LESSON № 11 MORAL EDUATION IN NURSING.
(Practical – 8 hours)
Theme: Moral Education in Nursing.
v Moral education.
v Nurse as health care provider
v Types of nurses
v Standards of medical ethics
v Nursing ethics as core component of moral education of a nurse
v Code of ethics for nurses
Nurses are on the front lines of the health care delivery team. They independently assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals to assist. Thus, nurses coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action.
One of the most important roles of the nurse is to be a patient advocate–to protect the interests of patients when the patients themselves cannot because of illness or inadequate health knowledge.
Nurses are patient educators, responsible for explaining procedures and treatments. For instance, nurses teach patients and their families how to eat in a healthier way, take medicines, change wound dressings, and use health care equipment.
Nurses empower patients, guiding them toward healthy behaviors and support them in time of need. When patients are able, nurses encourage and teach them how to care for themselves. Nurses provide physical care only when patients cannot do so for themselves.
As patients near the end of their lives, nurses provide dignity in death by advocating for sufficient pain medication and the opportunity to die at home to allow them to spend meaningful time with family members in their final days.
Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home, and helping patients adapt to their conditions and work toward full recovery.
Nurses, especially those working in community settings, work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education–to prevent some of the leading health problems of our time.
Skills, knowledge, and abilities required and used by Registered Nurses and Nurse Practitioners include:
· Speaking – Talking to others to effectively convey information.
· Service Orientation – Actively looking for ways to help people.
· Social Perceptiveness – Being aware of others’ reactions and understanding why they react the way they do.
· Reading Comprehension – Understanding written sentences and paragraphs in work related documents.
· Oral Comprehension – The ability to listen to and understand information and ideas presented through spoken words and sentences.
· Judgment and Decision Making – Weighing the relative costs and benefits of a potential action.
· Medicine and Dentistry – Knowledge of the information and techniques needed to diagnose and treat injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health care measures.
· Biology – Knowledge of plant and animal living tissue, cells, organisms, and entities, including their functions, interdependencies, and interactions with each other and the environment.
· Customer and Personal Service – Knowledge of principles and processes for providing customer and personal services including needs assessment techniques, quality service standards, alternative delivery systems, and customer satisfaction evaluation techniques.
· Chemistry – Knowledge of the composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
· Problem Sensitivity – The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
· Critical Thinking – Using logic and analysis to identify the strengths and weaknesses of different approaches.
Professional orientation of students:
The course will let the students to evaluate analytically the cultural development of pedagogical thought in the different historical epochs; it will broaden students’ cultural and spiritual outlook; the students will be able to understand and analyze the artifacts.
The idea of personal development for over two centuries excites and invigorates education, its theorists and practitioners, continuing to undergo multiple transformations. It was, more than any other country, was obsessed with the idea of an integrated personality, which became widespread only in the late nineteenth – early twentieth century. She migrated from the literature and the arts in science, particularly in philosophy, sociology, psychology, pedagogy. It led to the formulation of problems of complex, multifaceted study of personality.
Personality – integrated, harmonious, comprehensive development – was the ideal our compatriots. It seemed to them the power to bring the country out impasse, in which she stayed too long. Knowledge obtained identity, were mainly the results of speculative reasoning, but they paved the way for more accurate, specific and experimental research. Idea individual was not a disease ofphilosophy and psychology. It is not an orphan without family and tribe. Her designs were very hypothetical ‘close to its people’s spirit, her mentality, theoretical and ideological quest.
1. Nurse as health care provider
Nurses are on the front lines of the health care delivery team. They independently assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals to assist. Thus, nurses coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action.
Nursing: Nursing is the therapeutic relationship that enables the client to attain, maintain or regain optimal function by promoting the client’s health through assessing, providing care for and treating the client’s health conditions. This is achieved by supportive, preventive, therapeutic, palliative and rehabilitative means. The relationship with an individual client may be a direct practice role or it may be indirect, by means of management, education or research roles.
One of the most important roles of the nurse is to be a patient advocate–to protect the interests of patients when the patients themselves cannot because of illness or inadequate health knowledge.
