NURSING 2MM3 Chapter Notes - Chapter 2: Surrogate Decision-Maker, Endangerment, Health Professional

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Published on 16 Sep 2018
School
McMaster University
Department
Nursing
Course
NURSING 2MM3
Professor
ETHICS INTRODUCTION
Why an Ethical Framework?
o Understanding and communicating beliefs and values helps nurses prevent ethical
conflicts and work through them when they do happen
A Starting Point
- Describes ethical values important to the nursing profession
- To make decisions about ethical decisions, nurses have to be aware of personal values,
knowledgeable of clinical situations, and ethics, and they require the ability to think through
a problem and reach a decision that they can explain and justify
ETHICAL VALUES
- CNO has identified the following values as the most important:
o Client well-being
o Client choice
o Privacy and confidentiality
o Respect for life
o Maintaining commitments
o Truthfulness
o Fairness
- These values are shared by society and upheld by law
Types of Ethical Concerns
- Ethical conflict: when two or more ethical values apply but they each support diverging
courses of action
- Ethical uncertainty: unsure of what ethical values apply, or even where the moral problem is
- Ethical distress: when they know the right thing to do, but various constraints make doing
the right thing difficult
- Nurses can disagree about how to weigh ethical values, but at the end of the day, the
interventions need to meet the need of the client
- Identifying and solving ethical problems requires sensitivity, intellectual curiosity and
commitment
Resolving ethical conflicts
- Itʼs not always possible to find a resolution that satisfies everyone, so the best possible
outcome is identified with the client
- If a mutually agreeable solution canʼt be found, reanalyze the situation
o If still a resolution canʼt be reached, at least there will be a greater understanding
between everyone
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Client Wellbeing
- Facilitate the clientʼs health and welfare, and prevent harm
- Differentiate between what the nurse sees as beneficial and what the client sees as
beneficial
o Use clients view as a starting point
- May be hard to balance potential benefits with potential harm
- Nurses involved in research need to respect clientʼs wellbeing above all other objectives
o In collecting data watch for adverse responses and report positive and negative
responses to research team
Client Choice
- Self-determination, including the right to info needed to make choices and to consent to or
refuse care
o Clients know themselves, so when educated, they can make their own decisions
- Clients who arenʼt competent in all areas, may still be able to make decisions in some areas
and should be allowed to do so
- When client is completely incompetent, a therapeutic relationship should be maintained
with client and substitute decision maker
- There are, however, limits to client choice
o Clients canʼt choose to endanger others
o Client choice may be restricted to promote health (eg. smoking restrictions)
o In the case that the client asks the nurse to do something that is illegal or may
cause harm, nurse needs to inform client why they canʼt do so in a nonjudgmental
manner
- May be hard to consider client choice when it differs from the nurseʼs beliefs and values
o Nurse may believe they know whatʼs best, but client does have the right to choose a
risky course of action
o If the nurseʼs beliefs conflict with the clients, and the nurse doesnʼt think she can
provide care, they should withdraw and arrange for a substitute caregiver
§ If no other caregiver can be arranged, the nurse must provide care
Privacy and Confidentiality
- Privacy: limited access to a person
o Client needs to identify the important aspects of privacy
o Nurse should not unnecessarily intrude on clientʼs privacy
- Confidentiality: keeping personal info private
o All client info is private; however, client may consent to sharing the info with others
o Clients have the right to confidentiality, but relevant information is shared with
health care team, and client should be aware of this
- Sometimes nurses learn info that could harm client, if not revealed
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Document Summary

Ethical values: understanding and communicating beliefs and values helps nurses prevent ethical conflicts and work through them when they do happen. Describes ethical values important to the nursing profession. Cno has identified the following values as the most important: client well-being, client choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness, fairness. These values are shared by society and upheld by law. Ethical conflict: when two or more ethical values apply but they each support diverging. Ethical uncertainty: unsure of what ethical values apply, or even where the moral problem is. Ethical distress: when they know the right thing to do, but various constraints make doing the right thing difficult. Nurses can disagree about how to weigh ethical values, but at the end of the day, the interventions need to meet the need of the client. Identifying and solving ethical problems requires sensitivity, intellectual curiosity and commitment.