Ethnical Decision Making in Nursing

-define and provide examples of ethical terms
-define, compare and give examples of normative ethics theories as applies to nursing practice
-discuss ethical principles in nursing and application of the clinical setting
-identify sources of ethical norms in nursing and healthcare
-define and provide examples of various types of justice
-define and provide examples of bioethics in healthcare

Nurses Judged on Ethics
“the most trustworthy profession”
“the most honest and ethical profession”
-Gallup 2014

Ethics Terminology
1. well founded STANDARDS of RIGHT and WRONG (rights, obligations, benefits, fairness)
2. study and developmental of ethical standards

-statements about broad, GENERAL philosophical concepts e.g. justice, morbidity and autonomy

-PERSONAL character. private standards of right and wrong.

-rules and regulations that govern society

-enduring beliefs about “worth” of person, object, idea

-making a choice with conflicting moral chain
-usually making a choice between 2 bad choices 🙁

*ethics are the HIGHEST standard
*laws are the MINIMUM standard

Ethical Questions
+is being ethical the same as doing whatever society accepts? NO, Nazis and sterilizing males with defects are not ethical
+do ethics only apply to religious people? NO, it applies to everybody
+is being ethical the same as following the law? not always

Illegal not Immoral
-examples: traffic laws: speeding is illegal but not immoral, divorce, cheating

Ethical Dilemma
-making a choice with conflicting moral claim
-classic ethical dilemma: preserving or life VS prolonging of agony
-cardiac and respiratory function lost>death
-brain dead>legally dead 🙁

Major Ethical Theories
-META: deals with basic assumptions of moral thought, big broad concepts. where does morality come from.
-DESCRIPTIVE: sets out to describe what people think is right or wrong without making judgement, decides right or wrong, no judgement
-NORMATIVE: starts from assumption made in meta ethics and sets standards of behavior by which to judge
-APPLIED: application of normative ethics “how do we put moral knowledge into practice”
*standards of behavior: how to judge

Normative Ethics
-virtue ethics

Virtue Ethics
-philosopher: Aristotle
-virtue ethics focuses on a persons character, intentions
-virtue is a skill that can be learned
-eudemonia (deep non-superficial happiness), happiness, flourishing
-virtue is the mean between two vices (positive and negative extremes)
-example of vices: PATIENCE (passive pushover or impatient)
-strength: looks at the persons entire life
-weakness: element of relativism
-which virtue is more virtuous

Virtue Ethics Questions
-What are some key words that can be equated with this theory? eudemonia (flourishing happiness) persons character
-According to this theory would it be okay for the nurse to lie to a patient? Why or why not? by lying, nurse thinks patient will have a better outcome, intent to help? YES…dependent on intention
-What is can example of a nursing virtue and what would be the vices (or two extremes) of this virtue? compassionate and caring OR no emo attachment, non-caring, inhuman, can’t relate, apathetic

Teleological or Consequentialism
-consequentialism focuses on the CONSEQUENCES /OUTCOMES of an action to judge if action is right or wrong
-“end justifies the means” meaning no consistency
-we don’t know if what we did is good or bad unless we have the outcome
-question: why or why not is this theory good in guiding nursing practice? NOOOOOO we have standards of care with the intention of good outcomes but this is not consistent. although we had good intentions, outcomes may not always be what they should be

-philosopher: Bentham
-utilitarianism defined right and wrong by what brings the most good and least harm to the greatest NUMBER of people
-example: ER physician, does he save 4 or 1
-situation: during your shift at the hospital, there is a severe earthquake and subsequent fire in the hospital. according to this theoretical foundation what would you do? SAVE A GREATER NUMBER OF PEOPLE

-philosopher: Kant
-deontological theories focus on DUTY
-the action is good or bad regardless of the outcome
-the “golden rule”

Ethical Principles

-self determination
-right of patient to determine care
-nursing responsibility: respect patient rights, treat others with consideration, provide info needed to make decision
-clinical example: medication administration: teach risk and benefits and let them decide if they want to take it

-intentional or unintentional
-nursing responsibility: know how to work equipment, know skills, assess, monitor, remain up to date with knowledge (stay current: technology changes all the time)
-clinical example: sterile field (Foley>UTI) maintaing sterile technique

-doing good, bringing good
-benefit to the patient
-doing more than whats required, going the extra mile
-nursing responsibility: adhere to policies and protocols, “caring” for the patient, communicate

-nursing responsibility: provide good care for all patients
-dont ignore the patient!

