This document outlines a framework for ethical decision making and addresses specific ethical issues in nursing. It provides a 5-step process for patients and families to work through ethical decisions: 1) identify the problem, 2) gather facts, 3) identify and evaluate options, 4) make a decision, 5) act and assess. It also discusses commitments to patients, employers, colleagues, personal excellence, and the nursing profession. Specific issues covered include the chemically impaired professional, boundary violations, and whistleblowing.

1. Frame work for ethical
decision Making

2. • When patients and family must make ethica
decision, you many assisst them in working
through through this process within the fram of
their own values.
1. Identify and clarity of ethical problem: review
the situation to gain clear perception of the
problem (ask what decision to be made, does
decision involve a choicee between good and
bad, time constrains,,,,,,,

3. 2. Gather factual data: collect much
information, secreening data is affected by
the background of the indiviiduls. Thus
seeking other viewpoint may help
everyone involved to see the situation
more clearly.

4. 3. Identify and evaluat options: most ethical
problems would have more than one possible
solution all satisfactory or all non satisfactory.
- For each option consider its impact on each
person involved.
- Chose the option which benefits of all, least
harm, respect all rights and degnisity, keeping
your moral and ethical positiion,

5. 4. Make a decision: paitient, family and care
giver should make decision evene if it is
painful, even decising not to mak decision
is a decision.
Some times uncomforatble feeling would
result although there was thouroogh
analysis

6. • 5. act and assess: once course of action is
taken, it should be carried out, support the
family duirng the stage of carrying the
deciosn, continue to asses the outcome,
use the situation as a foundation from
which to grow and develop.
• -ask yourself:what have I learned from this
experince that will be useful in the future?
What wou I change???????

7. Specific ethical issues related to
the profession of nursing
1. Commitment to the patient
2. Commitment to your employer
3. Commitment to your colleagues
4. Commitment to personal excellance
5. Commitent to nursing profession

8. Commitment to the patient
• Nursing committed to well being of patient
• ANA and ICN code of etthics point nurse
obligation to fulfil this comitment.
• Patients must be approached as a unique
individuals who deserve concern, respect
and culturally copetement care that evolve
from EBP.

9. Commitment to your employer
• Once you have accepted the a positon in a
helathcare organization, you have acccepted the
responsiblities the postion include.
a. Responsible to work ethics: arrive to work on
time, if to be late; inform your supervisor, do not
abuse breaks and sickleave, be prepared for
three shifts even on weekends and holidays, no
persoanl business duirng work shifts,,,,

10. b. Responsible for use of supply: pilfering is
stealing object in a small amount e.g
adhesive bandagies, pens,,,,,,,,,,,,,, it
increase the cost load in the hospitals
• It include operating machien is
knowledgable manner reduce the cost

11. • It has been suggested that strategy to
improve the nurse shortage is to improve
the quality of working environment e.g:
relationship with colleagues.
• It is by collaborative approach, positive
attitude, respond to others in pleasant, be
sensitive and supportive, complement
other if the do good, provide assistance
when needed, support the new staff and
show care when following other staff.
Commitment to your collegies

12. • Ask the staff to show respect and
tolerance to each other as they are from
different generations
• All should work to create positive work
environment.

13. Commitment to personal
excellence
• It is responsibility to maintaining competence.
• Your careful self evaluation for strength and
weakness helps to protect the patient from poor
and inadequate care.
• Do not hesitate to ask for training if needed
• Formal (shared with manager) and informal
evaluation could be used
• Use format Display 8.3 self evaluation plan to
evaluate yourself, then plan to be made to
achieve the goals of training needs (by
workshops, courses, independence reading,,,.

14. Commitment to nursing profession
• It is to be concerned with personal
performance in nursing
• Peer evaluation could be used to maintain
high quality nursing care and not simply
noting errors or deficiency. This is ethical,
professional obligation.

15. Formal Evaluation
• It comes under quality assurance or
improvement.
• Quality assurance is planned program of
evaluation that include ongoing monitoring
of the give care and its outcomes.
• All type of evaluation first call for criteria to
be used in the evaluation. It may refer to
the process, outcome, or both

16. • There is two types of criteria used in
evaluation: process criteria and outcome
criteria
• Process criteria is to evaluate nursing
action (complete and appropriate)
• Outcome criteria is specific observable
patient behavior after nursing care
( desired result of the care).

17. • Informal evaluation: is example is peer
observation of other’s performance
• It could be affected by poor relationship.
• Tow nurses may use different approach in
evaluation but they could reach to a
positive result.
• Share it with others as the like to hear it
and it create positive climate for personal
growth.

18. • Addressing substandrd care: concern with
welfare of patient requires
acknowledgment of existence of
substandard care.
• If you have question about the a medical
care given to patient, ask supervisor,
check procedure manual before taking an
action to report it.

