NSG100 Stratford Wk 7 Immunizations and Health Disparities Discussion

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NSG100

Stratford University

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I have chosen an article about immunizations and health disparities as our final ethical discussion board. This is the link to the article: http://www.historyofvaccines.org/content/articles/ethical-issues-and-vaccines

This is full of ethical concerns, and I do not want to limit you, so please choose something from the article to discuss, identify an appropriate provision from the nursing code of ethics, and what you think should or could be done to address it. I think this topic has many personal opinions to it, and you can mention these because the public can have the same and naming helps us figure out how to address those concerns. Please remember to cite both the article and the book.

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© 2015 American Nurses Association PURPOSE AND EVOLUTION OF THE CODE AND PROVISIONS 1-3, NURSES AND PATIENTS Slide Deck 1 © 2015 American Nurses Association Provisions 1-3, Nurses and Patients What do we mean by nurses and patients? Provisions 1-3 address direct patient care and describe the most fundamental values and commitments of the nurse. 3 Scope of Nursing Ethics Unless separately referenced, all content comes from ANA’s Code of Ethics for Nurses with Interpretive Statements, 2015 (“the Code”) OR Fowler, M. D.M. (2015). Guide to the code of ethics for nurses: Development, application, and interpretation (2nd Ed.). Silver Spring, MD: American Nurses Association. *All images are public domain under the Creative Commons license and were retrieved from http://pixabay.com/en/. The question mark icon throughout indicates a discussion point or question to engage in dialogue. 4 What Is Ethics? ▪ A specialized area of philosophy dating back to ancient Greece and earlier ▪ ▪ Concepts of Hippocrates still inform today’s ethical issues. A systematic study of what is right and good measured against principles, virtues and core values of a profession. 5 Scope of Nursing Ethics Deals with: ▪ Character (what sort of person one ought to be) ▪ Conduct (how one should act) Deals with duties and obligations of nurses to: ▪ Patients ▪ Other health professionals ▪ The profession ▪ The wider public ▪ Global humanity 6 Why Ethics in Nursing? Because nurses… ▪ Serve vulnerable persons ▪ Promise to protect patients ▪ Impact patient well-being ▪ Depend on public trust ▪ Have a moral relationship with patients that gives rise to ethical obligations 7 Personal Values and Nursing ▪ ▪ Morality comprises personal values, character and conduct. Those entering nursing bring moral values stemming from: ▪ ▪ ▪ Religion, culture, family, education, life experience Embedded moral values are a starting point for ethical behavior and personal integrity. As nursing core values are learned and practiced, they are integrated with personal values to create a nursing moral identity. 8 Branches of Ethics METAETHICS ▪ Theoretical thinking about morality NORMATIVE ETHICS ▪ What is right/wrong, good/evil individual or collective choices APPLIED ETHICS ▪ Right/wrong, good/evil of actions in a specific profession or discipline 9 What Is an Ethical Code? An ethical code is an identifying feature of a profession to: ▪ Facilitate professional self-regulation and accountability ▪ Describe obligations of client-professional and colleague-tocolleague relationships ▪ Serve as a guide for analysis, decision and action 10 ANA’s Code of Ethics for Nurses with Interpretive Statements (“the Code”) ▪ ▪ ▪ ▪ ▪ ▪ ▪ Conveys shared ethical values, obligations, duties and ideals of nurses individually and collectively Provides an implied contract with the public Informs society of the moral values and ideals by which it functions Informs new professionals of the expected moral behaviors Guides the profession in self-regulation Provides a framework for ethical decision-making Is unapologetic, aspirational and nonnegotiable 11 Legacy of the Code ▪ ▪ ▪ ▪ Commitment to service is the most precious ideal of the nursing profession. The Code supports ideals of nursing’s service. The Code guides all nurses in living out the values and ideals of the profession. The Code is a living, ongoing legacy of core values from Florence Nightingale in 1850 to 2015 and beyond. 12 Evolution of the Code ▪ ▪ ▪ ▪ ▪ ▪ 1893: “Nightingale Pledge” 1926: Suggested Code in the American Journal of Nursing (AJN) 1940: Tentative Code, AJN 1950: The Code adopted by ANA 1956, 1960, 1968, 1976, 1985, 2001: Revisions of the Code 2015: Major revision of the Code 13 Maturation of the Code The Code was first adopted in 1950; it was periodically updated to reflect the changing context and practice of nursing. ▪ Early versions stressed ▪ ▪ ▪ ▪ Nurse’s obligation to carry out physician’s orders Rules of conduct, moral character, hygiene Duty with skill and moral perfection Later versions stressed ▪ ▪ Principles, especially respect for patient autonomy Nurse’s obligation to the patient, including protection from incompetent, unethical or illegal practice 14 Structure of the Code ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Preface Introduction Provisions 1-3 with Interpretive Statements: Nurses and Patients Provisions 4-6 with Interpretive Statements: Boundaries of Duties and Loyalty Provisions 7-9 with Interpretive Statements: Commitments Beyond Individual Patient Encounters Afterword Glossary Time line: The Evolution of Nursing’s Code of Ethics Note: The Interpretive Statements for each provision provide more specific guidance for practice, are responsive to the contemporary context of nursing, and recognize the larger scope of nursing’s concern in relation to health. 