(WEEK 6)

PROFESSIONAL ETHICS A branch of biological science concerned with the obligations of a member of a profession owes to the public, to his profession and to his clients FUNCTIONS OF THE PROFESSIONAL CODE OF ETHICS Set forth basic principles and regulations to serve as guidelines Serves as resources for the orientation of new practitioner for their duties, rights and privileges Serves as guidelines to identify and evaluate qualities synonymous with professional conduct Provides guidelines for the establishment and operation of education programs to prepare future members for service in the profession Identify common practices to be followed and those to be shunned Provides a guide for considering the relationships of individuals to their employers, co-workers, society in general and to their own profession Serves as basis for identifying standards of quality practice consistent with actions of the qualified, competent practitioner Provide by implication for legal actions against incompetents and violators of the code and for liability of the consequences of their actions Provide for due process under the law for practitioners unjustly accused of misconduct in the performance of their duties CODE OF ETHICS A formal statement of a groups ideals and values. Have higher requirements than legal standards and never lower than the legal standards of the profession CODE OF GOOD GOVERNANCE FOR THE PROFESSIONALS IN THE PHILIPPINES signed into law by Pres. G.M. Arroyo June 23, 2003 EO 220 to be adopted by the Governance Advisory Council and the Philippine Regulation Commission thru various Professional Regulatory Boards. OBJECTIVES OF ADOPTING A CODE OF GOO GOVERNANCE FOR PROFESSIONALS: Promote & establish ethical awareness and competency among Filipino professionals making accountable to their public liability and fulfill their professional obligations to their clients Empower professionals not only to upgrade or improve their technical and ethical proficiency but also to keep abreast with modern trends and technology in their respective professions. The HALLMARK OF TRUE PROFESSION is their WILLINGNESS to ACCEPT a SET OF PROFESSIONAL and ETHICAL PRINCIPLES. GENERAL PRINCIPLES OF PROFESSIONAL CONDUCT Professionals aside from having ethical commitment and personal resolve to act literally but to have also : a. Ethical awareness - ability to discern between right and wrong b. Ethical competency ability to engage in sound moral reasoning and consider carefully the implications of alternative actions SPECIFIC PRINCIPLES OF PROFESSIONAL CONDUCT 1. 2. 3. Service to others Professionals are committed to life of service to others Integrity and objectivity Professionals should perform their responsibilities with the highest sense of integrity and nationalism and spiritual values. Professional competence Professionals should have the knowledge, technical skills, attitudes and experience Obligation to keep up with new knowledge and techniques in their field and take part in lifelong continuing education program Solidarity and Teamwork Each profession shall nurture and support one organization for all its members

4.

Each member should put the broader interest of the profession above ones personal ambition and preference

5. 6. 7.

Social and Civic Responsibility Professionals should always carry out their professional duties with due consideration of the broader interest of the public. Global Competitiveness Every professional shall remain open to the challenges of a more dynamic and interconnected world rising up to global standards and level of professional practices aligned with global practices Equality of all Professions All professionals should treat their colleagues with respect and strive to be fair with one another.

eHealth Code of Ethics - From the Internet Healthcare Coalition Members published the eHealth Code of Ethics May 24, 2000 Vision is: To ensure that people worldwide can confidently and with full understanding of known risk realize the potential of the internet in managing their own health and the health of those in their care. Issued this code of conduct for marketers, health professionals and creators of Web sites With 8 concepts: 1. Candor discloses beneficial information on the World Wide Web 2. Honesty 3. Quality4. Informed consent 5. Privacy 6. Professionalism in online health care 7. Responsible partnering 8. Accountability NURSING ETHICS A set of ethical principles that is: a. shared by members of the group b. reflects their moral judgments over time c. serves as a standard for their professional actions NURSING CODE OF ETHICS Purposes of the Nursing Code of Ethics Inform the public about the minimum standards of the profession and help them understand professional nursing conduct Provide an indication of the professions commitment to the public it serves Outline the major ethical considerations of the profession Provide ethical standards for professional behavior Guide the profession in self-regulation Remind nurse of the special responsibility they assume when caring for the sick

