio-cultural environment, religious background, family. üIt is important to understand ethical principles and how they may vary between cultures (transcultural nursing). (Potter et al., 2019) 4 Values Review-Continued §Do values influence our decision making? üValues change and emerge over time with new information; new cultural shifts E.g., Rights to confidentiality, conservation. §What is values clarification and why is it an important process? üProcess of appraising personal values (personal reflection) not a set of rules. Becoming more aware of our own values and the valuing process in our lives. §What is a values conflict? üOur values and actions are at odds with the values and actions of others. When unable to come to a resolution it results in moral distress leading to an ethical dilemma. (Potter et al, 2019) 5 Review CNO Values §Fairness §Respect for life §Client well-being §Client choice §Truthfulness §Privacy and Confidentiality §Maintaining Commitments (to oneself, to the client, to nursing colleagues, to the nursing profession, to team members /colleagues and to quality practice settings) (CNO, 2019) 6 Review CNA Values and Ethical Responsibilities § Providing safe, compassionate, competent and ethical care § Promoting health and well-being § Promoting and respecting informed decision-making § Honouring dignity § Maintaining privacy and confidentiality § Promoting justice § Being accountable (CNA, 2017) 7 Values vs Morals Values: § Beliefs about the shared worth or importance of what is desired or esteemed within a society. Morals: §Shared and generational societal norms about what constitutes right or wrong conduct. E.g., The Golden Rule (Stanhope et al.,2022) 8 Question? As a semester three student what values have you developed or changed since the start of your school journey? Take a few moments to think of a few. 9 Applied Ethics §The study of good conduct, character and motives. §Field of ethics where theories and principles are applied to actual moral problems. §Why do we study ethics? üAid in making difficult decisions. üAssist in communication with other health care team members. üProvide greater understanding of our own values and beliefs. üPrepare health care providers for future challenges and issues related to ethics. (Potter et al., 2019) 10 Ethical Dilemma What is an Ethical Dilemma? §Puzzling moral problems in which morally justified reasons for both taking and not taking a certain course of action are envisioned. §A conflict between 2 sets of human values, both of which are judged to be “good” but neither of which can be fully served. 2 Types: 1. Decision-focused - what to do? 2. Action-focused - am I willing to do it? (Stanhope et al., 2022) 11 Video - National Nursing Ethics Summit (2014) §What Keeps Nurses Up at Night? https://youtu.be/pOakDs41IsI 12 Ethical Decision Making §The ability to make sensible ethical decisions based on: - underlying ethical principles, theories, systems - a decision-making model - a Professional Code of Ethics §A nurse must be aware of four aspects: 1. Own beliefs and values. 2. Appreciating diversity of views on ethical issues. 3. Recognizing an issue is an ethical dilemma/significance. 4. Sound basic knowledge of ethical theories/decision making models. (Potter et al., 2019) 13 Recap Ethical Values Studied throughout the program: § Autonomy § Beneficence § Non-maleficence § Justice; distributive justice § Veracity § Confidentiality § Fidelity 14 Autonomy Application § Is self governing. § Each person has the right to make decisions about personal goals. § A person is free to do as he or she wishes. A homeless man experiencing psychosis stops his anti-psychotic medication because it makes him sleepy. § How do you view this man’s autonomy? § Is autonomy good? § Are there subtleties of autonomy in this case? § Personal autonomy vs non-compliance. 15 Beneficence Application § Requires nurses to act in ways to benefit patients. § Do or promote good, Prevent harm and remove evil. Beneficence is part of our code of ethics: §“ The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a coworker or any other person” (ICN, 2006, p.3). 16 Non-Maleficence Application §Avoid causing any harm. §Avoid doing harm as a consequence of doing good. §Always consider the potential of harm. Examples: -Giving needles to a child may cause harm. However, if the needle is an immunization it is given to promote good. -Giving narcotics to treat a terminally ill person avoids harm but can also hasten death if in large amounts. (Burkhardt, Nathaniel, & Walton 17 Justice Application §Equitable, fair, and appropriate treatments in light of what is due to or owed to persons. §Distributive justice is an application of justice which occurs at different levels. Equal distribution of resources. Examples: -Access to health care -Hospital policies regarding occupying beds -Patient assignments 18 Veracity Application §Refers to truth telling and our moral obligation as health care providers to do so with all interactions. §Creates respect for all, open communication, trust and shared responsibility. §It ensures trust. Example: - A patient’s family members ask you to lie to the patient about their prognosis in attempts to “ protect the patient.” - How would you feel? - What would you do? 19 Practice Example A fellow nurse discloses to you over lunch that she mistakenly gave an incorrect dosage of medication to a patient earlier that day. She adds the patient hasn’t noticed or experienced any adverse effects. - What would you do? - Is the patient owed the truth, despite the lack of serious adverse effects? - Why or why not? 20 Confidentiality Application §Non-disclosure of private/secret information which one is entrusted. §In what situations would you override confidentiality? §What is the duty to warn third parties? §Remember actions considered ethical may not be legal! 