ETHICS DEFINEDETHICS DEFINED

• Ethics is a study of good conduct, Ethics is a study of good conduct, character, & motives & is character, & motives & is concerned with determining what is concerned with determining what is good or valuable for all people. It good or valuable for all people. It goes beyond personal preferences goes beyond personal preferences to establish norms & standards to establish norms & standards upon which individuals, professions upon which individuals, professions & societies agree.& societies agree.

NURSING ETHICSNURSING ETHICS

• Within nursing, specific values & Within nursing, specific values & moral requirements are necessary moral requirements are necessary to maintain the integrity of the to maintain the integrity of the profession. An ethical nurse will profession. An ethical nurse will act & treat others in specific ways act & treat others in specific ways that are consistent with nursing that are consistent with nursing norms & will be guided by more norms & will be guided by more than personal preferences or than personal preferences or values.values.

NURSING ETHICS (cont’d)NURSING ETHICS (cont’d)

• To become mature professionals who To become mature professionals who are able to participate effectively in the are able to participate effectively in the ethical dimensions of their practice, ethical dimensions of their practice, nurses must continue to develop a nurses must continue to develop a strong sense of their moral identity, strong sense of their moral identity, seek support from professional seek support from professional resources & expand their knowledge and resources & expand their knowledge and skill in the area of ethics. skill in the area of ethics.

NURSING ETHICS (cont’d)NURSING ETHICS (cont’d)

• A nurse assumes responsibility and A nurse assumes responsibility and accountability for nursing care accountability for nursing care provided.provided.

RESPONSIBILITYRESPONSIBILITY

• Refers to the execution of duties Refers to the execution of duties associated with the nurse’s particular associated with the nurse’s particular role. A nurse who acts in a responsible role. A nurse who acts in a responsible manner gains the trust of clients & other manner gains the trust of clients & other professionals. A responsible nurse professionals. A responsible nurse remains competent in knowledge & skills remains competent in knowledge & skills & demonstrates a willingness to perform & demonstrates a willingness to perform within the ethical guidelines of the within the ethical guidelines of the profession.profession.

RESPONSIBILITY RESPONSIBILITY (example)(example)

• When administering medications, When administering medications, the nurse is responsible for the nurse is responsible for assessing clients’ need for the assessing clients’ need for the drugs, giving them safely & drugs, giving them safely & correctly, and evaluating the correctly, and evaluating the responses.responses.

ACCOUNTABILITYACCOUNTABILITY

• Being answerable for one’s own Being answerable for one’s own actions. A nurse is accountable to actions. A nurse is accountable to self, the client, the profession, the self, the client, the profession, the employer, and societyemployer, and society

ACCOUNTABILITY ACCOUNTABILITY (example)(example)

• If a wrong dose of medication is If a wrong dose of medication is given, the nurse is accountable to given, the nurse is accountable to the client who received it, the the client who received it, the physician who ordered it, the physician who ordered it, the nursing service that set standards nursing service that set standards of expected performance, & society of expected performance, & society which demands professional which demands professional excellence.excellence.

ACCOUNTABILITY ACCOUNTABILITY (example cont’d)(example cont’d)

• Thus, when an error is made, the Thus, when an error is made, the nurse reports it and initiates care nurse reports it and initiates care to prevent further injury. to prevent further injury. Accountability calls for an Accountability calls for an evaluation of a nurse’s evaluation of a nurse’s effectiveness in practice.effectiveness in practice.

ACCOUNTABILITY ACCOUNTABILITY PURPOSEPURPOSE

• 1. To evaluate new professional 1. To evaluate new professional practices & reassess existing ones.practices & reassess existing ones.

• 2. To maintain standards of health care.2. To maintain standards of health care.• 3. To facilitate personal reflection, 3. To facilitate personal reflection,

ethical thought, & personal growth on ethical thought, & personal growth on the part of health care professionals.the part of health care professionals.

• 4. To provide a basis for ethical decision 4. To provide a basis for ethical decision making.making.

VARIABLES AFFECTING VARIABLES AFFECTING ETHICAL DECISIONSETHICAL DECISIONS

• Because ethical problems occur in Because ethical problems occur in situations involving people who situations involving people who have different approaches to have different approaches to “moral reasoning”, it is helpful if “moral reasoning”, it is helpful if the nurse can sort through the the nurse can sort through the various factors that influence a various factors that influence a persons’ thinking.persons’ thinking.

