NUR 3805 Florida State University Nursing Role and Scope Questions

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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 • Self-preservation • Relationships • Environment and moral obligation • Patients’ interests • Collaboration • Privacy • Competent practice • Accountability and delegation • 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 selfrespect 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?

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