Ch 5 ethical decision making


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Ch 5 ethical decision making

  1. 1. Ethics in the Life Sciences Chapter 5 Ethical Decision-Making 1
  2. 2. Learning Objectives • Use the nursing process to guide ethical Decision- making • Identify values that influence ethical decision making • Identify resources and barriers to ethical decision making • Discriminate between nurse values and patient values during ethical decision making • Identify strategies for promoting individualized ethical decision making • Identify multiple potential actions for resolving an ethical situation. 2
  3. 3. Ethical Decision-Making Ethical Decision-Making • Ethical situation occurs when an individual perceives that there is a conflict regarding the right thing to do. • Nurses may take on a number of roles in ethical situations. • These roles may include • The facilitator/organizer by arranging patient care conferences • As an agitator raising questions and seeking clarification from members of the health care team. • As a clarifier and educator. • As supportive listeners 3
  4. 4. Ethical Decision-Making Decision-making by a nurse • Nurses in the decision making role must first identify the types of ethical issues that need to be resolved. • The nurse must first understand his or her own personal and professional values to determine how to act. • Nurse must understand his or her own values. • The nurse must explore and understand the patients values. • The nurse may then have to make ethical decisions on behalf of the patient based on the patients own values and beliefs even if those beliefs and/or values are different than those of the nurse. 4
  5. 5. Ethical Decision-Making Facilitating patient decision-making • In many ethical situations, the nurse should serve as an advocate to the patient by providing the patient with the information an skills necessary to make an informed decision. • The nurse can help by clarifying terms, educating the patient about their medical care and assist the patient in identifying and prioritizing their own values. 5
  6. 6. Ethical Decision-Making Ethical decision-making goals • To determine the right solution for the issue at hand, or “what ought to be done” 6
  7. 7. Realities in Decision-Making Obstacles of recognizing an ethical situation • A variety of factors may keep nurses form recognizing when ethical situations are occurring. • In order for nurses to perceive that an ethical situation is occurring- the following must occur: • An emotional reaction • A sense of urgency • Nurse personalizes the situation or scenario • Nurse recognizes communication failure • Nurse recognizes disagreement regarding correct action 7
  8. 8. Realities in Decision-Making Strategies for fostering the recognition of ethical situations • Ethical decisions and decision making should not occur in isolation. • Decision makers should take the time needed to consider options. • The nurse should personalize the situations to assist in decision making. • Nurses should develop knowledge of ethics and ethical issues to ensure that personal feelings and beliefs do not interfere with decision making. • Nurses should continually to develop communication skills. 8
  9. 9. Ethical Decision-Making Using the Nursing Process Assessment • Gather subjective data- patients knowledge regarding medical diagnosis • What does the patient understand and what do they not understand. • Nurses must gather the information necessary to identify potential ethical issues or problems. 9
  10. 10. Ethical Decision-Making Using the Nursing Process Diagnosis • Identification of the ethical issue at hand is important part of the process so that decisions can be made based on the ethical issue. • Lack of experience in ethics and ethical issues may lead to misdiagnosis or missed diagnosis of ethical issues. 10
  11. 11. Ethical Decision-Making Using the Nursing Process Goals • When identifying goals of ethical decision making, goals should reflect values, beliefs and life ambitions of the focus person. • Nurse must discriminate between his or her own personal beliefs and values and those of the patient. 11
  12. 12. Ethical Decision-Making Using the Nursing Process Interventions and Ethical Rationale • Interventions comprise assessments, actions and education. • The nurse should identify and clarify the focus person’s values as well as the values of the other stakeholders involved in the situation. 12
  13. 13. Ethical Decision-Making Using the Nursing Process Evaluation • Evaluations can be done immediately after the decision and just prior to the implementation of the decision. • Allows evaluation of the decision and the chosen actions to determine if the identified goals address the ethical decision. • Evaluation should also occur after the identified action has been implemented and the situation is resolved. 13
  14. 14. Decision Analysis Model • A strategy to assist individual with identifying and prioritizing desired outcomes and values of potential actions that could be taken to resolve ethical problems. • Values are identified and prioritized to allow for evaluation of ethical issues. • Possible actions can be then identified an prioritized based on values. • Once implemented, outcomes can then be measured against values and actions implemented. 14
  15. 15. Resources for Facilitating Ethical Decision Making • The patient and patients surrogate decision-maker are one of the greatest resources for evaluating values, goals and priorities. • Professional publications may facilitate the nurses ability to implement ethical deliberations. • Professional organizations provide a code of ethics which will further guide the nurse in ethical decision making. • Professional journals can provide a point of reference for standards of care and ethical presentations. 15
  16. 16. Resources for Facilitating Ethical Decision Making Institutional Ethics Committee • Multidisciplinary groups such as nurses, physicians, dieticians, pharmacist, chaplains, administrators, ethicist can form an institutional ethics committee. • This committee can provide perspective and guidance in ethical dilemmas and assist in the ethical decision making process. 16
  17. 17. Resources for Facilitating Ethical Decision Making Ethics Consultant • Some institutions use ethics consultants to assist in providing guidance in ethical decision making processes. • The advantages of the ethics consultant is that they are well versed in ethics and ethical decision making processes. • A limitation of the ethics consultant is that they may only be able to provide a broad view of a situation that may have specific issues that need to be addressed. 17
  18. 18. Summary • Ethical decision making is a complex process. • Resources can assist in addressing barriers and other complex issues to facilitate resolution of ethical issues. 18