Values & Beliefs Moral Development Week 2 PDF

Values & Beliefs Values Clarification Moral Development PNG5 SELF & OTHERS WEEK 2 Overview  Within the context of culture and family, values and beliefs are established, lifestyle behaviors accepted or rejected  In order to work with individuals, families and communities, n...

Values & Beliefs Values Clarification Moral Development PNG5 SELF & OTHERS WEEK 2 Overview  Within the context of culture and family, values and beliefs are established, lifestyle behaviors accepted or rejected  In order to work with individuals, families and communities, nurses must examine their own values and beliefs  Developing self awareness will help us respond when we encounter values that differ from our own Ends in view  Exploration of the personal values and beliefs that you hold, their origins, their impact on your behaviors and interactions with others  Exploration of the importance of self- understanding for nursing practice  Understanding of values conflict and values clarification Values  What are values?  “Ones principles or standards, one’s judgement of what is valuable or important in life” (Oxford Dictionary, 1978)  “A set of personal beliefs derived from life experiences, interwoven with each other” (Arnold & Boggs, 2007)  Where do our values come from? What informs our values?  Family  Culture, ethnic background  Religious community  Schools  Work environment  Life experiences Kahoot Time! Values are…  More resistant to change than attitudes or beliefs  More difficult to identify than attitudes or beliefs  Central to who we are  Instilled in you by your earliest interpersonal relationships  Action-oriented and give direction and meaning to one’s life Values are measured by… The values people hold are often observed in their interest in, involvement with, and commitment to people, places, and things  The time and energy you are willing to expend to maintain them I value…  Why do nurses need to be aware of their personal values?  How might your personal values affect your nursing practice? Consider values in the following:  Abortion  DNR  Euthanasia (MAID)  Refusal of treatment  Culture, sexuality, religion How do values differ from beliefs and attitudes? Beliefs Attitudes  The way in which you  Learned predisposition to structure your respond to persons, understanding of reality objects or ideas in a favorable or unfavorable  What is true, what is false way  Most beliefs are based on  Reflects likes and dislikes previous experience Cognitive Dissonance  The mental discomfort you feel when your behaviors do not match your beliefs and values  The mental conflict that occurs when beliefs or assumptions are contradicted by new information https://youtu.be/G1-vaIe2FGM?si=XBjq8MeBn_D2J- 2Q Kahoot Time! Values and nursing  Values acquisition is the conscious assumption of a new value  Professional values are the values held in common by the members of a profession  Professional values acquisition describes the act of acquiring the values held by the profession https://youtu.be/hnZMJEoY3IQ?si=BWXwZyzCZi4sOy9- CNO Values in nursing care  Client well-being  Client choice  Privacy and confidentiality  Respect for life  Maintaining commitments  Truthfulness  Fairness Code of Ethics Guiding Principles 1. Nurses respect clients’ dignity 2. Nurses provide inclusive and culturally safe care by practicing cultural humility 3. Nurses provide safe and competent care 4. Nurses work respectfully with the health care team 5. Nurses act with integrity in clients’ best interest 6. Nurses maintain public confidence in the nursing profession Each principle is supported by a set of statements of core behaviors all nurses are accountable for. All principles have equal importance and work together to describe the conduct, behavior, and professionalism necessary for safe and ethical nursing practice in Ontario. CNO(2024) The Aude Family  Divide into groups of 4 or 5  Read the Aude family scenario and discuss the following:  What values might Emily hold regarding the lifestyles of the members of the Aude family?  Identifyand share the personal and professional values that challenge you in this scenario  IfEmily isn’t clear about her values, how might that interfere in her interview with Don and the continuing relationships with the family members? Scenario 2  You are nursing a 78 year old client who has an operable lung tumor. The doctor has been in to explain the surgery and tells him it can be performed within the next two days. After the doctor leaves the client tells you that he lives alone since his wife died a year ago and his family all live out of town. He says that he will not have surgery because he is too old and maybe it is God’s will that he die from cancer. In her own words – scenario in EHR- GO  Vanessa Rojas is a 36-year- old Hispanic female who has come to the clinic today for her 3-month diabetes visit. Since giving birth to her last child six years ago, she has had DMII and recurrent UTIs. She has had difficulty keeping her blood glucose levels down and a dietitian consult has been requested. Theories of Moral Development LAWRENCE KOHLBERG & CAROL GILLIGAN Moral Development Ends in View  Awareness of current theories of moral development  Recognize the importance of understanding one’s own assumptions and beliefs about moral issues  Willingness to explore the complexities of moral decision making Definitions  Moral – relating to right and wrong  Moral behavior – the way a person perceives those requirements and responds to them  Moral reasoning – reasoning that deals with ethical issues e.g. conflicting rights Moral Development  Complex personal process, involves learning what we ought to be and what ought not to be done  Involves more than just the imprinting of parents rules and values Kohlberg’s Stages of Moral Development  Pre-conventional morality  Good/bad right/wrong  Wrong gets punished, right reward https://youtu.be/bo  Egocentric reasoning biased by unwXLkme4?si=y0f8 personal interest  Conventional morality CnWy2x3o9iuO  Fit in with the expectations of family or group, please others  Post-conventional morality  Define own