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Ethicsinnursing
 

Ethicsinnursing

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    Ethicsinnursing Ethicsinnursing Presentation Transcript

    • Ethics in NursingEthics in Nursing Enie Novieastari, SKp.,MSNEnie Novieastari, SKp.,MSN DKKD FIK UIDKKD FIK UI
    • List of contentsList of contents  Definition of key termsDefinition of key terms  Ethics in nursing careEthics in nursing care  Nurses’ codes of ethicsNurses’ codes of ethics  Accountability and responsibilityAccountability and responsibility  Moral reasoning and theoriesMoral reasoning and theories  Ethical principlesEthical principles  Methodology for ethical decision makingMethodology for ethical decision making  Institutional ethics committeeInstitutional ethics committee
    • What is ethics?What is ethics?  A term with many meaningA term with many meaning  Simply stated, it is concerned with how peopleSimply stated, it is concerned with how people ought to act and how they ought to be inought to act and how they ought to be in relationship with othersrelationship with others  Concerned with establishing norms andConcerned with establishing norms and standards for human life and conduct should bestandards for human life and conduct should be  Good and bad, right and wrong, character orGood and bad, right and wrong, character or motivesmotives  Moral and ethics, used interchangeablyMoral and ethics, used interchangeably
    •  Etika: asal kata “ethos” (Yunani kuno)Etika: asal kata “ethos” (Yunani kuno) dalam bentuk tunggal punya banyak arti:dalam bentuk tunggal punya banyak arti: kandang; kebiasaan, adat; akhlak, watak;kandang; kebiasaan, adat; akhlak, watak; perasaan, sikap, cara berpikir. Dalamperasaan, sikap, cara berpikir. Dalam bentuk jamak “etha” yang berarti adatbentuk jamak “etha” yang berarti adat kebiasaan (Bertens, 2007)kebiasaan (Bertens, 2007)  EtikaEtika ~ moral~ moral dalam bahasa Latindalam bahasa Latin berarti kebiasaan, adatberarti kebiasaan, adat Secara etimologi etika dan moral samaSecara etimologi etika dan moral sama artiarti
    • Menurut KBBI (1999)Menurut KBBI (1999)  Etika berarti: ilmu tentang apa yang baik dan apaEtika berarti: ilmu tentang apa yang baik dan apa yang buruk dan tentang hak dan kewajiban moralyang buruk dan tentang hak dan kewajiban moral (akhlak)(akhlak)  Etik berarti:Etik berarti: 1. kumpulan asas atau nilai yang1. kumpulan asas atau nilai yang berkenaan dengan akhlakberkenaan dengan akhlak 2. nilai mengenai benar dan salah yang2. nilai mengenai benar dan salah yang dianut suatu golongan atau masyarakatdianut suatu golongan atau masyarakat  Etiket berarti:Etiket berarti: 1. secarik kertas yang ditempelkan pada kemasan1. secarik kertas yang ditempelkan pada kemasan 2. tatacara (adat, sopan santun dsb) dalam2. tatacara (adat, sopan santun dsb) dalam masyarakatmasyarakat
    •  Values and ethics are relatedValues and ethics are related  Values: building blocks for personal andValues: building blocks for personal and professional morality, influence one’s ethicalprofessional morality, influence one’s ethical decision making, relationship and conductdecision making, relationship and conduct  Values are based on experience, religion,Values are based on experience, religion, education, and cultureeducation, and culture  A person’s ethic flows from his/her valuesA person’s ethic flows from his/her values  Ethics is a study of good conduct, character, andEthics is a study of good conduct, character, and motives, and concerned with determining what ismotives, and concerned with determining what is good or valuable for all peoplegood or valuable for all people
    • Ethics in nursing careEthics in nursing care  In nursing, specific values and moralIn nursing, specific values and moral requirements are necessary to maintainrequirements are necessary to maintain integrity of the professionintegrity of the profession  An ethical nurse will act and treat others inAn ethical nurse will act and treat others in specific ways that are consistent with thespecific ways that are consistent with the nursing norms and will be guided by morenursing norms and will be guided by more than personal preferences or valuesthan personal preferences or values
    • An ethic of careAn ethic of care  Care: an action, a virtue, an affect, an ethicalCare: an action, a virtue, an affect, an ethical principle, or a way of being in the worldprinciple, or a way of being in the world  Care as an ethic for nursing is concerned notCare as an ethic for nursing is concerned not only with the resolution of ethical dilemmas, butonly with the resolution of ethical dilemmas, but also with the ways people behave towards onealso with the ways people behave towards one anotheranother  An ethic of care is concerned with relationshipAn ethic of care is concerned with relationship between people and with a nurse’s characterbetween people and with a nurse’s character and attitude toward others.and attitude toward others.
