Addressing Ethical Conflict in School Nursing

St. Louis Suburban School Nurse AssociationJanuary 18, 2018

Robin Landes Wallin DNP, RN, CPNP-PC, NCSNDirector of Health ServicesParkway School District

Planner, Presenter, Author Disclosures

ROBIN LANDES WALLIN

I disclose the absence of personal financial relationships with commercial interests relevant to this educational activity within the past 12 months.

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This presentation will provide school nurses with an ethical framework to help them recognize ethical conflict and develop strategies for responding to ethical problems encountered in school nursing.

•Goal

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•Objectives

Upon completion of this learning activity, participants should be able to:

Compare common ethical principles and theories.

Distinguish the concepts of moral distress, moral courage and moral residue.

1

2

3 Apply a model of ethical decision-making relevant

to school nursing.

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“A PROCESS OF REFLECTING CONSCIOUSLY ON OUR MORAL BELIEFS, [WHICH] CONSISTS OF AN ONGOING DIALOGUE ABOUT WHAT COMMUNITIES VALUE AND WHAT THEY SHOULD DO IN LIGHT OF THESE VALUES” (VOLBRECHT, 2002, P. 1)

What is ethics?

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“THE DISCIPLINE THAT ANALYZES THE VALUES AND NORMS THAT GUIDE NURSING”

NURSING ETHICS CONSIDERS THE “ IDEAL NORMS INTENDED TO GUIDE NURSES, INCLUDING VALUES, PRINCIPLES, AND VIRTUES OF THE NURSING PROFESSION”

(VOLBRECHT, 2002, P. 2)

What is nursing ethics?

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•Values

Non-moral Values

Moral Values

Personal Values

Religious Values

Professional Values

Cultural Values

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What kind of attitudes in others bother you the most?

What do you most want to be remembered for?

What type of limitation would bethe hardest for you to accept?

Do you think hospitals have a moral responsibility to offer care to community members who cannot afford to pay?

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Discussion - Identifying your values

Source: Uustal (1993,) pp. 26-27

Consequentialism

Principle-Based

Virtue Ethics and Care Ethics

•Ethical Theories

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•Rule- Based Ethics

• What actions are right or wrong?

• How can moral obligations be summarized into moral rules?

(Rose Mary Volbrecht , 2002, p. 59)

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• What kind of person should

I be?

• What kind of community

do we want to be?

•Virtue Ethics

(Rose Mary Volbrecht , 2002, p. 126)

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•Care Ethics

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Respect for Autonomy• the individual’s right to self-

determination

Nonmaleficence• avoiding intentionally causing harm

to others

Beneficence• promoting what is best for others

and ourselves

Justice• fairly distributing benefits, risks and

costs in society

•Ethical Principles

(Beauchamp and Childress, 2012)

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What ethical principles are involved in the concern that Michelle shared?

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Moral Distress

Moral Residue

Moral Courage

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Listen to the moral distress that Katherine is describing.

DISCUSSION

Share a time when you felt moral distress.

What was the situation?

What was the outcome?

Did you experience any moral residue?

How can we as school nurses address moral distress in school health services?

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Code of Ethics, 2015

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•American Nurses Association

http://www.nursingworld.org/mainmenucategories/ethicsstandards/codeofethicsfornurses

•National Association of School Nurses

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https://www.nasn.org/nasn-resources/professional-topics/codeofethics

Code of Ethics, 2016

Child Well-Being

•NASN Code of Ethics

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•NASN Code of Ethics

Diversity

Professional Competency

•NASN Code of Ethics

Excellence

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Professional Competency

•NASN Code of Ethics

Innovation

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•NASN Code of Ethics

Integrity

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•NASN Code of Ethics

Leadership

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•NASN Code of Ethics

Scholarship

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•Law and Ethics

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• 1. There is a conflict in values, obligations, loyalties, interests or needs.

•Six Criteria That Point to an Ethical Problem:

(AROKSAR, 2001, P.82)

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• 2. It requires a decision about the morally right action that should be made reflectively and thoughtfully;

•Six Criteria That Point to an Ethical Problem:

(AROKSAR, 2001, P.82)

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•3. It requires that the choice be influenced by ethical principles and values;

•Six Criteria That Point to an Ethical Problem

(AROKSAR, 2001, P.82)

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•

• 4. The identified choices for action seem to be equally problematic from an ethical perspective for those affected directly and indirectly;

•Six Criteria That Point to an Ethical Problem:

(AROKSAR, 2001, P.82)

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• 5. The choices are affected by the feelings and values of the involved individuals and by the demands or context of the situation;

•Six Criteria That Point to an Ethical Problem:

(AROKSAR, 2001, P.82)

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•6. The conflict requires an interdisciplinary approach for an ethically justifiable response.

•Six Criteria That Point to an Ethical Problem:

(AROKSAR, 2001, P.82)

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• 1. What should I value?

• 2. Who should I be?

• 3. What should I do?

•Value, Be, Do Ethical Decision-Making Model

(Cameron, 2000)

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•Framework for Ethical Decision-MakingMila Ann Aroskar (2001)

Step 1 - Ask yourself what is going on in the situation and identify all relevant information to the degree possible;

Step 2 - Identify the affected parties or stakeholders

Step 3 - Identify the specific ethical issues or conflicts

Step 4 - Identify choices for action and the ethical justification for each option

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•Framework for Ethical Decision-MakingMila Ann Aroskar (2001)

Step 5- Identify the foreseeable consequences of the different options for action

Step 6 - Select a course of action and evaluate the actual consequences

Step 7 - Identify what has been learned for use in similar problem-solving or decision-making situations

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Issues with child protection reporting

•Ethical Problems experienced by School Nurses

Conflicts in Professional Relationships (with parents, principals, administrators and supervisors)

Concerns with delegation and supervision of health assistants

Concerns maintaining confidentiality

Conflict over Do Not Resuscitate Policy

Pressure to work outside of nursing practice standards

Solum and Schaffer (2003)

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DISCUSSIONWhat values did Althea share?

Identify one ethical dilemma she described.

Apply the framework for ethical decision-making we discussed to the concern you identified.

How would you guide her decision-making?

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Discussion

Identify the ethical Dilemmas expressed by Sara in this video clip. Apply the Framework for Ethical Decision-Making.

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• Identify the ethical components of the problem.

• Use the framework we discussed to analyze the struggle and guide decision-making

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Your turn to share a concern with your group!

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Martin Luther King, 1963

Questions?

Robin Landes Wallinrwallin@parkwayschools.net

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References available upon request.

ResourcesAmerican Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org.

American Nurses Association & National Association of School Nurses. (2011). School nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursebooks.org.

National Association of School Nurses. (2016). Code of Ethics, Retrieved from https://www.nasn.org/nasn-resources/professional-topics/codeofethics