Face to Face Class Participation Guide Professional Nursing Concepts 2:
(You’ll turn this in – a hard copy – at the end of each face to face class).
You need to type it (no cutting and pasting, though! – it must be in your own words! (Cutting and pasting will result in a 0)! Use APA formatting for references. I do expect you to reference the assigned reading – through your work on this assignment you’re demonstrating your understanding of the reading and your ability to relate it to things you’ve previously learned.
Name: Melissa Agyemang
Dates: Either July 11
Concept / Exemplars Covered During Class: Professional Identify, Ethics, and Healthcare Quality
Today’s assignments were:
Assigned chapters in Giddens (2021): (Ethics and Health Care Quality)
Assigned chapters in Fundamentals text by Potter et a. (2022): Nursing Today and Ethics and Values
Review ANA’s Standards and Scope of Practice and Code of Ethics
Read brief article: What if You’re the Bully?
How does having a basic understanding of the ANA’s Standards and Scope of Practice help the nursing student to develop an appreciation for their professional responsibilities related to lifelong learning and professional development, competency, accountability, integrity, and altruism?
How might I use the information from the article on “What If You’re the Bully” to provide safe/ caring/ client-centered care in the future?
Choose one of the nine Provisions in the ANA’s Code of Ethics. Think of a specific concept we studied in Health Care of the Client II and relate it to that provision. How does what you learned about ethics relate specifically to that concept? (Be sure that your answer demonstrates what you learned from the assigned readings on Ethics).
Palliation is one of the concepts in Health Care of Client II that I can relate to, during the end of life,
What did I learn from this module on Health Care Quality that I had not previously considered and how does it relate to things I have seen in clinical? What do I want to learn more about after completing this assignment?
Any other thoughts/ questions?
Am I ever justified in withholding the truth from a patient? Should I respect the wishes of the family or the wishes of the patient? Is there a point at which the treatment I am providing causes more harm than good? What do I do when I suspect my best friend is caring for patients while under the influence of alcohol? When short-staffed, how do I divide my time among too many patients? Is there a limit to how many scarce resources I should provide to any one patient?
These are difficult questions, and not everyone will agree on the answers. On one level, these are practical problems and decisions that need to be made to do a job. However, on a deeper level, they are moral and ethical choices that speak to more than just our formal training and job description. They cannot be answered with simple logic or by referring to a policy or procedure manual. Rather, how you respond to such questions is a reflection of the core values, beliefs, and character that make you the person that you are and, ultimately, the professional that you become. The actions you take in response to ethically challenging situations often require great courage, compassion, or commitment. At the same time, failure to act or respond ethically can lead to serious and even dangerous errors, personal stress, and professional burnout.
Very few of us start our day wondering, “How can I harm someone today?” or “What unethical action should I take first?”1 In fact, most of us would like to end the day feeling as though we made a positive difference in the world and satisfied that we did our best. We want the respect of our colleagues and patients. Most important, we want to feel at home in our own skin. We want a sense of personal and professional integrity—the feeling of wholeness we experience when our actions are consistent with our core beliefs and values. Technical proficiency in nursing is important but not enough, in and of itself, to guarantee this sense of integrity. To achieve the ideal of professional integrity, one also needs the skills and abilities of ethical practice, including moral sensitivity, ethical reflection, ethical analysis, and ethical decision making.
Morality is a broad term without a single commonly recognized definition. Generally, the term morality is used to refer broadly to an accepted set of social standards or morals that guide behavior. Ethics and its various approaches deal more specifically with concepts of right and wrong. Although the terms ethics and morality, and the descriptors ethical and moral, are often used interchangeably, it is helpful to think of the various approaches to ethics as a foundation for morality and moral behavior. Thus, a simple working definition of ethics is the study or examination of morality through a variety of different approaches.2 To understand morality, an understanding of underlying concepts, assumptions, and methods of the various approaches to ethics is needed.
Ethics is also a process involving critical thought and action. Ethical sensitivity helps us recognize when there is an ethical problem or dilemma, ethical reflection and analysis enable us to think critically to rank our ethical obligations and priorities, and ethical decision making is a method of ensuring that the action we take is well reasoned and can be justified. Finally, moral courage enables us to act on our decisions even under the most challenging circumstances.
Each individual has his or her own moral comfort zone, or personal morality, within which ethical reflection and analysis occur. This comfort zone is both influenced by societal concepts of morality and unique to the individual and his or her own ethical foundations. Most of us do not give much thought to our ethical comfort zone. We think of ourselves as being ethical without entirely understanding how we act ethically in practice or why we so often falter ethically when confronted with difficult choices. Knowing and understanding who you are as a moral being, how you think ethically, and why you make certain decisions are critical to ethical practice as a nurse.
The various approaches to ethics begin with metaethics, the branch of philosophy that considers fundamental questions about the nature, source, and meaning of concepts such as good and bad or right and wrong. Rather than making judgments about right and wrong, metaethics provides a foundation for how to think about right and wrong or good and bad, and it provides a common language to use when considering the ethical or moral dimensions of a situation.1
Normative ethics, on the other hand, deals with very specific judgments about right and wrong in everyday actions. Normative ethics uses the language of ethics, along with factual information, prior experience, commonly held values and beliefs, and acceptable standards of behavior, to make everyday judgments.1
Finally, when faced with a moral choice, applied ethics refers to the process of applying ethical theory and reasoning to daily life. Applied ethics is sometimes also referred to as practical ethics,2 and it provides the justification for specific actions based on ethical reflection and reasoning.