VARIABLES (cont’d)VARIABLES (cont’d)

• EmotionsEmotions• Legal considerationsLegal considerations• Cultural diversityCultural diversity• Religious/Spiritual convictionsReligious/Spiritual convictions• Education levelEducation level• Past life experiencesPast life experiences• Developmental levelDevelopmental level

VARIABLES (cont’d)VARIABLES (cont’d)

• Societal changesSocietal changes• RaceRace• GenderGender• ClassClass• Economic levelEconomic level• Sexuality orientationSexuality orientation• Current state of “health”Current state of “health”

ETHICAL DECISION ETHICAL DECISION MAKING METHODSMAKING METHODS

• Each ethical situation or dilemma Each ethical situation or dilemma will be different, but the nurse in will be different, but the nurse in any setting can use the following any setting can use the following guidelines for ethical processing guidelines for ethical processing and decision making.and decision making.

METHODOLOGY (cont’d)METHODOLOGY (cont’d)

• Presume good willPresume good will• Identify all important personsIdentify all important persons• Gather relevant informationGather relevant information• Identify important ethical principlesIdentify important ethical principles• Propose alternative courses of Propose alternative courses of

actionaction• Take actionTake action

SENSITIVE ETHICAL SENSITIVE ETHICAL SITUATIONSSITUATIONS

• Bio-technologyBio-technology• Surrogate Pregnancy ContractsSurrogate Pregnancy Contracts• AdoptionAdoption• AbortionAbortion• Substance AbuseSubstance Abuse• AIDS/HIVAIDS/HIV• Death & DyingDeath & Dying• Living Wills/Health Care SurrogatesLiving Wills/Health Care Surrogates• Organ DonationsOrgan Donations

NAPNES CODE OF ETHICS NAPNES CODE OF ETHICS (LPN)(LPN)

• Refer to the printed sheetsRefer to the printed sheets

STANDARD OF PRACTICE STANDARD OF PRACTICE (LPN)(LPN)

• Refer to printed sheetsRefer to printed sheets

PATIENT BILL OF RIGHTSPATIENT BILL OF RIGHTS

• Considerate & respectful careConsiderate & respectful care• Relevant, current, understandable Relevant, current, understandable

informationinformation• Part of decision in plan of carePart of decision in plan of care• Advanced DirectivesAdvanced Directives• PrivacyPrivacy• Confidential communicationConfidential communication• Review recordsReview records

PATIENT BILL OF RIGHTS PATIENT BILL OF RIGHTS (cont’d)(cont’d)

• Appropriate/modern careAppropriate/modern care• Conflicting relationshipsConflicting relationships• Consent/Decline research Consent/Decline research

participationparticipation• Reasonable continuity of careReasonable continuity of care• Informed of hospital policies, Informed of hospital policies,

procedures & mission statementprocedures & mission statement

NURSE PRACTICE ACTNURSE PRACTICE ACT

• In all states in the US, nurse In all states in the US, nurse practice acts regulate the licensure practice acts regulate the licensure & practice of nurses. Each state & practice of nurses. Each state defines for itself the scope of defines for itself the scope of nursing practice.nursing practice.

LEGAL TERMS DEFINEDLEGAL TERMS DEFINED

• A A TORT TORT is a civil wrong made against is a civil wrong made against a property. Torts may be classified a property. Torts may be classified as unintentional or intentional. An as unintentional or intentional. An example of an unintentional tort is example of an unintentional tort is NEGLIGENCE NEGLIGENCE or or MALPRACTICE.MALPRACTICE. Intentional torts are willful acts that Intentional torts are willful acts that violate another’s rights (assault, violate another’s rights (assault, battery, defamation, and invasion of battery, defamation, and invasion of privacy).privacy).

LEGAL DEFINITIONS LEGAL DEFINITIONS (cont’d)(cont’d)

• NEGLIGENCE: Conduct that falls NEGLIGENCE: Conduct that falls below a standard of care.below a standard of care.