Nurses are patient educators, responsible for explaining procedures and treatments. For instance, nurses teach patients and their families how to eat in a healthier way, take medicines, change wound dressings, and use health care equipment.
Nurses empower patients, guiding them toward healthy behaviors and support them in time of need. When patients are able, nurses encourage and teach them how to care for themselves. Nurses provide physical care only when patients cannot do so for themselves.
As patients near the end of their lives, nurses provide dignity in death by advocating for sufficient pain medication and the opportunity to die at home to allow them to spend meaningful time with family members in their final days.
Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home, and helping patients adapt to their conditions and work toward full recovery.
Nurses, especially those working in community settings, work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education–to prevent some of the leading health problems of our time.
Nursing skills
Skills, knowledge, and abilities required and used by Registered Nurses and Nurse Practitioners include:
· Speaking – Talking to others to effectively convey information.
· Service Orientation – Actively looking for ways to help people.
· Social Perceptiveness – Being aware of others’ reactions and understanding why they react the way they do.
· Reading Comprehension – Understanding written sentences and paragraphs in work related documents.
· Oral Comprehension – The ability to listen to and understand information and ideas presented through spoken words and sentences.
· Judgment and Decision Making – Weighing the relative costs and benefits of a potential action.
· Medicine and Dentistry – Knowledge of the information and techniques needed to diagnose and treat injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health care measures.
· Biology – Knowledge of plant and animal living tissue, cells, organisms, and entities, including their functions, interdependencies, and interactions with each other and the environment.
· Customer and Personal Service – Knowledge of principles and processes for providing customer and personal services including needs assessment techniques, quality service standards, alternative delivery systems, and customer satisfaction evaluation techniques.
· Chemistry – Knowledge of the composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
· Problem Sensitivity – The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
· Critical Thinking – Using logic and analysis to identify the strengths and weaknesses of different approaches.
2. Types of Nurses
Nurses generally fall into several main groups, depending on where they work: in hospitals, in private practice, in private homes, etc.
Types of Nursing Careers
* AGENCY – Agency nursing is essentially where a nurse will register or sign up with an agency or similar group and tell them what hours they are available to work. The nurses are then contacted and offered work on a shift to shift basis.
Agency nurses are now in high demand, particularly, in the case of nurses with specialized training or experience.
See also: Travel Nursing
* AMBULATORY CARE – Ambulatory care nurses care for patients whose stay in the hospital or other facility will last for less than 24 hours. Ambulatory care nursing covers a broad range of specialties in the out-patient setting.
o American Academy of Ambulatory Care Nursing
* ANESTHESIA – Nurse Anesthetists work with surgeons, dentists, podiatrists, anesthesiologists, and other doctors to provide anesthesia to patients before, during, and after surgery or child birth.
o American Association of Nurse Anesthetists
* CARDIAC CARE – The Cardiac Care Nurse works with other members of the medical staff in assessing, intervening, and implementing nursing care for the cardiac patient.
o American College of Cardiovascular Nursing
* CASE MANAGEMENT – Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.
o American Case Management Association
* CRITICAL CARE – Critical Care nurses provide care for patients and families who are experiencing actual or potential life-threatening illness. More specific fields that fit into the Critical Care category include Cardiac Care, Intensive Care, and Neurological and Cardiac Surgical Intensive Care.
o American Association of Critical Care Nurses
* EMERGENCY – Emergency nurses assess patients, provide interventions and evaluate care in a time limited and sometimes hectic environment. Emergency nurses work independently and interdependently with various health professionals in an attempt to support patients and their families as they experience illness, injury or crisis.
o Emergency Nurses Association
* FORENSICS – Forensic nurses provide medical care to victims of crime, collect evidence after crimes occur, and provide medical care to patients within the prison system.
o International Association of Forensic Nurses
* GASTROENTEROLOGY – Gastroenterology (GI) nurses provide care to patients with known or suspected gastrointestinal problems who are undergoing diagnostic or therapeutic treatment and/or procedures. GI nurses practice in physician offices, inpatient and outpatient endoscopy departments, ambulatory endoscopy centers and inpatient hospital units.
