NUR 2030 Ethical Concerns in Nursing Practice

Define: Philosophic study of morality, or what is right and what is wrong; helps to answer the question about what one ought to do in a given situation.

Ethic

Define: A "discipline dealing with the ethical implications of biologic research and applications especially in medicine."

bioethics

Define: Basic standards for what we consider right and wrong that typically are based on religious beliefs social influences (including education), group norms, culture, and life experiences.

Morals

Define: Commonly derive from societal norms, religion, and family orientation, and they provide a framework for making decisions about the actions we take every day.

Values

Define: When we must choose between two things, both of which are important to us.

values conflict

Define: The process of becoming more conscious of naming what one values or considers worthy; increases our self-awareness or understanding of ourselves and assists us in making choices

Values clarification

Define: Any situation in which guiding moral principles cannot determine which course of action is right or wrong.

Ethical dilemma

Define: The right of self-determination or choice, independence, or freedom. Includes respect for the individual with the expectation that each person will be treated as unique and equal to other people.

autonomy

What are some words associated with autonomy?

dignity, inherent worth, self-reliance, individualism, and power

What is an example of autonomy?

Not giving a blood transfusion to a Jehovah's Witness who is hemorrhaging

What are the limits to autonomy?

if the autonomy of the client would harm the community. (does the autonomy of a client with a highly communicable disease take precedence over the right of the community not to be exposed to the disease?)

Define: Doing good or producing good, especially performing acts of kindness or charity; something that promotes life, development and fulfillment)

beneficence

What is an example of beneficence?

calling a child life specialist to help a child cope with an invasive procedure.

Define: The prevention of intentional harm.

Nonmaleficence

What is medical futility?

interventions are judged to have no medical benefit or in which the chance for success is low (DNR orders, patients in vegetative states)

What is the sanctity of life argument?

all life is good

Define: The quality of being just or fair, conformity to truth, fact or sound reason, or treating like cases similarly. Looks at the concept of moral rightness in action and attitude.

justice

Define: Distribution of rewards and punishments to everyone according to their merits or demerits; the expectation is that all individuals have an equal opportunity to acces scarce resources and healthcare organizations and health plans will provide to individual recipients the care and service each is due.

distributive justice

Distribution of limited medical resources is based on:

1. need
2. equity
3. societal contribution
4. ability to pay
5. client effort
6. merit

Define: Telling the truth or not intentionally deceiving or misleading clients.

veracity

_______ ______ has minimized situations in which clients are not provided full knowledge of their conditions.

informed consent

What are ethical theories?

A moral principles or a set of moral principles that can be used in assessing what is morally right or morally wrong in a given situation

What are three examples of ethical theories?

utilitarianism, deontology, social equity and justice

What is utilitarianism?

an act is right when it is useful in bringing about desirable or good end

What is deontology?

ethical decision-making based on moral rules and unchanging principles that are considered separately from consequences.

What is social equity and justice?

allows social and economic positions to be everyone's advantage and open to all; supports justice and equal rights for everyone

The following is an example of what ethical theory?
Public health department fully funds immunizations and provides only limited funding for episodic illness care; as preventing communicable disease will benefit many more than caring for individual illnesses.

utilitarianism

The following is an example of what ethical theory?
All participants in a research study have complete understanding of the study and its purposes. A participant is treated as a moral being with freedom of decision-making and not a means to an end. A participant who has a bad result might be immediately dropped from the study because their well-being is more important than the study itself.

deontology

The following is an example of what ethical theory?
One could not ethically justify using income inequalities or the ability to pay to determine a clients eligibility for access to healthcare.

social equity and justice

What are some factors that influence ethical decision-making?

code for nurses, the clients rights, social and cultural factors, science and technology, legislation, judicial decisions, funding, personal religious and philosophic veiwpoints

What is the framework for ethical decision-making?

1. identify and clarify the ethical problem
2. gather factual data
3. Identify and evaluate options
4. make a decision
5. act and assess

What are specific ethical issues related to the profession of nursing?

commitment to your patient, commitment to your employer, commitment to yourself, commitment to personal excellence, commitment to the nursing profession

What are risk factors for chemically dependency for nurses?

job stress, settings like icu or ed, frequent shift changes, staffing shortages, musculoskeletal injuries and pain, knowledge of medications, unrealistic personal expectations, frustration, powerlessness, anxiety, and depression. Denial is common.

Costs to the nursing profession related to the problem of chemical dependency include:

financial impacts related to illness, absenteeism, tardiness, accidents, errors, decreased productivity, and staff turnover; nurses with chemical dependency often obtain drugs from the supply available on the unit or divert drugs from clients

If you suspect a nurse on your unit is chemically impaired, what should you do?

collect and document facts, dates, and times when the situation occurred, report it to your supervisor.

What organizations must be notified for a report of a chemically impaired nurse?

state board of nursing and state board of pharmacy (if drugs are involved)

How should a chemically impaired nurse be confronted?

by an intervention team, give a requirement that treatment must be sought, and must be presented with the consequences of not seeking treatment.

Define: Situations in which nurses move beyond a professional relationship and become personally involved with a patient in their life.

boundary violation

Define: Any behavior that is seductive, sexually demeaning, harassing, or reasonably interpreted as sexual by the patient

professional sexual misconduct

What can professional sexual misconduct lead to?

loss of employment and possible criminal charges

What are indications of boundary breakdown?

nurse spends extended time with a patient, favoritism or possessiveness of a patient, meeting patients in isolated areas that have nothing to do with patient care, personal disclosure by the care provider.

What are some bioethical issues concerning death?

death defined, planning for end-of-life issues, euthanasia, rights issues surrounding death, withdrawing and withholding treatment, assisted suicide, the right to refuse treatment