27-a Code of ethics.pptx nursing research

adh

1. “ EHTHICAL ASPECTS OF NURSING ”

2. INTRODUCTION Ethics is the science relating to moral actions and one’s value system. Many nurses visualize ethics as dealing with principles or morality and what is right or wrong. Ethics is concerned with motives and attitudes and the relationship of these attitudes to good of the individual. ETHICS is the science that deals with the rightness and wrongness of actions. (Aiken 2004) BIOETHICS is the term applied to these principles when they refer to concepts within the scope of medicine, nursing and allied health.

3. DEFINITIONS ETHIC: An ethic is a standard of behavior or a belief valued by an individual or a group. It describes what ought to be, rather than what is-a goal to which an individual inspires. These standards are learned through socialization, growth and experience. Ethical standards, guidelines and principles are not legally enforceable unless they have been incorporated into the law. MORAL BEHAVIOR: is defined as conduct that results from serious critical thinking about how individuals ought to treat others. It reflects the way a person interprets basic respect for others. VALUES: are ideals or concepts that give meaning to the individual’s life. RIGHT: a right is defined as a “valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service.

4. CODE OF ETHICS Professional codes of ethics are system of rules and principles by which that profession is expected to regulate its members and demonstrates its responsibility to society. Nursing ethics provide the standards for professional behavior and is the study of principles of right and wrong conduct for nurses.

5. In India, nurses are following the international council for Nurses 1993 as given below: The fundamental responsibility of the nurse is 4 fold: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal; inherent in nursing is respect for life, dignity and rights of man. It is untreated by consideration of nationality, race, creed, colour, age sex, politics or social status. Nurses render health services to the individual, the family, and the community and co-ordinate their services with those of related group.

6. The Florence Nightingale pledge, prepared by Gretter It included the basic principles governing ethical practices as given below: I solemnly pledge myself before God and in the presence of assembly; to pass my life in purity and to practice my profession faithfully; I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug; I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling; With loyalty I will endeavour to aid the physician in the work, and devote myself to the welfare of those committed to my care.

7. ETHICAL PRINCIPLES   Principles are the norms that nursing, as a profession, both demands and strives to implement to everyday clinical practice. Ethical principles, that nurse should consider when making decisions are as follows: Respect for persons Respect for autonomy Respect for freedom Respect for beneficence (doing good) Respect for non-maleficence (avoiding harm to others) Respect for veracity (truth telling) Respect for justice (fair and equal treatment) Respect for rights Respect for fidelity (fulfilling promises) Confidentiality (protecting privileged information)

8. Respect for persons This principles not only applied to clinical situations, but it applies to all life situations. It directs individuals to treat themselves and other, with a respect to inherent to man’s humanness. It requires recognition on a sense that all share a common human destiny. The respects to persons need to be simplified as it affects nursing practice.  

9. Autonomy It refers to the person’s right to self-determination and independence. Autonomy means that individuals are able to act for themselves to the level own purposes and reason. The legal doctrine of informed consent is direct reflection autonomy.   There are three types of autonomy: freedom for action freedom for choice freedom for effective deliberation.

10. Freedom This principle of individual freedom decreases that patients be exempt from control by others to select and pursue personal health goals. This principle should be observed by staff nurses when planning patient care; and by nurse manager when leading subordinates.

11. Beneficence It refers to one’s duty to benefit or promote good for others. It dictates that a person is obliged to help others to advance their legitimate and important interest. It requires the balancing of harms and benefits. Professional education provides awareness that most nursing interventions are capable of producing undesirable, as well as desirable, patient outcomes. 

12. Non-maleficence It is the requirement to do no harm to others intentionally or unintentionally. This principle states one should do no harm. The nurse should interpret the term ‘harm’ to mean emotional and social as well as physical injury. Example: A good nurse manager performing evaluation of subordinates should emphasize their good qualities and give positive direction for growth. Destroying the employees self-esteem and self-worth would be considered doing harm their principles.

13. Veracity It is the duty to be honest or truthful. Veracity concerns truth and incorporates the concept that individuals should always tell the truth. It requires professional care-givers to provide with accurate and reality based information about their health status and care or treatment prospection. Truth is the basis for mutual trust between patient and the nurse Example : Nurse Managers use this principle when they give all the facts of a situation, truthfully and assist their employees to make decisions.

14. Justice This principle of justice requires treating others fairly, equally and giving persons their due. When there are resources to distribute in health care, nurses should allocate them in such a way that equal shares go to equal recipients. The following problems complicate the application of justice. Not everyone is equal in every way, sometimes there are situations in which it seems that one person should receive a greater or lesser share than another. Resources are limited. There is not always enough for each person to receive an equal share.

15. Fidelity It refers to the obligation to honor commitments and contracts. Fidelity is keeping one’s promises or commitments. This principle of fidelity holds that a person faithfully fulfills his duties and obligations. Fidelity is important in a nurse because a patient’s hope for relief and recovery rests on evidence of care-givers conscientiousness. Nurse Managers abide by this principle when they follow through on any promise they have previously made to employees, such as promised leave, a certain shift to be worked or a promotion to perception within the unit.

