Ethics Quiz 2

Chapters 6,7,9,9,10,11 & 14

What is though to be the root of ethics

caring

Moral art of nursing

nurses are committed to care for other human beings

Newman, Sime, Corcoran Perry definition of caring in nursing

study of caring in the human health experience

Caring about

• leads a person to be with the other person in his or her own world

• mindful and reflective, delivered with conscious intentionality and compassionate concern

• a nurse who cares about a patient is authentically committed to alleviating vulnerabilities, centering attention and concern on the other person, and preserving dignity and humanity

• moral and virtues come naturally to the nurse who genuinely cares about the patient

Taking care of

• encompasses competence in the technical aspects of delivering care

• focuses more on knowledge of scientific aspects of health care and on skillful practice

• giving expert technical nursing care is a moral imperative

Standards of nursing practice

• minimum expectations for safe nursing care

• may be described in detail specific acts performed by nurses or may outline the expected process of nursing care

• nurses are professionally, legally, and ethically accountable to meet standards

• criminal and civil courts rely on nursing standards to guide deliberations during malpractice cases

• describe practice and the minimum level of safe practice

• help ensure nurses are competent and safe to practice

• describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process.

Delegation of nursing tasks

• nurses bare primary responsibility and accountability for the nursing care patients receive, even when they delegate nursing activities to other RNs or LPNs or PCT/CNA

• upholding ethical principles of respect for persons, respect for autonomy, beneficence, nonmaleficence, fidelity, veracity, confidentiality and justice

• must be consistent with nurse practice acts, organizational policy, and standards of practice

• responsible for assessing individuals’ knowledge,, competence, experience and to monitor and evaluate the quality and outcomes of the care provided

• organizational policies don’t relieve nurses of this responsibility

• nurses must not delegate complex nursing tasks that require in-depth nursing knowledge and judgement such as assessment and evaluation

Authority

• a person or group has legitimate power and sovereignty

• authority to practice nursing is granted by legal statute, based on the contract the profession has with society

• state boards have the authority and responsibility to discipline nurses who dont follow established standards or who violate provisions of licensure law

Accountability

Nursing code of ethics

• The nurse is responsible and accountable for individual nursing practice

• The nurse promotes justice

• The nurse maintains cooperative relationships with others

• The nurse participates in advancement of the profession

• The nurse is concerned with broader societal issues that affect health

• The nurse must take into consideration duties to self

Ethical Decision-Making steps

• Step 1:

  • articulate the problem and determine a realistic goal

• Steps 2:

  • gather data and identify conflicting moral claims

• Steps 3:

  • explore potential strategies

• Step 4:

  • select and implement a strategy

• Stage 5:

  • evaluate outcomes and revise plan if needed

Situational Binds

• *interrupts the stage of ease

• interrupts the stage of ease and causes turmoil when a nurse’s belief and other claims conflict

• involve serious and complex involving professional relationships, divergent values, workplace demands, and other forces with moral overtones

• causes needless suffering by prolonging the life of dying patients or performing unnecessary tests and treatments, especially on terminal patients; legally hasting the death of patients

Stage of ease

• initial of moral reckoning

• conditions integral to the stage of ease include the properties of

  • becoming

    • which signifies core beliefs and values of the individual

  • professionalizing

    • which relates to the internalization of professional norms

  • institutionalizing

    • signifies the process of internalizing institutional social norms

  • working

    • unique and fulfilling experience of the working nurse

Stage of resolution

• the move to set things right signifies the beginning stages

• can change professional futures

• nurses will either make a stand or give up

  • professional risk

Stage of reflection

• nurses spend time thinking about their actions

• may last a lifetime and include remembering, storytelling, examining conflicts, and living with consequences

Justice

• ethical principle that relates to fair, equitable and appropriate treatment in light if what is due or owed to persons, recognizing that giving resources to some people will mean that others will not receive them

