Ethics is basics for nurses in clinical setting.

1. Federal Ministry of Health
Standards of Nursing Practice
National Training
Nursing Ethics
5/4/2017
Standards of Nursing Practice National Training: Nursing
Ethics

2. Outline
• Session 1: Introduction to Nursing Ethics (30 minutes)
• Session 2: Ethical Principles (1:30 hour)
• Session 3: Nursing Values (30 minutes)
• Session 4: Ethical Dilemmas and Ethical distress in Nursing (1:30
hour)
• Session 5: Ethical Decision Making in the Nursing Practice (1:00
hour)
• Session 6: Legal Aspects of the Nursing Practice (1:00 hour)
• Session 7: Nursing Code of Ethics (1:00 hour)
National Standards of Nursing Practice Training: Nursing Ethics 5/4/2017

3. Session 1
Introduction to Nursing Ethics
2/23/2024 CH-I-3

4. Session Objectives
 Define Nursing Ethics
 Describe Theories of Nursing Ethics

5. Brain Storming:
• What is Ethics?
2/23/2024 CH-I-5

6. Nursing Ethics
 Derived from the Greek word “ethos”, means custom
or guiding beliefs.
 Rules of conduct
 Determines the characteristics of a profession and is
also called as a “code of conduct”.
2/23/2024 CH-I-6

7. Nursing Ethics
 Provides the professional standards for nursing activities,
 Concerned with fundamental principles of right and wrong and what people
ought to do
 Inform our judgments and values and help individuals decide on how to act
2/23/2024 CH-I-7

8. Ethical Theories
oConsequentialism
 View that the correct moral response is related to the outcome, or
consequence, of the act.
oDeontology
 Focuses on rules, obligations and duties.
2/23/2024 CH-I-8

9. Ethical Theories
oVirtue Ethics
Emphasizes the moral character, or virtues of the individual.
oPrinciplism
Commonly used
An attempt to bring together the best elements of ethical theories
which are compatible with most societal, individual or religious
belief systems.
2/23/2024 CH-I-9

10. Ethical Theories
Utilitarianism
• Examines what creates the most happiness for the most
people
2/23/2024 CH-I-10

11. Group Activity (5 Minutes)
• Which theory will best suit for You and WHY?
2/23/2024 CH-I-11

12. Federal Ministry of Health
Session 2
Ethical Principles
2/23/2024 CH-III-3

13. Session Summary
• Ethics Definition
• Theories of Ethics
2/23/2024 CH-I-13

14. Session Objectives
 Identify Principles of Nursing Ethics
 Analyze Principles of Nursing Ethics
2/23/2024 CH-I-14

15. Activity: 5 Minutes
 State Principles of Ethics You Know
2/23/2024 CH-I-15

16. Ethical Principles
• Provide criteria on which to base judgments in relation to
ethical theories.
• Ethical principles include:
• Beneficence - to do good
• Give Example from participant Manual Page 50 and discuss for 3 Minutes
* CH-I-*

17. Ethical Principles
• Non Maleficence: To do no harm
• Give Example from participant Manual Page -- and discuss for 3
Minutes
• Respect for Autonomy: individuals have a right to make
decisions about their lives without interference from others.
• Give Example from participant Manual Page -- and discuss for 3
Minutes
* CH-I-*

18. Ethical Principles
Justice
 Equal and fair distribution of resources, based on analysis
of benefits and burdens of decision.
• Give Example from participant Manual Page -- and discuss
for 3 Minutes
2/23/2024 CH-I-18

19. Ethical Principles
Veracity: Duty to tell the truth
• Give Example from participant Manual Page -- and discuss for 3
Minutes
Fidelity: Duty to Keep Promises
• Give Example from participant Manual Page -- and discuss for 3
Minutes
2/23/2024 CH-I-19

20. Ethical Principles
Privacy and Confidentiality
 Privacy belongs to each person and, as such, it cannot be
taken away from that person unless he/she wishes to share
it.
 Confidentiality, on the other hand, means that the
information shared with other persons will not be spread
abroad and will be used only for the purposes intended.
 Give Example
2/23/2024 CH-I-20

21. Ethical Principles
Paternalism
• An application of power over the patient.
• Give Example from participant Manual Page -- and discuss for 3
Minutes
2/23/2024 CH-I-21

