Chapter 6: Values, Ethics, and Advocacy

Where do we make critical decisions about health care?
In the groups with other professionals and the bedside

True or false: We are increasingly distressed by the failure of society to provide adequate care for its most vulnerable members

An individual is not born with values, values are formed from information from the environment, family and culture

Belief about the worth of something or about what matters. It acts as a standard to guide one’s behavior

School is very important to me. What is this an example of?
A value

Value system
Organization of values in which each is ranked along a continuum of importance
Ex: If you value health/fitness more you may place less value on leisure/fun

The concern for welfare and well being of others – to do this we must understand the cultures, beliefs and perspectives for others and advocate for our patient

Which of the following demonstrates understanding cultures, beliefs, and perspectives of others?

Human Dignity
Respect for ALL patients and colleagues – We must respect all humans

Honesty and providing care based on an ethical framework accepted within the profession. Be honest, document honestly and accurately. Correct your errors and be accountable!

Social Justice
Upholding moral, legal and humanistic principles. (Be fair and consistent with policies, follow the rules – think justice – follow the legal rules)

Respect a pt’s right to make their own healthcare decisions (A pt has a right to be ‘autonomous’

Should we be value neutral and nonjudgemental?

Values Clarification
Discovering one’s own values by assessing, exploring and determining what those personal values are and how the affect decision making – its how people come to understanding their own values [Clarification of Values]

A principle of values clarification is that
No one set of values is right for everyone

Steps of values clarification
1 – Choosing: You choose the value from alternatives
2 – Prizing: You prize and cherish what you chose
3 -Acting: You incorporate and act with that value

Where do values come from?
Significant Life Events

Belief that one’s own culture is the best and the only way

Ethics and Morals are the same – T or F

A systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing

Think of Ethics is how you treat people you do not know – how to you treat people at work! – Nursing codes of Ethics

Morals are more personal then ethics – they are personal/communal standards of what right or wrong

Values affect Ethics and Example
Yes, Values are related to ethics. If I place value on safety, I am more likely to secure my pt’s safety.

Responsible research conduct, genetic enhancement, environmental ethics and sustainable healthcare – They do research about what should a person do to live a moral life and make good ethical decisions

Clinical ethics
Concerned with ethical problems at the bedside

Nursing Ethics
Subset of bioethics – formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgements

Examples of common ethical issues
Cost containment jeopardizing pt. welfare
Protecting pt. rights
End of life decisions
Informed consent to treatment procedures
Breaches of pt. confidentiality
Incompetent, unethical or illegal practices of colleagues

Principles of bioethics
Autonomy – respect autonomy/decisions of pets
Nonmaleficence – Do not harm
Beneficence – Benefit the pt.
Justice – Be fair
Fidelity – Keep your promise

Ethical Dilemma
Situation where two moral principles are in conflict

Ethical Distress
Nurses knows the right thing to do but other factors make it hard to follow the correct course of action
“The nurse is in distress – she know the right thing to do but is confused”

Types of Ethical Dilemmas
Empirical Knowledge vs Personal Belief
Freedom Vs Control
Pro Choice and Pro life

Empirical Knowledge Vs Personal Belief
Jehovah’s Witness against blood transfusion

Freedom Vs Control
A pt. wants to stop eating, but it will cause her harm. Does the nurse have the ‘right’ to force her to eat?

Pro-Choice versus Pro-life
The nurse may think abortion is murder, can he/she support the pt.’s right to autonomy

Ethical Distress examples [Think when the SANE nurse who came into class was in distress]
End of life care – Aggressively treating terminally ill pt’s instead of referring them to hospice/comfort care
Lack of staff and resources – leads to less time spent with pt and below average care

What is the first clue that a nurse may perceive a moral issue is present in a situation?
Inability to distinguish between right and wrong, good and bad

Nursing Process in Making Decisions
1) Assess the situation – Gather data about the situation and factors that give rise to the problems, the views of the main people (the pt., the family, staff) and the social situation
2) Diagnose (Identify the ethical problem – is it a Ethical conflict?)
3) Plan – Identify options and consequences for each and pick the best one – Apply ethical theories and principles and consult with respected colleague and decide the best course of action
4) Implement
5) Evaluate

