Week 1 (Power, Identity, Discrimination in Nursing Care)

what is ethics?

• etymology of ethics

  • moral

  • custom/habits

• norms of conduct that distinguish between acceptable and unacceptable behaviour

ethics vs morality

• Morals = personal beliefs

• Ethics = external standards of  group or society 

ethics as inquiry (types)

• bioethics

• practical ethics

• professional ethics

• medical ethics

• healthcare ethics

• nursing ethics 

ethics adresses…

• QUANTITY of lives save

• QUANTITY of pain/trauma

• QUALITY of lives saved

• social worth

• PURPOSEFUL action vs passive inaction

• sense of DUTY, duty to care

why study ethics in nursing practice 

• Nursing about relationships

• Nurses have moral commitment to those they care for (CNO)

• Nurses are moral agents 

• Examine all ethics and bioethics issues from the perspective of nursing theory and practice

nursing ethics

examine all ethics and bioethics issues from the perspective of nursing theory and practice (ex. person, care, culture, health, environment) 

what is an ethical dilemma…

• Actions have effects on selves and others

• Choice that involves opposing moral principles in support mutually inconsistent courses of actions

how societal values shape perceptions of ethical nursing care. 

• Different characteristics such as money, power, access, and values 

• Characteristics, needs, conflict of interest, geographic locations

• Advances technology

• Socio-economic factors

• Political issues 

• Nurses values vs client values clashing 

• CONTEXT is important

historical, spiritual, religious influences on nursing ethics

• Power differences between people

• Different groups have different social, economic, and political positions = diverses needs, experiences, and interests might be seen as “others”

historical influences

• Legacy of unethical practices 

• Evolution of medical ethics

• Increases emphasis on pt rights, informed consents, and autonomy

social influences 

• Cultural beliefs and vales impacting pt choice/communication

• Health disparities and systemic inequalities

• Media and tech influence on public health expectations/ethics

Religious influences

• Beliefs about life, death, healing

• Moral frameworks may conflict with medical recommendations

• Religious leaders/families influencing healthcare decisions and consent 

moral reasoning and nursing origins

• A judgement process that is part of decision making of what is considered right and wrong

• Ethics noun, moral reasoning action

importance of ethical theory in guiding nursing decisions

• Provide framework to navigate moral diliemas

• Consistent and fair decision making

• Protect pt right and dignity

• Virtue (positive trait, right behaviour, ex. kindness, patience, empathy) 

• Virtue ethics example of ethical theory

  • Nurses virtues influenced by their hx

principles and theories of ethics

• Virtue ethics - moral character of the person

• Deontology - duty and obligation (Jean Watson, compassion/empathy)

• Utilitarianism - good for most ppl

• Caring theory 

Kohlberg’s Theory of Moral Development

• Level 1 = avoidance, fear, punishment (students often here) 

• Level 2 = focus on social conformity guild not following expectations

• Level 3 = social values recognized, justice, dignity, (want to be at level 3, advocate in strategic way)

• Moral principles even when conflict with society

CNO ethical values that guide practice (embedded in Code of Conduct) 

• client well-being 

• client choice 

• privacy and confidentiality 

• respect for life

• maintaining commitments

• truthfulness and fairness 

client well-being - CNO code of conduct

• Promote safe space

• Physical but also emotional, cultural, psychological well-being

client choice - CNO code of conduct

• ex) right to refuse care

• Nurse ensures informed decision making, not influenced by fear, misunderstanding, pressure

• Non-coercive communication  

privacy and confidentiality - CNO code of conduct

• Protect pt personal health information

• Respect pt privacy

• Health decisions confidential

respect for life - CNO code of conduct

• Within boundaries of client’s values and rights

maintaining commitments - CNO code of conducts

• Duty of care to pt and fetus but primarily accountable to the mother

• Do not abandon the pt 

truthfulness and fairness - CNO code of conduct

• Explain risks, benefits, alternatives

• Transparent about consequences

• Do not withhold or distort information 

• Reflect on biases and pt decision making process

• Equal respect and support regardless of pt choices 

CNA Code of Ethics 2017

• Centered around nursing values and responsibilities

  • Safe, competent, ethical care

  • Health and well-being

  • Choice

  • Dignity

  • Confidentiality

  • Justice

  • Accountability

  • Quality of practice environments

Case study of indigenous pt who does not want c-section

• Respect for informed decision making

  • Pt right to refuse treatment even if life-saving for fetus 

  • Respected if pt is deemed competent to make decision

  • Pt received all relevant information

• Preserving dignity

  • Cultural background, personal values, bodily autonomy 

• Promoting justice

  • Pt may face inequities and biases

  • Nurse advocates for culturally safe care

  • Nurse recognizes systemic barriers

• Promoting health and well-being

  • Protect both mother and fetus 

  • Engage in ongoing communication

• Being accountable

  • Informed consent or refusal properly recorded

  • Must escalate the ethical dilemma to ethics committee

CNO Code of Ethics is for…

• Framework for making ethical decisions

• Not state law, but acts of governing nursing profession

• Collective responsibility and individual among colleges

• Professional promises 

Ethical Decision-Making Model (EDMM)

• Assess and describe citation

• Male plan, decided approach

• Implement plan/take action

• Evaluate the outcome

autonomy - indigenous c-section case study 

mother’s right to refuse surgery, even at the risk of fetal life

beneficence/non-maleficence - indigenous c-section case study 

nurse’s duty to prevent harm to the fetus 

justice/fairness - indigenous c-section case study 

recognizing and addressing systemic injustices and trauma in indigenous health care