o Society of Gastroenterology Nurses Association
* GERIATRICS – Geriatric nurses care for elderly patients in a number of settings which include the patients home, nursing homes, and hospitals. Geriatric nurses face constant challenges because their patients are often very ill, very complex, and very dependent on the nurses skills.
o American Geriatrics Society
* HOLISTIC – Holistic nurses provide medical care for patients while honoring the individual’s subjective opinions about health, health beliefs, and values. Holistic nursing requires nurses to integrate self-care, self-responsibility, spirituality, and reflection into their daily nursing care.
o American Holistic Nurses Association
* HIV/AIDS – HIV/AIDS nurses provide healthcare for patients who are HIV or AIDS positive. These nurses usually have specialized training in HIV/AIDS.
o Association of Nurses in AIDS Care
* INFORMATICS – Nursing informatics is a broad field which combines nursing knowledge with the use of computers. Jobs in this field could range from the implementation of a new computer network within a hospital to the sales of computer systems to hospitals by an outside computer company.
o American Nursing Informatics Association
* LEGAL NURSING – Legal nursing combines the use of the legal system with a thorough knowledge of the nursing field. Legal nurses are usually seasoned veterans of the nursing field who work with attorneys to review medical documents and determine if medical negligence occurred.
o American Association of Legal Nurse Consultants
* MIDWIFERY – Midwives are nurses that are specially trained to deal with childbirth and providing prenatal and postpartum care. The midwife is qualified to deliver babies by themselves unless there are extenuating circumstances which require the midwife to consult with a physician.
o American College of Nurse-Midwives
* MILITARY – Military nurses work in a variety of settings, ranging from family practice at a local military base to providing emergency care for the wounded during war times.
* NEONATAL – Neonatal nurses provide care for newborns by assessing the patient to ensure good health, providing preventative care to prevent illness, and caring for the babies which are sick. The neonatal nurse is responsible for anticipating, preventing, diagnosing and minimizing illness of newborns.
o National Association of Neonatal Nurses
* NEUROSCIENCE – Neuroscience nurses care for patients using new therapies and innovative technologies to treat diseases of the nervous system.
o American Association of Neuroscience Nurses
* NURSE PRACTITIONER – Nurse practitioners are advanced practice nurses who have obtained their masters degree and are qualified to prescribe medication, and interpret diagnostic and laboratory tests.
o American Academy of Nurse Practitioners
o American College of Nurse Practitioners
* OCCUPATIONAL HEALTH – The Occupational Health Nursing is responsible for improving, protecting, maintaining and restoring the health of employees. By providing this care for employees, the occupational health nurse is able to influence the health of the organization.
o American Association of Occupational Health Nurses
* ONCOLOGY – Oncology nurses provide health care for cancer patients at all stages of treatment and remission.
o Oncology Nursing Society
* PEDIATRIC – Pediatric nurses care for children in all aspects of health care. Pediatric nurses practice in a variety of settings which include hospitals, clinics, schools, and in the home.
o Association of Pediatric Oncology Nurses
o National Association of Pediatric Nurse Associates and Practioners
* PERIOPERATIVE (OR) – Perioperative nurses work in operating rooms in tertiary care hospitals, community and rural hospitals, day care surgery units and specialized clinics. They often provide post-anesthetic care in rural hospitals or specialized units where nurses provide total patient care.
o American Society of Perianesthesia Nurses
o The Association of Perioperative Registered Nurses
* PSYCHIATRIC – Psychiatric nurses provide care for patients and families with psychiatric and mental illnesses. These nurses practice in a variety of settings which include hospitals, and institutions.
o International Society of Psychiatric-Mental Health Nurses
* RESEARCH – Research nurses perform clinical and basic research to establish a scientific basis for the care of individuals across the life span-from management of patients during illness and recovery to the reduction of risks for disease and disability, the promotion of healthy lifestyles, promoting quality of life in those with chronic illness, and care for individuals at the end of life.
o National Institute of Nursing Research
* SCHOOL NURSING – School nurses work with students and faculty of schools providing medical care and other support in an in-school environment.
o National Association of School Nurses
* TRANSPLANT – Transplant nurses work in a variety of settings and function in various aspects of transplant procedures. They assist in the transplantation of various body parts which include, but are not limited to: liver, kidney, pancreas, small bowel, heart, and lungs.
