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(WEEK 6)

PROFESSIONAL ETHICS

- A branch of biological science concerned with the obligations of a member of a profession owes to the

public, to his profession and to his clients

FUNCTIONS OF THE PROFESSIONAL CODE OF ETHICS

- Set forth basic principles and regulations to serve as guidelines- Serves as resources for the orientation of new practitioner for their duties, rights and privileges- Serves as guidelines to identify and evaluate qualities synonymous with professional conduct- Provides guidelines for the establishment and operation of education programs to prepare future members for

service in the profession

- Identify common practices to be followed and those to be shunned- Provides a guide for considering the relationships of individuals to their employers, co-workers, society in

general and to their own profession- Serves as basis for identifying standards of quality practice consistent with actions of the qualified, competent

practitioner- Provide by implication for legal actions against incompetents and violators of the code and for liability of the

consequences of their actions- Provide for due process under the law for practitioners unjustly accused of misconduct in the performance of

their duties

CODE OF ETHICS

- A formal statement of a groups ideals and values.- Have higher requirements than legal standards and never lower than the legal standards of the profession

CODE OF GOOD GOVERNANCE FOR THE PROFESSIONALS IN THE PHILIPPINES

- signed into law by Pres. G.M. Arroyo June 23, 2003 EO 220 to be adopted by the Governance AdvisoryCouncil and the Philippine Regulation Commission thru various Professional Regulatory Boards.

OBJECTIVES OF ADOPTING A CODE OF GOO GOVERNANCE FOR PROFESSIONALS:

- Promote & establish ethical awareness and competency among Filipino professionals making accountable totheir public liability and fulfill their professional obligations to their clients

- Empower professionals not only to upgrade or improve their technical and ethical proficiency but also to

keep abreast with modern trends and technology in their respective professions.

The HALLMARK OF TRUE PROFESSION is their WILLINGNESS to ACCEPT a SET OF PROFESSIONALand ETHICAL PRINCIPLES.

GENERAL PRINCIPLES OF PROFESSIONAL CONDUCT

- Professionals aside from having ethical commitment and personal resolve to act literally but to have also :a. Ethical awareness

- ability to discern between right and wrongb. Ethical competency

- ability to engage in sound moral reasoning and consider carefully the implications of alternative actions

SPECIFIC PRINCIPLES OF PROFESSIONAL CONDUCT

1. Service to others

Professionals are committed to life of service to others2. Integrity and objectivity

Professionals should perform their responsibilities with the highest sense of integrity andnationalism and spiritual values.

3. Professional competence

Professionals should have the knowledge, technical skills, attitudes and experience

Obligation to keep up with new knowledge and techniques in their field and take part in lifelong

continuing education program4. Solidarity and Teamwork

Each profession shall nurture and support one organization for all its members

Each member should put the broader interest of the profession above ones personal ambition and

preference

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5. Social and Civic Responsibility

Professionals should always carry out their professional duties with due consideration of the

broader interest of the public.6. Global Competitiveness

Every professional shall remain open to the challenges of a more dynamic and interconnectedworld rising up to global standards and level of professional practices aligned with global practices

7. Equality of all Professions

All professionals should treat their colleagues with respect and strive to be fair with one another.

eHealth Code of Ethics

- From the Internet Healthcare Coalition Members published the eHealth Code of Ethics May 24, 2000- Vision is:

To ensure that people worldwide can confidently and with full understanding of knownrisk realize the potential of the internet in managing their own health and the health of

those in their care.- Issued this code of conduct for marketers, health professionals and creators of Web sites

- With 8 concepts:1. Candor discloses beneficial information on the World Wide Web

2. Honesty

3. Quality-

4. Informed consent

5. Privacy6. Professionalism in online health care

7. Responsible partnering

8. Accountability

NURSING ETHICS

- A set of ethical principles that is:a. shared by members of the group

b. reflects their moral judgments over time

c. serves as a standard for their professional actions

NURSING CODE OF ETHICS

Purposes of the Nursing Code of Ethics

Inform the public about the minimum standards of the profession and help them understandprofessional nursing conduct

