DEFINITIONS

A. What You Should Know

 

Define:

Deontology:___________________________________________________________________, Kantianism_____________________________________________________________________, virtue ethics____________________________________________________________________, compassion____________________________________________________________________, discernment____________________________________________________________________, trustworthiness_________________________________________________________________, integrity_______________________________________________________________________, and particularism________________________________________________________________.

1. What are focal virtues?___________________________________________________________

2. What are values?________________________________________________________________ How are they acquired and clarified?________________________________________________

3. Why is self-awareness important in professional nursing?________________________________

4. What is the difference between overt and covert values?_______________________________

5. Define these terms as they relate to nursing: autonomy_________________________________, informed consent_______________________________________________________________, paternalism_____________________________________________________________________ beneficence____________________________________________________________________ prevent harm___________________________________________________________________, remove evil or harm_____________________________________________________________, Nonmaleficence_________________________________________________________________, veracity, _______________________________________________________________________

confidentiality,_________________________________________________________________

justice_________________________________________________________________________

distributive justice_______________________________________________________________,

use of material rules_____________________________________________________________,

fidelity________________________________________________________________________.

6. How can moral distress impact nursing practice?_______________________________________

___________________________________________________

B. What You Should Know

*Instructions: Complete this document either in Word or manually (and scanned) and place in the appropriate drop-box before the start of class (ex. If your class begins at 12:00 pm, submit no later than 11:59). This must be completed in its entirety to receive the allotted participation points. All of this information is found in the Power Point presentations and assigned readings. You must be prepared to discuss this information during the synchronous class session. Format your submission: LastnameFirstinitial_Class2_WYSK.doc or .pdf

Week 1, Class 2: What you should know…

1. Where are values learned__________________________________________________?

2. How many levels are in Kohlberg’s Theory of Moral Development?________. Name and define them______________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

3. How many stages are in the theory?_______ What are they called? _________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

4. What is an androgenic study? What is the significance of this topic to us?____________

________________________________________________________________________

5. What is the underlying premise for Gilligan’s study of the Psychological Development of Women?________________________________________________________________

6. How many phases are in Gilligan’s theory? _____What are they called?______________

________________________________________________________________________

7. What is Fowler’s definition of faith? __________________________________________

________________________________________________________________________

8. What are the stages of Fowler’s Theory of Faith Development?_____________________

________________________________________________________________________

9. Why should nurses be spiritually & culturally sensitive in their practice?______________

________________________________________________________________________

10. Define wholistic health care_________________________________________________

11. Define spiritual care_______________________________________________________

12. Define American individualism_______________________________________________

13. How can a nurse’s faith & spiritual health impact their practice?____________________

________________________________________________________________________

14. What is complementary medicine?___________________________________________

15. Name some cultural healthcare treatments____________________________________

_________________________________________

Ethics in Nursing

NUR 4242

Notes # 1

Social, Philosophical, and Other Historical Forces Influencing the Development of Nursing

2

Introduction

Moral action is the historical basis for the creation, evolution, and practice of nursing.

Moral beliefs produce rules of action, or ethics.

Throughout history, spiritual beliefs, religious practice, philosophy, cultural norms, and political factors influenced changes in nursing.

3

Introduction

In the United States, Western tradition and philosophy is the predominate context for nursing.

In an increasingly multicultural environment, it is important to fully appreciate the beliefs and traditions of others.

Social Theory

5

We can only understand each aspect of a social phenomenon in relation to the history and structure in which it is found.

To understand the meaning of ideas and behaviors, we must objectively view them in the context of historical and social practices and entanglements of power and interest.

Influence of Social Need

6

Social need is the criterion for the existence of all professions.

Helping professions find their origin, purpose, and meaning within the context of culturally accepted moral norms, individual values, and perceived social need.

ANA Social Policy Statement

Moral Thought

7

Related to the thoughtful examination of right and wrong, good and bad.

Begins as individuals’ or groups’ desire to meet the needs of others.

Empathy is a motive for moral reasoning and action.

Moral Thought and Nursing

The practice of nursing is focused on meeting the health care needs of others; therefore, the practice of nursing originates in moral thinking.

8

Nursing as Part of Society

9

Professions exist to meet the needs of society.

Nursing must serve the interest of the “larger whole of which it is a part.”

Society grants professionals the exclusive right to practice within defined limits.