moral values, rational moral judgements with universal perspective Carol Gilligan on Women and Moral Development  Initial Stage – Caring for self  Self most important, focus on survival  Transition period – sees need for relationships and connection with others https://youtu.be/2  Second Stage – Caring for others W_9MozRoKE?si=d  Need for caring relationships with focus on not hurting others CTmycDAtqCPe0j  Transition period – recognizes challenges with lack of c balance  Third Stage – Caring for Self and Others  Care for self & others and balance between two,  Decisions are focused on care Learning from Kohlberg and Gilligan  Men and women construct social morality differently  Inter-gender communication calls for compromise and mutual understanding  One needs to appreciate the female morality of care and relationship as well as the masculine morality of impersonal justice  Gilligan’s theory of moral development is considered an ethic of care orientation Kahoot Time! Another Kahoot! Ethics  Formal statements about expected standards of moral behavior (practices or beliefs) of a particular group  Professionally and publicly stated  Formal responding process used to determine conduct  Is about right and wrong in how humans conduct themselves in relation to one another Moral vs Ethical  Moral – good in character, capable of understanding right and wrong  Ethical – agreement with principles of right conduct or good living expressed in a system or code Ethical Theory  Examination of moral basis for judgments, actions, duties, obligations  Provides the foundation for logical and consistent decision making 2 questions at the core  What is the meaning of right and good?  What is the morally right thing to do in a given situation? Contemporary Ethical Theories Deontology Immanuel Kant (1724-1804)  Examinesituation for existence of essential rightness or wrongness, based on ethical principles e.g. autonomy, truthfulness, justice  Process depends on mutual understanding and acceptance of the principles  Does not look to the consequences of actions  Limitation: choosing among conflicting principles Deontological Model or Duty Based Model “rightness” of an action is determined by the adherence to a set of principles and rules regardless of the outcome If an act is by its nature right, you should perform that act even if someone is harmed as a result. If an act is by its nature wrong, you should not perform that act even if someone might be helped. Contemporary Ethical Theories Utilitarianism John Stuart Mill (1806 – 1873)  Value of something determined by its usefulness  Also known as consequentialism  Greatest good for the greatest number of people  Focus is on consequences or outcomes Utilitarian or Goal-Based Model  The “rightness or wrongness” of an action is always a function of its consequences  Rightness is the extent to which performing or omitting an action will contribute to the overall good of the client  Good is defined as maximum welfare or happiness  The rights of the client and the duties of a nurse are determined by what will achieve maximum welfare Utilitarian or Goal based Model  When conflict in outcome occurs, the correct action is the one that will result in the greatest good for the majority  The “goodness” of an action is determined solely by its outcome  Example? Kant vs. Mill https://youtu.be/yhZPIUSXWCM Ethical Dilemmas A nurse frequently has to act in value- laden situations Contemporary Ethical Theories Bioethics  Founded in 1970’s as a result of limitations of current theories for addressing ethical issues in health care  Moral decision making in health care should be guided by 4 principles:  Autonomy = ability to make choice for yourself  Beneficence = doing or promoting good for others  Nonmaleficience = doing no harm  Justice = fairness  Veracity = duty to tell the truth / not lie  Fidelity = be loyal and honor commitments  Examine each situation  determine priority principle(s)  use that principle to guide action Mrs. West  Mary is a nursing student enrolled in a course in which students learn how to live a client centered philosophy in practice. The course has a clinical practicum in a med/surg hospital setting where students and staff nurses are co-assigned to patients. One of Mary’s clients, Mrs. West requests some of the pain medication prescribed for her. In ensuing conversation, Mary learns that Mrs. West isn’t able to swallow large tablets and so the nurses have been crushing her meds and mixing them in applesauce. Also, Mrs. West says she only wants one tablet because she doesn’t like the drowsy feeling she gets when she takes two tablets. Mrs. West cont.  On her way to get the med, Mary sees her co-assigned staff nurse and tells her what she is doing. When the nurse learns that Mary intends to give the patient only one tablet, she insists that she give her two. Mary states she wants to respect the patient’s wishes. At this point the nurse states she will give the medication herself. She does and gives her two medications crushed in applesauce.  When Mary returns to the room, Mrs. West says her head feels “fuzzy” and she asks how many tablets she was given.  Mary does not know how to respond. Informed Choice  Informed consent  Client must be capable and competent to make informed decisions  It is often the nurses’ responsibility to assist clients to make these decisions Feminist Ethics  Critique of conventional ethics and social ethics  Look to the nature of relationships between people for guidance in working out ethical dilemmas  Attention to gender and gender-based issues  Underlying values”  Social justice  Relationships  community Relational Ethics  Ethical understandings formed in / emerge from a person’s relationships with others  Way of “being” rather than mode of decision making  Four themes:  Environment – entire health care system  Embodiment – awareness of what others may be experiencing  Mutuality – benefit for both nurse and client, no harm to either  Engagement – connecting and setting boundaries Ethical Dilemma  A situation where there are two or more conflicting courses of action and there is no clear direction on one