Provide an indication of the professions commitment to the public it serves

Outline the major ethical considerations of the profession

Provide ethical standards for professional behavior

Guide the profession in self-regulation

Remind nurse of the special responsibility they assume when caring for the sick

International Council of Nurses

- An organization of all nurses all over the world collaborating to strengthen nursing service, nursing education

and professional ethics

- Ms. Ethel Gordon- English nurse initiated the forming of international organization for nurses 1899- The International Council of Nurses was organized July 1899

- The member association in the Philippines is the Philippine Nurses Association(PNA) 1929

- First adopted by the International Council of Nurses (ICN) 1953 an international code of ethics for nurse

(WEEK 7)

THE CODE OF ETHICS FOR NURSES IN THE PHILIPPINES

o Code of Ethics of Filipino Nurses

- Dean Emeritus Julita Sotejo of PNA Special Committee developed a Code of Ethics for the Filipino Nurses

1982

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- 1984- the Board of Nursing officially adopted the International council of Nurses (ICN) Code of Ethics andadded the 5th commitment promotion of spiritual environment as Board Resolution No. 633.

- 1989 PRC approved the Amended Code of Ethics by the general assembly of PNA in 1990

BRIEF HISTORY OF THE PHILIPPINE NURSING LAW

- Act No. 2493 of 1915 the practice of nursing was contained in this act that regulated the practice of nursing- Applicants needed to be:

21 years old good moral character

requires 2 years and a half of instruction

graduates were called first class nurses

those who desired to be second class filed application with the district health officer inthe district where they resided

- Act 2808 of 1919- known as the First True Nursing Law

Created the board of examiners for nurse

1920- the first board examination in the Philippines was given- RA 877 Philippine Nursing Law of 1953

Organization of the Board of Examiners for Nurses

Provisions regarding nursing schools and colleges and miscellaneous provisions relativeto the practice of nursing

- RA 4704 of 1966 amended certain portions of RA 877

Proposed 1 professional program in nursing and widening the scope of nursing practice(PNA of 1976)

- RA 7164-or the Philippine Nursing Act of 1991

revised all the laws regulating the practice of nursing in the Philippines- RA 9173 or the Philippine Nursing Act of 2002

Empowered and ordered the Board of Nursing to promulgate a Code of Ethics forRegistered Nurses in coordination with the PNA

- The Code of Good Governance for the Professions in the Philippines was utilized as the principal basis withall the principles under the said Code (Code of Ethics)integrated and applied to the nursing profession

THE HUMAN PERSON

- One is human by virtue of ones genetic code, while a person is a member of a moral community.

- A person has the following elements:

The Personhood

Has characteristics recognized by the community (consciousness of objects

and events, ability to feel pain, ability to reason, self-motivated activity,capacity to communicate and ones concept of the self)

With moral status

Acknowledged with right ( most of the focus of ethical thought is the personwith personal rights and responsibilities)

Elements of the Personhood

A subject- human beings exist as creatures under the rule of God ,the Creator, subject to His authority

Embodied subject- have human body

Part of the Material World- God created the world, took dust andformed man and breathed life into it

Inter-relational with Person- relationship between different people

An Interdependent Social Being- need to care for each other.

Historical- individual exists within a historical framework andinterested in their ancestors

Equal but Unique- each person has equal right despite economic,educational or psychological differences yet not all the same

Called to Know and Worship God- ability to know and respond toGod; capacities and gifts benefit to the community

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(wk 8)

THE HUMAN ACT AND THE ACTS OF MAN

Human Act

- Actions that are deliberately done involving human reasoning and intellect- Performed consciously and knowingly

Acts of Man

- Actions done by a person considered unseemly- Not dependent upon intellect and free will

Elements of Human Act

Knowledge

Aware of what he is doing whether good or bad

Freedom

Acting by his own volition and power

Passion as fear and anger are possible hindrance to human acts as they cloud judgment and freewill

Actual Choice or Voluntariness performed by an agent who decides willfully to

perform the act.

1. Principle of Indirect Involuntariness (PRINCIPLE OF TWO-FOLD EFFECT)To be judged as morally good an action with double effect must have the following criteria:

a. Action must be morally good and must not be evil by itselfb. The good effect must be willed and the bad effect merely allowed.c. The good effect must not come from evil action but must come from the initial action directly.d. The good effect must have greater effect than the bad effect.