21 Fidelity Application § Practice of keeping promises. § Tied to our professional conduct. § Loyalty and faithfulness within a nurse patient relationship. Example: - Practicing within the established scope of practice and definition of nursing. - Remaining competent to practice. 22 Practice Application Ahmed is a new nursing graduate on a busy surgical floor. His preceptor Marta and he have a collegial and friendly working relationship and Ahmed is grateful to Marta for her help and patience as he orients to the floor. Marta has shared some personal information with Ahmed during coffee breaks that she has a difficult home life, as she is going through a divorce and custody hearings for her children. While on shift today, Ahmed witnesses Marta closing the controlled medication cupboard and then taking two pills to the sink with a cup in her hand. For the rest of the day, she appears more calmer than usual. Ahmed confronts Marta and she admits to doing this and promises not to again. She stated, “I have been so stressed, please promise me you won’t say anything, this is the only and last time I’ll do this.” At shift count the narcotic cabinet is short two Ativans (Burkhardt, Nathaniel, & Walton, 2018, p. 21). 23 Practice Application Questions 1.What alerts you to the presence of an ethical dilemma? 2.How do you feel when confronted with difficult ethical decisions? 3.What resources do you use to help you deal with ethical dilemmas? 24 Review Major Ethical Theories 1. Consequentialism: Utilitarianism -Key concept: the greater societal good 2. Deontological -Key concepts: duty-based ethics; moral behavior 3. Communitarianism -Key concepts: abstract universal principles not adequate, use of history and tradition and concrete moral communities. Virtue ethics The ethic of care Feminist ethics 25 Consequentialism: Utilitarianism §What is the right thing to do? §What is right produces good. §Actions are right when they increase happiness and diminish misery and wrong when they have the opposite effect. §The ethical choice is the one with the best consequences, outcomes or results. §Based on principle of utility or usefulness. Examples: -Harm reduction approach -Needle exchange program -Policy of hostage negotiation 26 Deontological Theory §Moral rules are absolute and apply to all people, for all times, in all situations. §What is “right” and what is “wrong.” §Rules of right and wrong are based on obligations and duties (truth, promise, justice). §Overriding principle of “duty” not the consequences. §Consequences may be irrelevant as long as duty to do right is met. Example: Nurses’ Code of Ethics stresses the importance of fulfilling duties that are inherently owed to patients, and the importance of preserving the dignity and autonomy of each individual patient. 27 Quick Quiz Which of the following statements best illustrates deontological ethical theory? a. "I believe this disease was allowed to occur by a supreme being." b. "He has become a stronger individual through experiencing the loss of his father." c. "It would never be right for a person to stop cardiopulmonary resuscitation efforts." Correct d. "The chemotherapy did not cure this person, but it provided a better life for him.“ 28 Communitarianism § Abstract, universal principles are not an adequate basis for moral decision making. § History, tradition, and concrete moral communities should be the basis of moral thinking and action. § Theories with a communitarian focus: - Virtue ethics - The ethic of care - Feminist ethics (Stanhope et al,, 2022) 29 Virtue Ethics § One of the oldest types of ethical theory (dating back to ancient Greek philosophy) § Virtues are acquired, excellent traits of character that dispose humans to act in accord with their natural good. § Examples of virtues: benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. (Stanhope et al,, 2022) 30 Caring and the ethic of care § Based on feminist theory § A response to the technological advances in health care science, to the desire of nurses to differentiate nursing practice from medical practice. § Emphasizes a belief in the morality of responsibility in relationships that emphasize connection and caring. (Stanhope et al,, 2022) 31 Feminist ethics §Supports critical thinking and focus on issues such as gender, power, and socioeconomic status. §Knowledge about the social, cultural, political, economic, environmental, and professional contexts that oppress women as individuals or within a family, group, or society. (Stanhope et al,, 2022) 32 Frameworks for Working Through Ethical Issues § Use problem-solving processes § Serve as guides for making ethically sound decisions that can be morally justified. 