Chapter 6 Values ethics and advocacy PDF

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Ivy Tech Community College NRSG 100 Chapter 6: Values, ethics, and advocacy VALUES Value = belief about something, about what matters, that acts as a standard to guide one’s behaviors. Person’s values influence belief about human needs, health, illness, the practice of health behaviors, and human responses to illness Value system = organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct DEVELOPMENT OF VALUES Formed during a lifetime from information from environment, family, and culture Common modes of values transmission 1. Modeling = children learn what is high or low from observing others 2. Moralizing = children taught a complete value system by parents or an institution that allows little opportunity for them to weight different values 3. Laissez-faire = children explore values on their own and to develop personal value system. Can lead to confusion and conflict 4. Rewarding and punishing = children rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values 5. Responsible choice = children encouraged to explore competing values and to weight consequences VALUES ESSENTIAL TO A PROFESSIONAL NURSE 1998 American Association of Colleges of Nursing identified five values that epitomize the caring, professional nurse Each nurse should examine his or her own personal values to see if they match these five values Nurses are encouraged to be nonjudgmental Professional Values

Definition

Examples

Altruism

Nurse’s concern for welfare and well-being of patients, other nurses, and healthcare providers

Mentors other professionals Demonstrates understanding of culture, beliefs, and perspectives of others

Autonomy

Nurse respects patients’ rights to make decisions about healthcare

Plans care with patients, not for them Provides information so patient can make informed choices

Human dignity

Nurse values and respects all Provides culturally patients and colleagues competent and sensitive care Protects the patient’s privacy Preserves patient confidentiality

Integrity

Nurse is honest and provides care based on ethical framework that is accepted by profession

Documents care accurately and honestly Demonstrates accountability for own actions

Social justice

Nurse works to assure equal treatment under the law and equal access to quality healthcare

Promotes universal access to healthcare Encourages legislation and policy consistent with the advancement of nursing and healthcare

VALUES CLARIFICATION Definition = process by which people come to understand their own values and value system Nurse can use values clarification to assist when teaching and counseling patients. Valuing focuses on three main activities 1. Choosing = chooses freely after careful considerations of consequences of each alternative 2. Prizing = involves pride, happiness, and public affirmation 3. Acting = combining choices into one’s behaviors with consistency and regularity on the value ETHICS Definition = systemic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing Begins in childhood and develops gradually Morals = personal or communal standards of right versus wrong TYPES OF ETHICS Bioethics = encompassing a number of fields and disciplines grouped under life sciences. Issues in bioethics – responsible research conduct, genetic enhancement, environmental ethics, and sustainable healthcare Clinical ethics = branch of bioethics concerned with ethical problems that arise while caring for patients. Issues = valid consent or refusal and how one ought to respond to requests for medically futile treatment or assisted suicide Nursing ethics = = subset of bioethics, is the formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments. Issues = cost-

containment issues that jeopardize patient welfare, end-of-life decisions, breaches of patient confidentiality, and incompetent, unethical, and illegal practices of colleagues THEORIES OF ETHICS Ethical theories are systems of thought that attempt to explain how we ought to live and why 2 broad categories = action guiding and character guiding Action guiding have 2 main categories = utilitarian and deontologic Utilitarian = rightness or wrongness of an action depends on the consequences of the action Deontologic = an action is right or wrong independent of its consequences

Principle-based approach Combines elements of both utilitarian and deontologic theories Principle

Moral rule

Autonomy

Respect rights of patients to make decisions

Nonmaleficence

Avoid causing harm

Beneficence

Benefit the patient and balance benefits against risks and harms

Justice

Give each his or her own due; act fairly

Fidelity

Keep promises

Ethical dilemmas arise when adherence to basic ethical principles results in two conflicting courses of action Care-based approach Directs attention to the specific situations of individual patients viewed within the context of their life narrative Characteristics of the care-based approach 1. Centrality of the caring relationship 2. Promotion of the dignity and respect of patients as people 3. Attention to the particulars of individual patients 4. Cultivation of responsiveness to others and professional responsibility 5. Fundamental moral skills to include virtues like kindness, attentiveness, empathy, compassion, reliability ETHICAL CONDUCT Nurses who practice high-quality care base their practice on professional standards of ethical conduct

ETHICAL AGENCY Ability to behave in an ethical way and to do the ethically right thing to do because it is the right thing to do 7 elements of ethical agency

Definition

Ethical sensibility

Ability to recognize when the ethical moment occurs

Ethical responsiveness

Ability and willingness to respond to the ethical challenge

Ethical reasoning and discernment

Knowledge and ability to use sound theoretical practical approaches to thinking through ethical challenges

Ethical accountability

Ability and willingness to accept responsibility for one’s ethical behavior and to learn from the experience

Ethical character

Cultivated dispositions that allow one to act as one believes one ought to act

Ethical valuing

Conscious and critical way that which squares with good ethical character and ethical integrity

Transformative ethical leadership

Commitment and proven ability to create a culture in which people do the right thing because it is the right thing to do