2. Principle of Double Effect: Human Acts with Good and Bad Effect

Human acts result in both good and bad consequences

The human act to be performed becomes an ethical problem

Conscience

- Making moral decisions demand

a. Maturity and responsibilityb. Understanding of realityc. Attentive to the wisdom of the pastd. Discern the biases and demands of a particular situation

Definition of Conscience

- practical judgment of human reason concerning the moral goodness or evil of ones action- small voice within telling us whether we have done something right or wrong or decisions we are

considering is a good one or bad one

Concepts of Conscience

Heteronomous conscience

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- focus solely on laws and obligation, commands and prohibitions

- tied to normative ethics

Autonomous conscience

- Totally subjective- Ignores the law and by itself determines what is right and what is wrong

Levels of Conscience

Antecedent actual conscience

Refers to the whole process of making judgment in conscience before the moral act

Concomitant actual conscience

Actual awareness of being morally responsible for the goodness or badness of a particular act

which man carries out

In effect, mans conscience informs him that hes acting in a good way or morallyreprehensible

Consequent actual conscience

Involves the process of reflection on ones moral responsibility relative to past action

Dimensions of Conscience

Man develops a general sense of value which is the awareness that he should do good and avoid evil

Man search for truth and turns into a variety of sources as Bible, Koran , religions and churches,

educational institutions, traditions and competent professionals for guidance

After searching for the truth and turning into sources, man can eventually come up with concrete

judgment and specific decision

Formation of Conscience

Man says I must follow my conscience.- needs discernment and application of what is right and whatis wrong

Obey your conscience- must be properly understood to be properly used; choice made in good faith tomake what one ought himself to be

The dignity of human person implies and demands the integrity of the moral conscience

Man must try to make sure that ones moral judgment is right by :

Diligently learning the laws of moral life

Seeking expert advice on difficult cases

Removing the obstacles to right judgment

Personal examination of conscience

Formation of conscience is a long and comprehensive process that will later facilitate an

immediate and right judgment in any concrete situation

Doubtful Conscience

- The suspension of judgment on the moral goodness of an action because the intellect can not see clearlywhether it is good or bad

- Doubt may refer :

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To law itself in its content

To the action

If there is reasonable ground for doubt, one may not act until it is solved

Principles in Resolving a Doubtful Conscience

The most important reflex principles are:

A doubtful law does not bind

In case of doubt, the professor has a better right

A person is presumed innocent until proven guilty

In case of doubt, one has to judge according to what ordinarily happens

An act is to be proven valid until proven otherwise

In case of doubt, what is odious should be restricted and what is favourableshould be expanded

Scrupulous Conscience

Action is sinful based on weak or insufficient reason

- The symptoms are:

Excessive anxiety over the sufficiency of good actions especially over the validity of past confessions

Fastidious accusations, scrutinizing and unnecessary circumstances especially with regards to internalsins

Persistence in ones opinion leading one to mistrust ones confessor and go from one confessor toanother

- Causes of scrupulous conscience are:

Natural such as physical (sickness)

Moral- such as self-centeredness, dealing with excessively strict person, or even hidden pride

- Remedies of scrupulous conscience

Removal of its cause

Strict obedience to ones confessor

Orderly work and suitable recreation

Prayer

Trust in God who is our Father

Lax Conscience

Judges without sufficient reason that a certain action is not sinful or is slightly sinful

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PHARISAIC ( excessively or hypocritically pious)- conscience characterized by stiffcorrectness in some things especially external and unimportant ones together with great laxity

in matters of far greater importance

Causes of lax conscience:

Poor moral education

Dealing with corrupt people Strong disorderly passions

Immersion in vices for a long period of time

j

Principles Used in Moral Discernment

Principles of double effect

Principle of the lesser evil

Principle of material and formal cooperation

1. Cooperation in this context means physical or moral concurrence

with the principal agent in an immoral act

2. Formal cooperation is present when one concurs with the sinful deedof another and gives internal consent to do it.

3. Material cooperation means that one somehow externally participatesin anothers sinful deed without giving any internal consent

Making moral decisions

Choosing the action does not fully promote humanity

A mature moral decision is not that we ought to do but what we ought ourselvesto be

o Modifiers of Human Acts

Man is responsible before God only for true human acts.

