Ethics
is the study or examination of morality through a variety of different approaches.
How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person who you are and, ultimately, the professional wh
Societal ethics
Society provides a normative basis for ethical behavior with laws and regulations.
Law is the minimum standard of behavior to which all members of society are held.
In nursing, legal standards include:
Clinical standards of care
Liability
Negligence
Malpr
Organizational Ethics
involves a set of formal and informal principles and values that guide the behavior, decisions, and actions taken by members of an organization as well as the organizational structures, systems, practices, policies, and procedures developed to ensure ethi
Professional Ethics
Ethical standards and expectations of a particular profession
Held to a higher standard because of privileged role in society
Code of conduct
Aimed at the highest ideals of practice
The Code of Ethics for Nurses of the American Nurses Association (ANA) es
ANA's Code of Ethics for Nurses states the following:
The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of heal
Bioethics
Ethical questions surrounding biological sciences and technology
Clinical Ethics
Decisions made at the bedside
Personal Ethics
personal ethics describes an individual's own ethical foundations and practice
Continuously intersect with other categories of ethics.
Do not overlap perfectly; consequently, a potential for conflict exists.
Sources of ethics are not static and change ove
Research ethics
Conduct of research using humans and animals.
Attributes and Criteria
Sources of ethics
Ethical problems and dilemmas
Ethical analysis and decision-making
Ethical problems
is simply a problem with an ethical dimension. Most ethical problems have a reasonably clear solution, whereas others can be quite complex or involve competing ethical priorities.
Ethical dilemmas
involves a problem for which in order to do something right you have to do something wrong.
An example in patient care is determining whether aggressive treatment at the end of life will cause more harm than benefit.
Ethical Analysis and Decision Making
� Do I have a duty to tell the truth?
� What is the greater harm?
� To whom is my primary loyalty?
� What are the best interests of my patient?
Ethical Principles
is a general guide, basic truth, or assumption that can be used with judgment to help determine a course of action.
Respect for Persons
simply maintains that human beings have an unconditional moral worth that requires us to treat each individual person with great value, dignity, and respect.
autonomy
is an important extension of this principle and suggests that patients must be treated in a way that respects their self-determination by expressing their wishes and making informed choices about their treatment.
veracity
the principle of truth telling
Nonmaleficence
directs us to act in ways that avoid harm to others, including even the risk of harm.
In health care, the primary focus is on harms such as pain, disability, or death; however, harm is difficult to define, and both patients and providers may be concerned
Beneficence
is an obligation to do good by acting in ways that promote the welfare and best interests of others.12 Patients can reasonably expect that you, as a nurse, will promote their health and well-being.
justice
is concerned with treating people equitably, fairly, and appropriately.This means we owe our patients care and treatment that do not arbitrarily discriminate against them as an individual or as a member of a class of individuals.
ANA's Code of Ethics for
Fidelity
is the principle that requires us to act in ways that are loyal. In the role of a nurse, such action includes keeping your promises, doing what is expected of you, performing your duties, and being trustworthy.
Ethics of Duty
Is the right thing to do.
For example, if a nurse becomes aware that a friend and colleague has been diverting narcotics because she has developed an addiction, and the nurse reports her friend to her supervisor because that is what the organizational pol
Ethics of Consequence
Is the greatest good for the greatest number.
For example, if the nurse mentioned previously reports her friend because she is concerned that some patients are being harmed when their pain medications are diverted and all patients are at risk if her frien
Ethics of Character
Is based on life experiences and a willingness to reflect on our actions.
Ethics of Relationship
Is the nature and obligation inherent in human relationships.
For example, she might first approach her friend and offer to accompany her to speak with the appropriate party in the organization to arrange for treatment and address the legal implications o
Failure to act or respond in an ethically appropriate way has been linked to:
Serious and potentially dangerous errors
Personal stress
Professional burnout
Ethical Issues in Nursing
Protecting patients' rights and human dignity
Not respecting informed consent treatment
Providing care with risk to the health of the nurse
Using or not using chemical or physical restraints
Understaffing
Prolonging the living and dying process with inapp
Ethical Decision Making
Health care decisions that present an ethical dilemma are not made by individuals alone.
A health care organization's compliance officer and compliance committee are charged with the responsibility of ensuring that ethical standards are met.
Institutions
Moral distress
occurs when a person is unable to take what he or she believes is the morally appropriate action to take or when a person acts in a manner contrary to his or her personal and professional values.
Self-doubt, lack of assertiveness, and the perception 410of
accountability
refers to the ability to answer for one's actions. You ensure that your professional actions are explainable to your patients and your employer.
Responsibility
refers to a willingness to respect one's professional obligations and to follow through. An example is following an agency's policies and procedures. As a nurse you are responsible for your actions and the actions of those to whom you delegate tasks.
value
is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior.
For example, in some cultures decisions about health care flow from group or family-based discussion rather than independent dec
Deontology
defines actions as right or wrong on the basis of their "right-making characteristics" such as fidelity to promises, truthfulness, and justice
Utilitarianism
relies on the application of a certain principle (i.e., measures of "good" and "greatest") (Beauchamp and Childress, 2012). The difference between utilitarianism and deontology is the focus on outcomes. Utilitarianism measures the effect that an act will
Key Steps in the Resolution of an Ethical Dilemma
Step 1: Ask the question, Is this an ethical dilemma? Step 2: Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information.