o International Transplant Nurses Society
* TRAUMA – Trauma nurses care for patients in an emergency or critical care setting. These nurses generally care for patients who have suffered severe trauma such as a car accident, gun shot wound, stabbing, assault, or other traumatic injury.
o Trauma Nurse
* TRAVEL NURSING – Travel nurses work for an agency that provides nurses to hospitals and other health care facilities across the country. Travel nurses usually get to choose which locations they are willing to travel to and are typically given assignments which last for 13 weeks or more. Travel nurses usually make a very good salary, receive paid housing accommodations, sign-on bonuses, and other excellent benefits.
* UROLOGY – Urology nurses care for patients in such specialties as oncology, male infertility, male sexual dysfunction, kidney stones, incontinence, and pediatrics. Urology nurses may also participate in such urological surgeries as surgery for cancer, general urology, plastic, infertility, brachytherapy, lithotrispy, and pediatric surgery.
o American Nephrology Nurses Association
o Society of Urologic Nurses and Associates
* WOMEN’S HEALTH – Women’s health nurses participate in fields such as OB/GYN, mammography, reproductive health, and general women’s health. Thesenurses practice in a variety of settings.
Hospital Nurses
Hospital nurses, the largest group, are staff nurses who provide bedside nursing care and carry out the medical regimen prescribed by physicians. They also supervise licensed practical nurses and aides. Hospital nurses are typically assigned to one area such as surgery, maternity, pediatrics, emergency, ICU, or oncology, but they sometimes rotate among departments.
Certified Nurse Assistant (CNA)
Certified nurse assistants are also known as nurses’ aides, patient care technicians, home health aides or home health assistants (HHAs). CNAs provide patients with assistance in their daily living tasks, working under the supervision of a registered nurse. They can be found in hospitals, as well as in different types of nursing homes, adult living facilities, and even in private homes. Their close interaction with patients, often for hours each day, puts them in a position to observe their patients’ health status and inform their reporting nurse of any changes.
Office Nurses
Office nurses care for outpatients in physicians’ offices, clinics, and emergency medical centers. They assist with examinations, administer injections and medications, dress wounds and incisions, assist with minor surgery, and maintain records. Some also perform routine laboratory and office work.
Licensed Practical Nurse (LPN)
Licensed practical nurses work in all areas of health care, and have more training than CNAs, but less than RNs. LPNs provide basic bedside care such as taking vital signs, preparing and giving injections, applying dressings and ice packs, and monitoring the patient’s overall condition. LPNs also observe and report adverse reactions to medications or treatments, sometimes performing routine laboratory tests. They also help patients with daily activities such as bathing, dressing, and personal hygiene, and some LPNs help deliver and care for infants. Licensed practical nurses may work in hospitals, nursing facilities or physicians’ clinics, and experienced LPNs may supervise nursing assistants and aides.
Nurse Midwife
A nurse midwife is an RN who has completed additional specialized education iurse midwifery. Nurse midwives practice the obstetrical and gynecological care of pregnant women, including prenatal care, delivery, and infant care after birth. Many work with the same women from puberty until menopause. Nurse midwives often pursue certification through the American College of Nurse Midwives to become certified nurse midwives.
Nursing Home Nurses
Nurses who work iursing homes manage manage care for residents with conditions ranging from a fracture to Alzheimer’s disease. Although they often spend much of their time on administrative and supervisory tasks, nursing home nurses also assess residents’ health, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform invasive procedures, such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitation units for patients with strokes and head injuries.
Public Health Nurses
Public health nurses work in government and private agencies, including clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities.
Public Health Nurses work with communities to help plan and implement programs for immunizations, blood pressure testing, and other health screening. They instruct individuals, families, and other groups regarding health issues such as preventive care, nutrition, and childcare.
Nurse Practitioners
Nurse practitioners are the most advanced nurses, with the power to write prescriptions and independently diagnose and treat patients.
Registered Nurses (RNs)
Registered nurses (RNs) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and rehabilitation.
RNs also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it is usually the work setting that determines their daily job duties.