    • Nurses Code of EthicsNurses Code of Ethics  Nursing has developed code of ethics thatNursing has developed code of ethics that describe ideals for professional conductdescribe ideals for professional conduct  Codes reflect ethical principles widely acceptedCodes reflect ethical principles widely accepted by members of the professionsby members of the professions  See Kode Etik Keperawatan Indonesia:See Kode Etik Keperawatan Indonesia: - Perawat dan klien- Perawat dan klien - Perawat dan praktek- Perawat dan praktek - Perawat dan masyarakat- Perawat dan masyarakat - Perawat dan teman sejawat- Perawat dan teman sejawat - Perawat dan profesi- Perawat dan profesi
    • Accountability and responsibilityAccountability and responsibility  Nurse assumes responsibility and accountability forNurse assumes responsibility and accountability for nursing care providednursing care provided  Responsibility: execution of duties associated with theResponsibility: execution of duties associated with the nurse’s particular rolenurse’s particular role Example: when administering the meds, the nurse isExample: when administering the meds, the nurse is responsible for assessing the client’s need for the drug,responsible for assessing the client’s need for the drug, giving them safely and correctly, and evaluating thegiving them safely and correctly, and evaluating the responsesresponses  A nurse who acts in a responsible manner gains the trustA nurse who acts in a responsible manner gains the trust of client and other professionalsof client and other professionals  A responsible nurse: competent in knowledge and skillsA responsible nurse: competent in knowledge and skills and demonstrates a willingness to perform within theand demonstrates a willingness to perform within the ethical guidelines of the professionsethical guidelines of the professions
    •  Accountability means being answerable forAccountability means being answerable for one’s own actionsone’s own actions  A nurse is accountable to self, the client, theA nurse is accountable to self, the client, the profession, the employer, and societyprofession, the employer, and society  If a wrong dose of meds given, the nurse isIf a wrong dose of meds given, the nurse is accountable to the client who receive it, theaccountable to the client who receive it, the physician who ordered it, the nursing servicephysician who ordered it, the nursing service that set standard of expected performance, andthat set standard of expected performance, and the society, which demands professionalthe society, which demands professional excellenceexcellence  To be accountable, the nurse acts according toTo be accountable, the nurse acts according to the professional code of ethicsthe professional code of ethics
    • The purpose of professional accountability:,The purpose of professional accountability:,  To evaluate new professional practicesTo evaluate new professional practices and reassess existing onesand reassess existing ones  To maintain standards of health careTo maintain standards of health care  To facilitate personal reflection, ethicalTo facilitate personal reflection, ethical thought, and personal growth on the partthought, and personal growth on the part of health care professionalsof health care professionals  To provide a basis for ethical decisionTo provide a basis for ethical decision makingmaking
    • Moral reasoningMoral reasoning  ““Doing ethics” involves participating in a criticalDoing ethics” involves participating in a critical thought process about right and wrong, goodthought process about right and wrong, good and bad, or thinking about situationsand bad, or thinking about situations  A process that occurs in many client-nurseA process that occurs in many client-nurse interactioninteraction  Developing an understanding of the complexDeveloping an understanding of the complex thought process (moral reasoning) involved inthought process (moral reasoning) involved in processing ethical situations helps nursesprocessing ethical situations helps nurses participate more fully in the discussionsparticipate more fully in the discussions  Most moral reasoning happens after an ethicalMost moral reasoning happens after an ethical situation has been recognized and before onesituation has been recognized and before one acts on the situationacts on the situation
    •  Emotions play an important role in ethicalEmotions play an important role in ethical reasoningreasoning  People feelings or emotions are different andPeople feelings or emotions are different and change in the same person from day to day orchange in the same person from day to day or hour to hourhour to hour  Feelings should be honored, acknowledged, andFeelings should be honored, acknowledged, and used as a consideration in moral reasoningused as a consideration in moral reasoning without making ethics simply a discussion aboutwithout making ethics simply a discussion about the validity and sincerity of individual’s feelingthe validity and sincerity of individual’s feeling  Ethics is concerned with developing a system ofEthics is concerned with developing a system of shared values in a pluralistic societyshared values in a pluralistic society
