Presentation on theme: "Foundations in Evidence Based Practice"— Presentation transcript:
1 Foundations in Evidence Based Practice Introduction to Ethics
2 Introduction to ethics Our care for patients should be based on sound judgement(or evidence based practice!!)..some of this judgement is about having a strong sense of what is right or wrong..having a strong sense of what we should be doing and shouldn’t be doing as nurses..having a strong sense of what our priorities ought to be
3 Introduction to ethics Nurses frequently have to make difficult decisions for which there is not always a quick, easy or ‘correct’ answere.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?Nevertheless, nurses still have to be able to explain and account for these decisions and actionsThe NMC Code can act as a guideThis can be seen as a ‘code of ethics’ – a set of important principles to help guide nurses
4 Achievement of practice outcomes includes consideration of ethical issues Domain 1 Professional and Ethical Practice1.3 Demonstrate an awareness of, and apply ethical principles to, nursing practice.Outcomes:1.3.1 Demonstrate respect for patient and client confidentialityTHIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT HOW YOU RESPECT PATIENTS GENERALLY1.3.2 Identify ethical issues in day to day practice
5 What is an ‘ethical issue’? When you have to judge what is right or wrongChoosing between optionsDeciding whether to do something or do nothingShould I or shouldn’t I?Weighing up the potential impact of your decisions or actionsA dilemma – making a difficult choice
6 Ethical issues in health care We usually think of the ‘big’ issuese.g. definition of life, what is a person, quality of life, prolonging life, ending life, human rights.But day to day ethical issues can involve:Respecting peopleTreating people with dignityTreating people fairlySupporting patient’s choicesThese ‘principles’ are encompassed in the NMC codeThe code is a useful source of ethical principles in health care
7 Another source of ideas in health care ethics Principles of Biomedical Ethics (Beauchamp and Childress, 2001)They discuss:4 key principlessupplemented by 4 rules
9 Autonomy Respect a person’s right to make their own decisions Teach people to be able to make their own choicesSupport people in their individual choicesDo not force or coerce people to do things‘Informed Consent’ is an important outcome of this principle
10 Beneficence (to do good) Our actions must aim to ‘benefit’ people – health, welfare, comfort, well- being, improve a person’s potential, improve quality of life‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.Act on behalf of ‘vulnerable’ people to protect their rightsPrevent harmCreate a safe and supportive environmentHelp people in crises
11 Non – maleficence (to do no harm) do not to inflict harm on peopledo not cause pain or sufferingdo not incapacitatedo not cause offencedo not deprive peopledo not killBoth Beneficence and Non-maleficence underpin EBP
12 Justice Treating people fairly Not favouring some individuals/groups over othersActing in a non–discriminatory / non-prejudicial wayRespect for peoples rightsRespect for the law
13 JusticeDistributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)How should we share out healthcare resources?How do we share out our time with patients?Deciding how to do this raises some difficult questionsPatients should get…..an equal share ?just enough to meet their needs ?what they deserve ?what they can pay for ?
14 4 ethical rulesVeracity – truth telling, informed consent, respect for autonomyPrivacy – a persons right to remain private, to not disclose informationConfidentiality – only sharing private information on a ‘need to know basis’Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may have done
15 Ethics 2 broad philosophical theories 1) consequentialism – taking the consequences of our actions into consideration2) deontology – basing our actions on a set of principles or duties
16 ConsequentialismActions are right or wrong according to the balance of their good and bad consequencesthe right act is the one that produces the best overall resultUtilitarianism (what action has the greatest utility - use/benefit/positive outcome) is a type of consequentialism
17 Utilitarianism most prominent consequence-based theory based on the principle of utilityactions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue (e.g. harm)
18 Deontology Duty or principle based theory An act is right if it conforms to an overriding moral dutyFor example – do not tell lies, do not kill.E.g. Christian ethics – The Ten CommandmentsBut Christian ethics are not important for some people in the world so moral duties vary between cultures and societiesA moral duty or principle is one that is:laid down by god / supremely rational beingor is in accordance with reason / rationalityor would be agreed by all rational beingsThe NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set of principles/duties.
19 References http://www.nursingethics.ca/articles.html Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th Edition Oxford University PressHunt G (1994) Ethical Issues in Nursing Routledge. LondonSeedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester.Watt H (2000) Life and Death in Health Care Ethics Routledge. Londonzlist/ethics.html
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