The following elements may lessen or even eliminate moral responsibility:

Ignorance- lack of knowledge of a person capable of knowing.

Different types of ignorance

1. Ignorance of the law lack of knowledge that a particular law exists

2. Ignorance of the fact- lack of realization that one is violating a law

3. Vincible ignorance- culpable negligence; DOES NOT ELIMINATERESPONSIBILITY BUT LESSENS IT; DESTROYS VOLUNTARINESS AND

RELIEVES THE AGENT OF RESPONSIBILITY

4. Simple Vincible ignorance- no sufficient effort to dispel ignorance

5. Crass Vincible ignorance- results from a mere lack of effort.

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6. Affected Vincible ignorance- deliberately fostered in order to avoid any obligationthat knowledge might bring to light

7. Invincible ignorance- cannot be dispelled because the person is unable to secureadequate information even after a reasonable effort or simply the person does notknow there is a problem.; ELIMINATES RESPONSIBILITY

FEAR - an agitation or disturbance of mind resulting from some present or imminent danger. Types of fear are:

1. Light fear- an evil threatening is either present-but-slight or grave-but-remote

2. Grave fear- evil threatening factor is considered serious

3. Intrinsic grave fear- agitation of mind which arises because of a disposition within ones ownmind or body

4. Extrinsic fear- arises from something outside oneself and justly caused

* FEAR DIMINISHES THE VOLUNTARY NATURE OF AN ACT

Concupiscence- any human impulses or the tendency of human nature towards evil; technically

called PASSIONS

1. Types of Concupiscence:

a. Antecedent concupiscence- sort which precedes an act of the will is not willfullystimulated as sudden anger; lessens the voluntariness and responsibility but does nottake them away

b. Consequent concupiscence- stimulated by the will such as deliberate anger; person iscompletely responsible

Violence- external factor applied by someone on another in order to compel him to perform an

action against his will

1. Perfect Violence- either be physically or morally perfect ; violence is entirely involuntaryand there are no moral responsibilities

a. A physically perfect violence- every possible means of resisting is utilized

b. A morally perfect violence- all powers of resistance that should be used areemployed.

2. Imperfect Violence- some resistance is shown but not as much as should be; less voluntaryand so the moral responsibility is lessened but not taken away completely.

Other Factors Affecting the Voluntary Nature of Human Actions-

1. Habit- acquired by repetition and characterized by a decreased power of resistance and anincreased facility of performance; sometimes called second nature meaning something

deeply ingrained in an individual through acquisition rather than inborn.

2. Temperament- sum total of those qualities which mark an individual ; heredity andenvironment play important roles in forming a persons temperament

Four Major Temperaments:

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a. Sanguine pleasing, agreeable, not a good leader because not very stable

b. Choleric domineering, strong-willed, good leader

c. Melancholic- pessimistic, brooding, usually unscrupulous, despairs easily

d. Phlegmatic easy-going, lacking initiative, trustworthy

*A PERSONS TEMPERAMENT CAN AFFECT HIS WILL TO THE EXTENT OF

SOMEWHAT LESSENING THE COMPLETELY VOLUNTARY NATURE OF HIS

ACTIONS

Mental States- nervous mental disorders can completely take away the voluntary nature of

certain acts; affect the proper operation of intellect and will

o Human Rights

Those items which are a persons due as a member of the society; no; earned and existindependently of law or public opinion; founded on essential and universal need; occur in the

context of a culture and influenced by the beliefs or value systems of that culture

Types of Rights

A right is something owed to an individual according to just claims; legal guarantee or moral

and ethical principles

Welfare rights- known also as legal rights as they are guaranteed by law; Bill of

Rights

Ethical rights- based on moral or ethical principles that usually do not require the

power of law to be enforced; in reality these are privileges

Option rights- based on the fundamental belief in the dignity and freedom of humans;

basic human rights; give individuals the freedom to choice but within boundaries.