course of action (which is the least wrong or most right)  Nurses may experience ethical uncertainty when faced with a situation in which they are unsure of what values apply or even where the moral problem is. They may also experience ethical distress when they know the “right” thing to do, but various constraints make doing the “right” thing difficult. Processing an Ethical Dilemma 1. Determine whether the issue is an ethical dilemma 2. Gather all the information relevant to the case 3. Examine and determine your own values on the issues (and values of everyone involved) 4. Verbalize the problem 5. Consider possible course of action 6. Reflect on the outcome 7. Evaluate the action and the outcome Mr. Reed  Mr. Reed is on the palliative care unit. He is dying and presents to you in considerable pain. His respirations are very slow and shallow. As his nurse you wonder whether or not to administer the next ordered dose of morphine to relieve the pain, or to hold it because it is a respiratory depressant. Kahoot Time! Group Discussion  Review the scenario given to your group and answer the following questions:  What is the moral issue in the situation?  What is your personal response to the moral issue in the situation?  What are the origins of your response to the situation? E.g. from your childhood development, the readings or from other sources?  How does your response fit with the ideas of Kohlberg and Gilligan?  What are the benefits of exploring moral issues as they occur:  In your own life  In your chosen profession of nursing Scenario #1 Working in a Store Leslie is working in a clothing store that specializes in popular teen styles. She is working with a young woman, Patti, who has been there for a couple of years and who has been given the responsibility for being in charge and for opening and closing up. After Leslie has been there for about three weeks, Patti asks her to go along with some minor shoplifting. She describes the method as food proof and justifies it by saying that they both earn so little money and the store does a good business. Scenario #2 Perfect Paper from the Internet After working hard on a paper for his ethics class and not feeling too confident about its quality, Paul is approached by his friend Carl who is literally hopping up and down with pleasure. Guess what I’ve got? He whispers. He then shows Paul his paper. It is perfect. It is exactly what was described in the assignment and I didn’t write anything but my name. Paul says that he doesn’t understand. Carl told him that he scoffed the paper from the Internet. Scenario #3 Minding Your Own Business You learn that your best friend is cheating on their mate. You are also good friends with your best friend’s mate. Should you mind your own business or tell your friend’s mate what you know? Scenario #4 Body Piercing A student complained that she had been told by faculty in a health program that piercings on her lips and tongue were not acceptable for the clinical placement she was to begin off campus. Several reasons were given for the ruling that she must remove all but two ear studs during her time at the placement. She was told that for health reasons, divisional policy, and the policy of the outside agency, she would have to comply with the ruling if she wanted to go out on placement. The student felt that this was discriminatory because she considered piercing a matter of style and personal preference, and not a matter of health or professional standards. She felt the ruling was not fair. She explained that the tongue and lip studs could not be easily removed and it might mean having to have them redone after the placement. The student admitted that the program policy concerning jewelry and dress was very clear. She also admitted that she had had the piercing done after she knew of the policy. Scenario #5 Incompetence Mary has a friend at work, Cory, who is under a great deal of personal stress. Cory has indicated that she is grateful for the support and help she is receiving from her nursing colleagues. Mary, however, has begun to notice that Cory’s practice has become much less competent. Cory is failing to do appropriate assessments of her clients. Mary has also noted that, at times, Cory’s judgement has seemed impaired and that she is increasingly disorganized. Cory is also becoming short tempered with other staff and abrupt to clients. No serious mistakes have been made yet. Mary has tried to speak with Cory about her concerns, but Cory says that she is doing fine. Scenario #6 Spouse Didn’t Survive Mrs. Vasque, a 67 year old woman, is hospitalized with multiple fractures and lacerations caused by a car accident. Her husband, who was killed in the accident, was taken to the same hospital. Mrs. Vasque, who was driving the car, constantly questions Kate, the nurse about her husband. Scenario #7 First Injection A postoperative client asks you, a student nurse, who is about to administer an intramuscular injection for pain, “Is this your first shot?” It is your first injection and you are anxious. What we learned today…  Origins of our personal values and the impact they have on our behaviors and interactions with others  How our personal values may influence our nursing decision making process and interactions with other professionals  An awareness of current theories of moral development  The importance of understanding one’s own assumption and beliefs about moral issues  Explored the complexities of moral decision making using case scenarios For next class (Week 3 – Spirituality)  Complete the readings posted in FOL  Reflect on your own spirituality. Some questions you might ask yourself as you prepare for class are:  Am I a spiritual person? How did I develop my spirituality?  Where am I on my spiritual journey? How do I express my spiritualty?  Speak to someone who influences your spirituality. Discuss their role and how thy influence your spirituality. If no particular person influences your spirituality, reflect on what influences your spirituality. You may bring something to class that represents your spirituality Kahoot Time! Kahoot Time – Beliefs, Attitudes and Values