Chapter 22 Ethics and Values - PowerPoint Presentation

Slide1

Chapter 22

Ethics and ValuesSlide2

Ethics and Values DefinedEthicsThe study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large.ValuesPersonal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior.Slide3

Basic Terms in Health EthicsAutonomyCommitment to include patients

in decisions

Beneficence

Taking positive actions to help others

Nonmaleficence

Avoidance of harm or hurtJusticeBeing fair FidelityAgreement to keep promisesSlide4

Professional Nursing Code of EthicsA set of guiding principles that all members of a profession acceptHelps professional groups settle questions about practice or behaviorIncludes advocacy, responsibility, accountability, and confidentialitySlide5

The ANA Code of EthicsThe nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.Slide6

Case StudyAnna Moreno is an 82-year-old African American widow and retired schoolteacher. She lives with her 55-year-old daughter and three teenage grandchildren. Her daughter Lucille is a single mother and a full-time nurse. Anna assists with the care of her grandchildren when her daughter is at work. She also volunteers at the library and at her church. She has diabetes and high blood pressure, both controlled with diet and medication.Slide7

1. Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle ofA. Autonomy.B. Fidelity.C. Justice.D. Nonmaleficence.Quick Quiz!Slide8

Ethics and PhilosophyDeontologyDefines actions as right or wrongUtilitarianismProposes that the value of something is determined by its usefulnessFeminist EthicsFocuses on the inequality between peopleEthics of CareEmphasizes the importance of understanding relationships, especially as they are revealed in personal narrativesSlide9

Case Study (cont’d)Lucille accompanies her mother to the physician’s office for a routine visit. When her mother steps out to have some lab work done, Lucille asks to speak privately to the nurse, Mary Ann, and reveals some serious concerns. Lucille had received a call from the manager of the library where her mother volunteers. The manager described finding Ms. Moreno in the janitor's closet one day, confused and tearful. Slide10

Nursing and ValuesEthical dilemmas almost always occur in the presence of conflicting values.To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Sometimes people have such strong values that they consider them to be facts, not just opinions. Sometimes people are so passionate about their values that they provoke judgmental attitudes during conflict.Slide11

Values ClarificationStatementRankStatementPreparing for the future is an important activity and reflects maturity.1 2 3 4Life has a predestined course. The individual should follow that course.Vague answers are dishonest and confusing.

1 2 3 4

Vague answers are sometimes preferred because they avoid

embarrassment and confrontation.

Punctuality and efficiency are characteristics of a person who is both intelligent and concerned.

1 2 3 4Punctuality is not as important as maintaining a relaxed atmosphere, enjoying the moment, and being with family and friends.When in severe pain, it is important to remain strong and not to complain too much.1 2 3 4When in severe pain, it is better to talk about the discomfort and express frustration.StatementRankStatementPreparing for the future is an important activity and reflects maturity.1 2 3 4Life has a predestined course. The individual should follow that course.Vague answers are dishonest and confusing. 1 2 3 4Vague answers are sometimes preferred because they avoidembarrassment and confrontation.Punctuality and efficiency are characteristics of a person who is both intelligent and concerned.1 2 3 4Punctuality is not as important as maintaining a relaxed atmosphere, enjoying the moment, and being with family and friends.When in severe pain, it is important to remain strong and not to complain too much.1 2 3 4When in severe pain, it is better to talk about the discomfort and express frustration.Slide12

Values Clarification (cont’d)StatementRankStatementAddressing someone by his or her first name shows friendliness. 1 2 3 4Addressing someone by his or her first name is disrespectful.Direct questions are usually the best way to gain information. 1 2 3 4

Direct questioning is rude and could cause embarrassment.

Direct eye contact shows interest.

1 2 3 4

Direct eye contact is intrusive.

Ultimately the independence of the individual must come before the needs of the family.1 2 3 4The needs of the individual are always less important than the needs of the family.Slide13

Case Study (cont’d)The manager expressed growing concern about Ms. Moreno’s ability to finish tasks, such as reshelving books and taking phone messages. She recommended that Lucille get an evaluation of her mother’s mental status. Lucille tells the nurse that she is not at all convinced that her mother is having mental problems. Slide14

How to Process an Ethical DilemmaStep 1: Ask if this is an ethical dilemma.Step 2: Gather all relevant information.Step 3: Clarify values.Step 4: Verbalize the problem.Step 5: Identify possible courses of action.Step 6: Negotiate a plan.Step 7: Evaluate the plan.Slide15

Institutional ResourcesEthics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee. Slide16