Step 3: Clarify values. Distinguish among fact, o
A nurse on the medical-surgical unit tells other staff members, "That client can just wait for the lorazepam; I get so annoyed when people drink too much." What does this nurse's comment reflect?
a) Demonstration of a personal bias
b) Problem solving base
a) Demonstration of a personal bias
1. A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which p
d) Adult Protective Services
1. Which of the following legal defenses are the most important for a nurse to develop?
a) Dedication
b) Certification
c) Assertiveness
d) Accountability
d) Accountability
1. Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing s
b) Slander
1. A client is brought to the ER by EMS after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury, multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent
c) Transport the victim to the operating room for surgery
1. The nurse hears a client calling out for help and hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the inciden
c) The client was found lying on the floor
slander
occurs when one speaks falsely about another. For example, if a nurse tells people erroneously that a patient has gonorrhea and the disclosure affects the patient's business, the nurse is liable for slander.
libel
is the written defamation of character (e.g., charting false entries in a medical record)
Negligence.
is conduct that falls below the generally accepted standard of care of a reasonably prudent person (Karno, 2011). The law establishes the standard of care to protect others against an unreasonably great risk of harm (Westrick, 2014). Negligent acts such a
malpractice
is one type of negligence and often referred to as professional negligence. When nursing care falls below a standard of care, nursing malpractice results. Certain criteria are necessary to establish nursing malpractice: (1) the nurse (defendant) owed a du
Informed consent
is a patient's agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal (Westrick, 2014). Informed consent requires a health care provider to disclose information in terms a patien
Floating.
Nurses who float must inform the supervisor of any lack of experience in caring for the type of patients on the nursing unit. They should request and receive an orientation to the unit. Supervisors are liable if they give a staff nurse an assignment that
Health Care Providers' Orders.
The health care provider (physician or advanced practice nurse) is responsible for directing medical treatment. Nurses follow health care providers' orders unless they believe that the orders are in error, violate agency policy, or are harmful to the pati
Risk management
involves several components, including identifying possible risks, analyzing them, acting to reduce the risks, and evaluating the steps taken to reduce them (Miller, 2011). TJC (2016) requires the use of quality improvement and risk-management procedures.
occurrence report or incident report
Both quality improvement and risk management require thorough documentation. One tool used in risk management is the
Examples of an occurrence include patient or visitor falls or injury; failure to follow health care provider orders; a significant complai
invasion of privacy
protects a patient's right to be free from unwanted intrusion into his or her private affairs. HIPAA and HITECH Act privacy standards have raised awareness of the need for health care professionals to provide confidentiality and privacy.
False Imprisonment.
occurs with unjustified restraint of a person without a legal reason. This occurs when nurses restrain a patient in a confined area to keep the person from freedom. False imprisonment requires that the patient be aware of the confinement. An unconscious p
Battery.
is any intentional offensive touching without consent or lawful justification (Shilling, 2011). The contact can be harmful to the patient and cause an injury, or it merely can be offensive to the patient's personal dignity. In the example of a nurse threa
Assault
is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact (Shilling, 2011). No actual contact is required for an assault to occur. For example, it is an assault for a nurse to threa
Tort
are civil wrongful acts or omissions made against a person or property
Intentional torts
are deliberate acts that violate another's rights such as assault, battery, and false imprisonment.
Quasi-intentional torts
are acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character.
unintentional tort,
which includes negligence or malpractice.
Good Samaritan laws
to encourage health care professionals to assist in emergencies. These laws limit liability and offer legal immunity if a nurse helps at the scene of an accident. For example, if you stop at the scene of an automobile accident and give appropriate emergen
Health Insurance Portability and Accountability Act (HIPAA, 1996)
provides rights to patients and protects employees. It protects individual employees from losing their health insurance when changing jobs by providing portability. It allows individual employees to change jobs without losing coverage as a result of preex
Privacy
is the right of patients to keep personal information from being disclosed
Confidentiality
protects private patient information once it is disclosed in health care settings. Patient confidentiality is a sacred trust.
Health Information Technology for Economic and Clinical Health Act (HITECH Act, 2009)
expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs. Under the HITECH Act nurses must ensure that patient PHI is not inadvertently conveyed on social media and in particular that p
living wills
represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. With this document a patient is able to declare which medical procedures he or she wants or does not want when termina
advance directives
include living wills, health care proxies, and durable powers of attorney for health care.
They are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process. The Patient Self-Deter
Mental Health Parity Act as Enacted Under PPACA
required insurance companies to offer the same level of coverage for mental health care that they provide for medical and surgical care.
Emergency Medical Treatment and Active Labor Act
when a patient comes to the emergency department or the hospital, an appropriate medical screening occurs within the capacity of the hospital. If an emergency condition exists, staff must evaluate the patient and may not discharge or transfer him or her u
Patient Protection and Affordable Care Act (PPACA or ACA, 2010),
is characterized by four themes embedded in nursing practice: (1) consumer rights and protections; (2) affordable health care coverage; (3) increased access to care; and (4) stronger Medicare to improve care for those most vulnerable in our society.
criminal laws
protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation
misdemeanor
is a crime that causes injury but does not inflict serious harm
felony
is a serious offense that results in significant harm to another person or society in general
Common Sources of Negligence
Failure to assess and/or monitor, including making a nursing diagnosis
� Failure to observe, assess, correctly diagnose or treat in a timely manner
� Failure to use, calibrate, or replace equipment required to safely care for the patient
� Failure to docu