International Council of Nurses An organization of all nurses all over the world collaborating to strengthen nursing service, nursing education and professional ethics - Ms. Ethel Gordon- English nurse initiated the forming of international organization for nurses 1899 The International Council of Nurses was organized July 1899 The member association in the Philippines is the Philippine Nurses Association(PNA) 1929 First adopted by the International Council of Nurses (ICN) 1953 an international code of ethics for nurse

(WEEK 7)
THE CODE OF ETHICS FOR NURSES IN THE PHILIPPINES o Code of Ethics of Filipino Nurses Dean Emeritus Julita Sotejo of PNA Special Committee developed a Code of Ethics for the Filipino Nurses 1982

1984- the Board of Nursing officially adopted the International council of Nurses (ICN) Code of Ethics and added the 5th commitment promotion of spiritual environment as Board Resolution No. 633. 1989 PRC approved the Amended Code of Ethics by the general assembly of PNA in 1990

BRIEF HISTORY OF THE PHILIPPINE NURSING LAW Act No. 2493 of 1915 the practice of nursing was contained in this act that regulated the practice of nursing Applicants needed to be: 21 years old good moral character requires 2 years and a half of instruction graduates were called first class nurses those who desired to be second class filed application with the district health officer in the district where they resided Act 2808 of 1919- known as the First True Nursing Law Created the board of examiners for nurse 1920- the first board examination in the Philippines was given RA 877 Philippine Nursing Law of 1953 Organization of the Board of Examiners for Nurses Provisions regarding nursing schools and colleges and miscellaneous provisions relative to the practice of nursing RA 4704 of 1966 amended certain portions of RA 877 Proposed 1 professional program in nursing and widening the scope of nursing practice (PNA of 1976) RA 7164-or the Philippine Nursing Act of 1991 revised all the laws regulating the practice of nursing in the Philippines RA 9173 or the Philippine Nursing Act of 2002 Empowered and ordered the Board of Nursing to promulgate a Code of Ethics for Registered Nurses in coordination with the PNA The Code of Good Governance for the Professions in the Philippines was utilized as the principal basis with all the principles under the said Code (Code of Ethics)integrated and applied to the nursing profession THE HUMAN PERSON One is human by virtue of ones genetic code, while a person is a member of a moral community. A person has the following elements: The Personhood

Has characteristics recognized by the community (consciousness of objects and events, ability to feel pain, ability to reason, self-motivated activity, capacity to communicate and ones concept of the self) With moral status Acknowledged with right ( most of the focus of ethical thought is the person with personal rights and responsibilities) Elements of the Personhood

A subject- human beings exist as creatures under the rule of God , the Creator, subject to His authority Embodied subject- have human body Part of the Material World- God created the world, took dust and formed man and breathed life into it Inter-relational with Person- relationship between different people An Interdependent Social Being- need to care for each other. Historical- individual exists within a historical framework and interested in their ancestors Equal but Unique- each person has equal right despite economic, educational or psychological differences yet not all the same Called to Know and Worship God- ability to know and respond to God; capacities and gifts benefit to the community

(wk 8)
THE HUMAN ACT AND THE ACTS OF MAN Human Act

Actions that are deliberately done involving human reasoning and intellect Performed consciously and knowingly

Acts of Man Actions done by a person considered unseemly Not dependent upon intellect and free will

Elements of Human Act Knowledge Aware of what he is doing whether good or bad Freedom Acting by his own volition and power Passion as fear and anger are possible hindrance to human acts as they cloud judgment and freewill Actual Choice or Voluntariness performed by an agent who decides willfully to perform the act.

