Ethical Decision Making Week 3

Ethical problems involve situations where there are conflicts between one or more values and uncertainty about the correct course of action. Ethical problems involve questions about what is right or good to do at individual, interpersonal, organizational and even societal levels. Ethical uncertainty occurs when a nurse feels indecision or a lack of clarity, or is unable to even know what the moral problem is, while at the same time feeling uneasy or uncomfortable. Ethical dilemmas arise when there are equally compelling reasons for and against two or more possible causes of action and where choosing one course of action means that something else is relinquished or let go. True dilemmas are infrequent in health care. More often there are complex ethical problems with multiple courses of actions from which to choose. Ethical courage standing firm on a moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself Ethical disengagement- Ethical or moral disengagement can occur if nurses begin to see the disregard of their ethical commitments as normal. A nurse then may become apathetic or disengaged to the point of being unkind non compassionate or even cruel to other health care workers and to persons receiving care. Ethical or moral distress a feeling of discomfort that arises in situations where nurses know or believe they know the right thing to do but for various reasons (including fear or circumstances beyond their control) do not or cannot take the right action or prevent a particular harm. Ethical violations involve actions or failures to act that breach fundamental duties to the persons receiving care or to colleagues and other health care providers. Ethical or moral residue nurses experience ethical or moral residue when they seriously compromise themselves or allow themselves to be compromised. The moral residue nurses carry forward from these kinds of situations can help them reflect on what they would do different in similar situations in the future. What are the Canadian Nurses Association values related to ethical decision making? Providing safe, compassionate, competent care- nurses have a responsibility to conduct themselves according to the ethical responsibilities outlined in this document and in practice standards in what they do and how they interact with persons receiving care as well as with families, communities, group, populations and other members of the healthcare team. Promoting health and well being- nurse provide are directed first and foremost toward the health and well being of the person, family community in their care.

Promoting and respecting informed decision making- nurse recognize that capable persons may place a different weight on individualism and may choose to defer to family or community values in decision making. Preserving dignity- nurses in their professional capacity, relate to all person with respect Maintaining privacy and confidentiality- nurses respect the right of people to have control over the collection, use access and disclosure of their personal information. Promoting justice- nurses refrain from judging, labelling, demeaning, stigmatizing, and humiliating behaviours towards persons receiving care, other health-care professionals and each other. Being accountable- nurses are honest and practice with integrity in all of their professional interactions. What is the College of Nurses of Ontarios values related to ethics? Client well-being Promoting client well-being means facilitating the clients health and welfare, and preventing or removing harm. Client choice Client choice means self-determination and includes the right to the information necessary to make choices and to consent to or refuse care. Clients know the context in which they live and their own beliefs and values. As a result, when they have the necessary information, they can decide what is best for themselves. Privacy and confidentiality Privacy is limited access to a person, the persons body, conversations, bodily functions or objects immediately associated with the person. Because people have different beliefs and values about privacy, the important aspects of privacy need to be identified by individual clients. Nurses need to provide care that maintains the dignity and privacy of clients and should not unnecessarily intrude on a clients privacy. Confidentiality involves keeping personal information private. All information relating to the physical, psychological and social health of clients is confidential, as is any information collected during the course of providing nursing services. Clients, however, may consent to sharing information with others. Respect for life- respect for life means that human life is precious and needs to be respected, protected and treated with consideration. Maintaining commitments Nurses have an obligation to maintain the commitments they assumed as regulated health professionals. Maintaining commitments means keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings.

Truthfulness- means speaking or acting without intending to deceive. Truthfulness also refers to providing enough information to ensure the client is informed. Omissions are as untruthful as false information. As health care has changed, so have the restrictions on disclosure in dealing with clients. Many health care professionals formerly believed that clients could be harmed by knowing the details of their illnesses. Health care professionals now believe that clients have the right to and will benefit from full disclosure. Honesty builds trust, which is essential to the therapeutic relationship between nurses and clients. Fairness means allocating health care resources on the basis of objective health-related factors. The Canada Health Act provides access to health care for all Canadians. Health care resources, however, are limited; this makes it difficult to make decisions about who receives care and what kind of care they receive. What is the role of an ethics committee? The clinical ethics committee is any committee that is recognized as being primarily involved in ethical issues regarding patient care. At times the issues health care teams and families face are often extremely complex and not easily resolved. Ethics committees exist to provide education, guideline, advice and support in dealing with these issues. Ethics committees can take a passive role and wait for issues to be brought to them or take an active role in influencing practice across an organization. What is an ethical decision making process? Why is it important to practice? It provides a guide to facilitate communication and discussion of the issues and can serve as useful tools to guide nurses in their thinking about a particular issue or question. Ethical decision making process: y y y y y y y Determines who is involved- who should be participating in the discussion of this issue? The patient? The healthcare team? Describe the issue- determine whether the situation constitutes an ethical issue or an ethical violation. Assess the situation- what is the patient diagnosis, prognosis, age? What is the patient cultural background and religion? Clarify values- what are your beliefs about the situation? What are the values of the patient, the family and other members of the team Explore the story and note reactions share the story from each perspective Identify ethical principles- which principles apply to this situation Clarify legal rules- are there any legal rules that govern this situation (e.g release of confidential information)

y y y

Explore options and alternatives how many options are available? Evaluate each in relation to ethical theories and principles. What are the potential consequences of each alternative? Decide the course of action- is the course of action more consistent with ethical theories, principles, and rules? Develop an action plan-once the choice has been made how will it be carried out? Evaluate the plan- review the situation regularly. Modify the plan or strategy as required.

How does the CNO suggest nurses work through ethical situations in nursing practice? Working through ethical situations begins with understanding the values of all concerned. Because nearly every ethical situation involves other members of the health care team, these people need to be part of the discussion to resolve the issues and develop an acceptable plan of care. An ethics resource person in the agency, such as an ethicist, clergy member or ethics committee, can also be of assistance. Other resources are literature. Due to its familiarity to nurses, the nursing process provides a viable approach for examining situations involving ethical values. These situations may involve ethical uncertainty, ethical distress or ethical conflicts. Assessment/description of situation Pay close attention to all aspects of the situation, taking into account clients beliefs, values, wishes and ethnocultural backgrounds. Plan/approach Develop an action plan that takes into account factors drawn from the assessment, options and consequences. Sometimes doing nothing is the best course of action. This should be a conscious decision, since doing nothing will affect the outcome and should not be a means of avoiding a decision. Implementation/action Carry out the agreed upon actions. Sensitivity, good communication and interpersonal skills are necessary. All who are affected by the situation need to be kept informed. Evaluation/outcome Determine if the result is satisfactory. Involve those who were part of the initial assessment and planning, including the client.