• MALPRACTICE: Results when MALPRACTICE: Results when nursing care is below that required nursing care is below that required for safe nursing practice.for safe nursing practice.

LEGAL DEFINITIONS LEGAL DEFINITIONS (cont’d)(cont’d)

• No intent is needed for negligence No intent is needed for negligence to occur. It is established by law to occur. It is established by law for the protection of others against for the protection of others against reasonable risk of harm. It is reasonable risk of harm. It is characterized chiefly by characterized chiefly by inadvertence, thoughtlessness, inadvertence, thoughtlessness, carelessness, or inattention.carelessness, or inattention.

NEGLIGENCE & NEGLIGENCE & MALPRACTICE (cont’d)MALPRACTICE (cont’d)

• If a nurse performs a procedure for If a nurse performs a procedure for which they have not been trained which they have not been trained and do it carefully, but still harm and do it carefully, but still harm the patient, a claim of negligence the patient, a claim of negligence or malpractice could be made.or malpractice could be made.

NEGLIGENCE & NEGLIGENCE & MALPRACTICE (cont’d)MALPRACTICE (cont’d)

• If nurses give care that does not If nurses give care that does not meet appropriate standards, they meet appropriate standards, they may be held negligent. Because may be held negligent. Because these actions are performed by a these actions are performed by a professional, the negligence of the professional, the negligence of the nurse is termed malpractice.nurse is termed malpractice.

NEGLIGENCE & NEGLIGENCE & MALPRACTICE RISKSMALPRACTICE RISKS

• IV therapy errors resulting in IV therapy errors resulting in infiltration of phlebitisinfiltration of phlebitis

• Burns from improperly monitored Burns from improperly monitored heat therapyheat therapy

• Falls resulting in injuryFalls resulting in injury• Failure to use aseptic techniqueFailure to use aseptic technique• Errors in sponge, instrument, or Errors in sponge, instrument, or

needle counts in surgical casesneedle counts in surgical cases

NEGLIGENCE & NEGLIGENCE & MALPRACTICE (cont’d)MALPRACTICE (cont’d)

• Nurses must perform all Nurses must perform all procedures correctly. They must procedures correctly. They must also use professional judgment as also use professional judgment as they carry out MD orders as well as they carry out MD orders as well as independent nursing therapies for independent nursing therapies for which they have authority.which they have authority.

NEGLIGENCE & NEGLIGENCE & MALPRACTICE (cont’d)MALPRACTICE (cont’d)

• The following actions must take place The following actions must take place for Nursing Negligence to occur:for Nursing Negligence to occur:

• Nurse owed a duty to patientNurse owed a duty to patient• Nurse did not carry out dutyNurse did not carry out duty• Patient was injuredPatient was injured• Patient’s injuries were result of the Patient’s injuries were result of the

nurse’s failure to carry out the dutynurse’s failure to carry out the duty

STUDENT NURSE ROLESTUDENT NURSE ROLE

• Student nurses must also practice Student nurses must also practice nursing in a reasonably safe nursing in a reasonably safe manner. They should never be manner. They should never be assigned to tasks for which they assigned to tasks for which they are unprepared & should be are unprepared & should be carefully supervised by carefully supervised by instructors/staff as they learn new instructors/staff as they learn new procedures.procedures.

STUDENT ROLE (cont’d)STUDENT ROLE (cont’d)

• Student nurses are expected to Student nurses are expected to perform as professional nurses perform as professional nurses would in providing safe patient would in providing safe patient care.care.

• Student nurses must be Student nurses must be accountable for informing staff of accountable for informing staff of their current safe level of practice.their current safe level of practice.

STAYING LEGALSTAYING LEGAL

• Nurses can reduce their chances of Nurses can reduce their chances of being named in lawsuits by following being named in lawsuits by following standards of care, giving competent standards of care, giving competent health care, & developing an empathetic health care, & developing an empathetic rapport with patients. In addition, rapport with patients. In addition, careful, complete, & objective careful, complete, & objective documentation serves as evidence of documentation serves as evidence of the standard of nursing care provided.the standard of nursing care provided.