15 Emphasis of the Code ▪ ▪ ▪ ▪ All nurses, all roles with various scopes of practice and settings Relationship with other caregivers, including unlicensed personnel Increasing diversity of patients and nurses Wholeness of character: Nursing as a lifetime endeavor; core values and dispositions pervading all aspects of life 16 Revision Considerations ▪ ▪ ▪ ▪ ▪ Not lightning rod for controversial, divisive public debate Not political Timeless language, no buzzwords that outdate Succinct, clear, and understandable to students and new nurses Useful to all nurses in all roles and settings 17 Nursing Is Value Laden Caring for those suffering in the most vulnerable moments of life: ▪ Finding meaning ▪ Bearing witness ▪ Facilitating healing ▪ Being present ▪ Expressing caring 18 Ethical Theories ▪ Nursing draws from many ethical theories, including: • • • • ▪ ▪ Kantian Normalism Utilitarianism Virtue Ethics Ethic of Caring The Code functions at mid-range Any of these theories can be used “behind” the Code 19 Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person. Interpretive Statements 1.1 1.2 1.3 1.4 1.5 Respect for Human Dignity Relationships With Patients The Nature of Health The Right to Self-Determination Relationships With Colleagues and Others 20 1.1 Respect for Human Dignity Patient dignity is the foundation of nursing ethics. ▪ Dignity is inherent, not “earned.” ▪ A patient never loses dignity, e.g., when comatose, delirious, frail, or in an altered state. ▪ A nurse must approach every patient with respect for dignity, regardless of personal attributes, health state, or any other situational or patient variable. Source: Ferrell, B.R., & Coyle, N. (2008). The nature of suffering and the goals of nursing . New York, NY: Oxford University Press. 21 How would you react? If you had to care for a hospitalized terrorist who injured himself while bombing your hometown…how does the Code guide you? 22 1.2 Relationships With Patients ▪ ▪ Trust Honoring patient choices, even when risky How would you react? ▪ If a patient is self-harming by cutting to soothe anxiety, is this an autonomous choice? Should you stop the patient? ▪ How does the Code guide you? 23 1.3 The Nature of Health ▪ Care shaped by patient preferences, needs, values, choices ▪ Evidence provides the science of options; patient particulars help choose the options How would you react? ▪ Can you refuse to care for an Ebola patient to avoid risking your own health? ▪ How does the Code guide you? 24 1.4 The Right to Self-Determination Patients have a right to decide for themselves. ▪ The patient, and decisions made by the patient, are to be respected regardless of personal attributes of the patient, conflicting values, or circumstances. 25 Informed Consent for Treatment ▪ Elements of informed consent: • • • ▪ ▪ Assent if a minor Advance directives: • ▪ Capacity to decide Pertinent, understandable information Voluntary decision Living will, five wishes, DPAHC If declared by court “incompetent” to decide: • • • • Incompetence is a legal/court decision Power of attorney or next of kin Substituted judgment Best interest standard 26 Who Is the Patient? ▪ Individual ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Resident in LTC Consumer in mental health Client Recipient of care Family Group Community Population 27 Who Is the Final Decision-Maker? Respect for autonomy ▪ ▪ The patient, if competent If family disagrees with the patient… • • ▪ ▪ Are family goals realistic? How do you know? What about futile treatment recommended by doctor? If family members disagree among themselves, who arbitrates? If family makes decision that conflicts with physician’s orders, who arbitrates? 28 Compromised Autonomy ▪ ▪ ▪ ▪ ▪ ▪ Age: Infant, child Comatose Developmentally disabled Dementia, hypoxia, OBS, head injury Cognitive impairment from drugs, alcohol Setting constraints: prisoners, students, patients 29 Health Literacy ▪ ▪ Self-determination depends on awareness of decisions to be made Patient’s ability to comprehend treatment options may be impaired by: ▪ ▪ ▪ ▪ ▪ ▪ Cognitive capacity Literacy, language proficiency, or educational level Visual or hearing impairment Anxiety in presence of health professionals Fear Important to assess patient’s understanding of treatment options and implications 30 Balance Protection Over Under Paternalism Negligence 31 At the End of the Day… Nurses must live with their own conscience ▪ Adequate ethical justification for decisions and actions to sleep at night ▪ Principles can only go so far ▪ Clinical judgment is in the end situational, contextual and personal ▪ Ethical decisions always entail ambiguity and uncertainty 32 Interpretive Statement 1.4 “Nurses may not act with intent to end life even though such actions may be motivated by compassion, respect for autonomy or quality of life considerations.” Autonomy to accept, refuse, or terminate care: ▪ Foregoing nutrition and hydration ▪ Withholding or withdrawing life-sustaining treatment ▪ Honoring advance directives 33 Doctrine of Double Effect ▪ ▪ Nurse may administer medications with the intent of reducing symptoms of dying, even though the secondary impact may decrease respirations and perhaps hasten death The nurse’s actions do not cause the death, the terminal illness causes the death 34 1.5 