22. Group Activity
 Group the participants in to four and Distribute 4 different
cases
 Ask Participants to Read the case study from the participant
Mannual on Page ----- for 5 minutes and to discuss on the
issue for 5 Minutes more
 The participants come back to the larger class and discuss
the points they raise together ( 30 minutes)
2/23/2024 CH-I-22

23. Session Summary
• Principles of Ethics
2/23/2024 CH-I-23

24. Federal Ministry of Health
Session 3:
Definition of nursing
values
2/23/2024 24

25. Learning Objectives:
At the end of this session, participants will be able to:
• Explain nursing values
• Explain ideal nurse ethical competencies
2/23/2024 25

26. Introduction
• Why do you think being a nurse is important, worthwhile and
worth striving for?
• What do you think the nurse should value most and why?
• Have you ever felt you are maintaining these values? If not
why and what should be done to maintain these values?
26

27. Definition Nursing Value
Values
“What is important, worthwhile and worth
striving for” and made who we are as individuals.
Values are also beliefs that are considered to be
socially and personally desirable
2/23/2024 27

28. Values
• Are unwritten standards, ideals, or concepts
• Give meaning to a person’s life and
• Serve as a guide for making decisions and setting priorities in
daily life.
• Are impacted by the society, culture, morals and beliefs
• Are related and overlapping.
• Are considered to be socially and personally desirable.
2/23/2024 28

29. Professional nursing values
• The term refers to the attitudes, beliefs, and priorities of
nurses
• Ultimately functions as a guide and motivation in nurses
interactions
• They are the guiding beliefs and principles that influence
nurses work behaviour.
• Individually held and shared among nurses
2/23/2024 29

30. Ideal Nursing Ethical Competencies
1. What are the characteristics of an ideal nurse?
2. To what extent nurses are applying these characteristics?
2/23/2024 30

31. Federal Ministry of Health
10 Ideal Nurse Competencies
1. Moral integrity:
i. Honesty
ii. Truthfulness and truth
telling,
iii. Benevolence
iv. Wisdom and
v. Moral courage;
2. Communication:
vi. Mindfulness and
vii. Effective listening; and
3. Concern:
viii. Advocacy
ix. Power and
x. Culturally sensitive care
2/23/2024 31

32. 1. Moral Integrity
2/23/2024 32
“State of being, acting like, and becoming a certain
kind of person. This person is honest, trustworthy,
consistently doing the right thing and standing up for
what is right despite the consequences” (Laabs’s,
2011).

33. Moral Integrity
People with moral integrity:
• Pursue a moral purpose in life,
• Understand their moral obligations in the community
• Committed
• To execute good and right actions using pragmatic application
2/23/2024 33

34. i. Honesty
• It is being “real, genuine, authentic, and bona fide
• Nurses must
• Stay true to their word.
• Stay committed to their promises to patients and
• Follow through with appropriate behaviours,
• Such as returning to patients’ hospital rooms as promised to help them
with certain tasks.
2/23/2024 34

35. ii. Truthfulness and Truth Telling
• It is the intermediate state between imposture (excessiveness) and
self-deprecation (deficiency).
• Being genuine in all words and deeds and is never false or phony.
Nurses
• Are usually ethically obligated to tell the truth and
• Are not intentionally to deceive or mislead patients
Case study
2/23/2024 35

36. iii. Benevolence
• Characterizations of a benevolent person
• Altruistic, kind-hearted, caring, courteous, and
warm-hearted
• Common descriptors
• compassionate care, kindness
2/23/2024 36

37. iii. Benevolence
• Benevolence is a central motivating factor
• Nurses has to seek out ways to perform acts of kindness
rather than only recognizing ways to do good
2/23/2024 37

38. iv. Wisdom
• Requires calculated intellectual ability, contemplation,
deliberation, and efforts to achieve a worthy goal.
• Develops with intellectual accomplishment, and practical
expertise
• Nurses must have the feature of intellectual accomplishment
and the proclivity to seek the right and the good
2/23/2024 38

39. v. Moral Courage
Nurses with moral courage
• Stand up for or act upon ethical principles to do what is right
• Make a personal sacrifice for what they believe is the right
• Choose ethically right decision, even when under intense
pressure
• Act according to their core values, beliefs, or moral
conscience.
2/23/2024 39

40. v. Moral Courage
Examples
• Confronting or reporting a peer who is stealing and using drugs at
work;
• Confronting a physician who ordered questionable treatments not
within the reasonable standard of care;
• Confronting an administrator regarding unsafe practices or
staffing patterns;
• Standing against peers who are planning an emotionally hurtful
action toward another peer;
2/23/2024 40

