Nursing Ethics
Terms
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- Values conflict
- Personal values are at odds with those of patients, colleagues, or the institution.
- Integrity
- Adherence to moral norms that is sustained over time.
- Values clarification
- The process of becoming more conscious of and naming what we value or consider worthy.
- Moral Values
- A special case of values because the particular circumstances that call them forth deal with ethical issues or dilemmas.
- Axiology
- The study of values in art - aesthetics; in human relations & conduct - ethics, & in relation to beliefs regarding relationship with the divine - religion.
- Values
- Ideals, beliefs, customs, modes of conduct, qualities or goals that are highly prozed or preferred by individuals.
- Overt Values
- Values of individual institutions and organized health care systems that are explicity communicated through philosophy and policy statemsnts.
- Covert Values
- Covered up
- Moral distress
- Reaction to a situation in which there are moral problems that seem to have clear solutions, yet we are unable to follow our moral belief because of external restraints.
- Moral Development
- A product of the sociocultural environment in which we live and develop.
- Ethic of justice
- An approach to ethical decision making based on objective rules and principles in which choices are made from a stance of separateness.
- Ethic of Caring
- The moral imperative is grounded in relationship with and responsibility for one another.
- Faith
- A generic feature of the human struggle to find and maintain meanding...a dynamic existential stance, a way of leaning into and finding or giving meaning to the conditions of our lives.
- Intuitive Projective Faith
- Stage 1. Infancy. Image and fantasy filled.
- Mythic-Literal Faith
- Stage 2. Story provides a major source of meaning and a world view based on reciprocity and fairness.
- Synthetic-Conventional Faith
- Stage 3. Movement into the world beyond the family. Values & beliefs are derived from other interpersonal relationships.
- Individuative-Reflective Faith
- Stage 4. Persons must begin to take responsibility for their own beliefs, values, and commitments.
- Conjunctive Faith
- Stage 5. Requires an opening to our inner depths in which we are able to recognize values, beliefs, and myths developed within our particular cultural, social, or religious tradition that separate one from others.
- Universalizing Faith
- Stage 6. Absolute love and justice become prime, and we focus energy on transforming the present reality toward a transcendent actuality inclusive of all beings.
- Profession
- A complex, organized occupation preceded by a long training program.
- #1 Criteria of a profession
- A profession entrusts the education of its practitioners to institutions of higher education.
- Expertise
- The characteristic of having a high level of specialized skill and knowledge.
- Autonomy
- Self governing. Trumps the principle of life.
- Accountability
- Being answerable to someone for something one has done. It is grounded in the moral principles of fidelity and respect for dignity, worth, and self-determination of clients.
- Mature profession
- Accountability is the hallmark of a mature profession.
- Mechanisms of Accountability
- Code of ethics, standards of nursing practice, nurse practice acts, nursing theory and practice derived from research.
- Code of nursing ethics
- An explicit declaration of the primary goals and values of the profession that indicates the profession's acceptance of the responsiblity and trust with which it has been invested by society.
- Standards of Nursing Practice
- Written documents outlining minimum expectations for safe nursing care.
- Internal standards of nursing practice
- Those developed within the profession of nursing for the purpose of establishing the minimum level of nursing care.
- External standards of nursing practice
- Guides for nursing care that are developed by non-nurses, the government, or institutions.
- Nurse practice acts
- The foremost legal statute regulating nursing. Protects the public, defines nursing practice, describes the boundaries of practice, establishes standards for nurses, and protects the domain of nursing.
- Authority
- The state of having legitimate power and sovereignty.
- Appeals to conscience
- Personal and subjective beliefs, founded on a prior judgment of rightness or wrongness.
- First obligation
- To the patient
- Loyalty
- A natural product of long-term acquaintance and close working relationships.
- Spectrum of Urgency
- The amount of time available before a decision of care has to be made.
- Civil Rights Act of 1964
- Unlawful for an employer to hire or fire an individual base of race, color, religion, sex or national origin.
- Americans with Disabilities Act of 1990
- Provides comprehensive protection to Americans with disabilities.
- Quality of Life
- A subjective appraisal of factors that make life worth living and contribute to a positive experience of life.
- Beneficence
- Balancing benefits and harms.
- Nonmaleficence
- Do no harm
- Euthanasia
- Causing the painless death of a person in order to end or prevent suffering.
- Medical Futility
- Situations in which interventions are juedge to have no medical benefit, or in which the chance for success is low.
- Do Not Resuscitate Order (DNR)
- A written directive placed in the patient's medical chart indicating that CPR is to be avoided.
- Advance Directive
- Instructions indicating one's wishes regarding health care interventions or designating someone to act as a surrogate in making such decisions in the event that one loses decision making capacity.
- Guardian Ad Litem
- Guardian of a person. Makes decisions regarding life and health.
- Genetic diagnosis
- A process of biopsy of embryos to determine the presence of genetic flaws and gender prior to implantation.
- Genetic Engineering
- The ability to alter organisms genetically for a variety of purposes, such as developing more disease-resistant fruit & vegetables.
