Essentials of Nursing Leadership Management 4 th Edition
- Slides: 56
Essentials of Nursing Leadership & Management, 4 th Edition N 246 Leadership Ethics & Quality S. Buckley, 2010 (Adapted from Nursing Leadership and Management, Whitehead, Weiss, Tappen)
Essentials of Nursing Leadership & Management, 4 th Edition In the beginning… § § There were no antibiotics There were no ICUs There were no CT scanners and MRIs There were just physicians and nurses who cared for people in sickness and in health § Were there ethics?
Essentials of Nursing Leadership & Management, 4 th Edition
Essentials of Nursing Leadership & Management, 4 th Edition
Essentials of Nursing Leadership & Management, 4 th Edition
Essentials of Nursing Leadership & Management, 4 th Edition Early nursing leaders
Essentials of Nursing Leadership & Management, 4 th Edition
Essentials of Nursing Leadership & Management, 4 th Edition
Essentials of Nursing Leadership & Management, 4 th Edition finances
Essentials of Nursing Leadership & Management, 4 th Edition 1960 s § Technological advances allowed for the development of intensive care units § New biomedical developments § Advances in surgical techniques, such as open heart surgery
Essentials of Nursing Leadership & Management, 4 th Edition Reasons for new inquiries in nursing § Technological advances created new questions for health-care professionals regarding the use of technology, RN role and outcomes § Changing views and perspectives on the concepts of life and death § Dissatisfaction of RN’s with traditional manner of learning (mentoring) and desire to have a scientific base for practice (professional scientists) § Interest by healthcare practitioners about application of values in professional practices, and how to discuss these issues.
Essentials of Nursing Leadership & Management, 4 th Edition Bioethics § A sub discipline of ethics § The study of medical morality
Essentials of Nursing Leadership & Management, 4 th Edition Concepts of Ethics evolve from moral perspectives, which form values and standards. Influenced by families, environment, social issues, culture, religion, cognition, law. Ethical action depends, in part, on the ability of people to recognize that a moral issue exists in a given situation, knowing how to take appropriate ethical action if and when required, and on personal commitment and a genuine desire to achieve a moral outcome (Johnstone, 1999, from: Ethics in Nursing Practice, 2 nd ed, Fry, S. T, Johnstone, M. )
Essentials of Nursing Leadership & Management, 4 th Edition Value Systems definitions § § § A set of related values Intrinsic values-located within, the real nature of a thing. Extrinsic values-from without Personal values Professional values Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.
Essentials of Nursing Leadership & Management, 4 th Edition § Historical values of nursing:
Essentials of Nursing Leadership & Management, 4 th Edition Nursing today § Values in nursing today:
Essentials of Nursing Leadership & Management, 4 th Edition Value Formation § Values are learned-therefore, influenced by family, culture, environment, cognition. § Values change with maturity and experience § The number of values an individual holds is not as important as what values they consider important
Essentials of Nursing Leadership & Management, 4 th Edition Types of Values § § Personal Cultural Religious professional
Essentials of Nursing Leadership & Management, 4 th Edition Values Clarification § § Critical thinking Choosing Identifying-verbalizing? Acting
Essentials of Nursing Leadership & Management, 4 th Edition Belief Systems § These are organized ways of thinking about why people exist within the universe § Their purpose is to explain such concepts as: § § Life and death Good and evil Health and illness Individualism/rights
Essentials of Nursing Leadership & Management, 4 th Edition ETHICS AND MORALS
Essentials of Nursing Leadership & Management, 4 th Edition Morals § An individual’s own code for acceptable behavior § Standards of goodness or rightness that arise from an individual’s conscience § They act as a guide for individual behavior § Learned § Capable of making a distinction between right and wrong in conduct
Essentials of Nursing Leadership & Management, 4 th Edition Values § Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.
Essentials of Nursing Leadership & Management, 4 th Edition Standards § Something established for use as a rule or basis of comparison in measuring or judging quality, value, extent.
Essentials of Nursing Leadership & Management, 4 th Edition Laws § Rule of conduct established and enforced by the authority, legislation or custom of a given community, state, or other group. § May change with fluctuating social morals and viewpoints.
Essentials of Nursing Leadership & Management, 4 th Edition Ethics § Having to do with moral standards, conforming to the standards of conduct of a given professional group. Implies conformity with an elaborated, ideal code or moral principles. § Concerned with the motivation behind the behavior § Bioethics is the application of these principles to life-and-death issues
Essentials of Nursing Leadership & Management, 4 th Edition Ethical Theories § Deontological-based on duty to commitment, considers the intention of the action, not the consequences of the action. It is the individuals goodwill that determines worthiness, not the outcome. § Teleological-(utilitarianism)-what makes an action right or wrong is its usefulness. Right encompasses actions that have positive outcomes, wrong is composed of actions that result in poor outcomes. § Principalism-involved in biomedical issues, integrates ethical principles to resolve conflicts in situations.