The scope of ethics is broad, encompassing many different dimensions of our lives. For example, we all live and work within larger systems, each of which has its own moral and ethical dimensions. We are all members of a larger society, we work in organizational settings, and we function within the parameters of a particular profession. To fully understand the scope of ethics, one must consider how each of these dimensions interacts with us, as individuals, in shaping our ethical foundation and behavior (Fig. 40.1).
FIGURE 40.1 Scope of Ethics.
At the top, there are societal ethics that serve the larger community. Society provides a strong normative basis for ethical behavior through the legal and regulatory systems. Law is a minimum standard of behavior to which all members of society are held and that, generally, serves the interests of society as a whole. Laws prohibiting fraud and abuse or unauthorized release of medical information are examples of behaviors that society has deemed immoral and unethical. Legal standards such as the clinical standard of care, liability, negligence, and malpractice are based on legal and ethical obligations owed to patients. Other areas of our professional lives are guided by regulatory parameters such as the practice act that defines educational requirements and scope of practice as a nurse or the accreditation standards that determine how a healthcare facility must operate. Compliance with these minimum standards for practice is expected of all healthcare professionals and the organizations within which they practice.3 Following the law is the most basic ethical standard required for the privilege of working as a licensed professional in health care. However, even as a minimum standard, law can create moral conflict for nurses, which is evident in issues such as abortion and provider-assisted dying, on which there remains broad disagreement within society.
Organizational ethics involves a set of formal and informal principles and values that guide the behavior, decisions, and actions taken by members of an organization. These principles and values are expressed in the organizational systems, practices, policies, and procedures developed to ensure ethical operation. The billions of dollars spent annually as a result of healthcare fraud and abuse is an example of ethical failures at the level of the organization.4 Ideally, organizational ethics directs all aspects of an organization and its culture, from its mission and values to how it treats customers and its employees, its financial practices, and how it responds to the needs of the larger community and the environment.5
Professional ethics refers to the ethical standards and expectations of a particular profession. Because professions have held a privileged role in society, their members are often held to a higher standard in terms of ethics. Therefore, ethics becomes a fundamental element of one’s professional identity and character as a nurse. As stated by Crigger and Godfrey, “The relationship between the patient and the nurse is, first and foremost, an ethical one.”6, p33 Ethical standards and expectations of practice are often expressed in a code of ethics or code of conduct that embodies the unique demands and philosophies of a particular profession. Unlike the minimum standard of the law, professional codes of ethics tend to offer general guidelines that are aimed at the highest ideals of practice. The Code of Ethics for Nurses of the American Nurses Association (ANA) establishes clear priorities in the ethical practice of nursing, such as compassion, respect, and primary commitment to the patient as well as advocacy for patient rights.7 For example, the first provision in the ANA’s Code of Ethics for Nurses states the following:
The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person.
Although this is an admirable ideal, how many of us can say that we live our lives or practice our professions in ways that always treat others with perfect compassion and respect, valuing every individual equally, and without any form of bias? Instead, it is the responsibility of the individual nurse to interpret this statement in terms of what it means in each unique situation and how well or poorly it is being demonstrated in his or her professional practice.
Bioethics and Clinical Ethics
Bioethics and its subcategory of clinical ethics are closely related to professional ethics. Bioethics deals broadly with ethical questions surrounding the biological sciences, emerging healthcare technologies, and health policy. Clinical ethics is involved primarily with decision-making at the bedside and other patient-specific issues. Research ethics is a specialized field within bioethics that examines the ethical conduct of research using human subjects and animals.
Finally, and perhaps most important, personal ethics describes an individual’s own ethical foundations and practice. Our personal ethics continuously intersects with these other categories of ethics; however, they do not perfectly overlap, so there is much potential for conflict. In addition, the sources of our ethics change over time just as we continue to change with time.
ATTRIBUTES AND CRITERIA
The attributes of ethical nursing practice begin with the sources of ethics and involve skills and abilities needed to identify and distinguish ethical problems and dilemmas and then apply a disciplined approach to analysis and action.
Sources of Ethics
The beliefs, values, and methods that define ethical practice are influenced by a variety of sources. Natural intersections and places of agreement exist between the various sources; however, they can also conflict with each other, creating competing beliefs and inconsistency in the way we approach ethical issues (Fig. 40.2).
Family initially forms the most powerful influence on ethics, providing many of our earliest lessons about “right and wrong.” A similar influence is the culture in which we are raised, including cultural practices related to our ethnicity, geographic area, socioeconomic status, and faith tradition. Peers become a source of ethical awareness and practice, especially as we move into adolescence, begin to look outside the family for direction, and are exposed to new experiences in the larger world. Education introduces new ways of thinking about difficult issues. Professional education, in particular, is charged with both your technical training and your awareness of the ethical practice of the profession. Once in the workplace, your colleagues and the organization where you work may further alter your views and your behaviors.
FIGURE 40.2 Sources of Ethics.