/
© 2015 American Nurses Association © 2015 American Nurses Association

© 2015 American Nurses Association - PowerPoint Presentation

hotmountain
hotmountain . @hotmountain
Follow
343 views
Uploaded On 2020-06-23

© 2015 American Nurses Association - PPT Presentation

Purpose and Evolution of the Code and Provisions 13 Nurses and Patients Slide Deck 1 2015 American Nurses Association Provisions 13 Nurses and Patients What do we mean by nurses and patients ID: 784634

nurses patient patients code patient nurses code patients nursing values ethical health practice ethics protection interpretive moral professional statements

Share:

Link:

Embed:

Download Presentation from below link

Download The PPT/PDF document "© 2015 American Nurses Association" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

© 2015 American Nurses Association

Slide2

Purpose and Evolution of the Code and Provisions 1-3, Nurses and Patients

Slide Deck 1

© 2015 American Nurses Association

Slide3

Provisions 1-3, Nurses and PatientsWhat do we mean by nurses and patients?

Provisions 1-3 address direct patient care and describe the most fundamental values and commitments of the nurse.

3

Slide4

Scope of Nursing Ethics

Unless separately referenced, all content comes from

ANA’s Code of Ethics for Nurses with Interpretive Statements,

2015 (“the Code”) OR Fowler, M. D.M. (2015).

Guide to the code of ethics for nurses: Development, application, and interpretation

(2

nd

Ed.). Silver Spring, MD: American Nurses Association.

*All images are public domain under the Creative Commons license and were retrieved from http://

pixabay.com/en/.The question mark icon throughout indicates a discussion point or question to engage in dialogue.

4

Slide5

What Is Ethics?

A specialized area of philosophy dating back to ancient Greece and earlier

Concepts of Hippocrates still inform today’s ethical issues.

A systematic study of what is right and good measured against principles, virtues and core values of a profession.

5

Slide6

Scope of Nursing Ethics

Deals with:

Character

(what sort of person one ought to be)

Conduct

(how one should act)

Deals with duties and obligations of nurses to:

Patients

Other health professionals

The profession

The wider publicGlobal humanity

6

Slide7

Why Ethics in Nursing?

Because

nurses

Serve vulnerable persons

Promise to protect patients

Impact patient well-being

Depend on public trust

Have a moral relationship with

patients that gives rise to ethical obligations

7

Slide8

Personal Values and NursingMorality comprises personal values, character and conduct

.

Those entering nursing bring moral values stemming from:

Religion, culture, family, education, life

experience

Embedded moral values are a starting point for ethical behavior and personal integrity.

As nursing core values are learned and practiced, they are integrated with personal values to create a nursing moral identity.

8

Slide9

Branches of Ethics

METAETHICS

Theoretical

thinking about morality

NORMATIVE ETHICS

What

is right/wrong, good/evil

individual

or collective

choicesAPPLIED ETHICSRight/wrong, good/evil of actions in a specific profession or discipline9

Slide10

What Is an Ethical Code?

An

ethical code is an identifying feature of a profession

to:

Facilitate professional self-

regulation and accountability

Describe obligations of client-professional and colleague-to-colleague relationships

Serve as a guide for analysis,

decision

and action

10

Slide11

ANA’s Code of Ethics for Nurses with Interpretive Statements (“the Code”)

Conveys shared

ethical values, obligations,

duties and ideals of nurses individually and collectively

Provides an implied contract with the public

Informs society of the moral values and ideals by which it functions

Informs new professionals of the expected moral behaviors

Guides the profession in self-regulation

Provides a framework for ethical decision-making

Is unapologetic, aspirational and nonnegotiable11

Slide12

Legacy of the CodeCommitment

to service is the most precious ideal of the nursing profession

.

The Code supports ideals of nursing’s service

.

The Code guides all nurses in living out the values and ideals of the profession

.

The Code is a living, ongoing legacy of core values from Florence Nightingale

in 1850

to 2015 and beyond.12

Slide13

Evolution of the Code1893: “Nightingale Pledge

1926

: Suggested Code in the American Journal of Nursing (AJN)

1940

: Tentative Code,

AJN

1950

: The Code adopted by

ANA1956, 1960, 1968, 1976, 1985, 2001: Revisions of the Code2015: Major revision of the Code

13

Slide14

Maturation of the CodeThe Code was

first adopted in 1950;

it was periodically

updated to reflect the changing context and practice of nursing.

Early versions stressed

Nurse’s obligation to carry out physician’s orders

Rules of conduct, moral character, hygiene

Duty with skill and moral

perfection

Later versions stressedPrinciples, especially respect for patient autonomy

Nurse’s obligation to the patient, including protection from incompetent, unethical or illegal practice

14

Slide15

Structure of the CodePrefaceIntroduction

Provisions 1-3 with Interpretive

Statements: Nurses

and Patients

Provisions 4-6 with Interpretive

Statements: Boundaries

of Duties and Loyalty

Provisions 7-9 with Interpretive

Statements: Commitments

Beyond Individual Patient EncountersAfterwordGlossaryTime line: The Evolution of Nursing’s Code of EthicsNote

: The Interpretive Statements for each provision provide more specific guidance for practice, are responsive to the contemporary context of nursing, and recognize the larger scope of nursing’s concern in relation to health.

