1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 23 Ethical Dimensions of Patient Care

3. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Define ethics. Relate historical and philosophical influences to the ethical basis for professional nursing practice. Develop a personal philosophy of professional nursing. Analyze ethical principles and theories as a basis for professional nursing practice. Discuss participation on ethics committees in hospitals.

4. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company4 Objectives Apply a model for ethical decision making to an ethical dilemma. Examine ethical issues encountered in practice including cost containment, use of technology, and patients’ rights. Incorporate a personal ethic of social responsibility and service into professional practice. Promote an ethical culture within the practice setting.

5. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company5 Definition of Ethics  Ethics is the system of moral rules and principles that becomes the standard for professional conduct.  Morals pertain to the distinction between right and wrong and evolve with the stages of development.

6. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company6 Historical and Philosophical Influences on Nursing Practice  Social need  Religious and spiritual considerations  Women’s influences

7. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company7 Philosophy  Philosophy is the rational investigation of the truths and principles of knowledge, reality, and human conduct.  Personal philosophies stem from an individual’s beliefs and values.  A professional nurse’s personal philosophy impacts on the individual’s philosophy of nursing.  A combination of one’s nursing philosophy and the organizational philosophy of nursing form a foundation for ethical behavior in the practice setting.

8. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company8 Ethical Theories  Utilitarianism focuses on providing benefits to the greatest number.  Deontology focuses on duties or the means rather than focusing on the end to a goal.  Character ethics focuses on traits of a person that promote goodwill. These traits can be cultivated through moral reasoning.

9. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company9 Ethical Principles  Autonomy refers to convictions of independence, self- governing, and the belief that individuals have a right to self-determination.  The ethical principle of beneficence states that nurses must act in ways that benefit the patient.  Nonmaleficence obligates nurses to protect patients from deliberate harm or from uninformed participation in procedures or research.

10. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company10 Respect for Human Dignity and Confidentiality  Respect for human dignity ensures that patient participation is voluntary and free of coercion.  Both from a legal as well as an ethical perspective, nurses have a professional responsibility to judiciously protect patient information of a confidential nature.

11. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company11 Ethics Committees  These are interdisciplinary committees that help health care organizations develop ethical guidelines.  They review situations referred by health care staff.  Nurses play an essential role on ethics committees and must be active participants.

12. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company12 Ethical Decision Making  Nurse managers must make decisions at times that challenge the values the nurse personally holds.  Values are ideals, standards, principles, beliefs, objects, and behaviors that give meaning and direction to life. Clarifying values assists nurse managers in making decisions.  Model for ethical decision making: MORAL decision- making model

13. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company13 Ethical Issues Encountered in Practice  These include issues related to: Technology Cost containment Patients’ rights/patient advocacy

14. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company14 Social Responsibility and Service in Professional Nursing  Nursing competencies include embracing a personal ethic of social responsibility and exhibiting ethical behavior in all professional activities.  Questions can arise as to which aspects of society nurses owe their loyalty.  Ethical leadership and management are essential.

15. Chapter 23Copyright © 2003 Delmar Learning, a Thomson Learning company15 Social Responsibility and Service in Professional Nursing  Nurses can ensure that ethical principles are adhered to throughout all practice settings.  Nurse leaders are responsible for creating an ethically principled environment and for upholding the standards of conduct set by the profession.