- Genetic Screening
- A process which determines if persons are predisposed to certain diseases, & whether couples have the possibility of giving birth to a genetically impaired infant.
- Eugenics
- Keeping only the "good" babies.
- Paternalism
- A fatherly right & responsibility to use their supposedly superior knowledge & judgment to make decisions on behalf of patients.
- Justice
- The rights of fair treatment and privacy, including anonymity and confidentiality.
- Informed Consent
- Patients are given the opportunity to autonomously choose a course of action in regard to plans for health care.
- Advance Directives
- Instructions that indicate health care interventions to initiate or withhold, or that designate someone who will act as a surrogate in making such decisions in the event that we lose decision-making capacity.
- Competence
- The ability to make meaningful life decisions.
- Patient Self-Determination Act
- A federal law requiring institutions such as hospitals, nursing homes, HMOs, & home care agencies receiving Medicare or Midicaid funds to provide written info. to adult patients regarding their rights to make health care decisions.
- Complementary Therapies
- Acupuncture, herbal & nutritional interventions, healing touch, massage, and guided imagery.
- Active voluntary euthanasia
- An act in which the physician both provides the means of death & administers it, such as a lethal dose of medication.
- Assisted Suicide
- The patients receive the means of death from someone, such as a physician, but activate the process themselves.
- Plagiarism
- Taking another's ideas or work and presenting them as our own. (written, oral, or visual materials)
- Cheating
- Dishonesty and deception regarding examinations, projects, or papers.
- Forgery
- Fraud or intentional misrepresentation, for ex., altering or causing a grade to be altered in an academic record.
- Nuremberg Code
- A set of principles for the ethical conduct of research against which the experiments in the concentration camps could be judged.
- Respect for human dignity
- The rights to full disclosure and self-determination or automony.
- Coercion
- Threat of harm or penalty for not participating in the research or offering excessive rewards for participation.
- Full disclosure
- The potential participant be fully informed of the nature of the study, anticipated risks & benefits, time commitment, what is expected of the participant & the researcher, & right to refuse to participate.
- Right to privacy
- The participant determines when, where, & what kind of information is shared, with an assurance that infomration, attitudes, behaviors, records, opinions, & the like that are observed or collected will be treated with respect & kept in strict confidence.
- Confidentiality (in research)
- The researcher's assurance to participants that information provided will not be made public or available to anyone other than those involved in the research process without the participant's consent.
- Right to fair treatment
- Equitable treatment of participants in the selection process, during the study, & after the completion of the study.
- Informed Consent (in research)
- The researcher must ensure that the person who is agreeing to participate in the study comprehends the information included in the consent & has a chance to receive clarifications & additional information when needed.
- Ethical Treatment of Data
- Integrity of research protocols and honesty in reporting findings.
- Distributive Justice
- Fair, equitable, appropriate treatment in light of what is due or owed to persons, recognizing that giving to some will deny receipt to others who might otherwise have received these things.
- Material Rules
- To each person: an equal share, to each person according to: need, merit, social contribution, the person's rights, the greatest good to the greatest number.
- Utilitarian Theories
- Favor social programs that protect public health and distribute basic health care equally to all citizens.
- Utilitarianism
- Bentham & Mill. Action is good or bad in relation to the consequence. Do unto others. Deals with outcomes.
- Teological Theory
- Consequences determine if an act is right or wrong.
- Rule Utilitarianism
- Follow rules because overall good is maximized.
- Rationalism
- Opposite of Naturalism. Feelings & perceptions may seem similar but aren't
- Naturalism
- Based on human nature & psychology. People make similar decisions.
- Moral Philosophy
- Philosophical discussion.
- Ethics
- Social morality
- 4 Elements of ethics in nursing
- Willingness to work in emotionally painful job. Good knowledge base. Sensitive, patient and insightful. consistent decisions. (be there, knowledge, sensitive, decisions)
- Ms. Dock
- Radical feminist 1950's. Opposed to men in nursing.
- Empiracle
- Knowledge gained.
- Moral Regret
- Dissappointment at not being able to do both things.
- Ethical Discernment
- 2 Values that have merit, one is better - the prima facie duty.
- Prima Facie
- First Duty
- Decision Process
- 1.Gather data.2.Identify key participants.3.moral perspective.4.determine desired outcome.5.identify options.6.act on choice.7.evaluate outcomes.8.spectrum of urgency.
- Jameton
- 1984. Moral uncertainty. Moral Dilemma. Moral distress.
- Failure of autonomy
- Pt. has a different thought process. Pt. has different values. Pt. has different knowledge. Nurse focuses on work instead of pt.
- Deontology
- Relies on duties and rights. Kantianism - rigid and exceptionless. Awareness of ethical & moral values.
- Focal Virtues
- Compassion. Integrity, moral character. Trustworthiness. Discernment (wisdom)
- Aristotle
- Decide what to "be" not what to do.
- Act Utilitarianism
- A person may violate rules for overall good.