Role presentation ethical decision making-final
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  • 1. Ethical Decision Making Katelyn Taylor, Debrisha Johnson, Tanasha Varino, Rhonda Hyde D’Andra Humphrey, Pam Moore Britni Anderson, Katherine Washington NURG 5820 Fall 2013
  • 2. What is Ethical Decision Making? (Hamric & Delgado, 2009) The identification, deliberation and resolution of difficult moral problems With increasing demands on health care providers, there are increasing restrictions that battle the APNs fundamental values We must recognize moral dilemmas when they arise and hold ourselves accountable to our values and ethical codes ―Ethical decision making reflects both the art and
  • 3. Ethical Decision Making in Hamric’s Core Competencies of APN framework (Hamric, et al., 2009) Advance clinical practice presents numerous ethical issues APN must be able to adequately deal with ethical problems Ethical decision making transitions the APN from a technical role to a role that blends clinical knowledge with humanistic and spiritual knowledge
  • 4. Ethical Decision Making in Hamric’s Core Competencies of APN framework cont’d  Ethical Decision making is seen in the APN expanded collaboration skills  Provides APNs with knowledge to reduce power struggles, communicate effectively with interdisciplinary team, and facilitate consensus within the team when dealing with ethically difficult situations (Hamric et al., 2009)
  • 5. Ethical Decision Making in Hamric’s Core Competencies of APN framework cont’d  Occurs in 4 Phases (knowledge development, Knowledge application, creating an ethical environment, and promoting social justice within the healthcare system)  Not entirely linear  Competence in each phase depends on acquisition of skills and knowledge gained in the previous phase  Considered an evolutionary process in APN role development (Hamric et al., 2009)
  • 6. Traits of Ethical Decision Making (Nasman,Nystrom, Eri ksson, 2012) A trait is a quality or characteristic….a feature  Quality of care  optimizing the good and minimizing the evil in care  act out of human love and mercy  Virtue  manifestation of the absolute Good  Humility  Holistic Decisions
  • 7. Traits of Ethical Decision Making cont’d  Veracity and Justice  Systematic Approach/Structure  ―Ethical decision making requires a systematic approach and a schema to make practical ethical judgments‖ (Fasser, Erdman, Scott, & Waters, 2007 p. 35)  Evidenced Based  research-based care,as well as a care where caring is made visible, truthful, good, and beautiful—that is quality! (Nasman et al., 2012)
  • 8. Because of these traits: the right things at the right time will be done and for the right reasons Which is: ETHICAL DECISION MAKING! (Nasman et al., 2012)
  • 9. The virtues permeate the nurse’s becoming, being, and doing. Living the virtues helps the nurse to transform the values into deeds, deeds that have the patient’s best interest in mind, making use of evidence-based nursing as an art in the ethical act of caring. (Nasman, et al., 2012)
  • 10. Phases (Hamric & Delgado, 2009)  Phase 1: Knowledge Development - Moral Sensitivity  Phase 2: Knowledge Application – Moral Action  Phase 3: Creating an Ethical Environment  Phase 4: Promoting Social Justice Within the Health Care System
  • 11. Alternatives to ethical approaches  Casuistry  Direct analysis  Practical  Narrative Ethics  Full context  All parties considered  Virtue-Based Ethics  Moral decision  Feminist Ethics  Women and minorities considered  Balance of power  Care-Based Ethics  Connection  Interdependent (Hamric & Delgado, 2009)
  • 12. Strategies to resolve ethical conflicts (Hamric & Delgado, 2009)  Collaboration  Perspectives  Interaction and consensus  Decision and planning  Compromise  Accommodation  Coercion  Avoidance
  • 13. Sense making (Caughron et al., 2011)  Problem recognition  Situation developing  Information gathering  Relevant information  Determining preconceived ideas vs. truth  Information integration  Pattern identified  Solution determined ―ethical decision making is the pattern of results bearing on the relationship between sensemaking and ethical decision making‖ (p. 364)
  • 14. Ethical Decision- making in APRN practice Example #1: Organ procurement and a patient's wishes (Buppert, 2012)
  • 15. Ethical Decision- making in APRN practice cont’d (Buppert, 2012) Example #1 Steps:  1. Ethical analyses 2. Gather information
  • 16. Ethical Decision- making in APRN practice cont’d (Buppert, 2012) Example #1 Steps: 3. Structure a plan 4. Make a decision
  • 17. Ethical decision- making in APRN practice (Fernbach, 2011) Example #2 Do I Consent to Have My Child Immunized or Not?  Role of the NP  Parental reasons  Responses to parent
  • 18. Ethical decision- making in APRN practice cont’d (Fernbach, 2011) Ethical principles  Autonomy  Beneficence  Non-maleficence
  • 19. Research example 1 (Young, 2010) Not providing medications that violate moral principles Advantages in evoking ethical decision making Agreement within literature Limited right to refuse to participate in therapies that threaten their values and beliefs Referring to a clinician who provides these services
  • 20. Cont’d There are a number of advantages in allowing nurses to evoke these ethical situations as reasons for participating in certain procedures:  In general society does not want a clinician to forsake their own morals when entering a profession, the community usually embraces this concept  Ethical decision making allows professionals to exercise autonomy and independent judgment (Young, 2010)
  • 21. Cont’d  a successful process does not always result in a satisfactory outcome‖ (p. 337)  the outcome may leave ―moral residue‖, and continue to trouble those involved  ―the outcome may reveal the need for changes within the institution or healthcare system on a state or federal level‖ (p. 337)  the APN must deliberate and reflect on the outcome, and formulate how similar situations could be anticipated and resolved in the future (Hamric & Delgado, 2009)
  • 22. References  Buppert, C.P. (2012). Resolving ethical dilemmas. In R. Shuster (Ed.), Nurse practitioner's business practice and legal guide. (pp. 487-488). Sudbury, MA: Jones & Barlett Learning.  Caughron, J. J., Antes, A. L., Stenmark, C. K., Thiel, C. E., Wang, X., & Mumford, M. D. (2011). Sensemaking Strategies for Ethical Decision Making. Ethics & Behavior, 21(5), 351-366. doi:10.1080/10508422.2011.604293  Fasser, C. McGuire, A., Erdman, K., Scott, S., Waters,V. (2007). The ethics workup: a case-based approach to ethical decision- making instruction. Journal of Physician Assistant Education, 18 (1), 34-41.  Fernbach, A. (2011). Parental rights and decision making regarding vaccinations: Ethical dilemmas for the primary care provider. Journal Of The American Academy Of Nurse Practitioners, 23(7), 336-345. doi:10.1111/j.1745- 7599.2011.00627.x
  • 23. References cont’d  Hamric, A., & Delgado, S. (2009). Ethical decision making. In In Hamric, A.B., Spross, J.A. & Hanson, C.M (Eds.). Advanced Practice Nursing: an integrative approach (4th ed.) (pp. 315- 346). St. Louis, MO: Saunders.  Nasman, Y.. Nystrom, L., Eriksson, K. (2012). From values to virtue:the basis for quality of care. International Journal for Human Caring, 16 (2), 50-56.  Ulrich, C., Danis, M., Ratcliffe, S., Garrett- Mayer, E., Koziol, D., & Soeken, K. (2006). Ethical conflict in nurse practitioners and physician assistants in managed care. Nursing Research, 55(6), 391-401.  Young, A. (2010). Professionalism and ethical issues in nurse prescribing. Nurse Prescribing, 8(6), 284-290)
  • 24. Link to video  http://youtu.be/E4_Z6kHbjpw