Values Ethics and Accountability Taylor chapter 6 Values

Values, Ethics, and Accountability Taylor, chapter 6

Values � Ideas or beliefs a person considers highly important. � Learned through interactions with social systems such as family, culture, religion, school, work, friends, etc.

Ethics � Branch of philosophy dealing with standards of conduct and moral judgment. � Professional ethics are values held by a group that has standards to be upheld by its members in all situations. � In professional practice, nurses try to avoid allowing personal values to bias their treatment for patients.

Ethics Theories � Utilitarianism—base on concept of “The greatest good for the greatest number. ” The rightness or wrongness of an action depends on the consequences of the action � Deontologic—ethical standards or principles exist regardless of the ends or consequences

Examples of Ethical Guidelines for Practice � American Nurse’s Association Code of Ethics p. 100 � The Patient Care Partnership (formerly called The Patient’s Bill of Rights) p. 132 � Principles of Healthcare Ethics p. 97

Principles of Healthcare Ethics � Autonomy—respecting pts choices � Beneficence—doing good � Nonmaleficence—avoiding harm � Paternalism—combo platter � Justice—being fair � Fidelity—keeping promises � Veracity—being honest � Confidentiality—respecting privacy

Autonomy Creating the conditions in which patients can make their own decisions � Informed consent and advanced directives protecs the patient’s right for healthcare decision making. � Patients of sound mind can choose to be treated or not. � We also have to be culturally sensitive � › Navajo (to speak of ill will cause ill to happen) › Asian (may want another to make decision)

Beneficence � Doing or promoting good � Striving to achieve optimal outcomes � Act on behalf of patients to do good as defined by the patient. � Administering pain meds, performing dressing changes to promote wound healing, and providing emotional support are acts of goodness.

Nonmaleficence � Avoiding or removing harm � Protecting patients from impaired coworkers, identifying safety risks and preventing them, and reporting suspected abuse are examples of nonmaleficence.

Paternalism A combo of beneficence and nonmaleficence � Intentional limitation of autonomy, justified by the welfare or needs of another � The prevention of harm takes precedence over any potential evil caused by interference with the individual’s autonomy or liberty. � Consider nursing home placement for the elderly and tube placement for anorexic patients �

Justice Treating everyone with dignity and respect Providing comparable care A just healthcare system provides care on the basis of medical need and the degree of that need rather than ability to pay, social status, racial identity, or gender. � Deciding how much time to spend with a patient should be based on need not how likable they are. � Nurses should be aware of government and community resources for assistance � � �

Fidelity � Being faithful to one’s commitments or promises. � Providing safe care and maintaining competence. � Contract that exists between the patient and the nurse—what the patient can expect regardless of the nurse’s age, background, or personal values.

Veracity � Telling the truth and being honest with patients � The right to self-determination becomes meaningless if the patient does not receive accurate, unbiased, and understandable information. � One common dilemma is whether to tell the patient and/or family about a med error.

Confidentiality � Required that patient info remain private � Professional duty and legal obligation � Only those caring for patient have access unless patient signs consent � Nurses have right to access patient’s record, but need to be sure they are doing it for only care-related reasons.

Examples of Ethical Problems � Nurse/patient: › › › › Paternalism Withholding information Confidentiality Allocation of scarce nursing resources Advocacy in market driven environment Valid consent or refusal Conflict between patient/nurse interest Conflicts concerning new technology

Examples cont’d � Nurse/Patient › › › cont’d Withdrawing or withholding tx Family conflicts over care Client mistreatment by staff Maternal issues Pain control

Examples cont’d � Nurse/HCP: › Disagreement about proposed medical regimen › Conflict regarding scope of nurse’s role › Unprofessional, incompetent, unethical, or illegal HCP practice

Examples cont’d � Nurse/Institution: › Short staffing and whistleblowing › Healthcare rationing � Nurse/Nurse: › Claims of loyalty › Unprofessional, incompetent, unethical, or illegal nurse practice

Resolution of Dilemmas � Ask if this is an ethical dilemma � Gather info (assess) � Verbalize problem � Consider possibilities � Examine your own values � Negotiate the outcome � Evaluate the action

Functions of Ethics Committee � Education � Policy recommendation � Case consultation or review

Accountability � Being attentive and responsive to the healthcare needs of individual patients � Concern for patient transcends whatever happens during the shift � Ensuring continuity of care when leave patient � Try to maintain good judgment—remember that you are not totally responsible for the patient’s outcome.

Accountability � The ability and willingness to assume responsibility for ones actions and accepting the consequences of one’s behavior � Reliable, trustworthy, credible � ANA says, “Being answerable to someone for something done. ” � Being fully accountable requires autonomy and authority.

To Whom is the Nurse Accountable? � The patient � The profession � Other members of the healthcare team � To the employer � To self

Accountability to the Profession � ANA Code for Nurses � Nursing Quality Assurance & Quality Improvement Programs � Participate as a member of professional nursing organization(s)

Accountability to Clients � Clinical competence: knowing how & why things are done � Safe nursing care � Allow clients to participate in nursing care activities, including planning � Respect individual client differences � Altruistic intentions � Serve as a client advocate when the need arises

Accountability to Healthcare Team � Bring specialized nursing knowledge & skills to the health care delivery situation � Share information with team members � Confront if potential errors may occur � Perform nursing tasks with competence � Treat members with dignity & respect

Accountability to Employer � Quality of work � Protect against unsafe practice situations � Attitude conveyed about the agency

Accountability to Self � Practice nursing to personal standards using professional standards as a basis � Be true to oneself � Take care of personal, physical, mental, & spiritual health � Protect self from harm

Competence � Keeping up with new practices in your area � Make sure these practices are evidencebased and researched � Maintain competency requirements set up by the BON