Nlm Midterms Reviewer

NLM MIDTERMS REVIEWER I. Moral Ethical Responsibilities of Nurses and their Code of Ethics  

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Moral – specific ways of behavior in accomplishing ethical practices Morality – private personal standard of what is right and what is wrong in conduct, character, and attitude. - Behavior in accordance with customs or tradition and usually reflects personal or religious beliefs Personal morality – set of beliefs about the standards of right or wrong that help a person determine the correct or permissible action in a given situation.

Moral Development – the process of learning to tell the difference between right and wrong of learning, what ought and not ought to be done. Well known Theories of Moral Dev’t  Lawrence Kohlberg - Emphasize right and formal reasoning  Carol Gilligan - Emphasize care and responsibility 3 types of Moral Theories 1. Teleological (consequences) - Look to the consequences of an action in judging whether the action is right or wrong 2. Relationship (caring) - Judge actions according to a perspective of caring and responsibility 3. Principles and Duties (Deontological – duty) - Morality of an action is determined not by its consequences but whether it is done according to an impartial, objective principle.

Moral Principles 1.

The Golden Rule - “DO unto others what you would like others do unto you - Action must be morally good

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Good effect must be willed and the bad must merely be allowed 2. The two-fold effect/ Double effect - An action is done with two effects: one is good and the other is evil (Mass Immunization) - Good effect must not come from evil action but from the initial action itself - Good effect must be greater than the bad effect 3. The Principle of Totality - The whole is greater than any of its parts. 4. Epikia - Exception to the general rule 5. One who acts through an agent is Himself responsible - An accomplish/accessory/ part to the crime 6. No one is obliged to betray himself/herself - no one can force a person to answer a question 7. The end does not justify the means. - ex. Giving a sleeping tablet to a chronically ill person so she/he can die in peace. 8. Defects of nature may be corrected - ex pts. With harelip may have their defects corrected through plastic surgery. - withholding nutrition can constitute nursing neglect. 9. If one is willing to cooperate in the act, no injustice is done to him/her - ex. Human research - pts. Subjects himself to an experimental drug. 10. A little more or less does not change the substance of an act. 11. The greatest good for the greatest number - Mass immunization because of an epideminc. If one had a reaction to it the greater majority shall be considered. 12. Principle relating to the origin and destruction of life. Ex. Euthanasia 13. No one is held for the impossible - The doctor or the nurse cannot held to the impossible if they have done their best to take care of the patient and the later dies 14. The morality of cooperation 1

Good Samaritan Law  Generally, a nurse is not liable for injury that occurs as a result of emergency treatment provided that: 1. Standard care is provided at the scene of the emergency 2. The care is not grossly negligent 3. Act in good faith The Moral Decision-Making Model (Crisham, 1985) M – Massage the dilemma O – Outline Options R – Review criteria and resolve the problem A – Affirm position and act L – Look back. Evaluate the decision

Nursing Ethics -

A standard for professional behavior A guide to identify our conduct in relation to  Patients  Fellow nurses  Health care team  Our community  Our profession Practicing nurses are required to be registered nurses duly licensed by the PRC Best guides that the nurses may use in their performance of their duties are: a) Phil. Nursing Act of 2002, RA 9173 which defines the scope of nursing practice b) Standards of Safe Nursing Practice developed by the ANSAP (Association of Nursing Services Administration of the Philippines) with the Board of Nursing c) Code of Ethics for Nurses d) Job descriptions

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Ethics -

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The systematic study of what a person’s conduct and actions ought to be with regard to him or herself Justification of what is right or good

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What person’s life and rel. ought to be, not necessary what they are

Types: 1. Clinical Ethics - Literally concerned with the ethical problems “at the bedside” - E.g: informed consent 2. Bioethics - moral issues in the field of healthcare - systematic study of human behavior 3. Nursing ethics - Study of the historical and contemporary foundation of professional nursing actions in order to understand what “the good” the nursing provides for the individual and society - Refers to the ethical issues that occur in the nursing practice 4. Healthcare ethics - Pertain to how professionals fulfill their responsibilities and provide care to clients - The division of ethics that relates to human health - Fundamental principles of ethics serve as a basis for interpreting and analyzing clinical situations in decision making, when no set of absolute guidelines are available to answer a problem. Ethical approaches (THEORIES) 1. Teleological approach (Utilitarianism) - Greek: Telos means goal or end - Look to the consequences of an action in judging whether the action is right or wrong. - UTILITARIANISM: the greatest good for the greatest number and the end justify the means 2. Deontologic –duty 3. Virtue Ethics Approach - Known as aretaic ethics, focused primarily on the heart of the person performing the act.  Intellectual Virtue – power to deliberate about things good for oneself 2

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Moral Virtue – must be lived overtime in order to learned 4. Divine Command ethics - There is a supreme or divine being that sets down the rules to provide guidance to moral decisions Universal Ethical Principles

