chapter 22 ethics and values so ethics is the study of what is right and wrong within our conduct morals refer to a judgment about a behavior based on beliefs and ethics refers to the study of the ideals of right and wrong behavior a value is a deeply held personal belief about the worth that the person holds for the idea custom or an object study of bioethics represents a branch of ethics within the field of healthcare autonomy refers to freedom from external control in healthcare the concept of autonomy applies to respect for the autonomy of patients beneficence this refers to taking positive action to help others the concept of beneficence is fundamental to the practice of nursing the agreement to act with beneficence implies that the best interests of the patient remain more important than our own self-interest this also implies that nurses practice primarily as a service to others non-maleficence this refers to the avoidance of harm or hurt in healthcare ethical practice involves not only the will to do good but the equal commitment to do no harm justice refers to fairness and the distribution of resources this term is often used in discussions about access to health care which includes the just just just distribution of scarce services as well as resources fidelity this refers to faithfulness or the agreement to keep promises as a nurse we have a duty to be faithful to our patients that we care for to the institution we work for as well as to ourselves code of ethics this is a set of guiding principle that all members within a profession accept it is a collective statement about the expectations as well as standards of behavior advocacy refers to applying one's skills and knowledge to benefit another person responsibility is a willingness to respect one's professional obligations and to follow through accountability this is answering for your own actions so that you as the nurse ensure that your professional nursing actions are explainable to your patients as well as to the employer confidentiality this refers to the healthcare's obligation to respect patient privacy confidentiality is a fundament fundamental part of the nursing page patient relationship your patient is about to undergo a controversial orthopedic procedure the procedure may cause periods of pain although nurses agree to do no harm this procedure may be the patient's only treatment choice this example describes the ethical principle of what the answer is d sometimes to improve a patient's condition it's necessary to perform a procedure that will cause pain for the patient as a nurse we weigh the benefits and the risks with the patient in our quest to do no harm ethical dilemmas almost always occur during conflicting values to resolve an ethical conflict or dilemma we need to distinguish among value fact and opinion facts are supported by the objective data and opinions are supported by views or ideas that are not based on a fact sometimes people have extremely strong values that they actually consider them to be facts however when people express a strong emotion this is a sign that they feel their values are threatened sometimes individuals may be so passionate about their values that they may become judgmental in a way that it might intensify conflict so we need to clarify values we need to clarify our own nursing values our patients values and co-workers values clarifying values is an important and effective part of ethical disclosure and discourse these are various approaches to determining ethics so you can read that deontology we're looking at whether it's right or wrong in utilitarianism this is the values determined by its usefulness so each of these has their own specific definition after you read this first case study please pause and consider who is likely to need further health care in the near future after reading this slide what is your first thought process your first reaction to this situation after reading through this help come up with an answer as why you think lucille is convinced that her mother is not having medical i'm sorry mental problems all patients within the health care system interact with nursing at some point and the interaction is unique specific to the nursing profession so we as nurses will engage with patients over longer periods than anyone else within the system we're involved in intimate physical acts such as bathing feeding and various special procedures as a result of this oftentimes patients and families will feel more comfortable revealing information or asking questions that they will not share with anyone else it may be details about their family life information related to potential coping strategies personal preferences fears and insecurities we consider an ethical problem as a dilemma when the two opposing courses of action may both be justified by an ethical principle in moral distress instead of competing options for action as a nurse we feel the need to take a specific action while believing that action to be wrong as values and obligations ethical problems can create some very difficult emotions processing an ethical problem begins with recognizing that the ethical problem even exists hospitals routinely have an ethics committee that is devoted to teaching and processing of these types of issues and dilemmas the ethics committee will involve individuals from various disciplines and backgrounds and their major functions of ethics committee is to provide clinical ethics consultation develop and or revise policies that have to do with clinical ethics as well as hospital policy and facilitating education about issues in clinical ethics these are various issues that when we stop and consider them they come into our nursing life at various times throughout the day so you look at social media right is what they're playing what they're posting on there is it good is it bad you look at the quality of life is it quality of life versus quantity of life care of life so what do you believe your patient needs at the end of their life for their for their care and then disparities or access to health care if a nurse decides to withhold a medication because it might further lower the patient's blood pressure the nurse will be practicing what principle the answer is b if a nurse decides to withhold medication despite the provider's order the nurse is then accountable for their action as the nurse made the independent decision based upon their knowledge of the patient and the patient situation at that given moment after you read through this slide consider what you think about lucille's reaction think about the situation that this case presents to mary and the nurse and how um of processing the ethical dilemma so for this you need to review the steps for processing an ethical dilemma so on the last slide we noted that the nurse mary ann in step one has concluded that an ethical dilemma exists now i want you to apply the for the um sequential steps of the process go ahead and gather all of the relevant information for the case think about your own values and opinions