2. Clinical Ethical Issues
Many of our ethical issues arise when dealing with the:
-Beginning of human life
-End of human life
-Use of technology but there are other ethical.
Often they are viewed as clinical problems but not ethical problems.

3. مسائل اخلاقی بالین
وقتی که پرستاری با 8 بیمار بدحال کار می کند ”وقت وتلاش
کاری خود“راچگونه تقسیم می کند؟
وقتی که می بینید همکارتان دربخش یک کار غیراخلاقی انجام داده چه باید بکنید؟
بیماری درگیربیماری لاعلاج است وخانواده قراراست به اونگویند. اگربیمارازوضعیت سلامتی خودازشما پرسید چه جوابی خواهیدداد؟

4. مسائل اخلاقی بالین
-اصلا دروغ گفتن به بیمار کار اخلاقی هست؟ آیا دارونما یک
دروغ است؟
ازنظراخلاقی, پرستاری که بیماری رادوست نداردوواقعا نمی تواند به اوخدماتی ارائه دهد چه باید بکند؟
آیا بیماربایددر تصمیم گیری درمانی خوددرگیربشود؟ اگربیمار نوجوان باشد؟ اگر مسن باشد؟ اگرناتوان ذهنی باشد؟
آیاپرستاربایددستورپزشکی بیماری که می داند این دستور خطر بالقوه ای برای بیماردارد اجراکند؟

5. Health professionals have 2 basic ethical obligations: -To extend life
Two ethical principles are Do No Harm and Do Good. What do we mean by Harm and Good?
Health professionals have 2 basic ethical obligations:
-To extend life
-To lessen pain and suffering (do no harm).
Can they do both in this situation when morphine may shorten patient’s life?

6. 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

7. 1960s
Technological advances allowed for the development of intensive care units
New biomedical developments
Advances in surgical techniques, such as open heart surgery
The advances created new questions for health-care professionals

8. Ethics
Ethics deals with the “rightness” or “wrongness” of human behavior
Concerned with the motivation behind the behavior
Bioethics is the application of these principles to life-and-death issues

9. Morals An individual’s own code for acceptable behavior
They arise from an individual’s conscience
They act as a guide for individual behavior
Learned

10. Autonomy Nonmaleficence Beneficence Justice
Ethical Principles
Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Confidentiality
Veracity
Accountability

11. Autonomy Best medical interests Best interests
The freedom to make decisions about oneself
Nurses need to respect clients’ rights to make choices about health care.
Best medical interests Best interests
More to well-being than medical well being
مخالف

12. Who is autonomous ? 80 year old with dementia Drunk 2 year old
Understand + Form Values + Make Decisions
80 year old
with dementia
Drunk
2 year old
80 year old
You

13. Respecting autonomy
Respecting autonomy means enabling patients to make autonomous choices:
Reasonable choices
Adequate information
Clear explanation
Time to consider options
Not unduly pressurising
Being non-judgemental

14. 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.

15. Beneficence Biological Psychological Social
This principle means “doing good” for others.
Nurses need to assist clients in meeting all their needs:
Biological
Psychological
Social

16. Justice Every individual must be treated equally
This requires nurses to be nonjudgmental

17. Principles of distributive justice
(Beauchamp and Childress 2001)
To each person to:
1- Equal share
2-Individual need
3-Individual effort
4-Societal contribution
5-Merit
6-Free market exchanges

18. Continually increasing health care costs
هزینه های سلامت ودرمان بطورمدام افزایش می یابدکه باید درنحوه اجرای عدالت بهداشت ودرمان وپرداخت پرسنل لحاظ شود:
population increase
ageing population
increase demand for healthcare
new technologies, new procedures
personnel and other resources
Healthcare needs and desires are practically without limits.
Any healthcare system is thus going to face either a relative or absolute scarcity of resources at some time.
Resources
Government has the responsibility to determine how to administer the various public goods and services to individuals and society

