Foundations of Ethical Nursing Practice

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?

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Parker Rights & Media Specialist: Wes DeShano Media Development Editor: Shannon Sheehan Cover Image: © robertiez/iStock/Getty Images Plus/Getty Printing and Binding: RR Donnelley Cover Printing: RR Donnelley Library of Congress Cataloging-in-Publication Data Role development in professional nursing practice / [edited by] Kathleen Masters. – Fourth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-284-07832-9 (pbk.) I. Masters, Kathleen, editor. [DNLM: 1. Nursing–standards. 2. Nursing–trends. 3. Nurse’s Role. 4. Philosophy, Nursing. 5. Professional Practice. WY 16] RT82 610.73–dc23 2015022040 6048 Printed in the United States of America 19 18 17 16 15 10 9 8 7 6 5 4 3 2 1 Dedication This book is dedicated to my Heavenly Father and to my loving family: my husband, Eddie, and my two daughters, Rebecca and Rachel. Words cannot express my appreciation for their ongoing encouragement and support throughout my career. Contents Preface Contributors xv xix UNIT I: FOUNDATIONS OF PROFESSIONAL NURSING PRACTICE 1 1 3 2

A History of Health Care and Nursing Karen Saucier Lundy and Kathleen Masters Classical Era Middle Ages The Renaissance The Dark Period of Nursing The Industrial Revolution And Then There Was Nightingale… Continued Development of Professional Nursing in the United Kingdom The Development of Professional Nursing in Canada The Development of Professional Nursing in Australia Early Nursing Education and Organization in the United States The Evolution of Nursing in the United States: The First Century of Professional Nursing The New Century International Council of Nurses Conclusion References 3 6 8 9 10 13 22 23 25 27 28 39 40 41 43

Frameworks for Professional Nursing Practice 49 Kathleen Masters Overview of Selected Nursing Theories Nurse of the Future: Nursing Core Competencies Overview of Selected Non-Nursing Theories Relationship of Theory to Professional Nursing Practice Conclusion References 51 84 87 88 89 92 X 3 4 5 6 CONTENTS Philosophy of Nursing 99 Mary W. Stewart Philosophy Early Philosophy Paradigms Beliefs Values Developing a Personal Philosophy of Nursing Conclusion References 100 101 103 104 106 110 112 114 Foundations of Ethical Nursing Practice 117 Janie B. Butts and Karen L. Rich Ethics Ethical Theories and Approaches Professional Ethics and Codes Ethical Analysis and Decision Making in Nursing Conclusion References 118 121 126 129 134 135 Social Context of Professional Nursing 137 Mary W. Stewart, Katherine Elizabeth Nugent, Rowena W. Elliott, and Kathleen Masters Nursing’s Social Contract with Society Public Image of Nursing The Gender Gap Changing Demographics and Cultural Competence Access to Health Care Societal Trends Trends in Nursing Conclusion References 138 139 143 146 148 151 156 166 166 Education and Socialization to the Professional Nursing Role 173 Kathleen Masters and Melanie Gilmore Professional Nursing Roles and Values The Socialization (or Formation) Process Facilitating the Transition to Professional Practice Conclusion References 174 176 180 181 183 CONTENTS 7 Advancing and Managing Your

Professional Nursing Career UNIT II: PROFESSIONAL NURSING PRACTICE AND THE MANAGEMENT OF PATIENT CARE Patient Safety and Professional Nursing Practice 185 187 190 193 194 197 198 199 201 202 205 207 Jill Rushing and Kathleen Masters Patient Safety Critical Thinking, Clinical Judgment, and Clinical Reasoning in Nursing Practice Conclusion References 9 185 Mary Louise Coyne and Cynthia Chatham Nursing: A Job or a Career? Trends That Impact Nursing Career Decisions Showcasing Your Professional Self Mentoring Education and Lifelong Learning Professional Engagement Expectations for Your Performance Taking Care of Self Conclusion References 8 XI Quality Improvement and Professional Nursing Practice 207 216 231 233 237 Kathleen Masters Healthcare Quality Measurement of Quality The Role of the Nurse in Quality Improvement Conclusion References 237 240 249 251 253 Professional Nursing Practice 10 Evidence-Based Kathleen Masters 255 Evidence-Based Practice: What Is It? Barriers to Evidence-Based Practice Promoting Evidence-Based Practice Searching for Evidence Evaluating the Evidence Implementation Models for Evidence-Based Practice Conclusion References 255 257 258 259 262 265 268 270 XII 11 CONTENTS Patient-Centered Care and Professional Nursing Practice 273 Kathleen Masters Dimensions of Patient-Centered Care Communication as a Strategy to Support Patient-Centered Care Patient Education as a Strategy to Support Patient-Centered Care

Evaluation of Patient-Centered Care Conclusion References in Professional Nursing Practice 12 Informatics Kathleen Masters and Cathy K. Hughes Informatics: What Is It? The Impact of Legislation on Health Informatics Nursing Informatics Competencies Basic Computer Competencies Information Literacy Information Management Current and Future Trends Conclusion References and Collaboration in Professional Nursing Practice 13 Teamwork Sharon Vincent and Kathleen Masters Healthcare Delivery System Nursing Models of Patient Care Roles of the Professional Nurse Interprofessional Teams and Healthcare Quality and Safety Interprofessional Collaborative Practice Domains Interprofessional Team Performance and Communication Conclusion References Issues in Professional Nursing Practice 14 Ethical Janie B. Butts and Karen L. Rich Relationships in Professional Practice Moral Rights and Autonomy Social Justice Death and End-of-Life Care Conclusion References 274 276 278 293 294 295 301 301 302 304 307 311 314 319 320 321 325 326 328 332 335 338 339 343 344 347 348 353 355 360 370 371 CONTENTS and the Professional Nurse 15 Law Kathleen Driscoll, Kathleen Masters, and Evadna Lyons XIII 375