NATIONAL LEAGUE FOR NATIONAL LEAGUE FOR NURSINGNURSING

• NLNNLN• Membership: Anyone interested in Membership: Anyone interested in

the future of nursing.the future of nursing.• Objective: Improvement of care & Objective: Improvement of care &

education, workshops, conferences, education, workshops, conferences, eval svcs, politics.eval svcs, politics.

• Publish: Publish: Nursing & Health Care.Nursing & Health Care.

AMERICAN NURSES AMERICAN NURSES ASSOCIATIONASSOCIATION

• ANAANA• Membership: RN & SN’s onlyMembership: RN & SN’s only• Objective: Improvement of care & Objective: Improvement of care &

education, workshops, conferences, education, workshops, conferences, eval svs, a very strong political eval svs, a very strong political forceforce

• Publish: Publish: The American Journal of The American Journal of NursingNursing

NATIONAL FEDERATION OF NATIONAL FEDERATION OF LICENSED PRACTICAL LICENSED PRACTICAL NURSESNURSES

• NFLPNNFLPN• Membership: LPN & SPN’s onlyMembership: LPN & SPN’s only• Objective: Improvement of care & Objective: Improvement of care &

education, workshops, conferences, education, workshops, conferences, eval sys, politicseval sys, politics

• Publish: Publish: The Journal of Nursing CareThe Journal of Nursing Care

NAT’L ASSC OF PRACTICAL NAT’L ASSC OF PRACTICAL NURSES FOR EDUC & NURSES FOR EDUC & SERVICESERVICE

• NAPNESNAPNES• Membership: Anyone interested in Membership: Anyone interested in

Practical Nursing (BTC)Practical Nursing (BTC)• Objective: Improvement of care & Objective: Improvement of care &

education, workshops, conferences, eval education, workshops, conferences, eval sys, politics (focus on the LPN role)sys, politics (focus on the LPN role)

• Publish: Publish: Journal of Practical NursingJournal of Practical Nursing

BEGIN PVR #3BEGIN PVR #3

CONCEPTUAL CONCEPTUAL FRAMEWORKSFRAMEWORKS

• Conceptual Framework is the Conceptual Framework is the structure, scaffolding, or skeleton structure, scaffolding, or skeleton used to determine human used to determine human behaviors, learning styles, and behaviors, learning styles, and learning capabilities.learning capabilities.

• The development of nursing The development of nursing science, conceptual models & science, conceptual models & theory is a scholarly activity.theory is a scholarly activity.

NURSING THEORYNURSING THEORY

Theories, which are composed of concepts Theories, which are composed of concepts & propositions, focus more specifically & propositions, focus more specifically on the events & phenomena of the on the events & phenomena of the nursing discipline.nursing discipline.

Theory contributes to a sound basis of Theory contributes to a sound basis of nursing practice.nursing practice.

Nurses now & in the future need to have Nurses now & in the future need to have models of care from which their practice models of care from which their practice is based.is based.

NURSING THEORYNURSING THEORY

• As nursing continues to evolve, As nursing continues to evolve, nurses theorize about the nature of nurses theorize about the nature of nursing practice, the principles on nursing practice, the principles on which practice is based, & the which practice is based, & the proper goals & functions of nursing proper goals & functions of nursing in society. in society.

NURSING THEORYNURSING THEORY

• Conceptual and theoretical nursing Conceptual and theoretical nursing models are used to provide models are used to provide knowledge to improve practice, knowledge to improve practice, guide research and curricula, and guide research and curricula, and identify the domain and goals of identify the domain and goals of nursing practice.nursing practice.

HEALTH CARE THEORISTSHEALTH CARE THEORISTS

• Nightingale (1860) To aid “the body’s Nightingale (1860) To aid “the body’s reparative processes” by manipulating reparative processes” by manipulating the environmentthe environment

• Peplau (1952) Interaction btwn nurse & Peplau (1952) Interaction btwn nurse & clientclient

• Henderson (1955) Work Henderson (1955) Work interdependently with other health care interdependently with other health care workers to help client regain workers to help client regain independence quicklyindependence quickly

HEALTH CARE THEORISTS HEALTH CARE THEORISTS (cont’d)(cont’d)

• Abdellah (1960) Provide service to Abdellah (1960) Provide service to individuals, families, society. To be individuals, families, society. To be kind, caring & intelligent.kind, caring & intelligent.