VIRTUES OF NURSES Clinical virtues enable nurses to provide good patient care Examples of virtues: Competence Compassionate caring Self-effacement Trustworthiness Intelligence Practical wisdom Humility Courage Integrity Conscientiousness Subordination of self-interest to patient care NURSING CODE OF ETHICS Set of principles that reflect the primary goals, values, and obligations of the profession Purposes: 1) succinct statement of the ethical obligations and duties of every individual who enters the nursing profession, 2) profession’s nonnegotiable ethical standard, 3) expression of nursing’s own understanding of its commitment to society

Nine provisions: Provisions 1-3 describe the most fundamental values and commitments of the nurse; Provisions 4-6 address boundaries of duty and loyalty; Provisions 7-9 address aspects of duties beyond individual patient encounters NURSING STANDARDS OF PRACTICE 1991 American Nurses Association developed Standards of Clinical Nursing Practice. Standard V focuses on ethics and describes the nurse’s ethical obligations 1. Nurse’s practice is guided by the Code for Nurses 2. Nurse maintains patient confidentiality within legal and regulatory parameters 3. Nurse acts as a patient advocate and assists patients in developing skills so they can advocate for themselves 4. Nurse delivers care in a nonjudgmental and nondiscriminatory manner that is sensitive to patient diversity 5. Nurse delivers care in a manner that preserves or protects patient autonomy, dignity, and rights 6. Nurse seeks available resources that formulate nursing decisions A PATIENT’S BILL OF RIGHTS Includes rights and responsibilities of the patient while receiving care in the hospital BILL OF RIGHTS FOR REGISTERED NURSES Used to aid in improving workplaces and ensure nurse’s ability to provide safe, quality patient care Seven basic tenets of Bill of Rights for Registered Nurses 1. Nurses have right to practice in a manner that fulfills their obligations to society and to those who receive nursing care 2. Nurses have right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice 3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretative statements 4. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities 5. Nurses have the right to a work environment that is safe for themselves and their patients 6. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively ETHICAL EXPERIENCE AND DECISION MAKING 2 types of ethical problems faced by nurses = ethical dilemmas and ethical distress Ethical dilemma = two or more clear moral principles apply, but support mutually inconsistent courses of action Ethical distress = occurs when nurse knows the right thing to do, but either personal or institutional factors make it difficult to choose a course of action 4 A’s to Rise above Moral Distress

Ask

Act

Healthy work environmen t

Affir m

Assess Joint Commission mandates that all accredited agencies have mechanism for addressing ethical problems USING THE NURSING PROCESS TO MAKE ETHICAL DECISIONS Assess the situation (gather data) Diagnose (identify) the ethical problem Plan Implement your decision Evaluate your decision

ETHICALLY RELEVANT CONSIDERATIONS Balance between benefits and harms in the care of patients Disclosure, informed consent, and shared decision making Norms of family life Relationship between clinicians and patients Professional integrity of clinicians Cost-effectiveness and allocation Issues of cultural and/or religious variation Consideration of power EXAMPLES OF ETHICAL PROBLEMS Nurse-patient situations include paternalism (acting for patients without their consent to secure good or prevent harm), deception, confidentiality, allocation of scarce resources, advocacy, valid consent or refusal, conflicts between the patient’s and nurse’s values and interests, and conflicts concerning new technologies

Nurse-physician situations include disagreements about a proposed medical regimen, conflicts concerning the scope of the nurse’s role, and physician incompetence Nurse-nurse situations include claims of loyalty and nurse incompetence Nurse-institutional situations include short staffing, whistle blowing, and healthcare rationing Nurse’s personal moral convictions include beginning-of-life issues and end-of-life issues NURSING AND ETHICS COMMITTEES Chief functions = education, policy making, case review, consultation, and possibly research Multidisciplinary and provide a forum where differing views may be presented without fear of repercussions ADVOCACY IN NURSING PRACTICE Advocacy = protection and support of another’s rights Nurses who value patient advocacy: 1. Make sure that their loyalty to an employing institution or colleague does not compromise their primary commitment to the patient 2. Give priority to the good of the individual patient rather than to the good of society in general 3. Carefully evaluate the competing claims of the patient’s autonomy and patient wellbeing Nurse respects and supports patient’s right to make decisions to respect autonomy Nurse acts in the best interest of the patient to promote patient well-being REPRESENTING PATIENTS Nurse may serve as intermediaries Those with special advocacy needs = those uninformed concerning their rights and opportunities, those with sensory impairment, those who do not speak English well or at all, the very young and the elderly, those who are seriously ill, those who are mentally or emotionally impaired, those with physical disabilities, and those who lack adequate financial or human resources

PROMOTING SELF-DETERMINATION Important to educate public about advance directives Nurses facilitate a patient’s decision making Advocacy does not mean supporting patient in all their preferences BEING POLITICALLY ACTIVE Nurses need to advocate for the healthcare needs of those least empowered to do so for themselves...