Nursing Values and Ethics

Overview of Class Content

  • Source Material: Gregory Chapter 9, CNO (2025) Practice Guideline: Consent

  • Date: Week 5/4

Objectives

  • Differentiate between values and beliefs

  • Define ethics, morality, and ethical dilemmas

  • Demonstrate understanding of moral integrity and its associated concepts

  • Identify and describe the types of ethics and ethical theories

  • Describe the components and obligations related to the code of ethics and consent

  • Apply basic ethical principles to clinical scenarios

Beliefs vs. Values

  • Beliefs: Convictions held to be true, often without proof.

  • Values: Strong personal beliefs that set standards influencing behavior.

    • Consideration of right and wrong

    • Instilled during childhood

    • Evolve over time

    • Reflect in decisions/behaviors

Value Formation

  • Influences on value formation:

    • Cultural and social influences

    • Relationships

    • Personal needs

    • Education

    • Religion

    • Government

  • Variability among individuals; values can develop and change.

  • Importance of recognizing and respecting diverse value systems in healthcare.

Personal Values

  • Self-awareness regarding one
    ’s values and biases is crucial.

  • Examination of personal beliefs concerning life, health, illness, and death.

  • Potential for conflicts between personal values and patient values.

Ethics and Morality

  • Ethics: A branch of philosophy organizing thoughts about right and wrong in social contexts (Gregory et al., 2020, p. 167).

  • Connection between ethics and morality expressed through expectations of what ought to happen (Gregory et al., 2020, p.169).

Moral Integrity

  • Defined as a virtue relating to reliability and adherence to moral norms.

  • Involves trustworthiness and consistency between convictions and actions (Gregory et al., 2020, p. 170).

  • Attributes of moral integrity include:

    • Good moral character

    • Commitment to a clear set of values/beliefs

    • Consistency in behavior over time

Moral Autonomy

  • Characteristics related to moral autonomy:

    • Keeping promises

    • Being steadfast

    • Moral seamlessness

Ethical Dilemma

  • Defined as situations where values and beliefs lead to unclear courses of action, with strong ethical reasons supporting each alternative (Gregory et al., 2020, p. 168).

  • Dilemmas may present multiple reasonable or morally acceptable options (Gregory et al., 2020, p. 169).

Moral Distress

  • Defined as the experience of knowing the right action but being unable to take it due to constraints (Gregory et al., 2020, p. 168).

  • Can lead to feelings of anger, resentment, despair, and powerlessness.

  • Strategies to reduce moral distress must be explored.

Types of Ethics

  1. Bioethics: Ethical implications of biological and medical research and applications.

  2. Feminist Ethics: Focuses on a gender-sensitive approach to ethical issues.

  3. Nursing Ethics: Ethical standards and practices specific to nursing, including the Canadian Nurses Association Code of Ethics for RNs.

Ethical Theories

  1. Consequentialism (Utilitarianism): Evaluates actions based on outcomes.

  2. Deontology: Focuses on rules and duties rather than outcomes.

  3. Principlism:

    • Highlights four guiding principles:

      • Respect for Autonomy

      • Beneficence

      • Non-maleficence

      • Justice

Principlism: Considerations

  • Recognizes limitations; no universal application of principles.

  • Addresses scenarios of uncertainty and potential conflicts among ethical principles.

Ethical Dilemma Example

  • Scenario: Mr. Black, a father and guardian, refuses to vaccinate his children citing rights infringement.

  • Ethical Conflict: Balancing the advocacy for public health through vaccination against personal and parental rights.

Codes of Ethics

  • Purpose: Serve as foundations for ethical practice; articulates standards and obligations to clients and society.

  • Define acceptable and unacceptable behaviors in the nursing profession.

Nursing Code of Ethics (2025)

  • Replaces the 2017 version; guides ethical practices for all nurses.

  • Updates include:

    • Emphasis on reconciliation and anti-racism

    • Focus on nurse well-being and contemporary challenges

    • Modernized language for clarity in ethical responsibilities and decision-making.

Values and Guiding Principles (CNA Code of Ethics)

  1. Value 1: Honoring Dignity and Autonomy - Respecting inherent dignity and autonomy of all people.

  2. Value 2: Valuing Relationships and Humanizing Care - Focusing on the well-being and interests of individuals.

  3. Value 3: Maintaining Integrity and Accountability in Practice - Acting with integrity, honesty, and responsibility.

  4. Value 4: Pursuing Truth and Reconciliation - Upholding the principles of truth and reconciliation.

  5. Value 5: Promoting Social Justice - Advocating for rights and social determinants affecting health.

  6. Value 6: Providing Competent Professional Nursing Practice - Ongoing development of nursing knowledge and skills.

  7. Value 7: Preserving Privacy and Confidentiality - Respecting rights related to privacy and confidentiality in care.

Jurisprudence Exam

  • All registered nurses must pass the Registered Nurse/Registered Practical Nurse Jurisprudence Examination to register.

  • Topics include:

    • Nursing regulation

    • Scope of practice

    • Professional responsibility

    • Ethical practice

    • Nurse-client relationship

Jurisprudence Exam Format

  • Online, open-book format, consisting of 50 multiple-choice questions.

  • Registration fee: 40.00; candidates have 30 days to complete the exam after login.

Consent

  • Ethical and legal obligations exist for obtaining consent, established in common law and nursing standards.

  • Health Care Consent Act (HCCA): Outlines rules for when consent is necessary and who can consent for an incapacitated individual (CNO, 2025).

Features of Consent Legislation

  1. Health Care Consent Act (HCCA): Promotes autonomy and facilitates communication regarding treatment.

  2. Substitute Decisions Act (SDA): Governs decision-making for personal care or property for individuals who are incapable of consenting (CNO, 2025).

Informed Consent

  • Definition: Informed consent is when a person is provided the necessary treatment information that a reasonable person would require to make an informed decision (CNO, 2025, p. 5).

  • Must include:

    • Nature of treatment

    • Expected benefits

    • Material risks and side effects

    • Alternative options

    • Consequences of not having treatment

Steps to Obtaining Consent

  1. Assess capacity of the client.

  2. Provide emergency treatment when appropriate.

  3. Inform the client that a Substitute Decision Maker (SDM) may have to be involved.

  4. Identify the SDM.

  5. Obtain consent from the SDM (CNO, 2025).

Hierarchy of Substitute Decision-Makers

  1. Guardian appointed by the court.

  2. Named attorney for personal care.

  3. Appointed representative by the Consent and Capacity Board (CCB).

  4. Family members, ordered by:

    • Spouses or partners

    • Children aged 16 or older

    • Parents (custodial or access)

    • Siblings

    • Other relatives

  5. Public Guardian and Trustee (PGT) as last resort.

Ethical Case Scenario

  • Scenario: A nurse encounters a patient under the influence of substances demanding medication refills imperatively.

  1. Identify applicable ethical principles and implications.

  2. Outline appropriate actions the nurse should take based on ethical guidelines.