• Orlando (1961) Respond to pt’s Orlando (1961) Respond to pt’s behavior in terms of immediacy.behavior in terms of immediacy.

• Hall (1962) Provide care/comfort Hall (1962) Provide care/comfort during disease processes.during disease processes.

HEALTH CARE THEORISTS HEALTH CARE THEORISTS (cont’d)(cont’d)

• Wiedenbach (1964) Overcoming Wiedenbach (1964) Overcoming obstacles that interfere with ability to obstacles that interfere with ability to meet demands/needs.meet demands/needs.

• Levine (1966) Use of conservation acts Levine (1966) Use of conservation acts to optimize client’s resources.to optimize client’s resources.

• Johnson (1968) Reduce stress to speed Johnson (1968) Reduce stress to speed up the recovery process.up the recovery process.

• Rogers (1970) “Humanistic Science of Rogers (1970) “Humanistic Science of Nursing” to promote health & prevent Nursing” to promote health & prevent illness & to rehabilitate.illness & to rehabilitate.

HEALTH CARE THEORISTS HEALTH CARE THEORISTS (cont’d)(cont’d)

• Orem (1971) Bates ModelOrem (1971) Bates Model• King (1971) Communication useKing (1971) Communication use• Travelbee (l971) Assist patients Travelbee (l971) Assist patients

thru interpersonal processes.thru interpersonal processes.• Neuman (1972) Stress reduction.Neuman (1972) Stress reduction.• Patterson & Zderad (1976) Patient Patterson & Zderad (1976) Patient

awareness of “uniqueness” & awareness of “uniqueness” & “commonality”.“commonality”.

HEALTH CARE THEORISTS HEALTH CARE THEORISTS (cont’d)(cont’d)

• Leininger (1978) TransculturalLeininger (1978) Transcultural• Roy (1979) Psysiological, Roy (1979) Psysiological,

psychological, sociological & psychological, sociological & dependence-independencedependence-independence

• Watson (1979) Philosophy & Watson (1979) Philosophy & science of caringscience of caring

• Parse (1981) Man’s interaction with Parse (1981) Man’s interaction with environment & healthenvironment & health

OREM’S THEORYOREM’S THEORY

• Dorothea Orem (1971) developed a Dorothea Orem (1971) developed a definition of nursing that emphasizes the definition of nursing that emphasizes the client’s self-care needs. “Nursing has a client’s self-care needs. “Nursing has a special concern for man’s needs for self-special concern for man’s needs for self-care action & the provision & care action & the provision & management of it on a continuous basis management of it on a continuous basis in order to sustain life & health, recover in order to sustain life & health, recover from disease or injury, & cope with their from disease or injury, & cope with their effects.”effects.”

OREM’S THEORY (cont’d)OREM’S THEORY (cont’d)

• ““Self-care is a requirement of every Self-care is a requirement of every person – man, woman & child. person – man, woman & child. When self-care is not maintained, When self-care is not maintained, illness, disease, or death will occur. illness, disease, or death will occur. Nurses sometimes manage & Nurses sometimes manage & maintain required self-care maintain required self-care continually for persons who are continually for persons who are totally incapacitated.”totally incapacitated.”

OREM’S THEORY (cont’d)OREM’S THEORY (cont’d)

• ““In other instances, nurses help In other instances, nurses help persons to maintain required self-persons to maintain required self-care by performing some but not care by performing some but not all care measures, by supervising all care measures, by supervising others who assist patients, and by others who assist patients, and by instructing and guiding individuals instructing and guiding individuals as they gradually move toward as they gradually move toward self-care.”self-care.”

OREM’S GOALOREM’S GOAL

• To help the client perform self-care. To help the client perform self-care. Nursing care is necessary when the Nursing care is necessary when the client is unable to fulfill biological, client is unable to fulfill biological, psychological, developmental, or social psychological, developmental, or social needs. The nurse determines why a needs. The nurse determines why a client is unable to meet them, & how client is unable to meet them, & how much self-care the client is able to much self-care the client is able to perform. The goal of nursing is to perform. The goal of nursing is to increase the client’s ability to increase the client’s ability to independently meet these needs.independently meet these needs.