1. Principle of Indirect Involuntariness (PRINCIPLE OF TWO-FOLD EFFECT) To be judged as morally good an action with double effect must have the following criteria: a. Action must be morally good and must not be evil by itself b. The good effect must be willed and the bad effect merely allowed. c. The good effect must not come from evil action but must come from the initial action directly. d. The good effect must have greater effect than the bad effect. 2. Principle of Double Effect: Human Acts with Good and Bad Effect Human acts result in both good and bad consequences

Conscience -

The human act to be performed becomes an ethical problem

Making moral decisions demand a. Maturity and responsibility b. Understanding of reality c. Attentive to the wisdom of the past d. Discern the biases and demands of a particular situation Definition of Conscience practical judgment of human reason concerning the moral goodness or evil of ones action small voice within telling us whether we have done something right or wrong or decisions we are considering is a good one or bad one Concepts of Conscience Heteronomous conscience

- focus solely on laws and obligation, commands and prohibitions - tied to normative ethics Autonomous conscience - Totally subjective - Ignores the law and by itself determines what is right and what is wrong Levels of Conscience Antecedent actual conscience Refers to the whole process of making judgment in conscience before the moral act Concomitant actual conscience Actual awareness of being morally responsible for the goodness or badness of a particular act which man carries out In effect, mans conscience informs him that hes acting in a good way or morally reprehensible Consequent actual conscience Involves the process of reflection on ones moral responsibility relative to past action

Dimensions of Conscience Man develops a general sense of value which is the awareness that he should do good and avoid evil Man search for truth and turns into a variety of sources as Bible, Koran , religions and churches, educational institutions, traditions and competent professionals for guidance After searching for the truth and turning into sources, man can eventually come up with concrete judgment and specific decision

Formation of Conscience Man says I must follow my conscience.- needs discernment and application of what is right and what is wrong Obey your conscience- must be properly understood to be properly used; choice made in good faith to make what one ought himself to be The dignity of human person implies and demands the integrity of the moral conscience Man must try to make sure that ones moral judgment is right by : Diligently learning the laws of moral life Seeking expert advice on difficult cases Removing the obstacles to right judgment Personal examination of conscience

Formation of conscience is a long and comprehensive process that will later facilitate an immediate and right judgment in any concrete situation

Doubtful Conscience The suspension of judgment on the moral goodness of an action because the intellect can not see clearly whether it is good or bad Doubt may refer :

To law itself in its content To the action If there is reasonable ground for doubt, one may not act until it is solved

Principles in Resolving a Doubtful Conscience The most important reflex principles are: A doubtful law does not bind In case of doubt, the professor has a better right A person is presumed innocent until proven guilty In case of doubt, one has to judge according to what ordinarily happens An act is to be proven valid until proven otherwise In case of doubt, what is odious should be restricted and what is favourable should be expanded

Scrupulous Conscience

Action is sinful based on weak or insufficient reason The symptoms are: Excessive anxiety over the sufficiency of good actions especially over the validity of past confessions Fastidious accusations, scrutinizing and unnecessary circumstances especially with regards to internal sins Persistence in ones opinion leading one to mistrust ones confessor and go from one confessor to another

- Causes of scrupulous conscience are:

Natural such as physical (sickness) Moral- such as self-centeredness, dealing with excessively strict person, or even hidden pride

Remedies of scrupulous conscience Removal of its cause Strict obedience to ones confessor Orderly work and suitable recreation Prayer Trust in God who is our Father

Lax Conscience Judges without sufficient reason that a certain action is not sinful or is slightly sinful

PHARISAIC ( excessively or hypocritically pious)- conscience characterized by stiff correctness in some things especially external and unimportant ones together with great laxity in matters of far greater importance Causes of lax conscience: Poor moral education Dealing with corrupt people Strong disorderly passions Immersion in vices for a long period of time

j Principles Used in Moral Discernment Principles of double effect Principle of the lesser evil Principle of material and formal cooperation 1. 2. 3. Cooperation in this context means physical or moral concurrence with the principal agent in an immoral act Formal cooperation is present when one concurs with the sinful deed of another and gives internal consent to do it. Material cooperation means that one somehow externally participates in anothers sinful deed without giving any internal consent

Making moral decisions Choosing the action does not fully promote humanity A mature moral decision is not that we ought to do but what we ought ourselves to be

Modifiers of Human Acts Man is responsible before God only for true human acts.

