1. Values, Ethics, and Accountability
Taylor, chapter 6

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

3. 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.

4. 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

5. Examples of Ethical Guidelines for Practice
American Nurse’s Association Code of Ethics--handout
The Patient Care Partnership (formerly called The Patient’s Bill of Rights)--handout
Principles of Healthcare Ethics

6. 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

7. 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)

8. 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.

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

10. 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

11. 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

12. 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.

13. 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.

14. 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.

15. 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

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

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

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

19. 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

20. Functions of Ethics Committee
Education
Policy recommendation
Case consultation or review

21. 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.

22. 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.

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

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

25. 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

26. 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

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

28. 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

29. Competence Keeping up with new practices in your area
Make sure these practices are evidence-based and researched
Maintain competency requirements set up by the BON