15

Slide16

Emphasis of the CodeAll nurses, all roles with various scopes of practice and settings

Relationship with other caregivers, including unlicensed personnel

Increasing diversity of patients and nurses

Wholeness of character

: Nursing as a lifetime

endeavor;

core values and dispositions pervading all aspects of life

16

Slide17

Revision ConsiderationsNot lightning rod for controversial, divisive public debate

Not political

Timeless language, no

buzzwords

that outdate

Succinct, clear, and understandable to students and new nurses

Useful to all nurses in all roles and settings

17

Slide18

Nursing Is Value Laden

Caring for those suffering in the most vulnerable moments of

life:

Finding meaning

Bearing witness

Facilitating healing

Being present

Expressing

caring

18

Slide19

Ethical TheoriesNursing draws from many ethical theories, including:

Kantian

Normalism

Utilitarianism

Virtue Ethics

Ethic of Caring

The Code functions at mid-range

Any of these theories can be used “behind” the Code

19

Slide20

The nurse practices with compassion and respect for theinherent dignity, worth and unique attributes of every

person.

Interpretive Statements

1.1

Respect for Human Dignity

1.2

Relationships With Patients

1.3

The Nature of Health

1.4 The Right to Self-Determination1.5

Relationships With Colleagues and Others

20

Provision 1

Slide21

Patient dignity is the foundation of nursing ethics.Dignity is inherent, not “earned.”A patient

never

loses dignity, e.g., when comatose, delirious, frail, or in an altered state.

A nurse must approach every patient with respect for dignity, regardless of personal attributes, health state, or any other situational or patient variable.

Source: Ferrell, B.R., & Coyle, N. (2008).

The nature of suffering and the goals of nursing

. New York, NY: Oxford University Press.

21

1.1 Respect for Human Dignity

Slide22

22How would you react

?

If you had to care for a hospitalized terrorist who injured himself while bombing your hometown…

h

ow does the Code guide you?

Slide23

TrustHonoring patient choices, even when riskyHow would you react?

If a patient is self-harming by cutting to soothe anxiety, is this an autonomous choice? Should you stop the patient?

How does the Code guide you?

23

1.2 Relationships With Patients

Slide24

Care shaped by patient preferences, needs, values, choicesEvidence provides the science of options; patient particulars help choose the options

24

1.3 The Nature of Health

How would you react?

Can you refuse to care for an Ebola patient to avoid risking your own health?

How does the Code guide you?

Slide25

Patients have a right to decide for themselves.The patient, and decisions made by the patient, are to be respected regardless of personal attributes of the patient, conflicting values, or circumstances.

25

1.4 The Right to Self-Determination

Slide26

Elements of informed consent:Capacity to decidePertinent, understandable informationVoluntary decisionAssent if a minor

Advance directives:

Living will, five wishes, DPAHC

If declared by court “incompetent” to decide:

Incompetence is a legal/court decision

Power of attorney or next of kin

Substituted judgment

Best interest standard

26

Informed Consent for Treatment

Slide27

IndividualResident in LTCConsumer in mental health

Client

Recipient of care

FamilyGroup

Community

Population

27

Who Is the Patient?

Slide28

Respect for autonomyThe patient, if competentIf family disagrees with the patient…Are family goals realistic? How do you know?

What about futile treatment recommended by doctor?

If family members disagree among themselves, who arbitrates?

If family makes decision that conflicts with physician’s orders, who arbitrates?

28

Who

Is

the Final Decision-Maker?

Slide29

Age: Infant, childComatoseDevelopmentally disabledDementia, hypoxia, OBS, head injury Cognitive impairment from drugs, alcohol

Setting constraints: prisoners, students, patients

29

Compromised Autonomy

Slide30

Self-determination depends on awareness of decisions to be madePatient’s ability to comprehend treatment options may be impaired by:

Cognitive capacity

Literacy, language proficiency, or educational level

Visual or hearing impairment

Anxiety in presence of health professionals

F

ear

Important to assess patient’s understanding of treatment options and implications

30

Health Literacy

Slide31

Under

31

Protection

Paternalism

Negligence

Balance

Over

Slide32

Nurses must live with their own conscienceAdequate ethical justification for decisions and actions to sleep at night

Principles can only go so far

Clinical judgment is in the end situational, contextual and personal

Ethical decisions always entail ambiguity and uncertainty

32

At the End of the Day…

Slide33

“Nurses may not act with intent to end life even though such actions may be motivated by compassion, respect for autonomy or quality of life considerations.”