Relationships With Colleagues and Others Interdisciplinary ▪ All colleagues, including unlicensed personnel Inter-professional ▪ All licensed colleagues (medicine, pharmacy, social workers, dieticians, PT, OT, RT, etc.) Trans-professional ▪ Licensed colleagues working together on a team across fields of expertise 35 Create a Culture of Respect Cultivate civility, collaboration, and collegiality to ensure: ▪ Safe, quality patient care and outcomes ▪ Compassionate, transparent, effective health services ▪ A hospitable work environment 36 Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population. Interpretive Statements 2.1 Primacy of the Patient’s Interests 2.2 Conflict of Interest for Nurses 2.3 Collaboration 2.4 Professional Boundaries 37 2.1 Primacy of the Patient’s Interests ▪ Engagement, trust, intimacy, presence • ▪ Based on covenant relationship, existential encounter, response to vulnerability Respond in the here and now • • • • Attentiveness Responsibility Competence Responsiveness 38 Anticipate Nuances ▪ ▪ ▪ Contextual variables shift Decision-making never static or complete Approach may be • • • • • • Too broad/too narrow Too hasty/too delayed Too constrained/too flexible Too conventional/too visionary Too reductionist/too expansionist Too technical/not caring enough 39 Conflict Resolution ▪ ▪ When patient interests collide with those of others (family members, physician), the nurse’s primary commitment is to the patient. A nurse helps resolve such conflicts, so patient wishes may be honored. 40 2.2 Conflict of Interest for Nurses If a nurse stands to gain personally from a clinical situation, a conflict of interest exists. ▪ ▪ Disclosure of such a conflict to all involved is expected. Professional integrity may be damaged if a nurse does not withdraw from a conflict of interest. 41 “There comes a point in analysis of every ethical dilemma when people finally know what is right and what is wrong, regardless of analytical reasoning.” -George Annas, Law Professor 42 2.3 Collaboration Trust, respect, transparency ▪ Voicing ethical opinion ▪ Shared decision-making ▪ “Community of moral discourse” ▪ Equipping patients with the information, resources and courage to participate in mutual decision-making ▪ Shared responsibility for outcomes 43 2.4 Professional Boundaries ▪ Intensely personal work with vulnerable patients may generate emotional attachments • ▪ Gifts generally not appropriate Withdraw from problematic boundary situations with colleagues 44 Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Interpretive Statements 3.1 Protection of the Rights of Privacy and Confidentiality 3.2 Protection of Human Participants in Research 3.3 Performance Standards and Review Mechanisms 3.4 Professional Responsibility in Promoting a Culture of Safety 3.5 Protection of Patient Health and Safety by Acting on Questionable Practice 3.6 Patient Protection and Impaired Practice 45 3.1 Protection of the Rights of Privacy and Confidentiality Policies and practices in an age of technology ▪ HIPAA: Adhere to federal and state ▪ ▪ ▪ regulations Facebook: Completely off limits for patient photos or identifying information Caring Bridge: Patients decide, nurses should not engage Electronic Health Records: Only shared with those directly involved in care 46 3.2 Protection of Human Participants in Research ▪ ▪ Institutional Review Board (IRB) approval of relevant research proposal Voluntary participation of participants • ▪ ▪ No coercion, deceit Informed consent documented Right to withdraw at any point with no untoward consequences 47 Special Consideration for Vulnerable Subjects ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Fetuses and human embryos Pregnant women Children and minors Cognitively impaired persons Prisoners Traumatized and comatose patients Terminally ill patients Elderly/aged persons Economically or educationally disadvantaged persons Underserved populations 48 3.3 Performance Standards and Review Mechanisms ▪ ▪ Demonstrate ongoing knowledge, skills, dispositions and integrity for competence in practice Assume accountability for current, quality nursing practice according to national, state, and institutional standards 49 3.4 Professional Responsibility in Promoting a Culture of Safety ▪ ▪ ▪ ▪ ▪ ▪ Avoid or reduce errors Do not conceal errors Correct or treat errors Use chain of authority when reporting a problem Provide timely responsive communication Document 50 3.5 Protection of Patient Health and Safety by Acting on Questionable Practice If a nurse observes a violation of law, policy, or ethical standards that could jeopardize patient safety… ▪ ▪ ▪ What guidance does the Code provide? What ANA position papers provide additional guidance? What other policies or procedures need to be followed? 51 3.6 Patient Protection and Impaired Practice When impaired practice is suspected, patient safety may be jeopardized ▪ Identify colleagues whose practice may be impaired or who are placing patients at risk ▪ Follow chain of authority with compassion and caring so remediation and recovery may follow ▪ Access employee assistance program for help 52 What Will Guide Your Moral Compass? 