Nursing Resolving Conflicts
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Discussion board questions:
1. Think about the ethical theories and approaches in Chapter 4 and the moral conflicts you have experienced in the past. Have you used one of these approaches to resolving conflict? Which theory or approach have you used?
2. Has there ever been a time when you have experienced the dilemma of having to make a choice that you know will affect the well-being of another individual? Have you ever experienced moral suffering?
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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 Nursing Resolving Conflicts
• 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? Nursing Resolving Conflicts
• 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? … Nursing Resolving Conflicts