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1. Autonomy (informed consent) - Greek autos meaning self and nomos meaning governance - Involves self-determination and freedom to choose and implement 2. Veracity - truth 3. Beneficence - Doing good - Promotes doing act of kindness and mercy Non-maleficence - Do no harm Justice - Fairness of Equity Confidentiality of Information - Termed as privilege communication Fidelity - Faithfulness Paternalism - Allow one to make decisions for another, limits freedom of choice, and is seen as undesirable Respect for others - Is considered the highest principle that incorporates all other principles - Respect for others acknowledges the right of people to make their own decisions and to live by their decisions Utility - What is best for the common good Rights - Just claim and entitlement a) Autonomy - The right to be respected - Right to self-determinations 1. Advance Directives

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Documents that individual formulate indicating the type and kind of care they desire - Allow the competent person to make choice 2. Living Will - Document signed by a competent adult indicating what health care or kind of treatment wishes in the future - Terminally ill 3. DNR 4. Durable power of attorney for health care - Proxy derivative: allows an individual to designate another person to make decisions if client becomes incapacitated. - Also called SUROGATE decision b) c) d) e) -

Right and Cultural relativism Must be able to be applied to all cultures Right of the Unborn Right of Privacy and Confidentiality Right to competent care Freedom from harm Should be a balance between potential benefits of the patient’s medical regimen and the risk assumed by the patient f) Right to informed consent - Informed of possible outcomes, alternatives, and risk of the treatments and are required to give their consent feeling g) Inviolability of life - Life is sacred; nobody can take it away except GOD h) Stewardship BILL Right of the patients 1. Information to know about his/her conditions 2. Make decisions about his/her own care a. Informed consent (sound mind and legal age) b. Surrogate consent (legally competent person) 3. Privacy and confidentiality; privilege communication, trusting rel. with clients When to break: - For patient welfare - Public welfare 3

4. 5. 6. 7. 8.

- Patient consented - Court order Quality care Considerate/ respectful care Relevant, current, and understandable information Make decisions regarding their plan of care Have advantage directive

Responsibilities of RN 1. To give the kind of care the patient needs regardless of who they are 2. Pt. care shall be based on needs 3. When engage by any pt. or agency, they shall complete such services on the length of time stipulated in their contract 4. Shall not leave their pt. without proper permission/resignation or w/o relief 5. Should commit themselves to the welfare of those entrusted to them 6. RN’s shall be loyal to their sworn duty (role fidelity)

RN’S Responsibilities in Research (Human Subjects) 

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Patient’s Responsibilities 1. 2. 3. 4. 5. 6.

Provide accurate information Complying the instructions Informing the physician of refusal of treatment Paying hospital charges Following hospital rules and regulations Sharing respect and consideration

Bill of Rights of RN 1. Nurses have the right to practice in an environment that allow them to act in accordance with professional standards and legally authorized scope of nursing practice 2. RN have the right to work environment that supports and facilitate ethical practice in accordance with the code of ethics for nurses and interpretative statements. 3. RN have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities 4. RN have the right to negotiate the conditions of their employment

Helsinki Declaration of 1964 o Emphasizes that research subjects must be informed when a clinical/non-clinical will be of no personal benefit to them 2 types of research o Essentially therapeutic o Directed toward developing scientific knowledge Basic human rights o Right to informed consent o Right to refuse/withdraw from participation o Right to privacy o Right to confidentiality o Right to be protected from any harm  Risk benefit ratio Experimental subjects bill of right o Be told what the study is trying to find out o The frequent/important risk, side effects/discomforts that will happen for research purposes o Told of other choices o Be allowed to ask any questions o Be told what sort of treatment is available o Refuse to participate o Receive a copy of the signed and dated consent form o Be free from pressure

Code of ethics for nurses: 

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Lystra Gretter o Author of the 1st generally accepted code of ethics in the US (1893) o Patterned it in the Hippocratic Oath and named it after Florence Nightingale o 1st code has been used in Hollywood for film showing Isabel Hampton Robb o Wrote the 1st book on nursing ethics for Hospital and Private use (1900) o Patterned on Nursing Environment Marcia Sue De Wolf Bosek o 2007 4

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Code of Ethics should be modified and revised as the profession is faced with new situations

Code of ethics for Filipino nurses 

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Systematic guides for developing ethical behavior and provides direction for the nurses to act morally Emphasizes the 4-fold responsibility of nurses o To promote health o To prevent illness o To restore health and o To alleviate suffering

International Council of Nursing (ICN) 

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Organization through which nurses all over the world collaborate in strengthening nursing service Phils. Became a member since 1929 at the ICN Congress in Montreal, Canada Objective: o To provide a medium through which national nurses associations may share their common interest:  Working together  Promoting health  Caring of the sick o ICN’s Code of Ethics  4 principal elements  Nurses and people  Nurses and practice  Nurses and the profession  Nurses and co-workers  Nurses, Society, and Environment o 4 basic ethical principles applied to nursing  Four-fold  Renders service regardless of race, creed, nationality, and political belief  Protects life and respects dignity  Collaborates with other members of health team

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Dean Julita Sotejo o Developed the 1st Code of Ethics for Filipino Nurses Mrs. Anastacia Giron Tupas o Instrument for the FNA to be accepted in ICN held in Canada o PNA has approx. 780,000 RNs

Article 1 Preamble:  

Health is a fundamental right of every individual Primary responsibility to preserve health at all cost

Elements of the Code  1. 2. 3. 4.

Nurses and the Profession Loyalty and preservation Comply with the bylaws Continual learning and active participation Contribute to the improvement

Code of Governance

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