Essentials of Nursing Leadership & Management, 4 th Edition Ethical Principles § § § § Autonomy Nonmaleficence Beneficence Justice Fidelity Confidentiality Veracity Accountability
Essentials of Nursing Leadership & Management, 4 th Edition Autonomy § The freedom to make decisions about oneself § Nurses need to respect clients’ rights to make choices about health care
Essentials of Nursing Leadership & Management, 4 th Edition Nonmaleficence § Requires that no harm be caused to an individual, either unintentionally or deliberately § This principle requires nurses to protect individuals who are unable to protect themselves
Essentials of Nursing Leadership & Management, 4 th Edition Beneficence § This principle means “doing good” for others § Nurses need to assist clients in meeting all their needs § Biological § Psychological § Social
Essentials of Nursing Leadership & Management, 4 th Edition Justice § Every individual must be treated equally § This requires nurses to be nonjudgmental
Essentials of Nursing Leadership & Management, 4 th Edition Fidelity § Loyalty § The promise to fulfill all commitments § The basis of accountability (moral concept that involves acceptance by a professional nurse of the consequences of a decision or action)
Essentials of Nursing Leadership & Management, 4 th Edition Confidentiality § Anything stated to nurses or health-care providers by clients must remain confidential § The only times this principle may be violated are: § If clients may indicate harm to themselves or others § If the client gives permission for the information to be shared
Essentials of Nursing Leadership & Management, 4 th Edition Veracity § This principle implies “truthfulness” § Nurses need to be truthful to their clients § Veracity is an important component of building trusting relationships
Essentials of Nursing Leadership & Management, 4 th Edition Accountability § Individuals need to be responsible for their own actions § Nurses are accountable to themselves and to their colleagues
Essentials of Nursing Leadership & Management, 4 th Edition Ethical Codes § These are formal statements of the rules of behavior for a particular group of individuals § Ethical codes are dynamic § Most professions have a “code of ethics” to guide professional behavior
Essentials of Nursing Leadership & Management, 4 th Edition Organizational Ethics § Focus on the workplace § Ethical culture makes a difference § Senior leadership must promote an ethical culture-do they?
Essentials of Nursing Leadership & Management, 4 th Edition Ethical Dilemmas § Occur when a problem exists between ethical principles § Deciding in favor of one principle usually violates another § Both sides have “goodness” and “badness” associated with them
Essentials of Nursing Leadership & Management, 4 th Edition Ethical decision making § Consider cause, variables, precipitating events and implications § Reflect upon one’s own perspective and values § Explore options for action: § ANA code of ethics, facility standard and ethics, nurse practice act (BRN), legal issues, rights. § Select appropriate plan. Understand consequences of the plan. § Implement § Evaluate results
Essentials of Nursing Leadership & Management, 4 th Edition Current Ethical Issues
Essentials of Nursing Leadership & Management, 4 th Edition Issues to Consider § § § Assisted suicide Technology issues-as RN, as patient. Gene therapies, genetic counseling “Designer babies”, fertility issues, fetal success Organizational climate Family planning Social responsibility Immigration policies Resource management. Stem cell research DNR status
Essentials of Nursing Leadership & Management, 4 th Edition Conclusion § An issue is not an ethical issue for the nurse unless he or she has been asked § Always gather the facts prior to decisionmaking § Consider your personal beliefs and values
Essentials of Nursing Leadership & Management, 4 th Edition Quality issues § What is it? ? § The degree of excellence that distinguishes one thing from another § Relates to education and practice; professionals perceive that they are providing high-quality nursing education and patient care.
Essentials of Nursing Leadership & Management, 4 th Edition Why do we need it? § * current health care system is fragmented, poorly organized, inefficient use of resources. § *New technologies, availability of information (it), decreasing resources, increasing chronic disease states mandate a change. § * consumer dissatisfaction with current system
Essentials of Nursing Leadership & Management, 4 th Edition Quality improvement § Also known as performance improvement, focuses on processes or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change or improve the quality of care. (Saunders NCLEX review, 5 edition, Silvestri, L. , 2011) th
Essentials of Nursing Leadership & Management, 4 th Edition Professional organizations that focus on quality § * Joint commission on Accreditation of Healthcare Organizations (JACHO) § * American Nurses Association (ANA) § *Institute of Medicine (IOM)
Essentials of Nursing Leadership & Management, 4 th Edition IOM essential competencies § § § Provide patient centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Use informatics
Essentials of Nursing Leadership & Management, 4 th Edition Aims of IOM quality of care § § § Safe Effective Patient centered Timely Efficient equitable
Essentials of Nursing Leadership & Management, 4 th Edition IOM- cost of inefficiency § 44, 000 -98, 000 die each year § $17 -29 billion in total costs Nursing errors: *Medication *knowledge *procedure
Essentials of Nursing Leadership & Management, 4 th Edition Continuous Quality improvement (CQI) § § § Identify indicators Collect ongoing data on indicators Analyze and evaluate data Implement change (utilize evidence based practice)
Essentials of Nursing Leadership & Management, 4 th Edition How to monitor quality of care § § § Guidelines Protocols Algorithms Standards of care Critical pathways
Essentials of Nursing Leadership & Management, 4 th Edition How does structured care methodologies work? § Link process of care (issue) and outcome § Determine method of measurement § Clarify responsibilities of interdisciplinary team § Facilitate communication among team members § Document, apply systematic approach to measurement.
Essentials of Nursing Leadership & Management, 4 th Edition Root cause analysis § Process of learning from consequences; § Determine influences, establish linked chains of influences, determine necessary influences, analyze root (initial) cause. § Currently used to analyze errors and mistakes; attempts to evaluate series of events that may lead to errors (safety errors) and determine causative reason for error (process), rather than punitively blame
Essentials of Nursing Leadership & Management, 4 th Edition Risk management § § § part of QA Identify potential problems, risks Incident investigation Sentinel events Anticipate outcome, prevent recurrence
Essentials of Nursing Leadership & Management, 4 th Edition conclusion § § § § To enhance quality of care; Think critically Plan and report outcomes Make introductory rounds Plan partnership with the client Communicate plan Evaluate progress
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