personal values and work environment and a framework for ethical decision making

• nursing offers a variety of job opportunities to the new graduate and you will want to consider your personal values when choosing a position after graduation

• you cannot expect to avoid all conflict or problem situations, but you will want to avoid working in an area in which conflict is constant

personal values and work environment

example: if you believe that no indivudual should be denied lifesaving techniques, you might be unhappy working in a research institution where the effects of treatment or no treatment are studied

in this situation: making your views known and refusing certain assignments after you begin employment might result in termination

seeking employment

its important to find a work environment that is congruent with your _____ and _____ beliefs regardless of the type of organization. this will reduce conflict and moral distress

values, beliefs

workplace influences

by virtue of the position they hold in the health care system, nurses experience special pressures as they try to make decisions.

an awareness of these factors may help you as you grapple with personal problems in decision making and will be significant in your choice of jobs

factors that makes the nurses experience special pressures in decision making

status as an employee

collective bargaining contracts

collegial relationship

authoritarian and paternalistic background

institutional support for ethical behavior

consumer involvement in healthcare

• most nurses are employed in hospitals, nursing homes, outpatient clinics

• their ethical responsibility is to put the client’s best interests first but employers also have loyalty and obligations

• if the nurse puts the client’s best interests first, it can be disadvantageous decision for your employer

• as a result, nurses risk being fired, losing their careers

status as an employee

Carrie Lipton, a nurse in a community hospital's surgical unit, is asked by a chief surgeon to have patients sign blank surgical permits upon admission. Carrie believes this practice is unethical. When she raises her concerns, the surgeon angrily threatens to take his surgeries elsewhere. Carrie is summoned by the Chief Nurse Executive to discuss the matter, facing potential consequences, including being labeled a troublemaker or even losing her job, as the hospital could suffer economic losses if the surgeon leaves

status as an employer case #1

when nurses are consistently faced with situations, it is referred as the human condition of ______

moral distress

occurs when one knows the ethically correct action to take but feels powerless to take that action (moral distress)

end-of-life situations

fair distribution of resources

protection of client rights

importnat when there is disagreement about treatment

end-of-life situations

fair distribution of resources

resources must be distributed fairly in situations where resources are limited

protection of client rights

client’s rights must be respected and protected

collective bargaining contracts

protection function

freedom expansion

restriction on freedom

• protects nurses when making ethical decisions

• clarifies grounds and procedures for dismissal and protects individual nurses through grievance procedures

protective function

contracts can support nurses decisions and provide greater freedom

frredom expansion

some argue that conracts require complex procedures and restrict individual freedom

restrictions on freedom

collegial relationships

importance of support

unified approach

lack of collaboration

isolation

when nurses support each other and work collaboratively, a good environment is created for making ethical decisions

importance of support

can strengthen ethical decision

unified approach

nurses of different generations work in a unit, there is often a lack of support and collaboration

lack of collaboration

nurses try to solve problems alone and lack the experience of supporting each other

isolation

The historically authoritarian and paternalistic attitudes of physicians and hospitals often relegated nurses, most of whom are women, to dependent and subservient roles.

In some settings, ethical decisions are made without the participation of nurses, yet nurses are expected to implement the decisions.

authoritarian and paternalistic backgrounds

focuses on control and obedience with little emphasis on employee well-being

authoritarian

blends control with care, emphasizing employee well-being and loyalty

paternalistic

An institution or organization that recognizes the individuality of all employees and treats them with respect in regard to decisions may provide a working climate that supports ethical behavior

institution support for ethical behavior

Three major roles of the ethics committee include education, policy review and development and case review.

Through case review, the group provides guidance to the hospital community, clients, and their families on matters that may involve ethical concerns such as end-of-life care, consent for medical interventions when the client is unable to participate in the discussion or decisions regarding the termination of treatment.

nurses may face situations in which they are expected to take action based on the conclusions of others

• The nurse, recognizing the lifesaving benefit of the amputation, may have difficulty maintaining effective communication and rapport with the client and family because of his or her own conviction that an amputationis the best treatment.

consumer involvement in healthcare

A FRAMEWORK FOR ETHICAL DECISION MAKING

Over time, the steps have remained somewhat alike to the steps of the nursing process. When clients and families must make ethical decisions, you may assist them in working through this process within the framework of their own values.

• identify and clarify the ethical problem

• gather factual data

• identify and evaluate options

• make a decision

• act and assess

Identify and Clarify the Ethical Problem

To define the ethical concern, the situation needs to be reviewed so as to gain as clear perception of the problem as possible.

Questions need to be considered:

What is the decision to be made?

Does the decision involve a choice between good and bad?

Could this be damaging to someone or some group?

Who are the relevant parties to this decision?

What are their values?

Are there legal or institutional concerns?

Consider what ethical principles might be involve.

Are those principles in conflict?

Who should assume responsibility for this decision?

Is this an individual's decision or is it one in which a collaborative decision must be made?

What is your role or relationship to the problem?

Are there time constraints on making this decision?

What other factors influence the decision?

gather factual data

• It is important to have as much information about the unique situation as possible.

• Seeking other viewpoints may help everyone involved to see the situation more clearly.

  Who are the relevant people in the situation and what are their concerns and perspectives? Have they all been consulted?

• Consider whether legal cases might affect decision making in this case.

Identify and Evaluate Options

Most ethical problems have more than one possible solution. If only one solution existed, there would be no ethical dilemma because there would be no choice.

For each option, consider its impact on each person involved, how the impact on society as a whole will affect individuals in the option that were chosen

Guide Questions

What is the range of actions that could be taken?

What would be the anticipated outcome of those actions?

As a healthcare provider, they may find it difficult to decide. To not make a decision is, in fact, making a decision.

• must be made

• planned ahead

• navigate feelings

make a decision

responsibility and create meaningful outcome

must be made

confidence and clarity

planned ahead

navigate feelings

informed and balance choices

act and assess

Assess the outcomes as the processes go forward. Consider the relevance for a wider range of situation as the foundation grow and develop

A healthcare team decides to transition a terminal ill patient to hospice care after discussions with the family, ensuring they understand the rationale and outcomes

The team regularly checks inon the patient and family, evaluating comfort levels and emotional support. They gather feedback and identify areas for improvement

Situation: act and assess