apply ethic in nursing and application of ethic principles in specialty area such as critial care, neonatal intensive care unit and rehabilitation centre

slide share about the epply ethic in nursing and application at speciality area

1. Concept of Nursing Applied Ethics in Nursing Mdm Rozila Ibrahim May Session 2024 NBNS1223

2. Reflective previous tutorial and group discussion

3. Learning Outcome Learner's able to describe the essence of ethic in nursing Learner’s able to discuss issue in nursing ethics in daily practice Learner’s able to discuss the ethic in specialised nursing care; ethic issue in critical care (ICU), long –term care, in neonatal care nursing.

4. The essence of ethic in nursing Nurses are advocates for patients and must find a balance while delivering patient care, by providing clear, concise information about their medical condition, treatment options, and potential risks and benefits. Patients who are well-informed can actively participate in decisions about their care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values.

5. Beneficence kindness and charity, which requires action on the part of the nurse to benefit others. An example of a nurse demonstrating this ethical principle is by holding a dying patient's hand.

6. Non-maleficence The avoidance or minimization of harm. Nonmaleficence in nursing requires the provision of safe, effective, high-quality care. Examples of nonmaleficence in nursing include holding a medication due to adverse reactions or taking steps to ensure a safe work environment.

7. Autonomy providing adequate information to allow patients to make their own decisions based on their beliefs and values. Autonomy also relates to only providing nursing care within the scope of practice defined by state and organizational rules.

8. Justice patients have a right to fair and impartial treatment. This means no matter what a patient's insurance status or financial resources may be, or what gender identification, age or ethnicity they are, they have the right to fairness in nursing decisions.

9. Fidelity The commitment of nurses to their professional responsibilities and their duty to be trustworthy. It is about fulfilling promises made to patients and taking responsibility for assigned tasks. Fidelity in nursing ethics refers to the physical care provided by nurses to patients.

10. Discuss issue in nursing ethics in daily practice Miscommunication among healthcare worker Wrong medication Inform consent Negligence Malpractice

11. Ethic in specialized nursing care

12. End of life care in ICU (EOLC) Total care given to ill patients and his/her family following the decision to end treatment, with the aim to neither accelerate nor delay the death (Crowe & Macfarlane, 2013; Registered Nurses’ Association of Ontario, 2011) A collaborative multidisciplinary treatment approach which encompasses of holistic care, given to both dying patient and his/her family members with the intention to provide meaningful end of life, without ignoring patient right Canadian Hospice Palliative Care Association (CHPCA)

13. Ethic in specialized nursing care (Critical Care Unit - ICU ICU are units with limited bed capacity where critical decisions are made about a patient and the ethical burden is high due to the heavy burden of care and treatment. Given these situations, health professionals are expected to be more sensitive and aware especially of ethical issues. Individual personal care Critical ill patient

14. INTRODUCTION FOR EOLC Categories of patients to be considered for withdrawal or withholding of life support: “ Withholding “ – refers to never initiating a treatment “ Withdrawal “ – refers to stopping a treatment once started The distinction a treatment & stopping it is not itself of ethical significance: what is whether the decision is consistent & preferences.

15. cont ,.. INTRODUCTION FOR EOLC A patient with imminent death A patient with terminal condition

16. DO NOT RESUSSITATION (DNR) A do-not-resuscitate (DNR) order is a legal document that means a person has decided not to have cardiopulmonary resuscitation (CPR) attempted on them if their heart or breathing stops. People who choose to have a DNR usually have a terminal illness or other serious medical condition.

17. Cont..INTRODUCTION FOR EOLC A patient with severe and irreversible condition impairing cognition and consciousness but death may not occur for many months A competent patient who has stated his/her wish not to initiate or who has stated his/her wish to have life support withdrawn A patient who is brain dead (Malaysian Society of Anaesthesiologists , 2004 & Malaysia Medical Council, 2006)

18. Current practice of EOLC : Issues and Challenges Using Quality Indicator for EOLC by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup (Clarke et al., 2003) as a structure framework. There are six domains proposed, which are: Communication Patient and family-centered decision making

19. Cont.. Current practice of EOLC : Issues and Challenges Continuity of care Emotional and practical support Symptom management and comfort care Spiritual support Emotional and organizational support for critical care clinicians

20. Current practice of End of Life Care (EOLC) Issues & Challenges (using Quality Indicator for EOLC by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup as a structure framework) Communication Patient and family-centered decision making Continuity of care

21. Cont.. Current practice of End of Life Care (EOLC) Emotional and practical support Symptom management and comfort care Spiritual support Emotional and organizational support for critical care clinicians

22. Cont..Ethic in specialized nursing care (Critical Care Unit - ICU According to Jennet (1984) the critical care might be considered inappropriate if: unnecessary, because routine care would have achieved the same result; unsuccessful, because patient is too ill to recover; unsafe, because the risk of complications exceed the potential benefits; unkind, because the subsequent quality of life (QoL)is unacceptable; unwise, because of the diversion of limited resources. (Hinds & Watson, 2008)

23. Roles and responsibilities of Critical Care nurses When the direction of care has changed from curative intent to comfort, the principles of palliative care should be enforced, including: Supporting the family Communication Attending to psychological and spiritual needs Promote comfort to the patient

24. Ethic in specialized nursing care Rehabilitation /Long Term Care System’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals. Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place. Care focuses on physical comfort as well as emotional well-being.

25. Cont.. Ethic in specialized nursing care Rehabilitation /Long Term Care Advance directives competence and decision-making capacity decisions about life-sustaining treatment resident abuse restraints psychotropic medications risk management participation in research ethics committees.

26. Advance directive order Is a communication that specifies a person’s preferences about medical treatment should that should that person become incapacitated. Several types of advance directives include: DNR do not resuscitation allow –a-natural –death order Legal document Expresses an individuals desires regarding medical treatment – patient and family desired; organ donation

27. Cont.. Ethic in specialized nursing care Rehabilitation /Long Term Care Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected. Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level. The presence of family members in the care setting is encouraged and facilitated. Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.

28. Ethic in specialized nursing care Neonatal Care To understand the four ethical principles of autonomy, beneficence, nonmaleficence, and justice and apply these principles to clinical decision-making about care in the NICU. Ethical decision-making must be family-centered and respectful of cultural differences. Eg ; infants cannot make autonomous decisions; therefore, parents make autonomous decisions on behalf of their babies. Next, conflicts arise from the varying perspectives from which to present medical information to parents.

29. Cont..Ethic in specialized nursing care Neonatal Care Respect family autonomy and strive to ensure families have accurate, complete and understandable information in order to make informed decisions. Neonatal nurses maintain their professional integrity when resolving conflicts, always ensuring that patients' safety and best interests are protected.

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