53 © 2015 American Nurses Association PROVISIONS 4-6, BOUNDARIES OF DUTY AND LOYALTY Slide Deck 2 © 2015 American Nurses Association Provisions 4-6, Boundaries of Duty and Loyalty What do we mean by “boundaries of duty and loyalty”? Provisions 4-6 focus on the individual nurse’s responsibility and accountability in nursing practice, as well as the promotion of safe, quality health care. Provision 4 The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. Interpretive Statements 4.1 Authority, Accountability, and Responsibility 4.2 Accountability for Nursing Judgments, Decisions, and Actions 4.3 Responsibility for Nursing Judgments, Decisions, and Actions 4.4 Assignment and Delegation of Nursing Activities or Tasks 4.1 Authority, Accountability and Responsibility Nurses are always accountable for their own actions, maintaining their competence to ensure safe practice. ▪ Technological advancements require ongoing learning. ▪ Evidence-informed practice mandates continuous learning. ▪ Shifting patterns of health care delivery demand orientation to changing lines of authority, communication channels and multisystem policies. ▪ APRNs adhere to scope of practice, as state nurse practice acts vary and reform roles periodically. 4.2 Accountability for Nursing Judgments, Decisions, and Actions ▪ ▪ ▪ ▪ Fidelity (loyalty, including keeping promises, honoring agreements, performing competently, etc.) Veracity (truth-telling; nondeception) Beneficence (doing what benefits the patient) Nonmaleficence (non-infliction of harm) Beauchamp & Childress, 2013 Ethical Virtues of All Health Professionals ▪ ▪ ▪ ▪ ▪ Compassion Discernment Trustworthiness Integrity Conscientiousness Beauchamp & Childress, 2013 Virtues Specific to Nursing ▪ ▪ ▪ ▪ ▪ ▪ Wisdom Patience Compassion Honesty Altruism Courage 4.3 Responsibility for Nursing Judgments, Decisions and Actions ▪ ▪ ▪ ▪ ▪ ▪ Adhere to Nursing: Scope and Standards of Practice, including APRN scope and standards Maintain standards of practice Participate in peer review, credentialing Engage in committees and other mechanisms to make sound decisions about quality and safety of care Refuse assignments beyond competence Seek consultation when in doubt 4.4 Assignment Delegation of Nursing Activities or Tasks ▪ ▪ ▪ ▪ Delegate tasks consistent with your state’s nurse practice act Assess qualifications and competence of those whom you delegate or assign Participate in orientation, skill development, continuing education, competency verification and staffing policies to ensure safe care Engage in shared responsibility for educating student nurses Provision 5 The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Interpretive Statements 5.1 Duties to Self and Others 5.2 Promotion of Personal Health, Safety and Well-Being 5.3 Preservation of Wholeness of Character 5.4 Preservation of Integrity 5.5 Maintenance of Competence and Continuation of Professional Growth 5.6 Continuation of Personal Growth 5.1 Duties to Self and Others Nurses must take care of themselves before taking care of others. ▪ Self-regarding duties include health, safety, integrity, competence and professional growth. 5.2 Promotion of Personal Health, Safety and Well-Being Nurses have a duty to model health promotion to patients and the public. ▪ Fatigue and compassion fatigue may be occupational hazards for nurses in intense clinical practice. ▪ Balance in personal and professional life is essential for well-being. ▪ Good diet, exercise, healthy sleep patterns and healthy relationships are all factors in maintaining this balance. 5.3 Preservation of Wholeness of Character Nurses are moral agents in any setting, as they embrace the values of the profession and display them in their communication and actions. ▪ Nurses should assess risks to integrity ahead of employment decisions. ▪ Nurses’ personal values merge with professional values, creating an identity that is reflected in practice and permeates private life. • • ▪ Thieves, liars and cheats do not make good nurses! Felonious record disqualifies a person from becoming a nurse Nurses can foster a community of moral discourse where open dialogue about crucial health issues is facilitated. Undue Influence of Patients Because nurses are respected and have authority, their influence on patient decision-making may be unduly influential; nurses should avoid coercion or unintentional pressure in helping patients articulate their own values and preferences. How do you respond? An elderly patient faces a tough decision about whether to undergo chemotherapy to prolong her life. The patient asks you what you would do in her shoes. ▪ How do you respond? ▪ How does the Code guide you? 5.4 Preservation of Integrity ▪ ▪ When integrity is eroded, nurses may experience moral distress. Threats to integrity may be encountered in practice. ▪ ▪ ▪ Nurses may be asked to take action in conflict with personal or professional values or the Code. Nurses have a right and duty to express their opposition and only compromise if such a decision preserves their moral integrity. Integrity-preserving compromise is more likely in a safe environment of mutual respect where open moral dialogue is encouraged. ▪ Conscientious Objection Conscientious objection enables an individual to refuse participation in an activity that violates personal values or beliefs. ▪ Select an employer whose values correspond with your own, whose routine practices do not violate your beliefs. ▪ Timely appropriate communication to supervisors is necessary to make alternate arrangements in order to avoid “neglect of care” or “patient abandonment.” Conscientious Objection When is it imperative to refuse to participate in a practice that conflicts with your values? Thousand Shades of Grey “…ethics isn’t about choosing between right and wrong; it’s about choosing between grey and grey. It’s about choosing between two equally desirable, but mutually exclusive courses of action. Freedom