-faithful to keep promise
-promises establish trust
-nursing responsibility: follow through with promises and don’t make promises you can’t keep
-clinical example: why is keeping the promises important for the nurse/patient relationships? we want to establish trust

-truth telling
-nursing responsibility: document TRUTHFULLY not prematurely
-example: don’t pre-sign the MAR

-patient information will not be made public
-nursing responsibility: do not discuss patients in public areas or with those who do not need to know and do not access chart without purpose
-clinical example: celebrity charts at UCLA, nurses fired!

Types of Justice
-procedural justice
-distributive justice
-compensatory justice

Procedural Justice
-“fair play”
-everyone plays by the same rules
-a fair process determines who gets what and when
-an imbalance may be due to limited resources
-examples: transplant wait list has priorities and criterias/limitations on where you lie, helps protect back market system, colonoscopies at age 50 (colon CA)

Distributive Justice
-“fair share”
-fairness in what people receive, from goods to attention
-roots from socialism and communism
-examples: national healthcare, ZMapp to treat Ebola

Compensatory Justice
-“fair compensation”
-compensation for injuries by those who have caused the injury
-compensation (money award) is proportional to loss
-injury already occurred, harm has occurs and now they get sued
-examples: wrong limb amputation

Sources of Law
-CONSTITUTIONAL LAW: establishes the GENERAL organization of the federal government
-STATUTORY LAW: enacted by a LEGISLATIVE body, basically state law
-ADMINISTRATIVE LAW: rules and regulations to enforce statutory laws
-COMMON LAW: evolves from court decisions

CA Admin Code Pt Rights: #5
receive as much information about any proposed treatment or procedure as he may need to give informed consent or to refuse this course of treatment. except in emergencies, this information shall includes a description of the procedure or treatment, the medically significant risks involved in this treatment, alternate courses of treatment or non-treatment and the risks involved in each and to know the name of the person who will carry out the procedure

CA Admin Code Pt Rights: #6
if you suffer from severe chronic intractable pain, you have the option to request or reject true use of any or all modalities to relieve your pain, include opiate medication. your doctor may reduce to prescribe you opiate medication, but if so, must inform you that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.

CA Admin Code Pt Rights: #7
participate actively in decisions regarding medical care. to the extent permitted by law, this includes the right to refuse treatment.

CA Admin Code Pt Rights: #12
reasonable continuity of care and to know in advance the time and location of appointment as well as the physician providing care

Sources of Ethnical Norms
-Classifications: Official VS Unofficial (unofficial=no power of authority) and International, National or State

-Nurse Practice Act: official/state
-American Nurses Association: unofficial/national
-Joint Commission: national or state/unofficial
-Centers for Medicare and Medicaid Services (CMS): official/national
-Sigma Theta Tau Honor Society: unofficial/international

-bioethics is applied to human life or health
-the study of the typically controversial ethical issues emerging from new situations and possibilities brought by advances in biology and medicine
-examples: cloning, eugenics, euthanasia, GMO, stem cell research

Thompson and Thompson Decision Making Model
1. review situation
2. gather additional info
3. ID ethical issues
4. define moral position-personal
5. define moral position of key individuals
6. ID value conflicts
7. determine who should make decision
8. ID range of options-anticipate outcomes
9. decide course of action and carry out
10. evaluate results

-ethical behavior is contextual because every situation is different


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