WEEK 4 nuRSING ROLE AND SCOPE

Chapter 4

Foundations of

Ethical Nursing

Practice

Ethics

• Ethics versus morals

• Bioethics

• Nursing ethics

• Moral reasoning

– Kohlberg

– Gilligan

Values in Nursing

• Values emphasized in the Code of Ethics with

Interpretive Statements (ANA, 2001)

– Wholeness of character

– Integrity

– Basic dignity

– Personal dignity

Ethical Theories and Approaches

• Virtue ethics

• Natural law theory

• Deontology

• Utilitarianism

• Ethics of care

• Ethical principlism

Ethical Principlism

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

Professional Ethics and Codes

• The Nightingale Pledge (1893)

• Nursing Ethics: For Hospital and Private

Use (1900)

• ICN’s Code of Ethics for Nurses (1953)

• ANA’s Code of Ethics for Nurses (1950)

ANA’s Code of Ethics for Nurses

• Nine provisions with interpretive statements

containing specific guidelines for clinical

practice, education, research, and

administration

• The code is considered to be nonnegotiable in

regard to nursing practice

Examples of Themes in the Code of

Ethics with Interpretive Statements

• Respect for autonomy

• Relationships

• Patients’ interests

• Collaboration

• Privacy

• Competent practice

• Accountability and

delegation

• Self-preservation

• Environment and moral

obligation

• Contributions to the

nursing profession

• Human rights

• Articulation of

professional codes by

organizations

The ICN Code of Ethics for Nurses

• Nurses have 4 fundamental responsibilities:

– To promote health

– To prevent illness

– To restore health

– To alleviate suffering

Common Themes of ANA & ICN Codes

• Focus on the importance of nurses delivering

compassionate patient care aimed at alleviating

suffering; patient is the central focus of nurses’ work

• Applies to all nurses in all settings and roles;

nonnegotiable ethical nursing standards with a focus

on social values, people, relationships, and

professional ideals

• Share values of respect, privacy, equality, and

advocacy

• Both codes illustrate idea of nurses’ moral self-

respect

Ethical Analysis and Decision Making

in Nursing

• Ethical dilemmas and conflicts

• Moral suffering

• Team approach

• Case-based approach using 4 topics method

– Medical indications

– Patient preferences

– Quality of life

– Contextual features

Medical Indications

• What is the patient’s medical problem? History?

Diagnosis? Prognosis?

• Is the problem acute? Chronic? Critical?

Emergent? Reversible?

• What are the goals of treatment?

• What are the probabilities of success?

• What are the plans in case of therapeutic failure?

• In sum, how can this patient be benefited by

medical and nursing care, and how can harm be

avoided?

Patient Preferences

• Is the patient mentally capable and legally competent? Is

there evidence of incapacity?

• If competent, what is the patient stating about preferences

for treatment?

• Has the patient been informed of benefits and risks,

understood this information, and given consent?

• If incapacitated, who is the appropriate surrogate? Is the

surrogate using appropriate standards for decision making?

• Has the patient expressed prior preferences?

• Is the patient unwilling or unable to cooperate with medical

treatment? If so, why?

Quality of Life

• What are the prospects, with or without treatment, for a

return to normal life?

• What physical, mental, and social deficits is the patient

likely to experience if treatment succeeds?

• Are there biases that might prejudice the provider’s

evaluation of the patient’s quality of life?

• Is the patient’s present or future condition such that his

or her continued life might be judged undesirable?

• Is there any plan and rationale to forgo treatment?

• Are there plans for comfort and palliative care?

Contextual Features (1 of 2)

• Are there family issues that might influence

treatment decisions?

• Are there provider (physicians and nurses)

issues that might influence treatment

decisions?

• Are there financial and economic factors?

• Are there religious and cultural factors?

Contextual Features (2 of 2)

• Are there limits on confidentiality?

• Are there problems of allocations or resources?

• How does the law affect treatment decisions?

• Is clinical research or teaching involved?

• Is there any conflict of interest on the part of

the providers or the institution?