The following elements may lessen or even eliminate moral responsibility:

Ignorance- lack of knowledge of a person capable of knowing.

Different types of ignorance

1. 2. 3.

Ignorance of the law lack of knowledge that a particular law exists Ignorance of the fact- lack of realization that one is violating a law Vincible ignorance- culpable negligence; DOES NOT ELIMINATE RESPONSIBILITY BUT LESSENS IT; DESTROYS VOLUNTARINESS AND RELIEVES THE AGENT OF RESPONSIBILITY Simple Vincible ignorance- no sufficient effort to dispel ignorance Crass Vincible ignorance- results from a mere lack of effort.

4. 5.

6. 7.

Affected Vincible ignorance- deliberately fostered in order to avoid any obligation that knowledge might bring to light Invincible ignorance- cannot be dispelled because the person is unable to secure adequate information even after a reasonable effort or simply the person does not know there is a problem.; ELIMINATES RESPONSIBILITY

FEAR - an agitation or disturbance of mind resulting from some present or imminent danger. Types of fear are:

1. 2. 3. 4.

Light fear- an evil threatening is either present-but-slight or grave-but-remote Grave fear- evil threatening factor is considered serious Intrinsic grave fear- agitation of mind which arises because of a disposition within ones own mind or body Extrinsic fear- arises from something outside oneself and justly caused

* FEAR DIMINISHES THE VOLUNTARY NATURE OF AN ACT

Concupiscence- any human impulses or the tendency of human nature towards evil; technically called PASSIONS 1. Types of Concupiscence:

a.

Antecedent concupiscence- sort which precedes an act of the will is not willfully stimulated as sudden anger; lessens the voluntariness and responsibility but does not take them away Consequent concupiscence- stimulated by the will such as deliberate anger; person is completely responsible

b.

Violence- external factor applied by someone on another in order to compel him to perform an action against his will

1.

Perfect Violence- either be physically or morally perfect ; violence is entirely involuntary and there are no moral responsibilities

a. b. 2.

A physically perfect violence- every possible means of resisting is utilized A morally perfect violence- all powers of resistance that should be used are employed.

Imperfect Violence- some resistance is shown but not as much as should be; less voluntary and so the moral responsibility is lessened but not taken away completely.

Other Factors Affecting the Voluntary Nature of Human Actions-

1.

Habit- acquired by repetition and characterized by a decreased power of resistance and an increased facility of performance; sometimes called second nature meaning something deeply ingrained in an individual through acquisition rather than inborn. Temperament- sum total of those qualities which mark an individual ; heredity and environment play important roles in forming a persons temperament

2.

Four Major Temperaments:

a. b. c. d.

Sanguine pleasing, agreeable, not a good leader because not very stable Choleric domineering, strong-willed, good leader Melancholic- pessimistic, brooding, usually unscrupulous, despairs easily Phlegmatic easy-going, lacking initiative, trustworthy

*A PERSONS TEMPERAMENT CAN AFFECT HIS WILL TO THE EXTENT OF SOMEWHAT LESSENING THE COMPLETELY VOLUNTARY NATURE OF HIS ACTIONS

Mental States- nervous mental disorders can completely take away the voluntary nature of certain acts; affect the proper operation of intellect and will

Human Rights Those items which are a persons due as a member of the society; no; earned and exist independently of law or public opinion; founded on essential and universal need; occur in the context of a culture and influenced by the beliefs or value systems of that culture Types of Rights A right is something owed to an individual according to just claims; legal guarantee or moral and ethical principles Welfare rights- known also as legal rights as they are guaranteed by law; Bill of Rights Ethical rights- based on moral or ethical principles that usually do not require the power of law to be enforced; in reality these are privileges Option rights- based on the fundamental belief in the dignity and freedom of humans; basic human rights; give individuals the freedom to choice but within boundaries.