(wk 9)

THE CALLING OF THE HEALTH CARE PROVIDER

o TheHealth Care Profession- treats and tends to clients who are injured, sick, disabled or infirm. The

delivery of modern health care depends on an expanding interdisciplinary team of trainedprofessionals

o AHEALTH CARE PROVIDER OR HEALTH PROFESSIONAL- an organization or person who

delivers proper health care in a systematic and professional way to an individual in need of health care

services

o The CLIENT - receiver of competent nursing care

o Patients Right

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Patients rights moral and inviolable power vested in a client as a person to hold, do ordemand as his own

Every right in a client involves corresponding duty in a nurse to respect and violation is

morally wrong.

The INC Code of Ethics provides that inherent in nursing is respect for human rights,including the right to life, dignity and respect

Nursing care is unrestricted by considerations of age, color, creed culture, gender, nationality,politics , social status and disability

o The Patients Rights

Right to competent care

Nurse has the necessary education, training and experience

Personality to carry out the services for which they are responsible

Lacking in these, nurse may be sued for:

Negligence commission or omission of an act pursuant to a duty, that a

reasonably prudent person in the same or similar circumstance would or would

not do

Elements of Professional Negligence

a. Existence of a duty on the part of the health care professional incharged to the client, to use due care under circumstances

b. Failure to meet the standard of due care

c. Foreseeability of harm resulting from failure to meet the standards

d. The fact that the breach of this standard resulted in an injury to theclient

Common acts of negligence are:

a. Burns

b. Objects left inside the clients body

c. Loose dentures lodged in clients trachead. Falls of children and adults or unconscious or weak clients

e. Failure to observe and take appropriate action for emergencysituations

f. Medication errors

Malpractice

a. Negligent acts of persons engaged in the professions or occupation in

which highly technical or professional skills are employed

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b. Denotes stepping beyond ones authority; idea of improper or

unskillful care of a client by a nurse

c. Carelessness of professional personnel

Freedom from harm

a. Risk-benefit ration- appropriate balance between potential benefits of the clientsmedical regimen and the risks assumed by the client; benefits should outweigh the harm

b. Minimal risk exposure to the possibility of injury going beyond everyday situation

c. Medications are toxic and should be monitored for therapeutic as well as side effects

Right to Withdraw from participation

Right to confidentiality of information

1. Confidential information maybe revealed when:

a. Client himself permits such revelation

b. Case is medico-legal in nature

c. Client ill with communicable disease

d. To members of the health team if such information is relevant to hiscare

Right to Self-determination- related to the principle of autonomy

1. Clients rights under self-determination:

a. Right to informed consent-

Informed consent- knowledge information about and the consent to a

particular form of medical treatment before it is administered

b. Right to informed decision

c. Right to informed choice

d. Right to refusal of treatment

Limitations of a Patients Right

a. Clients right do not include the right to be allowed to die-

b. A patient in a declining condition does not possess the necessary mental capacity oremotional stability to make an informed consent

c. Patients rights are not absolute

The Magna Carta of Patients Rights

Patients Bill of Rights adopted by the American Physician Association (APA) or theAmerican Hospital Association (AHA)

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The Patients Bill of Rights within the scope of the proposed Magna Carta of Patients Rights-

humanizing element of health care ethics

Patients Duties And Obligations

The Dying Patients Bill of Rights

o The Health Care Provider

The Rights something owed to an individual according to just claims, legal guarantees or moraland ethical principles

Nurses Bill of Rights

o Bill of Rights and Responsibilities for Students of Nursing

Modern health care is a team practice

The goal is to render service to humanity

o Hypothetical Models used for the examination of the physician-client relationship

Engineering Model- the physician acts as a scientist who deals only the with facts

Priest Model- the physician operates from the moral position of knowing what is best for the

client; the client is made to believe that her own opinion is not of the same value as that of thephysician

Collegial Model- physician and client should see themselves as colleagues solving the common

problem of eliminating illness

Contractual Model- share decision making model which the client is accorded the right to make

decisions and have control over his own life whenever significant decisions are to be made.