Issues in Health Care EthicsQuality of life: central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNRGenetic screening: What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available?Care at the end of life: interventions unlikely to produce benefit for the patientAccess to care:

As a nurse, you will certainly deal with ethical issues related to access to care.Slide17

Ethics and Access to CareThe number of uninsured in the United States grew from 39 million people in 2000 to more than 46.3 million people by 2008—more than 15% of the total population.Many of the uninsured are women and children.Although two thirds of the uninsured are poor, nearly 80% come from working families. Slide18

2. If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of A. Responsibility. B. Accountability. C. Competency. D. Moral behavior.22 - 18Quick Quiz!Slide19

Nurses Collaborate With Other Professionals Consensus building: an act of discovery in which “collective wisdom” guides a group to the best possible decision A nurse’s point of view offers a unique voice in the resolution of ethical dilemmas.Slide20

Culturally Competent Care: End-of-Life DecisionsAcknowledgment of and respect for cultural differencesWillingness to negotiate and compromise when world views differBeing aware of one’s own values and biasesUsing communication skills that enhance empathyKnowing cultural practices of patient groups regularly seenUnderstanding that all patients are individuals who may not share the same views as others within their own ethnic groupSlide21

Case Study (cont’d)From Mary Ann’s perspective, Lucille seems angry and defensive about the manager’s report. She even accuses the manager of discrimination against older adults. She adamantly refuses offers of a physical or mental evaluation for her mother, or even to discuss the issues with her mother. Instead, she requests that the nurse write a letter that validates her mother’s good health. Slide22

Moral DistressMoral distress describes the anguish experienced when a person feels unable to act according to closely held core values.Because moral distress is a shared experience, efforts to alleviate distress are most successful when they are also shared.Slide23

Ethical Issues on AgingOlder people usually are not as familiar with the concept of autonomy as are people from younger generations. As people age, they develop clinical conditions that affect the communication process. Some patients become incapacitated by stroke or disease. Most older adults take multiple medications, some of which affect cognitive skills in subtle ways. Consensus about medical goals for the older adult is hard to achieve. Slide24

3. A nurse is working with a terminally ill adult patient. The nurse decides to tell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of processing an ethical dilemma is A. Articulation of the problem. B. Evaluation of the action. C. Negotiation of the outcome. D. Determination of values surrounding the problem.Quick Quiz!Slide25

Case Study (cont’d)After all, Lucille argues, her mother’s blood pressure is normal, and her blood glucose levels are within normal limits.Mary Ann realizes that this situation is complex. She will need to get the help of others to sort out the best response to Lucille’s request.Is this an ethical dilemma for Mary Ann?Slide26

Case Study (cont’d)Mary Anne has determined that the situation is an ethical dilemma. Now she must:Step 2: Gather all information relevant to the case.Step 3: Examine and determine her own values and opinions about the issues.Slide27

Case Study (cont’d)Step 4: State the problem clearly.Step 5: Consider possible courses of action.Step 6: Negotiate the outcome.Step 7: Evaluate the action. Slide28

Competencies of the New GraduateCompetencies identified by nursing organizationsNational Council of State Boards of Nursing CompetenciesNational League for Nursing CompetenciesCompetencies expressed by other groupsEmployers’ expectations regarding competenciesSlide29

Top Ten Nursing Activities Rank Ordered by Average Total Group FrequencyApply principles of infection controlProvide care within the legal scope of practiceEnsure proper identification of client when providing carePractices in a manner consistent with a code of ethics for registered nursesPrepare and administer medications, using rights of medication administrationSlide30

Top Ten Nursing Activities Rank Ordered by Average Total Group Frequency (cont.)Prioritize workload to mange time effectivelyUse approved abbreviations and standard terminology when documenting careMaintain client confidentiality/privacyProvide individualized/client centered care consistent with standards of practiceReview pertinent data prior to medication administrationSlide31

Employers Expectation Regarding CompetenciesPossess the necessary theoretic background for safe client care and for decision-makingUse the nursing process in a systematic wayRecognize own abilities and limitationsUse communication skills effectively with clients and coworkersSlide32

Employers Expectation Regarding Competencies (cont.)Work effectively with assistive personnel, delegating, and supervising nursing care tasks in an appropriate mannerProvide accurate and complete documentationPossess proficiency in the basic technical nursing skillsPossess basic skill in information technologySlide33

Worker Related CompetenciesDemonstrate a commitment to a work ethicFunction with acceptable speedSlide34

Personal Career GoalsFocusing your goalsSetting your goalsShort-term goals—encompass what you want to accomplish this month and this yearLong-term goals—where you want to be in your profession five or more years from nowMaintaining and enhancing your competence