OREM’S APPLICATIONOREM’S APPLICATION

• Man: Individuals who use self-care Man: Individuals who use self-care to sustain life & health, recover to sustain life & health, recover from disease or injury, or cope with from disease or injury, or cope with its effects.its effects.

• Health: The result of practices that Health: The result of practices that individuals have learned to carry individuals have learned to carry out on their own behalf to maintain out on their own behalf to maintain life & well-being.life & well-being.

OREM’S APPLICATION OREM’S APPLICATION (cont’d)(cont’d)

• Environment: External elements Environment: External elements with which man interacts in his with which man interacts in his struggle to maintain self-care.struggle to maintain self-care.

• Nursing: A human service that Nursing: A human service that assists individuals to progressively assists individuals to progressively maximize their self-care potential.maximize their self-care potential.

OREM’S APPLICATION OREM’S APPLICATION (cont’d)(cont’d)

• Synopsis of Theory: Individuals learn Synopsis of Theory: Individuals learn behaviors that they perform on their behaviors that they perform on their own behalf to maintain life, health & own behalf to maintain life, health & well-being.well-being.

• Application to Nursing Practice: Nurses Application to Nursing Practice: Nurses assist patients with self-care to improve assist patients with self-care to improve or maintain health.or maintain health.

SELF-CARE REQUISITESSELF-CARE REQUISITES

• UNIVERSAL SELF-CARE: Needs that UNIVERSAL SELF-CARE: Needs that support life processes & structural & support life processes & structural & functional integrity common to all (air, functional integrity common to all (air, food, H2O, elimination, activity, sleep, food, H2O, elimination, activity, sleep, etc)etc)

• DEVELOPMENT SELF-CARE: Needs that DEVELOPMENT SELF-CARE: Needs that promote development at each period of promote development at each period of the life cycle (Infancy thru gerontology & the life cycle (Infancy thru gerontology & special pregnant nds)special pregnant nds)

SELF-CARE REQUISITES SELF-CARE REQUISITES (cont’d)(cont’d)

• HEALTH DEVIATION SELF-CARE: HEALTH DEVIATION SELF-CARE: Needs for prevention or control of Needs for prevention or control of genetic or constitutional defects. genetic or constitutional defects. Needs are met by seeking out Needs are met by seeking out medical assistance, carrying out medical assistance, carrying out treatments, understanding & treatments, understanding & learning to live with the deficit.learning to live with the deficit.

SELF-CARE DEFICITSSELF-CARE DEFICITS

• Self-Care deficits are not having Self-Care deficits are not having the capacity to meet self-care the capacity to meet self-care demands. Nursing approaches & demands. Nursing approaches & care are aimed at those pts with care are aimed at those pts with actual or potential deficits. Nurses actual or potential deficits. Nurses use the “Nursing Process” to use the “Nursing Process” to pinpoint self-care deficits & plan for pinpoint self-care deficits & plan for ways to help the patient overcome ways to help the patient overcome them.them.

BTC SCHOOL OF NURSING BTC SCHOOL OF NURSING CONCEPTUAL CONCEPTUAL FRAMEWORKFRAMEWORK

• Based on Orem’s Theory of self-Based on Orem’s Theory of self-care. It complies with the Bates care. It complies with the Bates Technical College’s Mission Technical College’s Mission statement and all state statement and all state quidelines/requirements for quidelines/requirements for accreditation in the State of accreditation in the State of Washington.Washington.

BTC: WHY USE A BTC: WHY USE A FRAMEWORKFRAMEWORK

• Conceptual Frameworks enhance Conceptual Frameworks enhance the reliability and validity of the the reliability and validity of the material presented, it establishes material presented, it establishes “norms” of student practice, “norms” of student practice, encourages/fosters steady upward encourages/fosters steady upward & progressive nursing growth, and & progressive nursing growth, and increases integrity among the increases integrity among the student nurses.student nurses.

BTC: WHY (cont’d)BTC: WHY (cont’d)

• Appropriate use of conceptual Appropriate use of conceptual frameworks also provide an avenue frameworks also provide an avenue to accurately measure student to accurately measure student outcomes. Proven & predictable outcomes. Proven & predictable self-care models place the student self-care models place the student nurse on the path to efficacy.nurse on the path to efficacy.