Professionals have a reciprocal duty to society to practice competently.

Spiritual/Religious Influences

10

Contribute to the moral foundation of nursing

Influence the gender and activities of healers

Influence beliefs about the value of individuals, life, death, and health

Spiritual/Religious and Nursing

Nursing in some form has existed in every culture and been influenced by spiritual beliefs, religious practices, and related cultural values.

11

Gender Influences

12

In every culture, women have been healers.

Women’s status in society is central to determining the extent of freedom and respect granted to nurses.

Philosophical Influences

Philosophers ask important questions and propose theories that shape culture and influence society.

Questions about truth and reality

Theories about morality and the good life

Theories that impact the scientific method

Ancient Times

14

Cosmology describes how people of the culture view the structure, origin, and processes of the universe.

Early culture linked healers with the sacred.

There is early and diverse cultural evidence of women as healers and priestesses.

Ancient Times

Women were leaders in the healing arts when the reigning deity was feminine, bisexual, or androgenous.

As deities became more masculine the woman’s role as an independent, primary healer was taken away.

Ancient Greeks

Asclepius was the mythical god of medicine and healing. His followers established temples of healing or asclepieions.

Some of his mythological children included:

Hygieia—goddess of health—“hygiene”

Panaceia—goddess of healing—“panacea”

Iaso—goddess of medicine

Ancient Romans

Also worshipped Asclepius. Hippocrates may have studied at an asclepion.

Hippocratic oath begins, “I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea…”

The “Staff of Asclepius” is a snake ascending a staff. It is the official symbol of the AMA and AOA.

Mosaic Health Code

18

Was applied to every aspect of individual, family, and community life, including rest, sleep, cleanliness, hygiene, hand washing, care of food, and childbearing

Required inspection of food, detection and reporting of disease, methods of disposal of excreta, feminine hygiene, and isolation of those with communicable illness

Hippocrates: Father of Western Medicine

Revolutionized healing arts in Greece, established medicine as a profession, believed the care of the sick included observation, symptoms, rational conclusions, and a predictable prognosis.

Proposed the role of healing was to reinstate the healthy balance of four bodily humors.

The Hippocratic oath is attributed to him.

Philosophy in Ancient Times

Philosophers began questioning beliefs, mythologies, and folklore.

Used abstract thinking and asked questions about nature, religion, the origins and nature of things, and the nature of reality and truth

Socrates, Plato, and Aristotle proposed new ideas about truth, reality, relationships, ethics, and the right way to live.

Philosophy in Ancient Times

Socrates developed the Socratic method of teaching, which provides a systemic and objective approach to problem solving.

Aristotle proposed that the aim of the good life is eudaimonia (happiness, flourishing), which is achieved through a virtuous life of excellence.

Early Christian Era

22

Exerted profound influences on healing beliefs and practices.

With religious belief in a single male god, women’s healing role changed from that of a sacred healer to subservient caregiver.

Women’s place in the healing art was minimal when Jesus lived, but he challenged traditions by associating freely with women.

New Testament

The New Testament message regarding the care for others:

Caring for others represents caring for Jesus.

A spiritual reward is gained by caring for others.

Even in an evil world, one should love God and one’s neighbor.

Every person is an important member of God’s Kingdom.

Every person has worth and dignity.

23

Philosophy: Early Christian Era

St. Paul was a highly influential philosopher who held that there is a natural law of conscience in each person.

St. Augustine believed true reality was spiritual and Being comes from God. He emphasized the inner life and contemplation of God and examined the passions of the soul.

Philosophy: Middle Ages

Middle/Dark Ages saw social disruption and cultural deterioration. Most philosophy was theological at this time.

Thomas Aquinas synthesized Greek rationalism and Christian doctrine, which became the cornerstone of Catholic philosophy.

Retranslation of Plato and Aristotle (later Middle Ages).

Nursing in the Middle Ages

26

Based on imitating Jesus, who spent his life ministering to those in need.

Service was viewed as a means of securing salvation.

Religious orders were the way respectable women and men could serve as nurses.

Influences of Middle Ages Church

27

Credentialed health professionals.

Deeply anti-empirical beliefs.

Believed only God and the devil had the power to cause illness or promote healing.

Religious fervor saw treatment not approved by the Church as the work of the devil.

Women healers persecuted.

