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Nursing Ethics NURSING ETHICS Dana Bartlett, RN, BSN, MSN, MA Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material and textbook chapters, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students. Abstract The American Nurses Association (ANA) Code of Ethics for Nurses contains nine provisions developed for nurses to guide them in everyday nursing practice, helping nurses carry out their responsibilities and the ethical obligations when caring for patients. Making ethical decisions is an essential part of nursing practice. It involves specific values, attitudes, and conduct that nursing as a profession carry forward to benefit patients, the profession of nursing, and society as a whole. Nursing ethics according to the ANA and case examples of each ANA provision are discussed. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 1 Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 2.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Ethical decision-making is a necessary part of nursing practice. The professional practice of nursing is always changing and evolving to address the complex needs of society and of healthcare. Nurses need to be educated on ethical decision-making in healthcare to stay abreast of issues and to be actively involved as professionals in the dialogue of ethics. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 2 Course Purpose To provide nursing professionals with knowledge of the American Nursing Association’s (ANA) code of ethics and practical applications of the code in clinical situations. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Dana Bartlett, RN, BSN, MSN, MA, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 1/1/2016 Termination Date: 9/19/2018 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 3 1. Ethics are defined as a. behaviors/attitudes that a group considers desirable or harmful. b. personal feelings about right and wrong. c. beliefs that categorize attitudes and behaviors as good or bad. d. a system of morality. 2. Which of the following is a specific provision of the ANA code of ethics? a. Nurses should not profit unreasonably from their work. b. The nurse’s primary commitment is to the patient. c. A nurse should collaborate with other healthcare professionals. d. Nurses not interfere with a patient’s decision to refuse treatments. 3. True or false: The ANA code of ethics is considered equivalent to laws. a. True. b. False. 4. The ANA code of ethics states that nurses have responsibility for nursing practice. a. This provision is used to assign legal responsibility for nursing actions. b. This provision is intended to differentiate nurses from physicians. c. This provision reinforces that nurses are independent professionals. d. This provision clearly outlines what nurses can and cannot do. 5. Ethical decisions a. frequently require collaboration with other healthcare professionals. b. are seldom complicated or difficult. c. seldom require collaboration with other healthcare professionals. d. should never involve the patient; the nurse is the professional. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 4 Introduction The relationship between a nurse and patient is one of trust, responsibility, and caring. The healthcare environment is a professional workplace where nurses interact not only with patients but also with their co-workers and others. Because of this, the profession of nursing is inextricably linked with ethics. Ethics, in its simplest terms, means doing what is right. Doing what is right is part of the daily functions of the nurse. While ethics is part of every profession, each one has its specific ethical concerns. This module will examine ethics that are specific to nursing. Ethics, Values, And Morals This module will discuss the ANA’s code of ethics and the nine provisions of that code. In order to provide a background for that discussion, ethics, morals, and values will be defined and explained. Ethics Ethics involves specific behaviors and attitudes that a group of people or a society considers to be beneficial and desirable, as well as attitudes and behaviors that are considered bad and harmful. Ethics could also be considered as principles of conduct. Additionally, ethics are social in nature. Some of the aspects of ethics in healthcare are listed in Table 1, which relate to privacy, confidentially, beneficence, nonmaleficence, human dignity, informed consent, and autonomy. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 5 Table 1: Ethics In Healthcare Privacy - Seclusion from the presence of others Confidentially - Spoken, written or acted on in privacy Beneficence - Doing good, performing acts of kindness Nonmaleficence - Doing no harm Human Dignity - Respect for the intrinsic worth of humans Informed Consent - Right and responsibility to freely and voluntarily consent or refuse treatment or a procedure, and being given enough information to do so. Autonomy - Ability of an individual to maintain control over her/his life and health. Values Values are beliefs about attitudes and behaviors, and values categorize attitudes and behaviors as good or bad. Although we can offer explanations and rationales for our values, a value cannot truly be explained or defended; it can only be believed in or not, adhered to or ignored. Despite that, there are many values that are shared by essentially everyone and almost universally accepted to be good or bad. Morals Morals are closely connected to values, but the term moral is used to describe a person’s values. Someone who has what is considered to be good values and whose behavior reflects those values is said to be a moral person and to be someone who acts morally. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 6 ETHICS → VALUES → MORALITY Ethics then can be seen as values in action, and ethics are generated by the values of a group or a society or what that group or society believes is good or bad. Ethics is a set of rules for what society should and should not do and values are the underpinnings for specific ethics. Morality refers to how closely an individual or a group adheres to a set of ethics. A simple example can be used to connect these concepts. It is illegal to physically harm another person except for the purpose of self-defense or protecting someone else. Causing physical harm is illegal because we value each individual’s health and safety and believe that causing injury or pain to another person is wrong. Someone who commits a battery will be judged to have behaved immorally and perhaps unethically, as well. The specific value determines what is good or bad behavior. Ethics, Law, Religion, And Conscience Ethics are not law and laws are not ethics. Laws may be derived from ethics. Unlike ethics laws are binding and must be recognized by every member of a society. There can be ethical disputes, which remain simply disputes; but, breaking a law is quite different. nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com nurseCe4Less.com 7 Violation of a law is associated with a specific punishment; whereas, to violate an ethical standard may or may not be punishable. Importantly, ethics are not religion. Ethics are certainly part of religion, but religion is personal acceptance and belief in a system that has associated ethics, values, and morals. Ethics are not individual feelings of what is right or wrong. Ethics are not the conscience. Conscience belongs to an individual. Ethics
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