Transcript Ethical Foundations of Professional Nursing

Professional Nursing Practice
Concepts and Perspectives
Seventh Edition
Chapter 4
Ethical Foundations of
Professional Nursing
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Learning Objectives
4.1 Discuss how cognitive development, values, moral frameworks, and codes of
ethics affect decision making.
4.2 Explain how nurses can help clients clarify their values to facilitate ethical
decision making.
4.3 Analyze ways in which nurses can enhance their ethical decision-making
abilities.
4.4 Identify the moral principles involved in ethical decision making.
4.5 Explain the uses and limitations of professional codes of ethics.
4.6 Discuss common bioethical issues currently facing healthcare professionals.
4.7 Describe the advocacy role of the nurse.
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Hallmark Features
• A focus on foundational knowledge related to
professional nursing
– Includes nursing history, nursing theory, ethics, and
legal aspects, etc.
• An overview of professional nursing roles, issues,
and changes in the profession
– Discusses nurses as healthcare providers, learners
and teachers, and leaders
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Challenges and Opportunities
• Values conflicts
– Nurses’ established values and beliefs may conflict
with clients’
• Ethical-legal conflicts
– Right thing to do versus what is legal
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Learning Objective 4.1
Discuss how cognitive development, values,
moral frameworks, and codes of ethics affect
decision making.
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Values
• Highly personal
• Freely chosen
• Enduring beliefs or attitudes about the worth of a
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Person
Object
Idea
Action
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Values
• Derived from
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Cultural, ethnic, religious background
Societal traditions
Peer group
Family
• Motivate behavior, guide choices and decisions
– Moral
– Nonmoral
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Values
• Exist within a person and affect the person’s
relationship with others
• Becoming aware of one’s values is necessary in
order to make ethical decisions
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Values Transmission
• Learned through observation and experience
• Family, community, cultural and society influences
• Values are acquired gradually
• Professional values of the nurse are acquired
during socialization into nursing from
– Nursing experience
– Teachers
– Peers
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Values Transmission
• Nurses hold values that relate to competence and
compassion
• Nurses need to be
– Value-neutral
– Nonjudgmental
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Values Clarification
• Process by which individual values are identified,
examined, and developed
– No one set of values is right for everyone
– Identified values can be retained or changed
• Acts on free choice
• Fosters personal growth
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Values Clarification
• Valuing process components include
– Cognitive
– Affective
– Behavioral
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Identifying Personal Values
• Nurses need to understand their values about
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Life
Health
Illness
Death
• Ability to identify personal values leads to better
understanding of situations that may affect care
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Learning Objective 4.2
Explain how nurses can help clients clarify their
values to facilitate ethical decision making.
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Helping Clients Identify Values
• Help identify how values influence and relate to a
particular health problem
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List alternatives
Examine possible consequences of choices
Choose freely
Feel good about the choice
Affirm the choice
Act on the choice
Act with a pattern
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Learning Objective 4.3
Analyze ways in which nurses can enhance their
ethical decision-making abilities.
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Moral and Ethical Behavior
• Morals are personal ethics that guide individuals’
behavior and choice
• Ethics refers to the moral standards and beliefs of
a particular group
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Moral Development
• Process of learning what ought to be done and
what ought not to be done
– Morality
– Moral behavior
– Moral development
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Theories of Moral Development
• Lawrence Kohlberg
– Theory focuses on structure of thought about moral
issues
– Moral development progresses through three levels
and six stages
– Not always linked to age or growth and development
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Theories of Moral Development
• Lawrence Kohlberg
– People progress to different levels of moral
development, ranging from
 Egocentric actions to
 Behaviors that show concern for society
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Theories of Moral Development
• Kohlberg’s Levels and Stages
– Level I premoral or preconventional
 Stage 1: Obedience and punishment
 Stage 2: Instrumental/self-interest
– Level II conventional
 Stage 3: Good boy/good girl
 Stage 4: Law and order
– Level III postconventional, autonomous or principled
 Stage 5: Social contract
 Stage 6: Universal moral principle
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Theories of Moral Development
• Carol Gilligan
– Challenged Kohlberg’s theory in
 Its application to females
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Females socialized to be compassionate, responsible, and have a sense
of obligation
 Males socialized to organize relationships hierarchically
• Gilligan’s care perspective is organized around
– Responsibility
– Compassion (care)
– Relationships
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Theories of Moral Development
• Justice or fairness based on idea of equality
– Typically followed by men
• Ethic of care
– Typically followed by women
• Gilligan’s stages
– Stage 1: Caring for oneself
– Stage 2: Caring for others
– Stage 3: Caring for oneself and others
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Moral and Ethical Theories or
Frameworks
• General moral frameworks
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Teleology, consequential
Deontology, nonconsequential
Virtue ethics
Caring
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Learning Objective 4.4
Identify the moral principles involved in ethical
decision making.