16. Rights Right is an entitlement to behave in a certain way under circumstances, such as nurse’s entitlement to freely express personal beliefs and preferences by voting in a political election. The right may be mental rights or legal rights related to respective profession. The patient has right to privacy concerning medical care programme, to be examined and regarding the rules and regulations of the hospital.

17. Confidentiality Confidentiality is the duty to respect privileged information. The principle of confidentiality provides that care-givers should respect a patient need for privacy and use personal information about hi, or her only to improve care. Nurses should practice confidentiality to decrease patient vulnerability and share from widespread knowledge of personal information divulged during care.

18. ETHICAL DILEMMAS Ethical dilemma exists when moral claims conflict with one another. Usually the dilemmas occur when opposing views are seen for the solution of an issue and a decision must be made. There are no easy answers for how ethical dilemma should be resolved. It can be defined as: A difficult problem that seems to have no satisfactory solution. A choice between equally unsatisfactory alternatives. An ethical dilemma is a situation that requires an individual to make a choice between two equally unfavorable alternatives. - (Catalano, 2003)

19. SITUATIONS IN WHICH NURSES FACE DILEMMA Need to compute patient care to conserve scarce resources. Need to make treatment and care decisions for terminally ill patients. Need to obtain patients’ request for euthanasia. Need to balance the patients need for confidentiality and privacy against society’s needs for protection from unreasonable risk. Need to protect autonomy rights of children and incompetent adults concerning consent for research participation. Need to protect justice rights of patients who participate in random trials of experimental treatment.

20. ETHICAL DECISION MAKING

21. ETHICAL DECISION MAKING Ethical decision making involves trying to distinguish right from wrong in situation without clear guidelines. A decision- making model can help identify factors and principles that affect a decision. There are various models for ethical decision-making: Traditional model of ethical decision-making MORAL-Decision making model by Thirona and Halloraw Decision making model by Johnstone

22. (1) TRADITIONAL MODEL OF ETHICAL DECISION-MAKING Identify the problem Gather data to analyse the causes and consequences of the problem. Explore the optional solutions to the problem. Evaluate these optional solutions to the problem. Select the appropriate solution from all the options. Implement the selected solution. Evaluate the results.

23. DECISION MAKING MODEL BY THIRONA AND HALLORAW

24. (2) DECISION MAKING MODEL BY JOHNSTONE

25. Use of a decision making model, in working through ethical issues, allows the nurse to consider all factors, when ethical dilemmas require decisions to be made that affect the client, the family, the nurse and the employing agency. This decision making model is consistent with the standards of practice involves aspects of the nursing process.

26. (3) MODEL FOR ETHICAL DECISION - MAKING (From Curtin L: Nursing Forum 17:12, 1978)

27. MODEL FOR ETHICAL DECISION - MAKING (From Curtin L: Nursing Forum 17:12, 1978)

28. “ ROLE OF ADMINISTRATOR IN ETHICAL ISSUES ” The leadership roles and management functions of an administrator in ethics are as follows: He or she is self aware regarding own values and basic beliefs about the rights, duties and goals of human beings. Accepts that some ambiguity and uncertainty must b a part of all ethical decision-making.

29. “ ROLE OF ADMINISTRATOR IN ETHICAL ISSUES ” Accepts that negative outcomes occur in ethical decision-making despite high quality problem-solving and decision-making. Demonstrates risk taking decision-making. Roles models ethical decision-making, which are congruent with the code of ethics and inter respective statements.

30. “ ROLE OF ADMINISTRATOR IN ETHICAL ISSUES ” Actively advocates for clients, subordinates and the profession. Clearly communicate expected ethical standards of behaviour. Uses a systematic approach to problem-solving or decision-making when faced with management problems with ethical ramifications. Uses established ethical frameworks to clarify values and beliefs.

31. “ ROLE OF ADMINISTRATOR IN ETHICAL ISSUES ” Identify outcomes in ethical decision-making that should always be sought or avoided. Applies principles of ethical reasoning to define what beliefs or values form the basis of decision-making. Is aware of legal precedents that may guide ethical decision-making and is accountable for possible liabilities should they go against the legal precedent.

32. “ ROLE OF ADMINISTRATOR IN ETHICAL ISSUES ” Continuously re-evaluate quality of own ethical decision-making based on the process of decision-making problem-solving used. Recognizes and rewards ethical conduct of subordinates. Takes appropriate action when subordinate use ethical conduct of subordinates. Takes appropriate action when subordinates use unethical conduct.

33. REFERENCES B T Basavanthappa, Nursing administration, 1 st edition, Jaypee Brothers Medical Publishers; 474 – 510. Merry C. Townsend, psychiatry mental health nursing, 5th edition, Jaypee Brothers Medical Publishers; 76-88. Steuart W.Gail; Laraia T Michele, principles of psychiatry nursing, 8th edition, Mosby publication; 140-168. http://jrn.sagepub.com/cgi/content/abstract/1/3/175

34. REFERENCES Patricia A. Potter; Perry Anne Griffin: Fundamentals of nursing, 6th Ed, MOSBY An imprint of Elsevier; 45-49. www.googles .com Susan Westrick Killion, Katherine McCormack Dempski; Legal and ethical issues in nursing. Charles C Sharpe; Nursing Malpractice: Liability and risk management.