The Sources of Law Classification and Enforcement of the Law Nursing Scope and Standards Malpractice and Negligence Nursing Licensure Professional Accountability Conclusion References 376 378 381 384 387 392 400 402 Appendix A Standards of Professional Nursing Practice Appendix B Provisions of Code of Ethics for Nurses Appendix C The ICN Code of Ethics for Nurses Glossary Index 405 407 409 411 429 PrefaCe Although the process of professional development is a lifelong journey, it is a journey that begins in earnest during the time of initial academic preparation. The goal of this book is to provide nursing students with a road map to help guide them along their journey as a professional nurse. This book is organized into two units. The chapters in the first unit focus on the foundational concepts that are essential to the development of the individual professional nurse. The chapters in Unit II address issues related to professional nursing practice and the management of patient care, specifically in the context of quality and safety. In the fourth edition, the chapter content is conceptualized, when applicable, around nursing competencies, professional standards, and recommendations from national groups, such as Institute of Medicine reports. The chapters included in Unit I provide the student nurse with a basic foundation in areas such as nursing history, theory, philosophy, ethics, socialization into the nursing role, and the social context of nursing. All chapters have been updated, and several chapters in Unit I have been expanded in this edition. Revisions to the chapter on nursing history include the addition of contributions of prominent nurses and achievements related to nursing in the United Kingdom, Canada, and Australia.

The theory chapter now includes additional nursing theorists as well as a brief overview of several non-nursing theories frequently used in nursing research and practice. The social context of nursing chapter now incorporates not only societal trends, but also trends in nursing practice and education. The chapter related to professional career development in nursing has been completely rewritten for this edition. The chapters in Unit II are more directly related to patient care management. In the fourth edition, Unit II chapter topics are presented in the context of quality and safety. Chapter topics include the role of the nurse in patient safety, the role of the nurse in quality improvement, evidence-based nursing practice, the role of the nurse in patient-centered care, informatics in nursing practice, the role of the nurse related to teamwork and collaboration, ethical issues in nursing practice, and the law as it relates to patient care and nursing. Most Unit II chapters have undergone major revisions with a refocus of the content on recommended nursing and healthcare competencies. PrEfaCE The fourth edition continues to incorporate the Nurse of the Future: Nursing Core Competencies throughout each chapter. The Nurse of the Future: Nursing Core Competencies “emanate from the foundation of nursing knowledge” (Massachusetts Department of Higher Education, 2010, p. 4) and are based on the American Association of Colleges of Nursing’s Essentials of Baccalaureate Education for Professional Nursing Practice, National League for Nursing Council of Associate Degree Nursing competencies, Institute of Medicine recommendations, Quality and Safety Education for Nurses (QSEN) competencies, and American Nurses Association standards, as well as other professional organization standards and recommendations.

The 10 competencies included in the model are patient-centered care, professionalism, informatics and technology, evidence-based practice, leadership, systems-based practice, safety, communication, teamwork and collaboration, and quality improvement. Essential knowledge, skills, and attitudes (KSA) BOARD OF HIGHER EDUCATION NURSING INITIATIVE NURSING CORE COMPETENCIES im Qu pr alit ov y em en t Safety s Leade rship Nursing knowledge d ication Commun ali sio n PR A CT IC E ofe s Team w colla ork and bora tion ed as -b e em tic st ac Sy pr sm re nte -ce t n ie are Pat c Pr d e bas ce- e n e tic id Ev prac ENVIRONMENT TICE AC PR ic at rm fo In PR AC TI CE The science and practice of nursing PRACTICE ENVIRO NM EN T XVI K-Knowledge S-Skills A-Attitudes Source: Modified from Massachusetts Department of Higher Education. (2010). Nurse of the future: Nursing core competencies (p. 5). Retrieved from http://www.mass.edu/currentinit /documents/NursingCoreCompetencies.pdf PrEfaCE reflecting cognitive, psychomotor, and affective learning domains are specified for each competency. The KSA identified in the model reflect the expectations for initial nursing practice following the completion of a prelicensure professional nursing education program (Massachusetts Department of Higher Education, 2010, p. 4). Foundations of Ethical Nursing Practice

The Nurse of the Future: Nursing Core Competencies graphic illustrates through the use of broken lines the reciprocal and continuous relationship between each of the competencies and nursing knowledge, that the competencies can overlap and are not mutually exclusive, and that all competencies are of equal importance. In addition, nursing knowledge is placed as the core in the graphic to illustrate that nursing knowledge reflects the overarching art and science of professional nursing practice (Massachusetts Department of Higher Education, 2010, p. 4). This new edition has competency boxes throughout the chapters that link examples of the KSA appropriate to the chapter content to Nurse of the Future: Nursing Core Competencies required of entry-level professional nurses. The competency model in its entirety is available on .. Foundations of Ethical Nursing Practice