(wk 9)

THE CALLING OF THE HEALTH CARE PROVIDER

The Health Care Profession- treats and tends to clients who are injured, sick, disabled or infirm. The delivery of modern health care depends on an expanding interdisciplinary team of trained professionals A HEALTH CARE PROVIDER OR HEALTH PROFESSIONAL- an organization or person who delivers proper health care in a systematic and professional way to an individual in need of health care services The CLIENT - receiver of competent nursing care Patients Right

o
o

Patients rights moral and inviolable power vested in a client as a person to hold, do or demand as his own Every right in a client involves corresponding duty in a nurse to respect and violation is morally wrong. The INC Code of Ethics provides that inherent in nursing is respect for human rights, including the right to life, dignity and respect Nursing care is unrestricted by considerations of age, color, creed culture, gender, nationality, politics , social status and disability

The Patients Rights Right to competent care Nurse has the necessary education, training and experience Personality to carry out the services for which they are responsible Lacking in these, nurse may be sued for:

Negligence commission or omission of an act pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not do Elements of Professional Negligence a. b. c. Existence of a duty on the part of the health care professional in charged to the client, to use due care under circumstances Failure to meet the standard of due care Foreseeability of harm resulting from failure to meet the standards The fact that the breach of this standard resulted in an injury to the client

d.

Common acts of negligence are: a. b. c. d. e. f. Burns Objects left inside the clients body Loose dentures lodged in clients trachea Falls of children and adults or unconscious or weak clients Failure to observe and take appropriate action for emergency situations Medication errors

Malpractice a. Negligent acts of persons engaged in the professions or occupation in which highly technical or professional skills are employed

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b. c. Freedom from harm

Denotes stepping beyond ones authority; idea of improper or unskillful care of a client by a nurse Carelessness of professional personnel

a. b.
c.

Risk-benefit ration- appropriate balance between potential benefits of the clients medical regimen and the risks assumed by the client; benefits should outweigh the harm Minimal risk exposure to the possibility of injury going beyond everyday situation Medications are toxic and should be monitored for therapeutic as well as side effects

Right to Withdraw from participation Right to confidentiality of information 1. Confidential information maybe revealed when: a. b. c. d. Client himself permits such revelation Case is medico-legal in nature Client ill with communicable disease To members of the health team if such information is relevant to his care

Right to Self-determination- related to the principle of autonomy 1. Clients rights under self-determination: a. Right to informed consent-

Informed consent- knowledge information about and the consent to a particular form of medical treatment before it is administered b. c. d. Right to informed decision Right to informed choice Right to refusal of treatment

Limitations of a Patients Right a. b. Clients right do not include the right to be allowed to dieA patient in a declining condition does not possess the necessary mental capacity or emotional stability to make an informed consent Patients rights are not absolute

c.

The Magna Carta of Patients Rights Patients Bill of Rights adopted by the American Physician Association (APA) or the American Hospital Association (AHA)

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The Patients Bill of Rights within the scope of the proposed Magna Carta of Patients Rightshumanizing element of health care ethics Patients Duties And Obligations The Dying Patients Bill of Rights

The Health Care Provider

The Rights something owed to an individual according to just claims, legal guarantees or moral and ethical principles Nurses Bill of Rights

Bill of Rights and Responsibilities for Students of Nursing Modern health care is a team practice The goal is to render service to humanity

Hypothetical Models used for the examination of the physician-client relationship

Engineering Model- the physician acts as a scientist who deals only the with facts Priest Model- the physician operates from the moral position of knowing what is best for the client; the client is made to believe that her own opinion is not of the same value as that of the physician Collegial Model- physician and client should see themselves as colleagues solving the common problem of eliminating illness Contractual Model- share decision making model which the client is accorded the right to make decisions and have control over his own life whenever significant decisions are to be made.