Malpractice claims against nurses

• ALWAYS a tort offense

  • civil rather than criminal

• failure to properly assess and monitor

  • should know the patient’s condition, what it is now, and what it should be

  • recognize the implications of changes in a patient’s status

• failure to administer medications properly

  • medication errors

    • wrong dose, wrong route, wrong time, wrong patient

  • failure to foresee adverse effects of medications in particular situations

• failure to communicate

• failure to act

• failure to use medical equipment properly

• failure to properly plan and administer nursing care

• failure to exercise ordinary care to avoid causing emotional harm

Incivility

• social behavior that lacks respect, is rude, impolite, discourteous and offensive

  • ex. gossiping, spreading rumors, refusing to assist a coworker, name calling, using a condescending tone, publicly criticizing others

Bullying

• more frequent and intense than incivility

• a health-harming, repeated, abuse of power intended to humiliate, offend and cause distress

Prevention strategies of bullying and incivility

• becoming familiar w/ employer’s incivility and bullying prevention policies, professional and institutional codes of conduct, and the ANA Code of Ethics for Nurses with Interpretive Statements

• Anticipating bulling behaviors and practicing responses to deflect incivility and bullying when they occur

• demonstrating professional behavior by treating others with respect, using clear communication, offering assistance as needed and mentoring others

Horizontal Violence : Top Down

• supervisors address harmful actions towards those who report to them

  • e.x.

    • oppressive supervision, constant criticism, unrealistic demands

Horizontal Violence: Bottom Up

• workers or students bully or are uncivil to those that supervise or tech them

  • ex. public criticism or social media bashing, overt rudeness, and threatening or vindictive remarks

Lateral violence

• incivility or bullying that occurs between equals

Civil Rights Act of 1964

• made it unlawful for an employer to fail or refuse to hire or to discharge any individual, or to otherwise discriminate against any individual, because of the person’s race, color, religion, sex or national origin

• unlawful acts include discrimination on

  • compensation or payment

  • conditions of employment

  • privileges of employment

Americans with Disabilities Act of 1990

• does not require employers to hire individuals with disabilities

• demands employers base employment decisions solely upon job qualifications and ability, without regard to physical or mental disabilities

• protects employers from financial ruin in the case of undue hardship related to making workplace accommodations for persons with disabilities

Sexual harassment

• unwelcome conduct of a sexual nature which make a person offended, humiliated and/or intimidated

• can lead to claims of a hostile work enviornment

Strategies to nurture positive nurse-physician relationships

• practice with skill

• communicate clearly

• project confidence

• avoid negative behaviors

• reciprocate respect

Medical futility

• situations in which interventions are judged to have very little or medical benefit, or in which the chance for success is low

  • economics: if a particular intervention is judged to be of limited or no benefit for one person, should it be discontinued so it is available for another patient who can make better use of scare resource

• often discussed in relation to CPR, but it relates as well to interventions that preserve patients who are in persistent vegetative state or dependent on the technology of tertiary care settings

• * one difficulty there is no set definition of the concept

Palliative care

• comprehensive, interdisciplinary, total care

• focus on the comfort and support of patients and families who face a terminal illness that is no longer responsive to curative treatment

• requires delivery of coordinated and continuous services

• obligations nurses have is comfort and compassionate presence

• focuses on the best quality of life for the patient and family through meticulous control of pain and other symptoms

• support dignity and self-respect of the patient and family

Euthinasia

• causing painless death of a person to end or prevent suffering

  • ethics argue that the deterioration of the patients condition causes death

DNR

• do not resuscitate

• autonomy, self-determination, nonmaleficence and respect for the patient to not initiate CPR and withholding life-sustaining treatment

  • ** DNR does not mean do not treat

    • in the event of cardiac or pulmonary arrest

  • provide support and care

National Counsel of State Boards of Nursing social media guidelines

• nurses must not identify patients by name, post, or publish information that may lead to the patients identification

• nurses must not use personal devices to take, transmit, or post any photo or video images of patients

• nurses must not refer to patients in disparaging manner on social media

• nurses must maintain appropriate professional boundaries of nurse patient relationship on social media

• nurses must immediately report any breach of confidentiality or privacy '

• Nurses must comply with all employer policies related to employer-owned computers, cameras and other electronic devices, and use of personal devices in the workplace

Voluntary informed consent

• Individuals participate freely with full information about what it means to take part in whatever they are doing, and they give consent before they enter the research, organ donation, etc.