Health and the Crusades

28

Deplorable sanitary conditions, fatigue, poor nutrition, diarrhea, and the spread of communicable diseases

Military nursing orders formed as a response, which drew a large number of men into the field of nursing

Treatment

29

Some patients were treated as welcome guests; others were treated inhumanely.

Nurses who believed their duty was to God/the spiritual may have paid less attention to physical, emotional, and comfort needs.

Mental illness was seen as possession by the devil or punishment for sins.

Patients chained, starved, and sometimes tortured to try to drive out madness.

Women in the Middle Ages

30

“Women was created to be man’s [helper] but her unique role is conception…since for all other purposes men would be better assisted by other men.” Thomas Aquinas

“Woman is the gate of the devil, the path of wickedness, the sting of the serpent, in a world a perilous object.” St. Jerome

Women healers represented a political, religious, and sexual threat to both Church and state, which added to the beginning of the witch hunts.

Women in the Middle Ages

Religious- and Church-sanctioned secular nursing orders were the only avenues for women as nurses.

During the Crusades, nursing orders provided care in infirmaries and clinics.

Nursing orders were subordinate in the Church, but these women did exercise a degree of autonomy and independence.

Reformation

Led to laws and customs that discouraged the humane care of the poor and vulnerable

“Dark period of nursing”

Nursing orders expelled from hospitals

Hospital care provided by convalescent patients, prostitutes, prisoners, and drunkards

Also allowed for new types of thinking and opened the door for the Renaissance

Renaissance

33

Birth of scientific revolution and a new era in the healing arts.

Philosophical humanism emerged with humans rather than God as the focus.

Empiric phenomena and subjective reasoning became the focus of knowledge.

Brought relief from witch hunts but didn’t really change the lives of women.

Modern Era

Brought tremendous advances in science, politics, and philosophy.

Modern philosophers’ ideas directly influenced nursing.

Cartesian philosophy resulted in a separation between the acts of caring and curing.

Nurse’s role restricted to the caring realm.

Florence Nightingale

Florence Nightingale worked to free nursing from the bonds of the church.

Became a model for all nurses.

Addressed moral and social issues.

Was a nurse, statistician, sanitarian, social reformer, and a scholar.

35

Think About It and Discuss

36

Nursing is primarily a profession of women. How has the social status of women affected the status of the profession in the past and present?

Does the status of the nursing profession change its members’ ability to practice? Explain your answer.

Ethical Theory

Notes # 2

37

Ethics and Nursing

38

It is through the intimacy and trust of the nurse-patient relationship that nurses become critical participants in the process of ethical decision making.

By developing a working knowledge of ethical theory, nurses can make clear and consistent decisions.

Philosophy

39

The intense and critical examination of beliefs and assumptions.

It gives coherence to the whole realm of thought and experience and offers principles for deciding what actions and qualities are most worthwhile.

It gives shape to what would otherwise be a chaos of thoughts, beliefs, assumptions, values, contradictions, and superstitions.

Moral Theory

Provides a framework for cohesive and consistent ethical reasoning and decision making.

The best moral theories are part of larger integrated philosophies.

Two moral theories having the greatest influence on contemporary bioethics and nursing: utilitarianism and deontology.

Morals and Ethics

41

Moral philosophy is the philosophical discussion of what is considered good or bad, right or wrong, in terms of moral issues.

Moral issues are those which are essential, basic, or important and deal with important moral issues.

Ethics is a formal process making logical and consistent decisions, based upon moral philosophy.

Ethical Theories

42

Ethical theories explain values and behavior related to cultural and moral norms.

As a morally central health care profession, nursing requires astuteness concerning moral and ethical issues.

Professional codes of ethics provide a formal process for applying moral philosophy and ethics.

Naturalism

Regards ethics as dependent upon nature and psychology.

Proposes that nearly all people have a tendency to make similar ethical decisions despite differences in culture.

Sympathy is a motivating factor in moral decision making.

43

Rationalism

Rationalists believe feelings or perceptions, though they may seem similar in many people, may not actually be similar in all people.

Believe there exist universal truths, independent from humans, that can be known through the process of reasoning.

44

Utilitarianism

Sometimes called consequentialism, holds that an action is judged as good or bad in relation to the consequence, outcome, or end result that is derived from it.

Holds that no action is in itself either good or bad.

