NURS 321 Leadership: Module 10 Ch. 4: Ethical Issues

Ethical Issues for Nurse Managers

In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse-managers involves some ethical component. Multiple advocacy roles and accountability to the profession further increase the likelihood that managers will be faced with ethical dilemmas in their practice.

Ethical Issues Faced by All Nurses

In addition, nurses' moral lives are growing in complexity given rapid changes that are the result of scientific advances, a growing business ethos, and technological processes aimed at standardizing patient care.

Ethics is concerned with

doing the right thing, although it is not always clear what that is.

Legal and Ethical Are Not the Same

Sometimes, it is very difficult to separate legal and ethical issues, although they are not the same. Legal controls are generally clear and philosophically impartial. Ethical controls are much more unclear and individualized.

Ethics

1. The systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment.

2. The justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are.

3. The way a person approaches and solves ethical dilemmas is influenced by their values and basic beliefs about the rights, duties, and goals of all human beings.

4. Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals.

Moral Issues Faced by Nurses

1. Moral indifference

2. Moral uncertainty

3. Moral distress

4. Moral outrage

Moral Indifference

an individual questions why morality in practice is even necessary.

Moral Uncertainty

an individual is unsure which moral principles or values apply and may even be uncertain about what the moral problem is.

Moral Distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action.

Moral Outrage

occurs when a person witnesses the immoral act of another but feels powerless to stop it.

Ethical Dilemma

1. Defined as being forced to make a choice between two or more undesirable alternatives.

2. Self-awareness is a vital leadership role in ethical decision making, just as it is in so many other aspects of management.

Two Common Approaches to Ethical Decision Making

1. Deontological

2. Teleological

Deontological Approach

duty-focused normative approach centered on rules from which all action is derived

Teleological Approach

outcome-focused approach that places emphasis on results and protects the interest of the majority

Frameworks for Ethical Decision Making

1. Utilitarianism

2. Duty-based reasoning

3. Rights-based reasoning

4. Intuitionism

Utilitarianism

Decisions based on the greatest good for society (teleological model).

Duty-Based Reasoning

Actions guided by an inherent duty to act (deontological model).Duty 

Rights-Based Reasoning

Decisions considering individual rights (deontological model).

Intuitionism

Case-by-case ethical decision-making (deontological model).

Principles of Ethical Decision Making

1. Autonomy

2. Beneficence

3. Nonmaleficence

4. Paternalism

5. Utility

6. Justice

7. Veracity

8. Fidelity

9. Confidentiality

Autonomy

Promotes self-determination/freedom of choice

Beneficence (Doing Good)

The actions one takes should be done to promote good. Encourages these actions of good promotion.

Nonmaleficence (Do No Harm)

If the actions one takes cannot do good, then one should at least take actions that do no harm.

Paternalism

One individual assumes the right to make decisions for another. Allows one individual to make decisions for another.

Justice

1. Seeks fairness. Ensures fairness in treating individuals based on equality and differences.

2. Treats "equals" equally.

3. Treats "unequals" according to their differences.

Veracity

The obligation to tell the truth. Emphasizes truth-telling.

Fidelity

The need to keep promises. Stresses the importance of promise keeping.

Confidentiality

Keeping privileged information private. Mandates privacy in handling privileged information.

Utility

The good of the many outweighs the wants/needs of the individual. Prioritize the needs of the many over the individual.

To Make Appropriate Ethical Decisions

The nurse must use a professional approach that eliminates trial and error and focuses on proven decision-making models or problem-solving processes.

Ethical Problem-Solving Models/Processes

1. Traditional problem-solving process.

2. Nursing process.

3. MORAL decision-making model.

The Moral Decision-Making Model

1. M—Massage the dilemma.

2. O—Outline options.

3. R—Review criteria and resolve.

4. A—Affirm position and act.

5. L—Look back. Evaluate the decision making.

Professional Codes of Ethics

1. A code of ethics is a set of principles, established by a profession, to guide the individual practitioner.

2. The first code of ethics for nurses was adopted by the American Nurses Association in 1950 and has been revised six times since then (most recently in 2015).

3. Professional codes of ethics do not have the power of law. They do, however, function as a guide to the highest standards of ethical practice for nurses.

Strategies to Promote Ethical Behavior as the Norm

1. Separate legal and ethical issues.

2. Collaborate through ethics committees.

3. Use institutional review boards appropriately.

4. Role model and encourage ethical behavior.

Ethical Managers Do What

The most important thing a manager can do to create an ethical work environment is to role model ethical behavior.

Nurses as Ethical Leaders

• The best way for a manager to foster an ethical workplace is to model ethical behavior.

• A structured approach to problem-solving, thorough data collection, and careful analysis of alternatives ensure that the best possible decision is made, even if the outcome is imperfect.

• Ethical decision-making should not be judged solely by its outcome but by the integrity of the process.

• By incorporating these ethical principles and decision-making frameworks into practice, nurses can navigate complex moral challenges with confidence and professionalism.