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135 Cards in this Set
- Front
- Back
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Ethics definition? |
The branch of philosophy concerned with evaluating human action |
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What does ethics involve? |
The principles or assumptions determining how individuals or groups should conduct themselves |
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Characteristics of a person's ethics? |
Individualistic Fashioned by previous experiences, education and their environment Can change over time |
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What do ethics encompass? |
A process of determining right conduct from wrong conduct |
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What are values? |
Personal principles acquired from life experiences, family and peer relationships, religion, culture and law Personal beliefs about the worth of a given idea, attitude custom or object that influence behavior |
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What are values used to determine? |
Guiding routine decisions |
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What are ethics used to determine? |
Clinical decisions |
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Are individuals born with values? |
No. They are learned over time. |
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What happens when values and ethics interact with each other? |
They can cause conflict |
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Common Modes of Value Transmission |
Modeling Moralizing Laissez-faire Reward and punishment Responsible choice |
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What is modeling? |
Learn what is high or low value by observing parents |
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What is moralizing? |
Taught complete value system with little opportunities to weigh other values (church) |
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What is laissez faire? |
Explore own values Develop own value system |
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What is reward and punishment? |
Rewarded when demonstrating parents' values Punished when demonstrating other values |
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What is responsible choice? |
Encouraged to explore competing values and weigh their consequences |
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Are values static? |
No. They can change throughout the lifespan |
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What is the point of learning about ethics? |
Enables self analysis Helps to identify areas of discomfort and ethical "blind spots" Assists in mediating ethical conflict |
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What is law? |
Rules and regulations of society What a person did or failed to do Society as a whole as opposed to the individual within society Courts, statues, boards of nursing |
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What do ethics examine? |
Values, beliefs, and individual interpretations Why one acted as one did Good of the individual within society as opposed to all of society Ethics committees and professional organizations |
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Categories of Ethics |
Societal Ethics Organizational Ethics Professional Ethics Personal Ethics Bioethics Clinical Ethics Research Ethics |
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What are societal ethics? |
Clinical standard of care is guided by societal ethics |
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Example of societal ethics? |
Nurse Practice Act |
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What is the nurse's most important ethical role? |
Following the law and other expectations from society |
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What are organizational ethics? |
Mission statements for organizations |
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What are professional ethics? |
Professional standards, such as those for lawyers, doctors, nurses, social workers |
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What are personal ethics? |
Change over time; developed from own experiences |
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What are clinical ethics? |
Making decisions at the bedside regarding patient specific issues |
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What are research ethics? |
Specialized field in bioethics regarding conduct using human and animal subjects |
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What causes ethical conflict? |
No two categories perfectly overlap |
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Ethical Principles of Nursing |
Autonomy Beneficence Nonmaleficence Justice Fidelity |
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What is autonomy? |
Commitment to include patients in decisions |
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What is beneficence? |
Taking positive actions to help others |
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What is nonmaleficence? |
Avoidance of harm or hurt |
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What is justice? |
Being fair |
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What is fidelity? |
Agreement to keep promises |
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What does the principle of nonmaleficence state? |
One should do no harm including inflict pain and suffering |
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What does nonmaleficence demand? |
One should not impose risks of harm |
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When is an action wrong, according to nonmaleficence? |
An action is wrong if it inflicts harm on others. |
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What is harm? |
Emotional distress Property damage Loss of liberty to pain Disability Death |
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Rules of nonmaleficence |
Keep knowledge and skills current Know your own limitations Know when to refer Know when to delegate |
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What does the principle of beneficence state? |
Actions should benefit the patient |
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What must be balanced, according to beneficence? |
Benefits against risks and harm |
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Beneficence may also be viewed as... |
Promotion of health viewed from the patient's perception How the patient determines what is good |
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How must good be viewed, according to beneficence? |
Through the patient's eyes |
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Which actions are moral, according to beneficence? |
Actions are moral if they enhance a person's welfare |
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What does beneficence require? |
Existing harm be removed |
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Beneficence is interwoven with... |
Nonmaleficence |
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What does the ethical principle of justice state? |
People should be treated fairly and equally |
