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CulturallycompetentCareforpatientsandethicaldilemmas2.pptx
Culturally competent Care for patients and ethical dilemmas
Presented by
Agenda
Introduction
Ethical Decision-Making Model
Ethical Dilemma 1
Ethical Dilemma 2
Ethical Dilemma 3
Conclusion
References
Ethical Decision Making
1) Articulate the Problem
2) Collect information and perspectives on differing moral claims
3) Explore options
4) Choose and implement an option
5) Evaluate outcomes
Ethical Dilemma 1
Problem statement – what is the dilemma?
What are the perspectives on it?
Who are keystakeholders/decision makers?
What is the goal outcome for/of the patient?
Ethical Dilemma 1
Ethical Dilemma 1
General discussion slide if necessary; point out specific conflicts and options
Ethical Dilemma 1
Identify solutions and ways to evaluate outcomes
Ethical Dilemma 2
Problem statement – what is the dilemma?
What are the perspectives on it?
Who are keystakeholders/decision makers?
What is the goal outcome for/of the patient?
Ethical Dilemma 2
Ethical Dilemma 2
General discussion slide if necessary; point out specific conflicts and options
Ethical Dilemma 2
Identify solutions and ways to evaluate outcomes
Ethical Dilemma 3
Problem statement – what is the dilemma?
What are the perspectives on it?
Who are keystakeholders/decision makers?
What is the goal outcome for/of the patient?
Ethical Dilemma 3
Ethical Dilemma 3
General discussion slide if necessary; point out specific conflicts and options
Ethical Dilemma 3
Identify solutions and ways to evaluate outcomes
Conclusion
Restate Ethical Decision making framework – 30seconds
Restate examples given
Final closeout – leave audience with final question or thought?
References
Nathaniel, A. 2012. Chapter 7: Ethical decision making. [PowerPoint slides]. Retrieved from Resurrection University Brightspace, 10DEC2020.
References as Embedded Attachments
Powerpoint Ethics
Decision Model
CHAPTER 7
Ethical Decision Making
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Moral Problems
- Moral problems are complex.
- They may:
- Include intricate relationships among people with opposing views
- Incorporate a mix of values, risks, benefits, and harms
- Include solutions that are obscure until the situation unfolds
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Problem Analysis
- A problem is
- A discrepancy between the current situation and a desired state
- Usually unplanned and often unexpected
- Simple or complex, routine or moral
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Think About It
- Articulate the “current situation” and a practical “desired state.”
- A terminally ill patient with intractable pain
- A critically ill person with no health insurance
- An Alzheimer’s patient who wants to go home
- A narcotic drug abuser who has severe, chronic pain
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Types of Moral Problems
- Moral uncertainty
- Moral dilemma
- Moral distress
- Moral outrage
- Moral reckoning
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Moral Uncertainty
- Occurs when one senses that there is a moral problem, but
- Is not sure of the morally correct action,
- Is unsure which moral principles or values apply, or
- Cannot define the moral problem (Jameton, 1984).
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Dilemma
- A dilemma is a problem
- That requires a choice between two equally unfavorable and mutually exclusive options
- That seems to defy a satisfactory solution
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Moral Dilemma
- A moral dilemma occurs when solutions to a problem include conflicting moral claims.
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Moral Dilemma Presentation
- Two ways moral dilemmas may present:
- Evidence indicates that an act is morally right, and other evidence indicates that the act is morally wrong, but no evidence is conclusive.
- One moral rule supports one course of action and another moral rule supports another course of action, yet the two actions are mutually exclusive.
(Beauchamp & Childress, 2001)
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Think About It
- What are the conflicting moral claims in these situations?
- A terminally ill patient experiences severe intractable pain.
- A patient seeks an experimental treatment that is likely to cause harm.
- An alert elderly patient falls often, so the physician orders physical restraints.
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Moral Distress
- “… arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.” (Jameton, 1984, p. 6)
- “… nurses participate in the action that they have judged to be morally wrong.” (Jameton, 1993)
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Moral Distress
- More likely to occur in highly stressful situations or when dealing with more vulnerable patients. Factors:
- Ethical and working climate in the facility
- Relationships—especially with physicians and role expectations
- Stressors resulting from nursing shortage
- Results in psychosocial, physical, and emotional consequences for nurses
- When it occurs it is unfavorable for nurses and patients and can have a long-term impact
Moral Outrage
- … occurs when someone else performs an act the nurse believes to be immoral
- Nurses
- Do not participate in the act
- Do not believe they are responsible for wrong
- Believe they are powerless to prevent the act
(Wilkinson, 1987–1988)
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Moral Reckoning
- Encompasses moral distress, moral outrage, and more
- May last a lifetime
- Is a three-stage process
- Stage of ease
- Stage of resolution
- Stage of reflection
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Intervening Factors
- Intervening factors appear in ways that interfere with, alter, or obstruct action, and add to the complexity of ethical problems.
- Uncertainty
- Context
- Stakeholders
- Power imbalance
- Extraneous variables
- Other relevant cases
- Urgency
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Ethical Decision Making
- Basic features constitute every type of decision
- A problem
- Alternative solutions
- Uncertainty
- Outcome
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Effective Decision Maker Attributes
- Moral integrity
- Sensitivity, compassion, and caring
- Sense of responsibility
- Empowerment
- Patience and willingness to deliberate
- Knowledgeable about societal rules, ethical principles, and professional standards
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Decisions at the Bedside
- Ethics and ethical decision making are part of every aspect of nursing.
- Make decisions of moral importance daily
- Conscious of the moral nuances in each situation
- Ethic: personal consciousness of the moral importance that guides personal actions in particular situations.
- Various “ethics” such as “ethic of responsiveness” which includes respect for persons and a desire to do good
Ethical Decision-Making Model
- Articulate the problem
- Gather data and identify conflicting moral claims
- Explore strategies
- Implement the chosen strategy
- Evaluate outcomes
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