or security? Courage or comfort? Self-examination or blissful happiness?” -Will Ferguson, Happiness Ethical Unloading ▪ ▪ ▪ ▪ ▪ Moral distress Cumulative moral residue Crescendo effect Burnout/rustout Moral courage 5.5 Maintenance of Competence and Continuation of Professional Growth 5.6 Continuation of Personal Growth ▪ Evaluate performance periodically using standards and peer review ▪ Commit to lifelong learning and advanced study ▪ Broaden understanding of the world, human beings and themselves as moral agents in the world Provision 6 The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work settings and conditions of employment that are conducive to safe, quality health care. Interpretive Statements 6.1 The Environment and Moral Virtue 6.2 The Environment and Ethical Obligation 6.3 Responsibility for the Health care Environment 6.1 The Environment and Moral Virtue Virtues Expected of All: ▪ Integrity ▪ Respect ▪ Moderation ▪ Industry Additional Virtues Expected of All Nurses: ▪ Knowledge ▪ Skill ▪ Wisdom ▪ Patience ▪ Compassion ▪ Honesty ▪ Altruism ▪ Courage Moral Milieu For virtues to flourish, the work climate should foster: ▪ Respect and trust ▪ Mutual caring ▪ Communication ▪ Generosity ▪ Kindness ▪ Equality ▪ Prudence ▪ Transparency 6.2 The Environment and Ethical Obligation ▪ ▪ ▪ ▪ ▪ ▪ Create a culture of excellence Formulate clear policies and procedures Ensure all nurses have working knowledge of the Code Provide functional Ethics Committees Treat employees fairly and with dignity Facilitate mechanisms for grievances to be aired in a fair and timely fashion 6.3 Responsibility for the Health Care Environment ▪ ▪ ▪ ▪ Ensure ongoing professional development and evaluation of all staff Participate in interprofessional workplace advocacy to address unethical practice Continue to express concerns over unacceptable ethical practice, documenting these sequentially Resign after repeated unsuccessful attempts to change unjust or unethical practice in order to preserve integrity, or risk being complicit in unethical practice Mutual Ethical Integrity What can we do collaboratively to shape a future for nursing that fosters ethical integrity in all dimensions of practice? “Ethical living requires coping well with the lives fate has dealt us. Our lives routinely demand that we choose well from among myriad options for shaping our common destinies. We are enlarged by the magnitude of our responsibilities for shaping the future. Every human life takes on a singular majesty when dedicated to the noble quest for ethical living.” -Anita Allen, 2004 © 2015 American Nurses Association PROVISIONS 7-9, COMMITMENT BEYOND INDIVIDUAL PATIENT ENCOUNTERS Slide Deck 3 © 2015 American Nurses Association Provisions 7-9, Commitment Beyond Individual Patient Encounters What do we mean by “commitment beyond individual patient encounters”? Provisions 7-9 focus on the expanded duties of the nurse and the nursing profession in advancing nursing and health care nationally and globally. 3 Provision 7 The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. Interpretive Statements 7.1 Contributions Through Research and Scholarly Inquiry 7.2 Contributions Through Developing, Maintaining, and Implementing Professional Practice Standards 7.3 Contributions Through Nursing and Health Policy Development 4 7.1 Contributions Through Research and Scholarly Inquiry Knowledge development advancing the body of nursing science. ▪ All nurses engage in scholarly activity by providing evidenceinformed practice. ▪ Nurse researchers follow national/international standards for conducting research with human participants. ▪ All research must be approved by institutional review boards (IRBs) in compliance with national standards. ▪ Patient welfare must never be jeopardized for research findings. 5 Vulnerable Populations Do not generally have access to government or private resources to meet basic needs: ▪ Low-income persons ▪ Underserved populations ▪ People with disabilities ▪ Elderly persons ▪ Children ▪ Prisoners ▪ Homeless persons ▪ Mentally ill persons 6 Questions to Ask About Ethics of Research Studies ▪ ▪ ▪ ▪ ▪ ▪ ▪ Should a study be judged by today’s ethical standards or the standards applied at the time of the study? Were participants informed and did they comprehend risks? Did the research knowingly cause harm? Was harm a direct and foreseen result of the study or of some other factors? Did experimentation continue after harmful results were known? Was help available to subjects after the study? Were results suppressed, falsified or destroyed? 7 Questions to Ask about Ethics of Research Studies What are the implications of a research survey of Alzheimer’s patients? ▪ How could informed consent be obtained? ▪ How valid would verbal responses to a survey be? ▪ What steps could be taken to make such a study ethically acceptable and meaningful? 8 Research With Marginalized Subjects Nonmaleficence Right to Information Research Ethics Committees: Safeguard Dignity, Rights, Safety and Well-being of All Research Participants Right to Withdraw Informed Consent Volunteer to Participate Autonomy Professionals’ Use of Responsible Advocacy Research Ethics Committees: Ensure High-Quality Research That Offers Benefits to Participants, Services and Society Beneficence Paternalism AVOID: Exploitation, Coercion and Exclusion and Discrimination Facilitative Informs Policy and Service Provision Seek Active Involvement of Service Users Justice 9 7.2 Contributions through Developing, Maintaining and Implementing Professional Practice Standards Scope and standards inform practice in multiple specialties and all settings. ▪ Practice environments should facilitate implementation of these standards. ▪ Standards should be woven through any nursing program curriculum. 