19. Issues of Justice
1- وقتی که خدمات وامکانات ادامه حیات(تخت, دارو, اتاق عمل, تجهیزات و...) محدود است چه کسی باید این امکانات رادریافت کند؟
2- آیا پول خرج کردن برای بیماری که مرگ قریب الوقوع دارد صحیح است؟ تاچه حدباید خرج اوکرد؟
3- بهترین حالت نفع شخصی وعمومی کدام است؟

20. Fidelity Loyalty The promise to fulfill all commitments
The basis of accountability

21. Dignity: a Human Right? Freedom from The right to life
degrading treatment
Freedom of thought,
conscience and religion
The right to
liberty
Freedom of
expression
The right not to be discriminated
against in any of these
rights or freedoms
The right to
respect for
private and family life
The right to
peaceful enjoyment
of your property

22. 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

24. Veracity This principle implies “truthfulness”
Nurses need to be truthful to their clients
Veracity is an important component of building trusting relationships

25. Accountability
Individuals need to be responsible for their own actions.
Nurses are accountable to themselves and to their colleagues.

26. 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.
The Code of Ethics for Nurses. Why have a code? What does it say? What purpose does it serve?

27. ICN code for nurses was formed in 1933.
While the international code of nursing ethics accepted in 1953.
In 1973 the new ICN code of ethics was approved. It identifies four major responsibilities of the nurse:
Promote health.
Prevent illness.
Restore health.
Alleviate suffering.

28. 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.

29. Ethical Dilemmas

31. Dilemma Resolution Nursing Process MORAL Model Ethics Committees

32. رضايت نامه و برائت نامه
يعني امضاء مدركي كه بيمار قبل از تن دادن به هرگونه درماني از كليه خطرات عمل ، راههاي درماني و جايگزين و خطرات آن توسط پزشك آگاهي يابد.(تلویحی, اظهاری,رضایت درمواردخاص).
برائت يعني چنانچه بيمار در طي درمان دچار عوارض يا نقص عضوي گرديد ، پزشك در صورتيكه بر اساس موازين فني و علمي اقدام كرده باشد مقصر نيست

33. تفاوت رضایت و برائت؟
اگر پزشک فقط رضایت گرفته باشد، در صورت بروز مرگ، نقص عضو یا خسارت مالی، ضامن است ولی اکر برائت نیز تحصیل کرده باشد، عهده دار خسارت پدید آمده نیست.
فقط اصل برائت است که موجب سقوط ضمان می شود. البته در صورت قصور پزشکی، برائتی که قبل از درمان گرفته شده، باعث سقوط ضمان نیست.

34. Healthcare and Ethics Social Determinants HC Structures Pt-Prof

35. IT’S NOT ROCKET SCIENCE?
OR IS IT?
What do you do to ensure dignity in care?

36. Barriers to Patient Satisfaction
Wait Times
Overcrowding
Interruptions of caring
Consultants
Radiology &Laboratory…
Patient expects something from you

37. Common Patient Complaints
Too little time for patient interaction
Does not listen
Does not explain well
Shows no sympathy
Does not understand
Incompetent

38. Demographics affecting satisfaction
Age—older pts more satisfied
Ethnicity—minorities less satisfied
Gender—females less satisfied
Socioecominc—lower socioecomic less satisfied
Heath status—Chronic illness less satisfied

39. Increasing Patient Satisfaction
Greet the patient with a hand shake & a smile
TALK to your patient, not at them
Listen to what they have to say
Give them the opportunity to ask questions
Don’t be afraid to apologize & tell patient why they had to wait for x, y, z.
Listen to your support staff

40. How can you affect satisfaction?
COMMUNICATE
Utilize as well as listen to Patient Advocates
Put yourself in the patient’s shoes
positive patient interaction

41. The Communication Circle
MESSAGE
Source
Receiver
NOISE
FEEDBACK
The communication cycle involves an exchange of messages through verbal and nonverbal means.