19. • If you see your colleague providing poor
patient care, the effective solution is by
going directly to the person involved and
discuss what you have observed. It is in
private place and a soon as the situation
occur.
• The nurse would give rational for it and
you can get different view after his/her
explanation.

20. • If the person disagree because it in not in
the best interest of the patient, discuss it
with you immediate supervisor.
• Remember your attitude when
approaching other is crucial. i.e: your
facial expression, tone of voice this is to
be accepted more.

21. 1.A basic pattern of action in these
situation is:
a. the information you have should be based on
your observation not by gossip
b. Know the formal and informal reporting system
is the malpractice to be reported to licensing
board or to the supervisor
c. Report to the supervisor the dates, the
situation, and action you took, and what you
saw.
d. You may or may not be involved in the follow
up action (the supervisor might decide to follow
the staff him or herself).

22. 2.Alternative approach for Action
• If there no satisfactory solution to the situation,
tell your supervisor your opinion of taking the
problem to higher authority.
• Or contacting the designated committee in the
hospital by writing report explaining what has
happened.
• If you failed to have an action done; Another
solution is to discuss the issue with a person
who has influence to the system
• Final alternative solution is apply you resignation
letter as working in environment which has poor
practice cause conflicts with your values.

23. 3.Personal risks in reporting
• Remember you may be labeled as a
troublemaker,
• You may not be promoted as you are
against the system
• Losing the job is another risks
• But remember, role of change agent is not
an easy job

24. 4.Whistleblowing
• It is an effort made by a member or past
member of an organization to warn the
public about a serious wrongdoing or
danger created by an organization.
• Remember that whistleblowing has a risk
because it is exposing the public to the
unethical and incompetent healthcare
provider.

25. Before going for whistleblowing
consider:
• Consider contacting an attorney before
taking any steps
• Learn about policies or board of nursing
for the consequences
• Be certain of your facts and make it well
document
• Follow your healthcare organization’s
chain to continue your concern
• Be professional when dealing with others

26. Recommending a care provider
• If some body asks you about a specific
doctor and you do not have an idea about
it, say that you do not know
• You could say “I prefer to see Dr. N or Dr.
D rather than Dr. X”. Do not tell the
reasons and do not say I do not know if
you know who is the expert.

27. The chemically impaired
professional
• He is the person whose practice has
deteriorated because of chemical abuse,
e.g: alcohol and drugs.
• Addiction is defined as a compulsive
need for and use of habit forming
substance e.g: heroin, nicotine or alcohol
and well defined physiological symptoms
upon withdrawal.

28. • Dependency is strong desire and
impaired control over the use of substance
despite the consequence associated with
continued us.
• There is a strong possibility that if you
remain active in the profession, at some
time you might find yourself working with
chemically impaired colleagues.

29. Chemical impairment in healthcare
professionals
• Studies explored the probable use of
alcohol among nursing students
• Among health care professionals, the
prevalence of all substance was 32%.
• With emergency nurse 3.5 times as
marijuana or cocaine. Oncology and
administration nurses twice as likely to
engage in drinking and psychiatric nurses
most likely to smoke.

30. the causes for these were:
1. Frequent shift change
2. Staffing shortages leading to over time
working
3. Musculoskeletal injuries and pain
4. Frustration, anxiety, and depression

31. Recognizing the chemically
impaired nurse
• The following are their
characteristics:
1. Mood swings
2. Inappropriate behaviors
3. Frequent days off for improbable
reasons
4. Non compliance with acceptable
procedures
5. Deteriorating appearance

32. 6. Inconsistence job performance
7. Inadequate documentation
8. Unusual prescribing practices
9. Alcohol breath
10. Poor judgment or concentration
11. Dishonesty
12. Missed appointment
13. Boundary violations

33. Reporting the chemically impaired
colleague
• If you know any staff is chemically
impaired identify the rules in you country
• You could follow the channel of
communication for reporting it
• You should have reasons and evidence to
prove your concerns e.g: data, time,
situation occurred,,,,,,,,,,,,,
• You should not confront with the
suspected staff.

34. Boundary violation
• It refers to the situation where the nurse
move beyond a professional relationship
and become personally involved with a
patient and patient’s life.
• It represent violation of trust relationship
• Nurse should denied boundaries to the
relationship not to be a friend to the
patient.

35. Early indications for Boundary
violation are:
1. Spending extra time unnecessarily with
the patient
2. Visiting the patient when not on duty
3. Meeting patients in isolated area
4. Showing favoritism

36. • If you discovered such action:
1. Document the behavior, noting dates,
times, and name of individuals involved,
2. Keep your documents in an objective
data
3. Then share it with your immediate
supervisors