    •  Legal considerations also affect moral reasoningLegal considerations also affect moral reasoning  It is important to consider the law, the policies, orIt is important to consider the law, the policies, or the guidelines of policy and procedure in moralthe guidelines of policy and procedure in moral thinkingthinking  Ethics and laws are often in harmony, but notEthics and laws are often in harmony, but not alwaysalways  Relying on law as the primary consideration ofRelying on law as the primary consideration of moral standards is a form of legalismmoral standards is a form of legalism  For example: refuse to act the request aFor example: refuse to act the request a terminally ill, competent client to stop treatment,terminally ill, competent client to stop treatment, because of practitioners are afraid of being suedbecause of practitioners are afraid of being sued
    • Ethical principlesEthical principles  The most fundamental principle: respectThe most fundamental principle: respect for personsfor persons  The 4 other primary principles stem fromThe 4 other primary principles stem from this basic principle:this basic principle: 1. respect for autonomy1. respect for autonomy 2. beneficence2. beneficence 3. nonmaleficence3. nonmaleficence 4. justice4. justice
    •  Autonomy: individual should have freedomAutonomy: individual should have freedom to choose their own life plan and ways ofto choose their own life plan and ways of being moralbeing moral  The principles of nonmaleficence andThe principles of nonmaleficence and beneficence are viewed on a continuumbeneficence are viewed on a continuum ranging from not inflicting harmranging from not inflicting harm (nonmaleficence) to benefiting others by(nonmaleficence) to benefiting others by doing good (beneficence)doing good (beneficence)  Justice: treating others fairly and givingJustice: treating others fairly and giving persons their duepersons their due
    •  The secondary principles:The secondary principles: - veracity: the duty to tell the truth- veracity: the duty to tell the truth - confidentiality; the duty to protect privileged- confidentiality; the duty to protect privileged informationinformation - fidelity: the duty to keep promises- fidelity: the duty to keep promises  Informed consent: promotes and respectsInformed consent: promotes and respects autonomy by expanding the client’s knowledgeautonomy by expanding the client’s knowledge of his/her opinionsof his/her opinions  Advance directives: a form of communication inAdvance directives: a form of communication in which the persons can give direction on howwhich the persons can give direction on how they would like to be treated when they cannotthey would like to be treated when they cannot speak for themselvesspeak for themselves
    • Case for discussionCase for discussion  A woman was receiving treatment for advance cancer inA woman was receiving treatment for advance cancer in a large hospital. Her condition deteriorated anda large hospital. Her condition deteriorated and meaningful recovery from her illness was highly unlikely.meaningful recovery from her illness was highly unlikely. She was taken to an intensive care unit for impendingShe was taken to an intensive care unit for impending respiratory failure. She was competent and indicated thatrespiratory failure. She was competent and indicated that she did not want any further aggressive medicalshe did not want any further aggressive medical therapies but believed she needed the approval of thetherapies but believed she needed the approval of the male members of her family (her brothers), who lived inmale members of her family (her brothers), who lived in other city. Efforts were made to contact them and theyother city. Efforts were made to contact them and they indicated that they would come. Because they had 2indicated that they would come. Because they had 2 days of travel time, she had to be placed on a regimendays of travel time, she had to be placed on a regimen of ventilator therapy and blood pressure medication toof ventilator therapy and blood pressure medication to prolong her life until they could arrive and decide what toprolong her life until they could arrive and decide what to do. The nurse felt moral distress because she believeddo. The nurse felt moral distress because she believed that the client should have been able to make thethat the client should have been able to make the decision about her own life and death by her self. Itdecision about her own life and death by her self. It seemed wrong that she have to defer to the decision ofseemed wrong that she have to defer to the decision of her brothersher brothers
    • Kerangka pemecahan masalah etikKerangka pemecahan masalah etik  Mengembangkan data dasarMengembangkan data dasar  Mengidentifikasi konflikMengidentifikasi konflik  Membuat tindakan alternatifMembuat tindakan alternatif  Menentukan siapa yang terlibat dan siapaMenentukan siapa yang terlibat dan siapa pengambil keputusanpengambil keputusan  Mengidentifikasi kewajiabn perawatMengidentifikasi kewajiabn perawat  Membuat keputusanMembuat keputusan
    • Pengambilan keputusan etisPengambilan keputusan etis  Menunjukkan maksud baik yang relevanMenunjukkan maksud baik yang relevan  Mengidentifikasi semua orang yangMengidentifikasi semua orang yang pentingpenting  Mengumpulkan informasi yang relevanMengumpulkan informasi yang relevan  Mengidentifikasi prinsip etis yang pentingMengidentifikasi prinsip etis yang penting  Mengusulkan tindakan alternatifMengusulkan tindakan alternatif  Melakukan tindakanMelakukan tindakan
    • ReferencesReferences  Some text book in fundamentals nursing &Some text book in fundamentals nursing & ethicsethics