Home Health Nurses
Home health nurses provide nursing services to patients at home. They assess patients’ home environments and instruct patients and their families. Home health nurses care for a broad range of patients, such as those recovering from illnesses and accidents, cancer, and childbirth. They must be able to work independently and may supervise home health aides.
Home health nurses provide periodic services, prescribed by a physician, to patients at home. They also provide support to patients and their families, and at times work independently.
Occupational Health Nurses (Industrial Nurses)
Occupational health nurses, also called industrial nurses, provide nursing care at worksites to employees, customers, and others with injuries and illnesses. They give emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, conduct health examinations and inoculations, and assess work environments to identify potential or actual health problems.
Head Nurses or Nurse Supervisors
Head nurses or nurse supervisors direct nursing activities, primarily in hospitals. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to ensure that the patients receive proper care. They also may ensure that records are maintained and equipment and supplies are ordered.
Most popular 8 types of nurses
Nurses are respected and valued members of the medical community. They play a critical role in the health care field. Although the medical field is made up of many types of nurses, they are all exciting and rewarding careers. The following list outlines many types of nursing careers:
– Registered Nurse (RN): Registered Nurses work in almost all areas of the health care profession. They perform many tasks that include: administering treatments such as medications, performing certain medical procedures, monitoring vital signs, advising and supporting patients, educating patients about medical conditions, and keep families up-to-date on a patient’s status. Registered Nurses can specialize in certain medical areas
– Certified Nurse Assistant (CNA): Certified Nurse Assistants are also known as nurses’ aides, patient care technicians, home health aides, and home health assistants. CNAs are employed in a number of health care fields. They work in hospitals, nursing homes, private homes, and adult living homes. CNAs perform a number of duties that include: monitoring health such as recording a patients temperature, pulse, and respiration, helping patients eat, bathe, and dress, helping patients walk, keeping patients rooms in order, providing nutritious meals, answering patients’ call bells, and making beds. They may also help patients to exam rooms and even assist with simple procedures. CNAs report to a Registered Nurse.
– Licensed Practical Nurse (LPN): Although Licensed Practical Nurses have less training than Registered Nurses, they are employed in all areas of health care. They work in hospitals, nursing homes, and medical clinics. LPNs perform such duties as monitoring a patient’s overall condition, giving injections, recording vital signs, and applying dressings. They will also assist patients with personal hygiene and report any treatment reactions
– Critical Care Nurse: A Critical Care Nurse works with seriously injured and ill patients in the hospital. This type of nurse works in the ICU (intensive care unit) or CCU (critical care unit). Their job is to care for patients who are being treated for serious and life-threatening illnesses.
– Travel Nurse: A Travel Nurse is a nurse that travels to different areas and provides short term support when there is a nurse shortage. They will fill in when a full time nurse goes on maternity leave, during peak work times, if a nurse has a long term illness, or if a nurse is on an extended vacation. Thereassignments are short term but they are highly paid. An assignment usually runs for about 13 weeks. Travel Nurses often work in hospitals and medical clinics. Employers will provide many benefits such as free housing and health insurance.
– Licensed Vocational Nurses (LVN): Theses nurses perform the same job function as licensed practical nurses. LVNs provide certain medical services such as giving enemas, treating bedsores, bandaging wounds, and recording vitals. They also assist patients with bathing and dressing.
– Public Health Nurse (PHN): These nurses are registered nurses who have specialized in community health. They often go to community centers, homes, and schools where they assist individuals and families with health concerns. They work with community organizers regarding health related issues. They also perform the same duties as registered nurses.
– Nurse Practitioner: A Nurse Practitioner is a registered nurse who has specialized training and education which allows them to carry out many tasks normally performed by a doctor. Such tasks include diagnosing and treating illnesses and injuries. Some states allow practical nurses to write prescriptions.
These are just a few of the more popular areas of nursing. Nurses are on the front lines of health care and are usually the first people patients meet when faced with a health issue. Nurses provide valuable support for patients and their families making them an indispensable part of the health care community.
3. Standards of Medical Ethics
Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and the critique of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics.
There are various ethical guidelines. The Declaration of Helsinki is regarded as one of the most authoritative.