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Moral and Ethical Principles
• Ethical principles that help guide decision making
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Sanctity of life
Utility
Autonomy
Respect for person
Nonmaleficence
Beneficence
Justice
Fidelity
Veracity
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Ethics in Nursing
• Ethics
– Method of inquiry that helps people understand
morality of human behavior
– Refers to practices, beliefs, and standards of behavior
• Bioethics
– Applies ethics to life sciences and health care in an
interdisciplinary setting
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Ethics in Nursing
• Nurses are accountable for their ethical conduct
• Standard 7 in Nursing: Scope and Standards of
Practice relates to ethics
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Learning Objective 4.5
Explain the uses and limitations of professional
codes of ethics.
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Nursing Codes of Ethics
• Formal statements of a group’s ideals and values
• Higher than legal standards
• Established by the International Council of Nurses
(ICN)
– First adopted in 1953, revised in 2012
• ANA first adopted a code of ethics in 1950,
revised in 2001
– Published in a booklet called Code of Ethics for Nurses
with Interpretive Statements
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ANA Nursing Code of Ethics
• Purposes
– Succinct statement of ethical obligations and duties
– Nonnegotiable ethical standard
– Expression of nursing’s commitment to society
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Canadian and Australian Nurses
Codes of Ethics
• Canadian Nurses Association adopted a code of
ethics in 1980, revised in 2008
• Australian Nurses adopted a code of ethics in
1993, revised in 2002
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Nursing Codes of Ethics
• Nurses are responsible for being familiar with the
code that governs their practice
• Purposes
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Inform the public of minimum standards
Sign of professional commitment
Outline ethical considerations
Guidelines for professional behavior
Guide for self-regulation
Responsibility when assuming care for clients
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Learning Objective 4.6
Discuss common bioethical issues currently
facing healthcare professionals.
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Types of Ethical Problems
• Decision-focused
– What should I do?
• Action-focused
– Moral distress
– What can I do?
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Making Ethical Decisions
• Catalano developed a five-step ethical decisionmaking algorithm for nurses
• Components of decision-making process
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Facts of specific situation
Ethical theories and principles
Nursing codes of ethics
Clients’ rights
Personal values
Factors that contribute to or hinder ability to make a
choice
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Making Ethical Decisions
• Questions that help determine ownership of the
decision
– For whom is the decision being made?
– Who should be involved in making the decision, and
why?
– What criteria should be used in determining who
makes the decision?
– What degree of consent is needed by the subject?
• When compromise is necessary, the desirable
outcome is preservation of each person’s
integrity
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Making Ethical Decisions
• Winslow and Winslow’s elements of an integritypreserving moral compromise
– Some basic moral language must be shared
– A context of mutual respect must exist
– The moral perplexity of the situation must be honestly
acknowledged
– Legitimate limits to compromise must be admitted
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Specific Ethical Issues
• Increased incidences of conflict
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Elective abortion
End-of-life care
Organ donation
Genetic engineering
Allocation of health care
• Three categories of ethical issues
– Moral uncertainty
– Moral dilemma
– Moral distress
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Strategies to Enhance Ethical
Decision Making
• Become aware of one’s own values and ethical
aspects of nursing situations
• Be familiar with nursing code of ethics
• Understand the values of other healthcare
professionals
• Participate on ethics committees
• Participate in or establish a nursing ethics group
• Participate in or establish educational ethics
rounds
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Learning Objective 4.7
Describe the advocacy role of the nurse.
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Advocacy
• Advocacy – providing support for a patient’s
rights/best interests
• Three models of nurse advocacy
– Rights protection
– Values-based
– Respect-for-persons
• To be an advocate a nurse needs
– Self-knowledge
– Professional knowledge
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Advocacy
• Advocacy encompasses range of approaches
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Legal
Self
Collective
Citizen
• Defining attributes of patient advocacy include
– A therapeutic nurse-patient relationship in which to
secure patient’s freedom and self-determination
– Promoting and protecting patients’ rights
– Acting as an intermediary
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Advocacy
• An advocate supports clients in decisions; support
can involve
– Action
– Nonaction
• Underlying client advocacy are clients’ individual
rights
– To select values deemed necessary to sustain own life
– To decide which course of action will best achieve the
chosen values
– To dispose of values in a way they choose without
coercion by others
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Advocacy
• To be a client advocate involves
– Being assertive
– Recognizing that the rights and values of clients and
families must take precedence when they conflict with
those of healthcare providers
– Ensuring that clients and families are adequately
informed to make decisions about their own health and
health care
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Advocacy
• To be a client advocate involves
– Being aware that personal conflicts may arise
– Working with unfamiliar community agencies or lay
practitioners
– Political action
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