(wk 11)

QUALITIES AND RESPONSIBILITIES OF THE HEALTH CARE PROVIDER

o The health care provider is one who exercises skill and judgment or provides a service related to:

Preservation and improvement of the health of an individual

Treatment/care of individuals who are sick, injured, harmed, disabled or infirmed

o Jean Watsons Ten Primary Curative Factors:

The formation of a humanistic-altruistic system values

The instillation of faith-hope

The cultivation of sensitivity to ones self and others

The establishment of a helping-trusting relationship

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The expression of feelings both positive and negative

The systematic use of the scientific problem-solving method for decision making

The promotion of the interpersonal teaching-learning

The provision for a supportive, protective and or corrective mental, physical, socio-cultural and spiritualenvironment

Assistance with the gratification of human needs

Jean Watsons Ordering of Needs

Lower Order Needs

Biophysical Needs

1) The need for food and fluid

2) The need for elimination

3) The need for ventilation

Psychophysical Needs

1) The need for activity-inactivity

2) The need for sexuality

Higher Order Needs

Psychosocial Needs

1) The need for achievement

2) The need for affiliation

Intrapersonal-interpersonal Need

1) The need for self-actualization

The allowance for existential-phenomenological forces

Phenomenology- way of understanding people from the way things appear to them, from theirframe of reference

Existential psychology- study of human existence using phenomenological analysis

o Personal Characteristics of Health Care Providers

Calling

The ability to be present for others

A recognition and acceptance of their personal power

The knowledge that they have found their own way

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A willingness to be vulnerable and to take risks

Self-respect and self-appreciation

A willingness to serve as models for their clients

A willingness to risk making mistakes and admitting having made them

A willingness to grow in the profession

o Attitudes and Behavior Integral to Patient Care

Altruism- attend to the best interest of clients

Accountability- obligation to perform certain activities and duties

Excellence perform activities related to her profession with merit and superior quality

Duty has the moral and legal obligation to act and perform their functions and commit in theservice of society and profession

Honor and Integrity- committed to being fair, truthful, and straightforward in the interaction withpatients and other health professionals

Respect for others- demonstrate respect for patients and their families and other members of theteam

o Common Concerns of the Beginning Health Care Professionals

Anxiety

Expecting Instant Result

Dealing With Difficult Clients

Silent Client

Overly Demanding Client

Unmotivated Client

Understanding Ones Limitations

On Demanding Perfection

Self-Deception

Dealing with Transference and Counter-transference

Transference- the client unconsciously displace onto the nurse attitudes and feelings he/she

originally experienced towards others

Counter-transference- nurse displaces unto the client his/her attitudes and feelings from his/her

past

o Relationship

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Nurse- Physician Relationships

Nurse Client Family Relationship

Unavoidable Trust

Personal Dignity

1. Just Generosity

2. Misericordia- giving on urgent need without prejudice

3. Truthfulness

Patient Advocacy

Nurse- Nurse Relationships

(wk 12)

VIRTUES

o Definition

Virtue excellence in character; purposive disposition and character traits that are developedthroughout life.

Virtue Ethics based on the excellence of ones character and the consideration of what person wantsto become

o Historic Influence and Tradition

o Virtues in Bioethics- character of the health care provider which are morally praiseworthy traits that are

immeasurable

Professional Virtues

The nurse at all times maintains standards of personal conduct which reflects well on theprofession and enhance public confidence

The nurse owes the same duties to self as to others including the responsibility to preserve

integrity and safety.

must perform their professional duties in conformity with existing laws, rules, regulations,

measures and generally acceptable principle of moral conduct and proper decorum.

Secular Virtues- according to Plato, 4 classical Greek virtues are justice, temperance, courage andwisdom

Religious Virtues

o Virtue Based Nursing Model

Insight ( sophia)- wisdom; ability to think well about nature of the world

Practical wisdom (phronesis)- prudence; capability to consider the mode of action in order to deliverchange enhancing the quality of life.

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Choice (prohairesis)-

Goal or telos- characterized as active happiness and well being

o Virtues of Health Care Provider

Fidelity

Honesty

Humility

Respect

Compassion

Prudence

Courage

o Habits of the Health Care Provider

The Good Habits

Be Proactive

Being proactive in health care results to:

1. Adaptability

2. Independence

3. Satisfaction

Begin with the End In Mind

Put First Things First

Seek First to Understand, Then to Be Understood

Synergize- alliance

Sharpen the Saw

Vices of the Health Care Provider

Fraud cheating; criminal deception using false representation to gain an unjust advantage

Pride high or overbearing opinion of ones worth or importance

Greed- excessive desire especially for food or wealth

(wk 13)