By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as the British Doctor Thomas Percival (1740-1804) of Manchester wrote about “medical jurisprudence” and reportedly coined the phrase “medical ethics.” Percival’s guidelines related to physician consultations have been criticized as being excessively protective of the home physician’s reputation. Jeffrey Berlant is one such critic who considersPercival’s codes of physician consultations as being an early example of the anti-competitive, “guild”-like nature of the physician community. In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival’s work. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher. In the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics.
Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.
Values in medical ethics
In the United Kingdom, General Medical Council provides clear overall modern guidance in the form of its ‘Good Medical Practice’ statement. Otherorganisations, such as the Medical Protection Society and a number of university departments, are often consulted by British doctors regarding issues relating to ethics.
How does one ensure that appropriate ethical values are being applied within hospitals? Effective hospital accreditation requires that ethical considerations are taken into account, for example with respect to physician integrity, conflicts of interest, research ethics and organ transplantation ethics.
Autonomy
Autonomy is a general indicator of health. Many diseases are characterised by loss of autonomy, in various manners. This makes autonomy an indicator for both personal well-being, and for the well-being of the profession. This has implications for the consideration of medical ethics: “is the aim of health care to do good, and benefit from it?“; or “is the aim of health care to do good to others, and have them, and society, benefit from this?”. (Ethics – by definition – tries to find a beneficial balance between the activities of the individual and its effects on a collective.)
By considering Autonomy as a gauge parameter for (self) health care, the medical and ethical perspective both benefit from the implied reference to Health.
Beneficence
James Childress and Tom Beauchamp in Principle of Biomedical Ethics (1978) identify beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception and euthanasia fall beyond its purview.
Non-Maleficence
In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and must be balanced against the principle of beneficence (doing good).
Some American physicians interpret this principle to exclude the practice of euthanasia, though not all concur. Probably the most extreme example in recent history of the violation of the non-maleficence dictum was Dr. Jack Kevorkian, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show, 60 Minutes.
In some countries euthanasia is accepted as standard medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the “Primum no Nocere” is based on the realisation that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient. “Not acting” in those cases is believed to be more damaging than actively relieving the suffering of the patient. Evidently the ability to offer help depends on the limitation of what the practitioner can do. These limitations are characteristic for each different form of healing, and the legal system of the specific culture. The aim to “not do harm” is still the same. It gives the medical practitioner a responsibility to help the patient, in the intentional and active relief of suffering, in those cases where no cure can be offered.
“Non-maleficence” is defined by its cultural context. Every culture has its own cultural collective definitions of ‘good’ and ‘evil’. Their definitions depend on the degree to which the culture sets its cultural values apart from nature. In some cultures the terms “good” and “evil” are absent: for them these words lack meaning as their experience of nature does not set them apart from nature. Other cultures place the humans in interaction with nature, some even place humans in a position of dominance over nature. The religions are the main means of expression of these considerations.
Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of Non-maleficencediffers. Violation of non-maleficence is the subject of medical malpractice litigation. Regulations thereof differ, over time, per nation.
Double effect
Some interventions undertaken by physicians can create a positive outcome while foreseeably, but unintentionally, doing harm. The combination of these two circumstances is known as the “double effect”. A commonly cited, but fallacious, example of this phenomenon is the use of morphine in the dying patient. Such use of morphine can ease the pain and suffering of the patient, while simultaneously hastening the demise of the patient through suppression of the respiratory drive. If correct, this would be an example of the double effect; however, no research evidence supports the claim that appropriately administeredopioid drugs depress the respiratory system.
Informed consent
Informed consent in ethics usually refers to the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, nor the specific legal requirements, which vary from place to place, for capacity to consent. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next-of-kin make decisions for them. The value of informed consent is closely related to the values of autonomy and truth telling.
Confidentiality
Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege.
Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.
Confidentiality is mandated in America by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents. Many states in the U.S. have laws governing parental notification in underage abortion.
Traditionally, medical ethics has viewed the duty of confidentiality as a relatively non-negotiable tenet of medical practice. More recently, critics like JacobAppel have argued for a more nuanced approach to the duty that acknowledges the need for flexibility in many cases.