(wk 11)

QUALITIES AND RESPONSIBILITIES OF THE HEALTH CARE PROVIDER o The health care provider is one who exercises skill and judgment or provides a service related to: o Preservation and improvement of the health of an individual Treatment/care of individuals who are sick, injured, harmed, disabled or infirmed

Jean Watsons Ten Primary Curative Factors: The formation of a humanistic-altruistic system values The instillation of faith-hope The cultivation of sensitivity to ones self and others The establishment of a helping-trusting relationship

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The expression of feelings both positive and negative The systematic use of the scientific problem-solving method for decision making The promotion of the interpersonal teaching-learning The provision for a supportive, protective and or corrective mental, physical, socio-cultural and spiritual environment Assistance with the gratification of human needs

Jean Watsons Ordering of Needs Lower Order Needs

Biophysical Needs 1) 2) 3) The need for food and fluid The need for elimination The need for ventilation

Psychophysical Needs 1) 2) The need for activity-inactivity The need for sexuality

Higher Order Needs

Psychosocial Needs 1) 2) The need for achievement The need for affiliation

Intrapersonal-interpersonal Need 1) The need for self-actualization

The allowance for existential-phenomenological forces

Phenomenology- way of understanding people from the way things appear to them, from their frame of reference Existential psychology- study of human existence using phenomenological analysis

Personal Characteristics of Health Care Providers Calling The ability to be present for others A recognition and acceptance of their personal power The knowledge that they have found their own way

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A willingness to be vulnerable and to take risks Self-respect and self-appreciation A willingness to serve as models for their clients A willingness to risk making mistakes and admitting having made them A willingness to grow in the profession

Attitudes and Behavior Integral to Patient Care

Altruism- attend to the best interest of clients Accountability- obligation to perform certain activities and duties Excellence perform activities related to her profession with merit and superior quality Duty has the moral and legal obligation to act and perform their functions and commit in the service of society and profession Honor and Integrity- committed to being fair, truthful, and straightforward in the interaction with patients and other health professionals Respect for others- demonstrate respect for patients and their families and other members of the team

Common Concerns of the Beginning Health Care Professionals Anxiety Expecting Instant Result Dealing With Difficult Clients Silent Client Overly Demanding Client Unmotivated Client

Understanding Ones Limitations On Demanding Perfection Self-Deception Dealing with Transference and Counter-transference

Transference- the client unconsciously displace onto the nurse attitudes and feelings he/she originally experienced towards others Counter-transference- nurse displaces unto the client his/her attitudes and feelings from his/her past

Relationship

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Nurse- Physician Relationships Nurse Client Family Relationship Unavoidable Trust Personal Dignity 1. 2. 3. Just Generosity Misericordia- giving on urgent need without prejudice Truthfulness

Patient Advocacy

Nurse- Nurse Relationships

(wk 12)
VIRTUES o Definition

Virtue excellence in character; purposive disposition and character traits that are developed throughout life.

Virtue Ethics based on the excellence of ones character and the consideration of what person wants to become Historic Influence and Tradition Virtues in Bioethics- character of the health care provider which are morally praiseworthy traits that are immeasurable Professional Virtues The nurse at all times maintains standards of personal conduct which reflects well on the profession and enhance public confidence The nurse owes the same duties to self as to others including the responsibility to preserve integrity and safety. must perform their professional duties in conformity with existing laws, rules, regulations, measures and generally acceptable principle of moral conduct and proper decorum.

Secular Virtues- according to Plato, 4 classical Greek virtues are justice, temperance, courage and wisdom Religious Virtues

Virtue Based Nursing Model

Insight ( sophia)- wisdom; ability to think well about nature of the world Practical wisdom (phronesis)- prudence; capability to consider the mode of action in order to deliver change enhancing the quality of life.

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Choice (prohairesis)Goal or telos- characterized as active happiness and well being

Virtues of Health Care Provider Fidelity Honesty Humility Respect Compassion Prudence Courage

Habits of the Health Care Provider The Good Habits Be Proactive

Being proactive in health care results to: 1. 2. 3. Adaptability Independence Satisfaction

Begin with the End In Mind Put First Things First Seek First to Understand, Then to Be Understood Synergize- alliance Sharpen the Saw

Vices of the Health Care Provider

Fraud cheating; criminal deception using false representation to gain an unjust advantage Pride high or overbearing opinion of ones worth or importance Greed- excessive desire especially for food or wealth