41. 2. Communication
• Effective communication nurtures relationships and is
fundamental to nursing
• To be effective, nurses must reside in a state of mindfulness
and be an effective listener.
2/23/2024 41

42. vi. Mindfulness
Mindful nurses
• Are engaged and attentive in their activities or roles by continuously
analysing, categorizing, and distinguishing data
• Pay close attention to their attitudes and find ethical ways to interact
and behave.
• Mindlessness
• State of unawareness and not focusing, similar to functioning in
autopilot mode
2/23/2024 42

43. vi. Mindfulness
• Examples of the benefits of mindfulness
• Reduces stress, negative emotions, and depression
• Enhances attention skills and focusing
• Enhances communication skills
• Promotes more positive relationships
• Increases memory and learning capacity
• Increases the ability for a deeper type of empathy, compassion,
serenity, and altruism
2/23/2024 43

44. vii. Effective Listening
• Without effective listening
• Nurses:
• Cannot respond appropriately no matter how well-
meaning a person’s intention of listening is.
• Will not give competent care and
• Misinterpret facts, physician’s orders, or patient
interactions.
* *

45. 3. Concern
• Nurses feel a sense of responsibility to think about the scope
of care important for their patients;
• Sometimes a sense of worrying about the health or illness of
patients prompts nurses to action.
• Ethical competency of concern for patients composes
i. Being an advocate,
ii. Using power, and
iii. Giving culturally sensitive care
2/23/2024 45

46. viii. Advocacy
• Is pleading in favour of or supporting a case, person, group,
or cause,
• Three central characteristics of patient advocacy are:
• Safeguarding patients’ autonomy
• Acting on behalf of patients
• Championing social justice in the provision of health care
(Jezewski, 2006)
2/23/2024 46

47. vii. Advocacy
Barriers to nursing advocacy (Hanks, 2007)
• Conflicts of interest between the nurse’s moral obligation to the
patient and the nurse’s sense of duty to the institution
• Institutional constraints
• Lack of education and time
• Threats of punishment
• Barrier related to nurses’ expectations of a subservient duty to
medical doctors
2/23/2024 47

48. ix. Power
• Nurses with power have the ability to influence persons,
groups, or communities.
• Nurses are in powerful positions to improve quality of in
patient care and oversee professional nursing practice
standards.
2/23/2024 48

49. ix. Power
Properties of a powerful professional nursing practice
• Acknowledge their unique role
• Commit to continuous learning
• Demonstrate professional comportment
• Value collaboration and partner effectively with colleagues
• Actively position themselves to influence decisions and
resource allocation.
2/23/2024 49

50. ix. Power
Properties of a powerful professional nursing practice
• Strive to develop an impeccable character: to be
• Inspirational,
• Compassionate, and
• Have a credible, sought-after perspective (the antithesis of power as a
coercive strategy).
• Recognize that the role of a nurse leader
• Evaluate the power of nursing and the nursing department in
organizations
2/23/2024 50

51. x. Culturally Sensitive Care
• Cultural competence is the adaptation of care in a manner
that is consistent with the culture of the client
• Nurses must first have a basic knowledge of culturally diverse
customs and act accordingly
2/23/2024 51

52. x. Culturally Sensitive Care
ASK (Awareness, Sensitivity, and Knowledge) approach
1. What is the patient’s ethnic affiliation?
2. Who are the patient’s major support persons and where do they
live?
3. With whom should we speak about the patient’s health or illness?
4. What are the patient’s primary and secondary languages, and
speaking and reading abilities?
5. What is the patient’s economic situation? Is income adequate to
meet the patient’s and family’s need? (Lipson & Dibble, 2005)
2/23/2024 52

53. Federal Ministry of Health
Session 4:
Ethical dilemma and Ethical
distress in nursing practice
2/23/2024 53

54. Ethical dilemmas
• Is situations when
• Equally compelling ethical reasons both for and against a particular
course of action are recognized,
• Appropriate choice in the situation is unclear
• And a decision must be made
• Although each option can be justified as “good,” both have
pros and cons
• It creates uncertainty in the outcome
• May or may not be the same decision that others believe is the
* *

55. Ethical/Moral distress
• Moral/ethical distress is an emotion that occurs when
nurses have identified and know what right response is
called for, but institutional or other constraints make it
almost impossible to pursue the right course of action
(Jameton, 1984).
2/23/2024 55