Mill believed it to be in the spirit of the golden rule, “Do unto others as you would have them do unto you.”

45

Types of Utilitarianism

46

Act-utilitarianism: people choose actions that will, in a given circumstance, increase the overall good.

Allows for different, sometimes opposing, action in different situations.

Rule-utilitarianism: people choose rules in all situations that increase the overall good.

Rules that maximize happiness and reduce unhappiness.

Rules are easy to learn and should be strictly followed.

Deontology

47

Deontology is based upon the idea that rightness or wrongness of an act depends upon the nature of the act, rather than its consequences.

Ethical rules are universal, and humans can derive certain consistent principles to guide action.

Moral rules are absolute and apply to all people.

Kantianism

48

Kantianism is a particular deontological theory developed by Immanuel Kant.

The categorical imperative assumes that if an action is morally right, it is reasonable to imagine it as a strict universal law.

The practical imperative requires that one treat others always as an end and never as a means only.

Virtue Ethics

49

No rules or principles. Rather, actions are based upon a degree of innate moral virtue.

A moral virtue is a character trait that is morally valued.

A virtuous person has consistent moral action and morally appropriate desire and will naturally choose the morally correct action.

Focal Virtues

Although people have different character traits, all have the capacity to learn or cultivate those that are important to morality.

Compassion

Discernment

Trustworthiness

Integrity

50

Compassion

The ability to imagine oneself in the situation of another

An attitude of active regard for another’s welfare with an imaginative awareness and emotional response of deep sympathy

51

Discernment

A sensitive insight involving acute judgment and understanding, and eventuating in decisive action

Allows us to see appropriate actions in a given situation and requires sensitivity and attention attuned to the demands of a particular context

52

Trustworthiness

A confident belief in and reliance upon the ability and moral character of another person

Entails a confidence that another will act with the right motives in accord with moral norms

53

Integrity

Moral integrity means soundness, reliability, wholeness, and an integration of moral character.

Refers to our continuing to follow moral norms over time.

One with integrity has the consistency of convictions, actions, and emotions and is trustworthy.

54

Moral Particularism

Embraces the uniqueness of particular cases including the context, culture, situations, relationships, and individuals involved

Recognizes the need for rules that allow for exceptions in situations that deviate from the norm

Relies on other relevant moral principles for the starting point of judgment

Notes # 3

Ethical Principles

56

Ethical Principles

57

Basic and obvious moral truths that guide deliberation and action

Presuppose a basic respect for persons

Included in moral theories, although sometimes in different ways

Respect for Autonomy

Definition: self-governing

Freedom to make decisions about issues that affect one’s life free from lies, restraint, or coercion.

The autonomous person

Is respected

Is able to determine personal goals

Has the capacity to decide upon a plan of action

Is free to act on choices

58

Autonomy

Value of autonomy is culturally dependent.

Some cultures don’t regard all people as of equal value.

Some cultures value social structure over individual rights.

Respect for autonomy does not require respect for all autonomous decisions.

Must uphold respect for self and others who might be harmed by another’s choices.

Respect the principle rather than each action or choice.

Informed Consent

Practical application of the principles of respect for autonomy.

Demonstrates legal protection of personal autonomy in regard to specific medical treatments and procedures

Contemporary informed consent is a direct outcome of past research atrocities.

Paternalism and Advocacy

Paternalism: places power in the hands of the person who is making the decision for the patient. Implies that the decision maker knows what is best.

Advocacy: ensures the patient’s welfare and respects the patient’s autonomy because it aims to act according to the patient’s values.

May unwittingly cross from advocacy to paternalism

Noncompliance

Lack of participation in a regimen that has been planned by the health care professional but must be carried out by the patient.

Patient must have autonomous participation in plan formation

Nurse must assess the patient’s ability to carry out the plan

Ultimately, choices about health care practices belong to the patient.

Beneficence

Requires one to act in a way that benefits others:

Do or promote good

Prevent harm

Remove evil or harm

63

Do or Promote Good

Ask yourself:

How does one decide what is good?

When people disagree, who gets to decide?

Should other ethical principles, such as truthfulness and autonomy, be violated in the process of doing good?

64

Prevent Harm

Ask yourself:

In what instances might a nurse be compelled to prevent harm?

How far should a nurse go to prevent harm?

