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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. esmaeilmmm@yahoo.com

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؟ esmaeilmmm@yahoo.com

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؟ esmaeilmmm@yahoo.com

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? esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

Autonomy Nonmaleficence Beneficence Justice Ethical Principles Autonomy Nonmaleficence Beneficence Justice Fidelity Confidentiality Veracity Accountability esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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. esmaeilmmm@yahoo.com

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

Justice Every individual must be treated equally This requires nurses to be nonjudgmental esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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؟ esmaeilmmm@yahoo.com

Fidelity Loyalty The promise to fulfill all commitments The basis of accountability esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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

Accountability Individuals need to be responsible for their own actions. Nurses are accountable to themselves and to their colleagues. esmaeilmmm@yahoo.com

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? esmaeilmmm@yahoo.com

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. esmaeilmmm@yahoo.com

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. esmaeilmmm@yahoo.com

Ethical Dilemmas esmaeilmmm@yahoo.com

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Dilemma Resolution Nursing Process MORAL Model Ethics Committees esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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. esmaeilmmm@yahoo.com

Healthcare and Ethics Social Determinants HC Structures Pt-Prof esmaeilmmm@yahoo.com

IT’S NOT ROCKET SCIENCE? OR IS IT? What do you do to ensure dignity in care? esmaeilmmm@yahoo.com

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

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

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 esmaeilmmm@yahoo.com

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 esmaeilmmm@yahoo.com

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

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

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