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What must be given to each person, according to justice? |
What he or she is due |
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What does justice often refer to? |
An ability to judge without reference to one's feelings or interest |
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When is the principle of justice used? |
Situations of competing resources (two patients waiting for one kidney) |
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How does justice relate to malpractice suits? |
It helps determine compensation |
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What does the principle of fidelity mean? |
Keeping one's promises and commitments |
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Which principle is a core value of the nurse-patient relationship? |
Fidelity |
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What is the second provision of the ANA Code of Ethics? |
For the nurse to remember that her primary commitment is to the patient whether that patient is an individual, family, group or community |
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What does fidelity mean once we have received report? |
We have made a commitment to care for those patients during our shift and until we find a replacement for ourselves, we are responsible. |
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What does the principle of autonomy address? |
Personal freedom and self-determination |
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What does autonomy give us? |
The right to choose what will happen to one's own person |
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Example of autonomy? |
Informed consent |
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Is autonomy an absolute right? |
Restrictions may be placed on a person's right to endanger others, such as in the case of communicable disease |
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Can patients make their own decisions, even if the provider does not agree? |
Yes |
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When can the professional ethically act on the patients choice? |
As long as the patient selects from treatment options that are consistent with accepted standards of care |
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When may the provider decline to provide a service requested by the patient? |
If that service is in conflict with the standards of patient care |
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Examples of Values and Concepts |
Paternalism Veracity Informed Consent Confidentiality |
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What is paternalism? |
Doing what the professional thinks is best for the patient according to the professional's ability and judgment |
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What does paternalism require? |
Professional to become a "parent" to make decisions for patient |
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When should paternalism not be used? |
Never to benefit professional at expense of patient |
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What does paternalism conflict with? |
Autonomy |
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What is veracity? |
Requirement that the whole truth be told Telling the truth and not telling lies |
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What are examples of veracity? |
Completely answer patient questions Give as much information as the patient and family can understand Telling the patient when information is not available or known |
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When is the principle of veracity upheld? |
When ensuring the patient understands the information being told |
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What implications does informed consent have? |
Ethical and legal |
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What principle is informed consent based on? |
Autonomy |
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What does informed consent require? |
Professional must provide all relevant information needed to make a decision |
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What does informed consent allow? |
Patient to make decision based on information provided |
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What is informed refusal? |
Patient has right to assess all information provided by professional Patient can choose option that is not most valued by professional |
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Who can give informed consent or refusal? |
Adults Legal guardian or parent of a child Legal guardian of someone who is mentally disabled |
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What is the only exception for informed consent/refusal? |
The patient's life is in danger and an immediate procedure is required to save their life |
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What is the principle behind confidentiality? |
Fidelity It is morally right to keep promises and other commitments, both implied and explicit |
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What promise do health professionals make? |
To keep certain information confidential |
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Breaking confidence is... |
breaking faith |
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Is it ever ok to break confidentiality? |
Legal requirement to report diseases that can have an effect on the health of the public Reporting suspected child abuse Reporting criminal acts |
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What does utilitarian mean? |
The rightness or wrongness of an action depends on the consequences of that action |
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What does deontologic mean? |
An action is right or wrong based on a rule, independent of its consequences |
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What are feminist ethics? |
Focus on inequality between people |
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What are ethics of care? |
Emphasize the importance of understanding relationships, especially as they are revealed in personal narratives |
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What discipline is tied to ethics of care? |
Holistic nursing |
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What are the four phases of caring? |
Caring About Taking Care Of Care Giving Care Receiving |
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What is the moral element of caring about |
Attentiveness |
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What is the moral element of taking care of |
Responsibility |
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What is the moral element of care giving |
Competence |
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What is the moral element of care receiving |
Responsiveness |
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What is an ethical problem? |
A problem that has an ethical component |
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What is an ethical dilemma? |
A problem for which in order to do something right, you have to do something wrong It is not possible to meet all the ethical requirements in the situation |