ETHICAL DECISION MAKING IN NURSING

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o Origins of Ethical Problems in Nursing

Social and Technological Changes

Sources of Ethical Problems

1. Social changes such as womens movement and a growing consumerism

2. the large number of persons without health care insurance

3. The high cost of health care

4. Workplace redesigned under managed care

Conflicting Loyalties and Obligations

o Frameworks for Ethical Decision Making

Ethical Systems and Principles

Patients Bill of Rights

Professional Code of Ethics

Institution Policies

Laws

o Decision Making in Values Issues

Steps :

Step 1: Collect, Analyze and Interpret Data

Step 2: State the Dilemma

Step 3: Consider Choices of Action

Step 4: Analyze Advantages and Disadvantages of Each Course of Action

Step 5: Make the Decision

Traditional problem Solving Process

1. Identify the problem

2. Gather data to analyze the causes and consequences of the problem

3. Explore alternative solutions

4. Evaluate the alternative

5. Select the appropriate solution

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6. Implement the solution

7. Evaluate the results

Moral Decision Making Models- incorporates nursing process and biomedical ethics

Steps :

M O R A L

M - Massage the problem

Collect data, ethical problem and who should be involved in the

Decision-making

O - Outline options, identify alternatives and analyze causes and

consequences of each

R - Review criteria and resolve, weigh options against the values

Of those involved in the decision

A - Affirm position and act, develop the implementation policy

L - Look back, evaluate the decision making

o Murphy and Murphy the process does not solve the underlying problem but requires decision and

helps clarify basic beliefs and values of the people involve:

1. Identify the problem

2. Identify why the problem is an ethical decision

3. Identify the people involved in the ultimate decision

4. Identify the role of the decision-maker

5. Consolidate the short and long term consequences of each alternative

6. Make the decision

7. Compare the decision with decision makers philosophy of ethics

8. Follow up on the results of decision to establish baseline future decision making

o McDonald

1. Recognizing the moral dimension

2. Who are the interested parties? What are their relationships

3. What values are involved?

4. Weigh the benefits and the burdens

a. Benefits- production of goods for various parties and acting in fairness

b. Burdens- causing physical/emotional pain to various parties, imposing

financial cost and ignoring relevant values

5. Look for analogous cases

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6. Discuss with relevant others

7. Is this decision in accord with legal and organizational rules?

8. Am I comfortable with this decision?

o Thompson and Thompson

1. Review the situation to determine health problems, decision, needs, ethical components

and key individuals

2. Gather additional information to clarify the situation

3. Identify the ethical issues in the situation

4. Define personal and professional moral positions

5. Identify moral positions of key individuals involved

6. Identify value conflict, if any

7. Determine who should make the decision

8. Identify range of actions with anticipated outcomes

9. Decide on a course of action and carry it out

10. Evaluate/review results of decision/action

o Cassels and Redman

1. Identify moral aspects of nursing care

2. Gather relevant facts related to a moral issue

3. Clarify and apply personal values

4. Understanding ethical theories and principles

5. Utilize competent interdisciplinary resources

6. Propose alternative actions

7. Apply nursing codes of ethics to help guide actions

8. Choose and implement resolutive action

9. Participate actively in resolving the issue

10. Apply state and federal laws governing nursing practice

11. Evaluate the resolutive action taken

o Ethical Dilemmas

Examples are:

Difficult choices involving justice or fairness

Whether or not to follow a doctors order to administer a dangerously high dose of

narcotic drug

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o Nurses Obligations in Ethical Decisions

Maximize the clients well-being

Balance the clients need for autonomy with family members responsibilities for the clients

well-being

Support each family member and enhance the family support system

Carry out hospital policies

Protect other clients well being

Protect the nurses own standards of care

o Strategies to Enhance Decisions and Practice

Be aware of ones own values and the ethical aspect of nursing

Be familiar with the nursing code of ethics

Seek continuing education opportunities to stay knowledgeable about ethical issues in

nursing

Respect the values, opinions and responsibilities of other health care professionals that

may be different from your own

Participate in or establish ethic rounds

Serve on institutional ethics committee

Strive for collaborative practice in which nurse function effectively in cooperation with

other health care professionals

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