NUR 3805 Florida State University Nursing Role and Scope Questions

Nursing Role and Scope

1.  Think about the ethical theories and approaches in Chapter 4 and the moral conflicts you have experienced in the past.  Have you used one of these approaches to resolving conflict?  Which theory or approach have you used?

2. Has there ever been a time when you have experienced the dilemma of having to make a choice that you know will affect the well-being of another individual? Have you ever experienced moral suffering?

Chapter 4
Foundations of
Ethical Nursing
Practice
Ethics
• Ethics versus morals
• Bioethics
• Nursing ethics
• Moral reasoning
– Kohlberg
– Gilligan
Values in Nursing
• Values emphasized in the Code of Ethics with
Interpretive Statements (ANA, 2001)
– Wholeness of character
– Integrity
– Basic dignity
– Personal dignity
Ethical Theories and Approaches
• Virtue ethics
• Natural law theory
• Deontology
• Utilitarianism
• Ethics of care
• Ethical principlism
Ethical Principlism
• Autonomy
• Beneficence
• Nonmaleficence
• Justice
Professional Ethics and Codes
• The Nightingale Pledge (1893)
• Nursing Ethics: For Hospital and Private
Use (1900)
• ICN’s Code of Ethics for Nurses (1953)
• ANA’s Code of Ethics for Nurses (1950)
ANA’s Code of Ethics for Nurses
• Nine provisions with interpretive statements
containing specific guidelines for clinical
practice, education, research, and
administration
• The code is considered to be nonnegotiable in
regard to nursing practice
Examples of Themes in the Code of
Ethics with Interpretive Statements
• Respect for autonomy
• Self-preservation
• Relationships
• Environment and moral
obligation
• Patients’ interests
• Collaboration
• Privacy
• Competent practice
• Accountability and
delegation
• Contributions to the
nursing profession
• Human rights
• Articulation of
professional codes by
organizations
The ICN Code of Ethics for Nurses
• Nurses have 4 fundamental responsibilities:
– To promote health
– To prevent illness
– To restore health
– To alleviate suffering
Common Themes of ANA & ICN Codes
• Focus on the importance of nurses delivering
compassionate patient care aimed at alleviating
suffering; patient is the central focus of nurses’ work
• Applies to all nurses in all settings and roles;
nonnegotiable ethical nursing standards with a focus
on social values, people, relationships, and
professional ideals
• Share values of respect, privacy, equality, and
advocacy
• Both codes illustrate idea of nurses’ moral selfrespect
Ethical Analysis and Decision Making
in Nursing
• Ethical dilemmas and conflicts
• Moral suffering
• Team approach
• Case-based approach using 4 topics method
– Medical indications
– Patient preferences
– Quality of life
– Contextual features
Medical Indications
• What is the patient’s medical problem? History?
Diagnosis? Prognosis?
• Is the problem acute? Chronic? Critical?
Emergent? Reversible?
• What are the goals of treatment?
• What are the probabilities of success?
• What are the plans in case of therapeutic failure?
• In sum, how can this patient be benefited by
medical and nursing care, and how can harm be
avoided?
Patient Preferences
• Is the patient mentally capable and legally competent? Is
there evidence of incapacity?
• If competent, what is the patient stating about preferences
for treatment?
• Has the patient been informed of benefits and risks,
understood this information, and given consent?
• If incapacitated, who is the appropriate surrogate? Is the
surrogate using appropriate standards for decision making?
• Has the patient expressed prior preferences?
• Is the patient unwilling or unable to cooperate with medical
treatment? If so, why?
Quality of Life
• What are the prospects, with or without treatment, for a
return to normal life?
• What physical, mental, and social deficits is the patient
likely to experience if treatment succeeds?
• Are there biases that might prejudice the provider’s
evaluation of the patient’s quality of life?
• Is the patient’s present or future condition such that his
or her continued life might be judged undesirable?
• Is there any plan and rationale to forgo treatment?
• Are there plans for comfort and palliative care?
Contextual Features (1 of 2)
• Are there family issues that might influence
treatment decisions?
• Are there provider (physicians and nurses)
issues that might influence treatment
decisions?
• Are there financial and economic factors?
• Are there religious and cultural factors?
Contextual Features (2 of 2)
• Are there limits on confidentiality?
• Are there problems of allocations or resources?
• How does the law affect treatment decisions?
• Is clinical research or teaching involved?
• Is there any conflict of interest on the part of
the providers or the institution?