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How can you solve ethical problems or dilemmas? |
Use ethical analysis |
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What is ethical analysis dependent on? |
The ability to ask sound ethical questions |
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When do ethical dilemmas occur? |
When one or more ethical principle is in conflict |
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What is moral distress? |
A person is unable to act upon what he or she believes is the morally appropriate action to take When a person acts in a manner contrary to his or her personal or professional values |
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Examples of situations one might experience moral distress |
Inadequate communication betweenproviders about end of life care, inappropriate use of healthcare resources,continued life support when it is not the best interest of the patient,inadequate or poorly trained staff who cannot provide adequate care, inadequatepain relief provided to patients, false hope given to patients and families |
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Internal Barriers causing moral distress |
Self doubt Lack of assertiveness Perception of powerlessness |
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External barriers causing moral distress |
Inadequate staffing Lack of organizational support Poor relationships with colleagues Policies that conflict with care needs of patients |
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What are the two parts of moral distress? |
Stress response Moral residue/reactive distress |
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What is the stress response? |
Feelings of frustration, anger, guilt, anxiety, shame, withdrawal |
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What is moral residue/reactive distress? |
Lingering feelings that accumulate over time with each subsequent situation in which moral distress is experienced |
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What causes moral residue |
Unresolved moral distress |
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Three Response Patterns to Moral Residue |
Heightened response; conscientious objection, voicing objection Desensitization; passivity; withdrawing from ethically challenging situations Physical and psychological stress; burnout; leaving the profession |
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What happens to the health care professional with moral residue? |
Their core values, integrity and professional identity are undermined |
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Steps to Process an Ethical Dilemma |
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How does the nursing process relate to ethical decisions? |
Not an ethical theory in and of itself but an organizational template expected in all nursing practice |
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Questions to ask in assessment/data collection |
What is happening? What is the problem? |
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Questions to ask in assessment/analysis |
Analyze values and factual data |
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What to do during diagnosis phase |
Make a clinical judgment about the care, ethos or issues |
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How to consider outcomes/planning |
What would happen if? Identify a range of approaches |
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How to implement in ethical decisions? |
What is the fitting answer? The fitting answer should also be right. What is the outcome people can live with? |
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Questions for evaluation related to ethical decisions? |
What has happened? What can be learned from the situation? |
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Issues in Healthcare Ethics (examples) |
Quality of Life Genetic Screening End of Life Care Access to Care |
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What does culturally competent end of life care require? |
Acknowledgment of and respect for cultural differences. |
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What must one be willing to do when offering culturally competent end of life care |
Negotiate and compromise when world views differ |
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What must one be aware of in offering culturally competent end of life care |
One's own values and biases |
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What should the nurse use when offering culturally competent end of life care? |
Communication skills that enhance empathy |
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What should the nurse be familiar with to offer culturally competent care |
Cultural practices of patient groups regularly seen |
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What must the nurse understand about culturally competent care |
All patients are individuals who may not share the same views as others within their own ethnic group |
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What is contained in the Code of Ethics for Nurses? |
Central ethical values, duties, and commitments of nursing |
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How does the code of ethics for nurses change? |
It evolves with the changing social context of nursing |
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What do the statements in the Code of Ethics include? |
Ethical values Obligations Duties of every individual who enters the nursing profession |
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What does the Code of Ethics serve as? |
The profession's nonnegotiable ethical standard |
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What does the Code express? |
Nursing's own understanding of its commitment to society |
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What is competence? |
Ability to do something successfully |
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How can nurses demonstrate competence? |
Stay current on licensure and continuing education. Follow policies and procedures Remain aware of accreditation standards |
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How can nurses increase competence? |
Obtain specialty certifications Maintain a practice portfolio Join professional organizations |
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What is accountability? |
Answerable for own actions |
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What are nurses accountable for? |
The actions of others delegated to Patient Outcomes |
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4 Components of Philosophy of Nursing Practice |
Patient Health Environment Nursing |
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What are ethics committees? |
Usually multidisciplinary and serve several purposes: education, policy recommendation, case consultation |
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Who can request access to ethics committees? |
Any person involved in an ethical dilemma (nurses, physicians, providers, patients, family members) |