Autonomy to accept, refuse, or terminate care:

Foregoing nutrition and hydration

Withholding or withdrawing life-sustaining treatment

Honoring advance directives

33

Interpretive Statement 1.4

Slide34

Nurse may administer medications with the intent of reducing symptoms of dying, even though the secondary impact may decrease respirations and perhaps hasten deathThe nurse’s actions do not cause the death, the terminal illness causes the death

34

Doctrine of Double Effect

Slide35

InterdisciplinaryAll colleagues, including unlicensed personnel

Inter-professional

All licensed colleagues (medicine, pharmacy, social workers, dieticians, PT, OT, RT, etc.)

Trans-professional

Licensed colleagues working together on a team across fields of expertise

35

1.5 Relationships

With

Colleagues and Others

Slide36

Cultivate civility, collaboration, and collegiality to

e

nsure:

Safe, quality patient care and outcomes

Compassionate, transparent, effective health services

A hospitable work environment

36

Create a Culture of Respect

Slide37

The nurse’s primary commitment is to the patient, whether an individual, family, group,

community or

population

.

Interpretive Statements

2.1

Primacy of the Patient’s Interests

2.2

Conflict of Interest for Nurses2.3 Collaboration

2.4 Professional Boundaries

37

Provision 2

Slide38

Engagement, trust, intimacy, presenceBased on covenant relationship, existential encounter, response to vulnerabilityRespond in the here and nowAttentiveness

Responsibility

Competence

Responsiveness

38

2.1 Primacy of the Patient’s Interests

Slide39

Contextual variables shiftDecision-making never static or completeApproach may beToo broad/too narrowToo hasty/too delayed

Too constrained/too flexible

Too conventional/too visionary

Too reductionist/too expansionist

Too technical/not caring enough

39

Anticipate Nuances

Slide40

When patient interests collide with those of others (family members, physician), the nurse’s primary commitment is to the patient.A nurse helps resolve such conflicts, so patient wishes may be honored.

40

Conflict Resolution

Slide41

If a nurse stands to gain personally from a clinical situation, a conflict of interest exists.Disclosure of such a conflict to all involved is expected.Professional integrity may be damaged if a nurse does not withdraw from a conflict of interest.

41

2.2 Conflict of Interest for Nurses

Slide42

42

“There comes a point in analysis of every ethical dilemma when people finally know what is right and what is wrong, regardless of analytical reasoning.”

-

George Annas, Law Professor

Slide43

Trust, respect, transparencyVoicing ethical opinionShared decision-making“Community of moral discourse”Equipping patients with the information, resources and courage to participate in mutual decision-making

Shared responsibility for outcomes

43

2.3 Collaboration

Slide44

Intensely personal work with vulnerable patients may generate emotional attachmentsGifts generally not appropriateWithdraw from problematic boundary situations with colleagues

44

2.4 Professional Boundaries

Slide45

The

n

urse promotes, advocates for, and protects the rights, health, and safety of the patient.

Interpretive Statements

3.1

Protection of the Rights of

P

rivacy and Confidentiality

3.2

Protection of Human Participants in Research

3.3 Performance Standards and Review Mechanisms3.4

Professional Responsibility in Promoting a Culture of Safety

3.5

Protection of Patient Health and Safety by Acting on Questionable Practice

3.6

Patient Protection and Impaired Practice

45

Provision 3

Slide46

Policies and practices in an age of technologyHIPAA: Adhere to federal and state regulations

Facebook

:

Completely off limits for patient photos or identifying information

Caring Bridge:

Patients decide, nurses should not engage

Electronic Health Records:

Only shared with those directly involved in care

46

3

.1 Protection of the Rights of Privacy and Confidentiality

Slide47

Institutional Review Board (IRB) approval of relevant research proposalVoluntary participation of participantsNo coercion, deceitInformed consent documentedRight to withdraw at any point with no untoward consequences

47

3.2 Protection of Human Participants in Research

Slide48

Fetuses and human embryosPregnant womenChildren and minorsCognitively impaired personsPrisoners

Traumatized and comatose patients

Terminally ill patients

Elderly/aged personsEconomically or educationally disadvantaged persons

Underserved populations

48

Special Consideration for Vulnerable Subjects

Slide49

Demonstrate ongoing knowledge, skills, dispositions and integrity for competence in practiceAssume accountability for current, quality nursing practice according to national, state, and institutional standards

49

3.3 Performance Standards and Review Mechanisms

Slide50

Avoid or reduce errorsDo not conceal errorsCorrect or treat errorsUse chain of authority when reporting a problemProvide timely responsive communication

Document

50

3.4 Professional Responsibility in Promoting a Culture of Safety

Slide51

If a nurse observes a violation of law, policy, or ethical standards that could jeopardize patient safety…

51

3.5 Protection of Patient Health and Safety by Acting on Questionable Practice

What guidance does the Code provide?

What ANA position papers provide additional guidance?

What other policies or procedures need to be followed?

Slide52

When impaired practice is suspected, patient safety may be jeopardizedIdentify colleagues whose practice may be impaired or who are placing patients at risk

Follow chain of authority with compassion and caring so remediation and recovery may follow

Access employee assistance program for help

52

3.6 Patient Protection and Impaired Practice

Slide53

53What Will Guide Your Moral Compass?