10 7.3 Contributions through Nursing and Health Policy Development Nurses must advocate for health policies through institutional, local, regional, state, and national initiatives to improve quality of life for populations. ▪ Health policy advocacy should be included in nursing curricula. ▪ Nurses are more powerful when their voices are combined through professional organizations. 11 Provision 8 The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Interpretive Statements 8.1 Health Is a Universal Right 8.2 Collaboration for Health, Human Rights, and Health Diplomacy 8.3 Obligation to Advance Health and Human Rights and Reduce Disparities 8.4 Collaboration for Human Rights in Complex, Extreme or Extraordinary Practice Settings 12 8.1 Health Is a Universal Right Radical declaration: Health Is a Universal Right Creates obligation to advance health and human rights. 13 8.2 Collaboration for Health, Human Rights, and Health Diplomacy “If health is a human right, then a health disparity is a human rights issue and the struggle to achieve health equity for all is an issue of social justice.” -Jacquelyn Miller, CEO, Nebraska DHHS 14 “If we could change the health of the world by changing one thing, it would be to ensure equal rights for women.” -Eleanor Roosevelt 15 United Nations human rights include… ▪ Highest attainable standard of physical and mental health ▪ ▪ Equal access to adequate health care and services ▪ ▪ ▪ ▪ ▪ ▪ Including reproductive and sexual health Regardless of gender, race, or other status Equitable distribution of food, safe drinking water and sanitation Adequate housing, safe workplace Freedom from discrimination Education, including health and sex education Environment appropriate for a child’s physical and mental development 16 United Nations Millennium Development Goals 2000-2015 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Eradicate Extreme Hunger and Poverty Achieve Universal Primary Education Promote Gender Equality and Empower Women Reduce Child Mortality Improve Maternal Health Combat HIV/AIDS, Malaria and Other Diseases Ensure Environmental Sustainability Develop a Global Partnership for Development 17 United Nations Progress Report Check out the United Nations Progress Report: www.un.org/millenniumgoals/ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Extreme poverty is falling in every region, including Africa Water sources have improved Fewer people living in urban slums More children are in primary school (especially girls) Deaths under age 5 have fallen Millions more are receiving HIV antiretroviral therapy TB deaths are expected to fall dramatically Malaria cases have decreased 18 Global Challenges Remain ▪ ▪ ▪ ▪ ▪ ▪ Global economic crises slowed progress for some countries; unemployment persists Rural areas haven’t improved water sources enough Maternal mortality is still too high Hunger and malnutrition persist Slums are still growing Gender inequality and violence undermine efforts of women to reach goals 19 Underserved in Health Care ▪ ▪ Power differential exists between those who can access health care and those who cannot Uninsured, underinsured ▪ ▪ ▪ ▪ ▪ Marginally insured Tenuously insured Periodically insured Refugees and immigrants Stigma of welfare in America ▪ Less likely to secure Medicaid benefits Access to Care Is Still a Huge Issue for Millions 20 But What Can I Do About These Huge Problems? 21 Some Small Steps for Individual Nurses ▪ ▪ ▪ ▪ ▪ ▪ Read to stay informed Write letters to legislators Foster healthy lifestyles in your community Be aware of underlying community conditions contributing to health problems Create a clinical environment that is culturally sensitive to diverse cultural perspectives Join a professional organization that lobbies Congress for equitable policies 22 Your Voice Is Amplified in Professional Organizations ▪ Nursing: American Nurses Association • ▪ Multidisciplinary (Health) ▪ ▪ ▪ Specialty Organizations Public Health, American Public Health Association Rural Health Multidisciplinary/Multiorganizational ▪ ▪ Sociologists, political scientists, demographers Environmentalists, journalists, historians, geoscientists, climatologists and more 23 8.3 Obligation to Advance Health and Human Rights and Reduce Disparities Collaboration: An Instrument for Social Justice ▪ Inequality, poverty, and stigma erode health ▪ Social determinants of health must be addressed, including… • • • • • • Contaminated water and air Poor sanitation Hunger Limited education Violence, warfare Homelessness 24 Partnerships Collaborative partnerships with a united voice can impact legislation, policies, and relief efforts to alleviate suffering and create living conditions in which populations can flourish. 25 8.4 Collaboration for Human Rights in Complex, Extreme, or Extraordinary Practice Settings 26 Imagine… ▪ ▪ ▪ You are the only RN caring for three terminally ill patients in the ICU on the 5th floor during a hurricane that has knocked out power, contaminated the water, and produced structural damage to the hospital. Evacuation is not possible for four days during which you run out of IVs and morphine. The pharmacy is shut down and all pharmacists have evacuated. Patients are suffering in 105 degree heat with no fluids and no pain relief. One patient asks you to be merciful and end his suffering. What are your options? What guidance does the Code provide? 