1. Public/community health nursing ethics TAMPERE, MAIO DE 2008 Ana A. Queiroz Professor coordenator School of Nursing Coimbra aaq@esenfc.pt

2. Overview Introduction What is public health / community health nursing? Why talk about ethics? Basic values associated with community practice Ethical principles of Public Health The portuguese nurse code of ethics The ICN code of ethics Conclusions

3. What Is Public Health / Community Health Nursing? Public Health Nursing is the Practice of Promoting and Protecting the Health of Populations using Knowledge from Nursing, Social, and Public Health Sciences. American Public Health Association, Public Health Nursing Section, 1996

4. The WHO Europe Family Health Nursing Pilot in Scotland. Final Report. ISBN 0 7559 5199 9 http://www.scotland.gov.uk/Publications/2006/10/31141146/0

6. Public Health Nursing Interventions SYSTEM COMMUNITY INDIVIDUAL FAMILY Generalist or Specialist Role? The most frequently performed and highly prioritized intervention is case management on the individual-family level more than community or system level interventions.

7. Public Health Nursing Interventions PHNs tend to work with a wide variety of other health service providers. Top worksites are, private home, public health center, community agency, school.

8. Why talk about ethics?

9. Why Talk About Ethics? A sense of right and wrong has to be built into every level of society: - individual - community - nation - globe Something is right when it tends to preserve the integrity, stability, and beauty of the biotic community; it is wrong when it does otherwise.

10. Public/community health nursing ethics Traditional medical ethics emphasizes individuals: Autonomy right to decline care Non maleficence do no harm Beneficence seek benefit of patients Justice providing equal care to all Public Health ethics emphasizes Community: Interdependence individual actions effect others Participation public health decisions should include input from the public Scientific Evidence reasoned interventions based on facts, not beliefs or conjecture

11. Examples of Public Health Ethical Problems Flu vaccine allocation during shortage –How will values of utility and equality be balanced in prioritizing groups, and how are those decisions communicated to the public? Narrow social utility – ensure first responders receive vaccine so they can assist others Medical utility – ensure that populations at highest risk of mortality from flu receive vaccine Egalitarian – first come, first served or a lottery system to allow equal access Detention and observed therapy of TB patients Law provides public health with the power to detain TB patients who are suspected of non-compliance to their treatment regimens in a locked hospital ward How should public health determine that a patient is a compliance risk? Should the patient be detained until they finish the treatment regimen, or only until they are no longer contagious?

12. Codes of Ethics incorporate certain values or principles that should guide practice. Values are statements of an ideal that we try to achieve, while ethics offer us directives for action that are derived from the desired values. Why Talk About Ethics?

13. Basic values associated with community practice include: - Cultural diversity and understanding; -Self-determination and empowerment; -Development of a critical consciousness; -Mutual learning and partnership with constituents; -A commitment to social justice and the equal distribution of resources.

14. Promotion of justice and the equity Respect to the dignity human being Promotion of the welfare of the population Respect and stimulation to the autonomy Thomas, J. C. Sage, M. Dillenberg, J. and. Guillory V. J. (2002). |A Code of Ethics for Public Health. American Journal of Public Health, July; 92(7): 1057–1059. Kass, Nancy E. An Ethics Framework for Public Health. (2001). American Journal of Public Health, November, Vol 91, No. 11. Ethical principles of Public Health

15. - Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members. - Public health should advocate for, or work for the empowerment of, …ensuring that the basic resources and conditions necessary for health are accessible to all people in the community - Public health should seek the information needed to implement effective policies and programs that protect and promote health. * Adapted from Distinguishing Public Health Ethics from Medical Ethics, J. Thomas, Available at: http://www.phls.orghttp://www.phls.org Ethical principles of Public Health

16. The portuguese nurse code of ethics DIÁRIO DA REPÚBLICA I SÉRIE-A, N.º93 de 21/04/1998 Decreto-lei n.º 104/98 MINISTÉRIO DA SAÚDE Artigo 78.º 1 - The interventions of nursing are carried through, with the concern of the defence of the freedom and the dignity of the person human being and the nurse. 2- The universal values to observe in the professional relation are : a) The equality; b) The responsible freedom, with the choice capacity, having in attention the common good; c) The truth and justice; d) The altruism and solidarity; e) The competency and the professional perfection.

17. Artigo 78.º 3-Orienting principles of the activity of the nurses: a) The inherent responsibility to the role assumed before the society; b) The respect for the human rights in the relation with the customers; c) The Excellency of the exercise in the profession in general and the relation with other professionals. The portuguese nurse code of ethics

18. Artigo 80.º Of the duty with the community The nurse, being responsible with the community in the promotion of the health and in the adequate reply to the necessities in cares of nursing, assumes the duty of: a) To know the necessities of the population and the community where he is inserted; b) Participate in the orientation of the community in the brainstorming for the detected problems of health; c) Collaborate with other professionals in programs that answer to the necessities of the community. The portuguese nurse code of ethics

19. NURSES AND PEOPLE - The nurses primary professional responsibility is to people requiring nursing care. - In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. - The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. - The nurse holds in confidence personal information and uses judgement in sharing this information. - The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. - The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction. http://www.icn.ch/icncode.pdf The ICN Code of Ethics for Nurses

22. Public Health Interventions Systems Focused

23. Public Health Interventions Community Focused

24. Public Health Interventions Individual/Family Focused

25. Public Health Interventions Example: Advocacy

26. conclusions How often intimate relationships with vulnerable populations make us responsible to participate fully with them? as people learn to perceive social and political contradictions, they become able to take action against oppressive structures in their lives (Ford- Gilboe & Campbell, 1995)

27. Thanks Very Much!!!!!

28. Bibliography Clemen-Stone, S., Eigsti, D. G., & McGuire, S. L. (1998). Comprehensive community health nursing: Family, aggregate & community practice(5th ed.). St. Louis: Mosby- Year Book Inc. Childress, James et al, Public Health Ethics: Mapping the Terrain, Journal of Law, Medicine, & Ethics, Volume 30:2, (Summer, 2002) DIÁRIO DA REPÚBLICA I SÉRIE-A, N.º93 de 21/04/1998 Decreto-lei n.º 104/98 MINISTÉRIO DA SAÚDE Ford-Gilboe, M., Campbell, J. & Berman, H. (1995). Stories and numbers: coexisting without compromise. Advances in Nursing Science, 18 (1), 14-26. Kass, Nancy E. An Ethics Framework for Public Health. (2001). American Journal of Public Health, November, Vol 91, No. 11. Public Health Leadership Society website (Principles of the Ethical Practice of Public Health - Code of Ethics) http://www.phls.orghttp://www.phls.org Spradley, B. W., & Allender, J. A. (1996). Community health nursing: Concepts and practice(4th ed.). Philadelphia: Lippincott. Stanhop, M., & Lancaster, J.(2004). Community & public health nursing (6th ed.). St. Louis: Mosby Year Book. Thomas, J. C. Sage, M. Dillenberg, J. and. Guillory V. J. (2002). A Code of Ethics for Public Health. American Journal of Public Health, July; 92(7): 1057– 1059.