56. Ethical/Moral distress
• Has situational, cognitive, action, and feeling dimensions,
• Has short- and long-term effects
• Result in significant physical and emotional stress,
• Contributes to nurses’ feelings of loss of integrity and
dissatisfaction
• Affects relationships with patients and others
• Affect the quality, quantity, and cost of nursing care
2/23/2024 56

57. Ethical/Moral distress
Four A’s to Rise Above Moral Distress (2004)
1. Ask appropriate questions to become aware that moral distress is
present.
2. Affirm your distress and commitment to take care of yourself and
address moral distress.
3. Assess sources of your moral distress to prepare for an action plan.
4. Act to implement strategies for changes to preserve your integrity and
authenticity
Activity
2/23/2024 57

58. Federal Ministry of Health
Session:5
Ethical Decision Making in the
Nursing Practice
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics

59. Session Objectives
• identify appropriate ethical decision making procedures
• demonstrate sound ethical decision making ability
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics

60. Brain Storming
What is ethically sound decision?
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-60

61. Introduction
Ethical questions are a challenge to navigate
Consider the following issues:
• multiple clinical facts
• Patient values & preferences
• Concerns and values of family
• Contextual features including law
In some cases quick decision may be required
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-61

62. The Four Quadrant Approach
• Provides a framework for sorting through and focusing on
specific aspects of clinical ethics cases
• Connects the circumstances of a case to their underlying
ethical principles
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-62

63. The Four Quadrant Approach
The quadrants:
1. Medical indications
2. Patient preferences
3. Quality of life
4. Contextual features
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-63

64. Activity
Group work
• Discussion on the ‘Four topics approach’ participants manual
page #
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-64

65. Activity
• Case scenario: participant’s manual page #
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-65

66. Session Summary
• What are the things you need to consider in order to reach
into sound ethical decision?
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-66

67. Federal Ministry of Health
Session: 6
Legal Aspects of the Nursing
Practice
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-III-3

68. Session Objectives
• describe general legal concepts of nursing
• discuss legal issues in relation to the nursing practice
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-68

69. Activity
• Case scenario: participant’s manual page #
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-69

70. Functions of law in nursing
• Establishes legal ground for patient care
• Differentiates the nurses’ responsibilities
• Shows the boundaries of independent nursing action
• Maintains standard of care (accountability)
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-70

71. Activity
• Cases scenario: participant’s manual #
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-71

72. Negligence and malpractice
Malpractice
• wrongful conduct
• improper discharge of professional duties
• failure to meet the standards of acceptable care
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-72

73. Negligence and malpractice …
• Negligence (breach of duty) is the failure of an individual
to provide care that a reasonable person would ordinarily use
in a similar circumstance.
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-73

74. Assault and Battery
• Assault: is the intentional & unlawful offer to touch a person
in an offensive, insulting or physically intimidating manner.
• Battery: is the touching of another person without the
person’s consent
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-74

75. Selected Legal Aspects of Nursing Practice
• Informed consent
• Delegation
• Violence, Abuse, and Neglect
• Prescription (to be included in the manual)
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-*

76. Informed Consent
Major elements:
• The consent must be voluntary
• The consent must be given by a client who is capable and
competent to understand
• The client must be given enough information to be the ultimate
decision maker
• It is the responsibility of the person who performs the procedure
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-76

77. Informed Consent …
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-77

78. Informed Consent …
Information to be given:
• Diagnosis or condition that requires treatment
• Purpose of treatment
• What the client can expect to feel or experience
• The intended benefits of the procedure
• Possible risks
• Advantages and disadvantages of alternatives to treatment
(including no treatment)
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-78

79. Delegation
• Does the Nurse Practice Act (if any) permit delegation?
• Is there a list of procedure a nurse can delegate?
• Are there guidelines explaining the nurse’s responsibilities
when delegating?
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-79

80. Violence, Abuse, and Neglect
• the nurse must report the situation to the appropriate
authority.
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-80

81. Legal Responsibilities in Nursing
• Common-sense precautions
Follow accepted procedures
• Be competent in practice
• Ask for assistance
• Document well
• Do not give legal advice to clients
• Do not accept gifts 5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-81

82. Federal Ministry of Health
Session-7
Nursing Code of Ethics
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-III-3

83. • Modular
5/4/2017
National Standards of Nursing Practice Training: Nursing Ethics CH-I-83