27 Continuum of Vulnerability When individuals lose power to represent themselves and their needs, wishes, values, and choices, others must advocate for them. ▪ Potentially vulnerable ▪ Circumstantially vulnerable ▪ Temporarily vulnerable ▪ Episodically vulnerable ▪ Permanently vulnerable 28 Provision 9 The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. Interpretive Statements 9.1 Articulation and Assertion of Values 9.2 Integrity of the Profession 9.3 Integrating Social Justice 9.4 Social Justice in Nursing and Health Policy 29 9.1 Articulation and Assertion of Values Unified Voice to Assert Shared Values. ▪ Professional organizations articulate and share mutual values with the profession, colleagues, and the public. ▪ Unwavering Central Values • • • Promotion or restoration of health Prevention of illness and injury Alleviation of pain and suffering 30 The Perils of Social Change “All progress is precarious, and the solution of one problem brings us face to face with another.” -Martin Luther King Jr., 1963 “Be not afraid of going slowly, be afraid only of standing still.” -Ancient Chinese Proverb “Make haste, but do it cautiously.” -Marge Hegge 31 9.2 Integrity of the Profession ▪ ▪ ▪ ▪ ▪ ▪ Encouraging respect, fairness, and caring in all facets of nursing Ensuring nursing workforce sustainability Fostering higher education of nurses Advancing nursing science Supporting certification and licensure Facilitating evidence-informed practice 32 9.3 Integrating Social Justice Vigilance to influence those in power to: ▪ Improve health and health care ▪ Address unjust systems and structures ▪ Address underlying determinants of health ▪ Redress wrongs 33 Creating the Landing Strip to the Future “In today’s turbulent times, engaging people’s best thinking about complex issues without easy answers will be the key to creating the futures we want rather than the futures we get.” -Eric Vogt, The Art of Powerful Questions 34 9.4 Social Justice in Nursing and Health Policy ▪ ▪ ▪ Open and honest communication Work in concert to advance common good Environmental restoration 35 Global Burden of Disease (World Health Organization) 30 Richest Nations Population Disease Health $ Providers Africa, Southeast Asia Are Poorest Nations Population Disease Health $ Providers 36 Global Health Inequities Less than 10% of the world’s health research budget is spent on conditions that account for 90% of the world’s diseases! 37 World Health Americans can no longer isolate themselves from epidemics and pandemics in faraway places. We all share this fragile small planet, and share risk of infectious diseases fanning across the globe. 38 Global Injustice How are we to respond? 39 “Even if you’re on the right track, you’ll get run over if you just sit there.” -Will Rogers 40 “Nurses are messengers of hope for troubled times. Leave your footprints of hope for the next generation to follow.” -Marge Hegge 41 Chapter 6 Ethics and Legal Issues CHAPTER 6 OBJECTIVES • Apply ethical principles to decision making. • Discuss the importance of ethics to the nursing profession and its professional recognition. • Summarize current ethical issues. CHAPTER 6 OBJECTIVES • Define major legal terms. • Discuss the relevance of legal issues to nursing practice. • Explain how malpractice relates to nursing practice. • Discuss examples of ethical and legal issues. INTRODUCTION • Nursing profession has ethical responsibilities • Legal issues arise that every nurse must understand • Ethics and legal issues involve – professionalism – health policy – reimbursement issues – the organizations that provide health care. ETHICS AND ETHICAL PRINCIPLES (1 of 4) • Definitions – Ethics: a standard code or guide to behavior – Morals: an individual’s code of acceptable behaviors • Ethical Principles – Autonomy: focuses on the patient’s right to make decisions about matters that impact the patient – Beneficence: relates to doing something good and carding for the patient ETHICS AND ETHICAL PRINCIPLES (2 of 4) • Ethical Principles – Justice: is about treating people fairly – Veracity: is truth – Other suggested principles: • • • • • • Advocacy Caring Stewardship Respect Honesty Confidentiality ETHICS AND ETHICAL PRINCIPLES (3 of 4) • Ethical Decision Making – Ethical dilemma: occurs when a person is forced to choose between 2 or more alternatives, none of which is ideal. • • • • Involvement Assessment Plan Implementation ETHICS AND ETHICAL PRINCIPLES (4 of 4) • Professional Ethics and Nursing Practice – Benner et al, 2010 • Nursing education needs to focus more on ethical comportment • Students need to develop skills to respond ethically to errors and to make ethical decisions. • American Nurses Association Code of Ethics • Reporting Incompetent, Unethical, or Illegal Practices – Role of the State Board of Nursing CURRENT ETHICAL ISSUES (1 of 2) • Rationing Care: Who Can Access Care When Needed • Healthcare Fraud and Abuse • Ethics and Research – Informed consent – Institutional review boards (IRBs) – Physical harms – Psychological harms – Social and economic harms CURRENT ETHICAL ISSUES (2 of 2) • Organizational Ethics – Reimbursement compliance • Compliance officer – Whistle-blowing • False Claims Act LEGAL ISSUES: AN OVERVIEW (1 of 4) • Licensure • Nurse practice act • Critical Terminology – Assault – Battery – Civil law – Criminal law – Doctrine of res ipsa loquitur LEGAL ISSUES: AN OVERVIEW (2 of 4) • Critical Terminology – Emancipation – Expert