65

Remove Evil or Harm

Ask yourself:

In what type of situations would a nurse need to remove harm?

What are the risks to the nurse?

What characteristics does a nurse need in order to remove harm in a difficult situation?

66

Nonmaleficence

Requires one to refrain from causing harm, including:

Deliberate harm

Risk of harm

Harm that occurs during the performance of beneficial acts

67

Think About It

Doing good often includes causing harm; for instance, a surgeon might save a life (doing good) by amputating a limb (causing harm).

How does one balance good and harm?

When the outcome is unsure, who decides?

68

Veracity

Definition: telling the truth

Implies respect for others.

Is required of those who support autonomy of others.

Authorities disagree on the absolute necessity of truth telling in all instances.

69

Confidentiality

Definition: nondisclosure of private or secret information about another person

A traditional tenet of nursing and medical ethics

A legal mandate in nearly all cases

Is sometimes limited by harm and vulnerability

Flows from respect for persons and their autonomy

70

Justice

Relates to fair, equitable, and appropriate treatment in light of what is due or owed to persons

Recognizes that giving to some will deny receipt to others who might otherwise have received these things

71

Distributive Justice

Application of the principle of justice that focuses on distribution of goods and services

To each equally

To each according to need

To each according to merit

To each according to social contribution

To each according to the person’s rights

To each according to individual effort

To each as you would be done by

To each according to the greatest good to the greatest number

72

Material Rules of Distributive Justice

Systematic means of deciding such as:

Give to each person equally

Give to those who need it most

Give to those who deserve it most

Give to those who can pay for it

Give to those who arrive first

73

Use of Material Rules

Which material rule is used when:

Private hospitals turn away indigent patients?

Immunizations are given to all fifth graders?

A free clinic accepts only the first 30 patients?

Scholarships go to those with low incomes?

74

Fidelity

Definition: faithfulness and promise keeping

Nurses must faithfully

Uphold the profession’s code of ethics

Practice within established scope of practice

Practice competently

Keep promises to patients

75

Chapter 4

Values Clarification

76

Values

77

Values are ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups, or society.

Values influence choices and behavior, whether or not we are consciously aware of this influence.

Expressed by choices and behavior in daily life

Moral Values

78

Individual cognitive evaluation of right and wrong, good and bad, is reflective of moral thought.

Preferences or dispositions reflective of right or wrong, should or should not, in human behavior are considered moral values.

Acquiring Values

79

Personal ethical behavior flows from values held by an individual that develop over time.

Cultural, ethnic, familial, environmental, educational, and other experiences of living help shape our values.

Self-Awareness

80

Ethical relationships with others begin with self-knowledge and the willingness to express that awareness to others honestly and appropriately.

Self-knowledge is an ongoing, evolving process that requires us to make a commitment to know the truth about ourselves.

Values Clarification

Refers to the process of becoming more conscious of and naming what we value or consider worthy.

May lead to different insights for different people

Be willing to take an honest look at personal ideals, behavior, and motives

81

Enhancing Self-Awareness

82

Goes hand in hand with values clarification

The first and most important step in awareness of the self is the conscious intention to be aware of one’s:

Thoughts

Feelings

Emotional and physical responses

Insights into various situations

Motives

Valuing Process

83

Prizing and cherishing one’s beliefs and behaviors

Choosing one’s beliefs and behaviors by evaluating values received from others

Acting on these beliefs with a consistent pattern that reinforces actions supportive of these values

Journaling

84

Keeping a written record

Important to assist one in becoming aware of his or her own values

Values in Professional Situations

85

It’s important for the nurse to identify his or her own values, thoughts, and motives.

Values conflict.

When personal values are in conflict or at odds with a patient’s, colleague’s, or institution’s values.

Overt Values

Values of individual institutions and organized health care systems that are explicitly communicated through philosophy and policy statements

86

Covert Values

Values that may be implicit in expectations that are not in writing.

Many times, these covert values are only identified through participation in or controversies within the setting.

87

Moral Distress

88

Reaction to a situation in which there are moral problems that seem to have clear solutions, yet we are unable to follow our moral beliefs because of external restraints.

This often leads to a miserable work life.

Clarifying Values with Patients

89

Patients are consumers of health care.

Nurse and health care workers are providers of health care.

Patient and provider perceptions of what constitutes quality of care can be quite different.

Health History and Medical Information