1. Mosby items and derived items © 2011, 2008 by Mosby Inc., an imprint of Elsevier Inc.

2. Nursing Perspectives Chapter 9 Ethical Issues in Nursing Understanding the ANA Code of Ethics Chapter 9 Ethical Issues in Nursing Understanding the ANA Code of Ethics

3. Page 169 in your textbook American Nurses Association Code of Ethics Box 9-1

4. Provision 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems (ANA, 2001, p. 7). Practice kindness and respect, regardless of who is receiving his or her communication. The therapeutic use of self is expected in this provision. In every human interaction, we communicate one of three statements: – 1. Go away, my world would be better without you. – 2. You are an object, a task to be done, you mean nothing to me. – 3. You are a person of worth, I care about you (Fowler, 2008, p. 6).

5. The nurse must be mindful of… “Patients have a moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision making and treatment process” (ANA, 2001, p. 8).

6. Supporting Provision 1 Advocate for our clients – end-of-life issues, ageism, Some cultures defer decision making to other family members When “nurses eat their young” – Engage in lateral violence, harassment, or threatening behavior against another nurse

7. Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community (ANA, 2001, p. 9). May experience conflict between policy and provision of care Use veracity, fidelity, and nonmaleficence Must collaborate with other health care professionals to meet patient’s needs Must be mindful of professional boundaries The purpose of this relationship is not friendship but “…alleviating suffering, and protecting, promoting, and restoring the health of patients” (ANA, 2001, p. 11). In all encounters, regardless of the patient’s behavior, the nurse has the obligation to maintain professional boundaries.

8. Example of Provision 2 The ER nurse knows a patient that is being admitted for the fourth time this month for “pain”. The nurse enters the patient’s room and states “Well, you’re back again. Did your narcotic supply run out?”

9. Example of Provision 2 A client’s family does not want them to know that they have been diagnosed with a chronic illness. The family states “If he know he has that he will just give up”

10. Provision 3. The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient (ANA, 2001, p. 12) “Only information pertinent to a patient’s treatment and welfare is disclosed, and only to those directly involved with the patient’s care” (ANA, 2001,p. 12). HIPAA Example – A client shares that they do not want surgery but have agreed to it because the family wants them to have it.

11. Provision 3. The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient (ANA, 2001, p. 12) Focus on safeguarding research subjects – “Nurses have a duty to question and, if necessary, to report and to refuse to participate in research they deem morally objectionable” (ANA, 2001, p. 13). Focus on incompetence – “The nurse has a responsibility to implement and maintain standards of professional nursing practice” (ANA, 2001, p.13). – “I reported the problem to my manager and it is not my problem if it continues,” is not defensible in a court of law; it also represents a violation of The Code.

12. Provision 4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care (ANA, 2001, p. 16). “Accountability means to be answerable to oneself and others for one’s own actions” (ANA, 2001, p. 16). The nurse is accountable for the assignment of nursing responsibilities to other nurses and delegation of nursing activities to other health care providers. “Delegation is the process for the nurse to direct another person to perform nursing tasks and activities” (ANA & National Council of State Boards of Nursing, 2006). “Nurses may not delegate responsibilities such as assessment and evaluation; they delegate tasks” (ANA, 2001, p. 17)

13. Examples of Provision 4 A nurse works on a chemotherapy infusion unit and is expected to be maintain competency with infusion skills. She has not attended any updates about chemotherapy in the last 2 years. She has orders to infuse a relatively new chemotherapeutic drug but isn’t familiar with it. She decides to infuse the drug anyway. The client has an adverse reaction to the drug and is hospitalized.

14. Provision V. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth (ANA, 2001, p. 18). Nurses owe to themselves the same moral duties they owe others. Self-respect, or seeing the self as deserving of worth, is the foundation of this fifth provision. Professional growth and maintenance of competence require continuous acquisition of knowledge and skills relevant to a chosen specialty.

15. Example of Provision 5 A client asks a nurse “What do you think of the surgeon who is going to operate on me tomorrow?”. – The nurse may know that the surgeon has high rate of infection in surgical cases – But is it due to the actual surgical intervention or care provided post-surgically? – Also, you must consider the clients who might have been high risk anyway even before the surgery

16. Preservation of Integrity Nurses have the ethical obligation to disclose errors, and neither falsify records nor tolerate verbal abuse from health care workers of any status. “conscientious objection.” Where a particular treatment, intervention, activity or practice is morally objectable to the nurse, whether intrinsically so or because it is inappropriate for the specific patient, or where it may jeopardize patients and nursing practice, the nurse is justified in refusing to participate on moral grounds. Such grounds exclude personal preference, prejudice, convenience or arbitrariness (ANA, 2001, p. 20). Nurses have the ethical obligation to disclose errors, and neither falsify records nor tolerate verbal abuse from health care workers of any status. “conscientious objection.” Where a particular treatment, intervention, activity or practice is morally objectable to the nurse, whether intrinsically so or because it is inappropriate for the specific patient, or where it may jeopardize patients and nursing practice, the nurse is justified in refusing to participate on moral grounds. Such grounds exclude personal preference, prejudice, convenience or arbitrariness (ANA, 2001, p. 20).

17. Provision 5 cont. Nurses cannot abandon their patients and must provide other resources for the required nursing care. In situations where this is a repeated pattern, nurses must bring the situation to administrative levels. For example, nurses repeatedly are expected to practice in the unsafe environments of emergency rooms that refuse to go on divert when patient volume and acuity warrant such an action. Nurses cannot abandon their patients and must provide other resources for the required nursing care. In situations where this is a repeated pattern, nurses must bring the situation to administrative levels. For example, nurses repeatedly are expected to practice in the unsafe environments of emergency rooms that refuse to go on divert when patient volume and acuity warrant such an action.

18. Provision 6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action (ANA, 2001, p. 20). Nurses influence on the environment and the environment’s influence on the nurse Example – If an institution has or does not have policy in place for safety for nurses or for patients ---- – Nurses can collaborate to change this Nurses influence on the environment and the environment’s influence on the nurse Example – If an institution has or does not have policy in place for safety for nurses or for patients ---- – Nurses can collaborate to change this

19. Provision 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development (ANA, 2001, p. 22). Examples include mentorship, service on shared governance committees in the place of employment or in professional organizations, or leadership in their professional organization. Two professional nursing organizations focus on the importance of knowledge development, dissemination, and application to practice: National League for Nursing (NLN) and American Association of Colleges ofNursing (AACN).

20. Provision 8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs (ANA, 2001, p. 23). world hunger, environmental pollution, lack of access to health care, violation of human rights, and inequitable distribution of nursing and health care resources Nurses have a professional obligation to recognize their prejudices and demonstrate respect for the values and practices of those from different cultures.

21. Provision 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping of social policy (ANA, 2001, p. 24). Becoming a member and being involved in national organizations is important Through professional groups, nurses can influence change What are some national organizations that nurses can belong to?