Importance of communication
Many so-called “ethical conflicts” in medical ethics are traceable back to a lack of communication. Communication breakdowns between patients and their healthcare team, between family members, or between members of the medical community, can all lead to disagreements and strong feelings. These breakdowns should be remedied, and many apparently insurmountable “ethics” problems can be solved with open lines of communication.
4. Nursing ethics as core component of moral education of a nurse
Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distinguished by its emphasis on relationships, maintaining dignity and collaborative care.
Development of subject
The nature of nursing means that nursing ethics tends to examine the ethics of caring rather than ‘curing’ by exploring the relationship between the nurse and the person in care. Early attempts to define ethics iursing focused more on the virtues that would make a good nurse, rather than looking at what conduct is necessary to respect the human rights of the person in the nurse’s care. However, in the modern era, the ethics of nursing has shifted more towards the nurse’s obligation to respect these rights and this is reflected in a number of professional codes for nurses. For example, the importance of respecting human rights iursing is made explicit in the latest code from the International Council of Nurses.
Distinctive nature
Although much of nursing ethics can often appear similar to medical ethics, there are some factors that differentiate it. The focus of nursing ethics is on developing a caring relationship and this produces some differences. For example, a well established principle of traditional medical ethics is beneficence. Whereas, traditional medical ethics allows this to be expressed through paternalism, this approach would not be compatible with nursing ethics. This is because nursing theory seeks a collaborative relationship with the person in care. Themes that emphasizes respect for the autonomy and maintaining the dignity of the patient by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.
The distinction can be examined from a different angle. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics iursing ethics and some support for an ethic of care. This is considered by its advocates to focus more on relationships than principles and therefore to reflect the caring relationship iursing more accurately than other ethical views.
Some themes iursing ethics
Nursing seeks to defend the dignity of those in their care. In terms of mainstream ethical theory, this may be interpreted as having a respect for autonomy. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed consent that should be respected by the nurse. Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. A way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism.
Another theme is confidentiality and this is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life.
Also related to information giving is the debate relating to truth telling in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favourof truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications.
By observing the principles above, the nurse can act in a way that maintains the dignity of the individual in their care. Although this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area.
5. Code of Ethics for Nurses
Wheurses make professional judgments, their decisions are based on a reflection of consequences and on universal moral principles. A respect for individuals as unique persons is the most fundamental of these principles. Other principles deriving from this core principle are: doing good, avoiding harm, telling the truth, keeping promises, treating persons fairly, respecting privileged data, and self-determination.
A code of ethics states the primary goals and values of the profession. It indicates a profession’s acceptance of the trust and responsibility with which it has been empowered by society. A code of ethics serves to inform both nurses and society of the profession’s expectations and requirements in ethical matters. An ethical code provides a framework within which nurses can make ethical decisions and fulfill their responsibilities to the public, to other members of the health team, and to the profession.
The following Code of Ethics for Nurses was developed by the American Nurses Association (ANA). It is meant to serve as a guide throughout a nurse’s professional practice.
ANA Code Of Ethics For Nurses*
1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
6. The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
BIBLIOGRAPHY:
A. Principal:
1. The upbringing of children – http://www.fatheralexander.org/booklets/english/child.htm
2. http://www.thewaytotruth.org/pearls/upbringing.html
3. Principles of Upbringing children – http://www.al-islam.org/upbringing/
4. Moral Education – http://libr.org/isc/issues/ISC23/B8%20Susan%20Devine.pdf
5. BERKOWITZ, MARVIN W., and OSER, FRITZ, eds. 1985. Moral Education: Theory and Application. Hillsdale, NJ: Lawrence Erlbaum.
6. Moral Issues – http://www.hi-ho.ne.jp/taku77/
7. Education – http://www.educativ.info/edu/dezvedue.html
The methodical instruction has been worked out by: Vinnichenko O.Ya.
The methodical instruction was discussed at the Chair sitting «30» June 2012
Minute № 11
The Head of the Chair of philosophy, social studies
& foreign languages Ass.Prof.Melnychuk I.M.
TERNOPIL 2012