1. CNO Ethics Practice Standard, 2019- Nursing Process -p. 14. 2. 7 Steps to Analyze an Ethical Dilemma-Potter et al.- Box 7-4 p. 93. 33 Nursing Process Application Assessment Plan Consider all aspects of situation; is it a dilemma? Consider all possible actions May be no action Values clarification Best to least bad Ethnocultural background Policies, Procedures, Standards, Guidelines, Code of Ethics, Law Consult; resolve disagreements Possible resources E.g. Institution Ethics Board. Clarify issue Critical thinking Ethical Principles, Theory (CNO,2019) 34 Nursing Process Application Implementation Evaluation Carry out plan Is the outcome satisfactory? Communicate +++ Involve the team Emotional support for client, family, friends, caregivers, colleagues Revise the plan if necessary Was there proper time (usually not)? (CNO,2019) 35 7 Steps to Analyze Ethical Dilemmas 1. Determine if the issue is an ethical dilemma. 2. Gather all your information relevant to the case. 3. Examine and determine your own values on the issues. 4. Verbalize the problem. 5. Consider possible course of action. 6. Reflect on the outcome. 7. Evaluate the action and the outcome. (Potter et al., 2019, p. 93) 36 CNA Code of Ethics for Registered Nurses Clarify values and guidelines of ethical conduct in nursing practice Provides guidance for decision making concerning ethical matters Serves as a means of self-evaluation and self-reflection regarding ethical nursing practice Provides a basis for peer feedback and review Serves as a basis from which nurses can advocate for quality work environments that support delivery of safe, compassionate, competent, and ethical care. Informs other health care professionals and members of the public about the ethical commitments of nurses Upholds the responsibilities of being a self-regulating profession Concerns the social responsibility of the professionals who are accountable to society and to communities and implies an understanding of these foundations. (Stanhope et al., 2022) 37 Quick Quiz Which of the following best describes the nursing code of ethics? A. Provides specific ways to behave with patients. B. Has definite guidelines for decision making. C. Permits nurses to decide what is best for their patient. D. Provides guidance for relationships, behaviour, and decision making. 38 Ethical Decisions in Practice Case Study Tina is a 17-year-old female who is currently on the psychiatric unit with a diagnosis of depression. Tina reports that she has been sexually active since she was 14. She had an abortion when she was 15 and a second one just 6 weeks ago. She states that her mother told her she has “had her last abortion” and that she has to start taking birth control pills. She asks the practical nurse to give her some information about the pills and to tell her how to go about getting some. The nurse believes Tina desperately needs information about birth control pills, as well as other types of contraceptives, but the psychiatric unit is part of a Catholic hospital, and hospital policy prohibits distributing this type of information. 39 Let’s Examine the Case Study: §Is this an Ethical issue? Dilemma? §What Ethical principles and theories are involved? §What are the alternatives? §How are the CNO values related to the case? 40 Self Study Practice Application John is 16 years old, 2 years ago diagnosed with sarcoma of the right foot and received aggressive Chemo. His foot was amputated, and he has done well since. The cancer has now returned, John refuses treatment. He states that he cannot go through chemo again, nor does he want to lose his leg. Knowing the consequences, he maintains his refusal. His parents are very upset and wonder if he can be forced? What are the two most relevant Ethical Principles in this case? Are any of these principles in conflict? What CNA and CNO ethical values (2 from each) are involved? Which have priority? Would a review of ethical principles help John’s team and his family in developing a plan? What plan would you propose? How would you justify your choice? 41 References Burkhardt, M., Nathaniel, A., Walton, N. (2018). Ethics and Issues in Contemporary Nursing (3rd Canadian Edition). Toronto: Nelson. CNA.(2017). Code of Ethics for Registered Nurses. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/code-of-ethics-2017-e dition-secure-interactive.pdf?la=en&hash=09C348308C44912AF216656BFA31E33519756387 CNO.(2019). Ethics Practice Standard. https://www.cno.org/globalassets/docs/prac/41034_ethics National Nursing Ethics Summit. (2014). What keeps me up at night? [Video file]. https://youtu.be/pOakDs41IsI Potter, P. A., Stockert, P., Perry, A., Hall, A. (2019). Canadian fundamentals of nursing (6th ed.). Toronto, ON: Elsevier Canada. Stamler, L., Yiu, L., Dosani, A. (2016). Community health nursing, a Canadian perspective (4th ed.). Toronto, ON: Pearson. Stanhope, M., Lancaster, J., Jakubec, S., Pike-MacDonald, S. (2022). Stanhope and Lancaster’s Community health nursing in Canada (4th ed.). Elsevier. 42 Next Class: Module 2 Legal and Professional Issues Online Activities 43