witness – False imprisonment – Good Samaritan laws – Malpractice – Negligence – Proximate cause LEGAL ISSUES: AN OVERVIEW (3 of 4) • Critical Terminology – Respondent superior – Standards of practice – Statutory law – Tort LEGAL ISSUES: AN OVERVIEW (4 of 4) • Malpractice: Why Should This Concern You? – Negligence occurs in nursing and can lead to a malpractice suit • • • • Nurse has duty to patient Duty was breached Breach of duty was cause of harm Damage or injury to the patient occurred – Need to prove all elements for successful suit – Professional liability insurance for nurses CRITICAL ETHICAL AND LEGAL PATIENT-ORIENTED ISSUES • Confidentiality and Informed Consent • Advance Directives, Living Wills, Medical Power of Attorney, and Do-Not-Resuscitate • Organ Transplantation • Assisted Suicide • Social Media and Ethical and Legal Issues: A New Concern ANA Code of Ethics What came before Provisions 1-9 What are Ethics O 1896-The Nightingale Pledge O Considered the first code of ethics for O O O O nurses Patterned after the Hippocratic Oath Focus was on the moral purity of nurses Written by a nurse educator in honor of the ethical example displayed by Florence Nightingale Often administered at nursing graduations and pinnings Florence Nightingale Pledge “I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.” 1926 O 1926-A Suggested Code O Elegant, but not specific O 1926-published in American Journal of Nursing (AJN) O Provisionally accepted-but not specific at practical level O Never adopted 1940 O 1940- A Tentative Code O Organized around relationships O Nurse-to-patient, nurse to profession O Emphasized nursing as a profession O 1940-publish in AJN and again asked for comments from AJN readers O Never adopted ANA 1940 Code “The nurse has a basic concern for people as human beings, confidence in the power of personality for good, respect for religious beliefs of others, and a philosophy which will sustain and inspire others as well as herself.” Ethical Codes O Many versions proposed O 1950 version was the first to be officially accepted O The Code for Professional Nurses O Enumerated specific provisions O Professional relationships no longer overt organizing framework ANA 1950 “professional nurses do not permit their names to be used in connection with testimonials in the advertisement of products.” Speaks for itself Revised in 1956 “Professional nurses assist in disseminating scientific knowledge through any form of public announcement not intended to endorse or promote a commercial product or service. Professional nurses or groups of nurses who advertise professional services do so in conformity with the standards of the nursing profession” 1950 Code “The nurse must adhere to standards of personal ethics which reflect credit upon the profession.” 1960’s bring changes 1960 O Shift to how to uphold and enforce the code O Developed guidelines for handling alleged violations of the code 1968 O Dropped professional in title-code applied to professional and technical nurse O Dropped reference to private ethics of nurse O No specific mention of physicians O Provisions condensed down to 10 1970’s Bring more changes O 1976-Code of Nurses with Interpretive Statements O Patient participation in care O Nurse autonomy O Nurse as advocate O Use of client in place of patient O Nonsexist language 2001 O 2001 Code of Ethics with Interpretive Statements O Social justice O Recognition of intrinsic worth of all humans O Providing care according to professional standards O Just treatment of the nurse 2001ANA Code “the need for health care is universal, transcending all individual differences. The nurse establishes relationships and delivers nursing services with respect for human need and values, and without prejudice.” Provision 1 “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” Therapeutic use of self O In every human encounter we convey one of three messages-which one do you want to convey? O Go away, my world would be better without you O You are an object, a task to be done, you mean nothing to me O You are a person of worth, I care about you Provision 2 O “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” O This provision intentionally singled out to demonstrate its significant importance to the code of nursing Provision 3 “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” Provision 4 “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.” Delegation is O “….transferring the responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.” O ANA 1995 Provision 5 “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth” Provision 6 “The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.” Provision 7 “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.” Provision 8 “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” Provision 9 “The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy”
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Running head: ETHICS DISCUSSION POST

Ethics Discussion Post
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ETHICS DISCUSSION POST

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Ethics Discussion Post

Informed consent is an ethical issue in vaccine implementation and delivery because of
the need to provide the necessary and timeline information for parents and patients to make the
appropriate decision. According to The College of Physicians of Philadelphia (2019), it is ethical
when the recipients of vaccines or their parents or guardians are given tim...


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