• the nature of the health concern and prognosis is nothing is done

• description of all treatment options, even those that the HCP does not favor or cannot provide

• The benefits, risks, and consequences of all various treatment alternatives, including nonintervention

Advance Directives

• ensure that wishes regarding treatment are followed in the event that decision-making capacity is lost

Advance directives: Living wills

• legal documents giving directions to health care providers related to withholding or withdrawing life support if certain conditions exist

Advance directive: Durable power of attorney for health care

• allows a competent person to designate another as a surrogate or proxy to act on her or his behalf in making health care decisions in the event of the loss of decision-making capacity

Complementary therapies: nursing interventions

• recognize the patient’s right to use complementary therapies

• become more knowledgable about other modalities

• create an atmosphere encouraging nonjudgmental discussions of such interventions

Choices regarding recommened treatment

• choices about health care practices belong to patients

• patients should not be labeled in a negative way for choices in which nurses do not agree

Assisted suicide

• patient receives the means of death from someone such as a physician, but activate the process themselves

• Some states have death with dignity laws

  • legislation that enables patient to end their lives on their own terms when pain and suffering are intolerable

  • justification offered by proponents of these acts include respect for autonomy in choosing to end their life if its deemed intolerable due to conditions of a lingering terminal illness and compassion exhibited in relief of the patient’s suffering

Right to refuse care

• *informed consent based

• most people have a right to refuse care if treatment if for non-threatening illness

ANA code of ethics for nurses

• directs nurses to care for patients, regardless of their values or lifestyle; thus nurses need to be aware of potential judgemental attitudes toward patients

  • especially a patient with HIV/ AIDS

• be alert how attitudes may affect the quality of life

Confidentiality with HIV

• whether pts can be required to submit HIV testing in situations of potential or actual percutaneous exposure of health care workers to their blood

• to protect persons from potential discrimination, confidentiality of HIV testing and status is is generally ensured by the law

• *CDC emphasize HIV testing

Nurses responsibility for immunizations

• have professional responsibility to promote and protect the health of individuals and the community

• responsibility includes providing evidence-based education to parents and others regarding risks and benefits of immunizations including importance of community immunity

Malpractice

the legal term that refers to negligence committed by a person in a professional capacity such as a physician, nurse or lawyer

Four components of malpractcie

• the nurse had a duty to the patient

• there was a breach of that duty

• injury, harm, or damage occurred to the patient

• cause can be actual or proximate

Nurses as expert witnesses

• examining evidence

• giving depositions

• testifying in court

• witness effectiveness is influenced by

  • degree of preparation

  • depth of knowledge

  • confident delivery

  • experience

Phases of the health policy process

• Policy formulation

• Policy implementation

• Policy modification

• Policy evaluation

  • will go in a cycle of being evaluated and modified and implemented

Supreme Court

• the supreme court is not considered partisan, partisan policies play a tremendous role in judicial appointments

Nursing workplace issues

• mandatory overtime

• nurse-patient ratios

• discrimination in the workplace

Environmental health political issues

• clean indoor air

• clean groundwater

• air pollution control and global warming

Nursing political strengths

• strength in numbers, public approval

• once nurses become involved in health policy, they usually continue to be active

Emotions and ethical decisions

• both thinking and feeling have a legitimate role in decision making

• if you feel discomfort even though reason is pointing in a particular direction, you should explore both arguments posed through reason and your reactions to them

Extraneous variables

• intervening factors that influence decisions often include variables outside the direct patient care setting

• decision makers must consider institutional policy, professional standards, third-party payers, and public policy when making ethical decisions