(wk 13)
ETHICAL DECISION MAKING IN NURSING

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Origins of Ethical Problems in Nursing Social and Technological Changes Sources of Ethical Problems 1. 2. 3. 4. Social changes such as womens movement and a growing consumerism the large number of persons without health care insurance The high cost of health care Workplace redesigned under managed care

Conflicting Loyalties and Obligations

Frameworks for Ethical Decision Making Ethical Systems and Principles Patients Bill of Rights Professional Code of Ethics Institution Policies Laws

Decision Making in Values Issues Steps :

Step 1: Collect, Analyze and Interpret Data Step 2: State the Dilemma Step 3: Consider Choices of Action Step 4: Analyze Advantages and Disadvantages of Each Course of Action Step 5: Make the Decision

Traditional problem Solving Process 1. Identify the problem Gather data to analyze the causes and consequences of the problem Explore alternative solutions Evaluate the alternative Select the appropriate solution

2.
3. 4. 5.

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6. 7. Steps :

Implement the solution Evaluate the results

Moral Decision Making Models- incorporates nursing process and biomedical ethics

MORAL M - Massage the problem Collect data, ethical problem and who should be involved in the Decision-making O - Outline options, identify alternatives and analyze causes and consequences of each

R - Review criteria and resolve, weigh options against the values Of those involved in the decision A - Affirm position and act, develop the implementation policy L - Look back, evaluate the decision making

Murphy and Murphy the process does not solve the underlying problem but requires decision and helps clarify basic beliefs and values of the people involve: 1. 2. 3. 4. 5. 6. 7. Identify the problem Identify why the problem is an ethical decision Identify the people involved in the ultimate decision Identify the role of the decision-maker Consolidate the short and long term consequences of each alternative Make the decision Compare the decision with decision makers philosophy of ethics Follow up on the results of decision to establish baseline future decision making Recognizing the moral dimension Who are the interested parties? What are their relationships What values are involved? Weigh the benefits and the burdens a. Benefits- production of goods for various parties and acting in fairness b. 5. Burdens- causing physical/emotional pain to various parties, imposing financial cost and ignoring relevant values

8. McDonald 1. 2. 3. 4.

Look for analogous cases

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6. 7. 8. o

Discuss with relevant others Is this decision in accord with legal and organizational rules? Am I comfortable with this decision?

Thompson and Thompson 1. 2. 3. 4. 5. 6. 7. 8. 9. Review the situation to determine health problems, decision, needs, ethical components and key individuals Gather additional information to clarify the situation Identify the ethical issues in the situation Define personal and professional moral positions Identify moral positions of key individuals involved Identify value conflict, if any Determine who should make the decision Identify range of actions with anticipated outcomes Decide on a course of action and carry it out

10. Evaluate/review results of decision/action Cassels and Redman 1. 2. 3. 4. 5. 6. 7. 8. 9. Identify moral aspects of nursing care Gather relevant facts related to a moral issue Clarify and apply personal values Understanding ethical theories and principles Utilize competent interdisciplinary resources Propose alternative actions Apply nursing codes of ethics to help guide actions Choose and implement resolutive action Participate actively in resolving the issue

10. Apply state and federal laws governing nursing practice

11.
o

Evaluate the resolutive action taken

Ethical Dilemmas

Examples are: Difficult choices involving justice or fairness Whether or not to follow a doctors order to administer a dangerously high dose of narcotic drug

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Nurses Obligations in Ethical Decisions Maximize the clients well-being Balance the clients need for autonomy with family members responsibilities for the clients well-being Support each family member and enhance the family support system Carry out hospital policies Protect other clients well being Protect the nurses own standards of care

Strategies to Enhance Decisions and Practice Be aware of ones own values and the ethical aspect of nursing Be familiar with the nursing code of ethics Seek continuing education opportunities to stay knowledgeable about ethical issues in nursing Respect the values, opinions and responsibilities of other health care professionals that may be different from your own Participate in or establish ethic rounds Serve on institutional ethics committee Strive for collaborative practice in which nurse function effectively in cooperation with other health care professionals

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