Code of Ethics
set of principles the reflect primary goals, values, and obligations of the profession

Code of Ethics for Nurses
Developed to guide nurses in carrying out responsibilities consistent with quality nursing care and ethical obligations

Ethical issues in health care:
1. Paternalism:Acting based on what a parent would do
2. Deception:Have you done this before?
Confidentiality: Confidentiality for adolescents
3. (We breach confidentiality in an HIV case, child abuse, or if one harms themselves)
4. Allocation of nursing resources: Costly meds, organs, equipment, limited bed
5. Informed consent – If the pt. doesn’t want the procedure anymore, we must listen
6. Nurse Physician Relationship – Disagreements regarding the regime, scope of nurse’s role, physician incompetence, substance abuse – TELL IF YOUR DOCTOR IS DOING DRUGS
7. Assisted Suicide – Is it right to give a cancer pt. a drug to die if they want it?

According to the nursing code of ethics, the nurse’s first allegiance is to the
Client only

A nurse is caring for pts in the intensive care unit develops values from experience to form a personal code of ethics. Ethic statements best describe a characteristic of the development of a personal value system? Select all that apply?
a. People are born with values
b. Values are standards to guide behavior
c. Values are ranked on a continuum of importance
d. Values influence beliefs about health and illness
e. Value systems are not related to personal codes of conduct
f. Nurses should not let their values influence pt. care.
b. Values are standards to guide behavior
c. Values are ranked on a continuum of importance
d. Values influence beliefs about health and illness

Example that denote prizing in the process of values clarification
Pt. shows of new outfit after losing 20 pounds
Pt. proudly displays his certificate for completing marathon

A professional nurse with a commitment to social justice is most apt to
Provide universal access to healthcare [we are concerned with society – social justice]

Acting in accordance with an appropriate code of ethics and accepted standards of practice
Integrity – acting in accordance with an appropriate code of standards and being honest

A professional nurse committed to the principle of autonomy would be careful to
Provide the information and support a patient needed to make decisions to advance one’s own interests

A nurse performs a safety assessment of the home a frail elderly pt. to prevent harm to the pt. is acting in accordance with which of the principles of bioethics?
e. Monmaleficence

Protection and support of another’s rights
Patients with special advocacy needs include the very young and the elderly, those who are seriously ill, and those with disabilities
Effective advocacy may entail becoming politically active

Which of the following nursing situations is an example of the care-based approach to ethics? Select all that apply.
• Holding the hand of a dying client
• Providing a back rub to a client on bed rest
• Involving the parent in the bed bath of a child
Holding the hand of a dying client, providing a back rub and involving the parents are all examples of a care-based approach. The other choices are not reflective of this.

Which of the following nursing situations is an example of an ethical dilemma?
An ethical dilemma occurs when it is difficult for a decision to be made. If there is no signed DNR, then legally cardiac compressions must be started. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope.

Learning Outcomes Explain how values, moral frameworks, and codes of ethics affect moral decisions. Explain how nurses use knowledge of values to make ethical decisions and to assist clients in clarifying their values. When presented with an ethical situation identify …

Values something of worth; enduring beliefs or attitudes about the worth of a person, object, idea, or action. They are important because they influence decisions, actions, even nurse’s ethical decision making value set all the vales(eg, personal, professional, religious) that …

List five common modes of value transmission. • Modeling: children learn what is of high or low value by observing parents, peers, and significant others o may lead to socially acceptance or unacceptable behaviors • Moralizing: taught a complete value …

Which of the following theories of ethics most highly prioritizes the nurse’s relationship with patients and the nurse’s character in the practice of ethical nursing? a) Utilitarianism b) Care-based ethics c) Deontology d) Principle-based ethics b) Care-based ethics A client …

Which of the following ethical principles is related to the idea of self-determination? a) Beneficence b) Confidentiality c) Nonmaleficence d) Autonomy d. autonomy Explanation: Autonomy refers to self-rule, or self-determination; it respects the rights of patients or their surrogates to …

Which of the following theories of ethics most highly prioritizes the nurse’s relationship with patients and the nurse’s character in the practice of ethical nursing? a) Utilitarianism b) Care-based ethics c) Deontology d) Principle-based ethics b) Care-based ethics A client …

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