Ethics

• Advocacy


  To express and defend the cause of another
• Altruism


  Concern for the welfare and wellbeing of others
• Autonomy


  Right to self-determination
• Belief


  Interpretation or conclusion that one accepts as true
• Beneficence


  Obligation to assist others; actions promote good
• Integrity


  Acting in accordance with an appropriate code of ethics
• Justice


  Upholding of what is fair
• Morality


  Private, personal standards of what is right and wrong in conduct, character, attitude
• Nonmaleficence


  Do no harm and safeguard from harm; perform only interventions intended for good
• Social justice


  Upholding what is fair on a social scale
• Values


  Personal belief about the truths and worth of thoughts, objects, or behavior
• Values clarification


  Develop insight into values and how values influence actions; consciously identifying, examining, and developing individual values
• Veracity


  Complete and truthful information
• Human Dignity


  Inherent value, should be respected and treated equally
• 5 Nursing Values


  • Autonomy
  • Beneficence
  • Justice
  • Fidelity
  • Veracity
• 7 Ethical Principles


  • Right to make own decisions
  • Aim to benefit others and avoid harm
  • Treat all people fairly
  • Keep promises and don't make promises you can't keep
  • Be honest; tell the truth
  • Keep information private (HIPPA, confidentiality)
  • Accept responsibility for the consequences of your actions
• Codes of Ethics


  • Nightingale Pledge (1893)
  • International Council of Nurses (ICN)
  • American Nurses Association (ANA)
• ICN Code of Ethics - Nurses and people


  • Patient first/patient centered
  • Trusted to provide information and keep confidential
  • Health and social needs of public (vulnerable)
  • Equity
  • Respect, compassion, trustworthy/integrity, responsive
• ICN Code of Ethics - Nurses and practice


  • Responsibility, accountability, competence
  • Personal health
  • Judgement when accepting/delegating responsibility; utilizing new tech and EBP safely
  • Reflect well on the nursing profession
  • Help to maintain a culture of ethical behavior
• ICN Code of Ethics - Nurses and the profession


  • Major role in determining and implementing standards of practice
  • Research
  • Core of professional values
  • Safe equitable practice in a safe, ethical environment
  • Sustain natural environment and awareness of effects on health
• ICN Code of Ethics - Nurses and co-workers


  • Respectful collaboration
  • Safeguard clients against endangerment by co-worker
  • Support and guide co-workers in ethical conduct
• ANA Code of Ethics

  • Practice with compassion and respect
  • Maintain primary commitment is to the patient
  • Promote, advocate, and protect the rights, health, and safety of the patient
  • Practice authority, accountability, and responsibility for decisions/actions
  • Commit to self care and personal/professional growth
  • Establish, maintain, and improve the ethical environment of the work setting
  • Advance the profession of nursing through research and scholarly inquiry
  • Collaborate to protect human rights and reduce health disparities
• Vulnerable Populations


  • Children
  • Pregnant women
  • Incarcerated individuals
  • Older adults
  • Cognitively impaired individuals
  • Undocumented status
• Ethical obligation to respect client's beliefs and right to autonomy throughout the care process
• Advance Directives


  • Living Will designates types of medical treatments you want
  • POA identifies who you want to make decisions on your behalf
  • Combination Directive is the 2 combined
• Ethical Decisions


  1. Maximize patient well-being

  2. Balance client's need for autonomy with family member's responsibilities for client's well-being; preserve integrity for all

  3. Support each family member and family support system; spiritual advisors

  4. Facility policy

  5. Protect well-being of others

  6. Protect own standards of care
• Ethical Reasoning


  1. Identify the issue based on the people who will be most affected (stakeholders)

  2. Clarify personal values and their influence on your decisions

  3. What will your role be in the decision?

  4. What are the possible courses of action?

  5. What are the outcomes/consequences associated with each choice?

  6. List the options and rate them; best balance of benefit over harm

  7. Develop a plan with the main stakeholders

  8. Implement, monitor, and evaluate responses
• Enhancing Ethical Practice


  • Awareness of your own values and the ethical aspects of nursing
  • Familiar with nursing code of ethics
  • Continuing education
  • Respect for others (clients, co-workers)
  • Participate in ethics rounds
  • Serve on ethics committee
  • Strive for collaborative and interprofessional practice
• Current Resources for Ethics


  • Agency for Healthcare Research and Quality (AHRQ)
  • ANA Center for Ethics and Human Rights
  • National Reference Center for Bioethics Literature
  • American Society of Law and Ethics
  • American Society of Bioethics and Humanities
  • Nursing Ethics of Canada
  • Markkula Center for Applied Ethics
• DNR prescription in the client's medical record


  Call the provider to verify the existence of an active DNR prescription
• Possible actions


  • Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time
  • Explain to the client that you never know what can happen during surgery and to fill out the papers just in case
  • Contact a client representative to talk with the client and offer additional information about the purpose of advance directives
  • Inform the client that surgery cannot be conducted unless the advance directives are completed
• Works Cited: Alfaro-LeFevre, R. (2013). Critical thinking, clinical reasoning, and clinical judgment (5th ed.). St. Louis, MO: Elsevier.