Frame work for ethical decision making
- 1. Frame work for ethical decision Making
- 2. • When patients and family must make ethica decision, you many assisst them in working through through this process within the fram of their own values. 1. Identify and clarity of ethical problem: review the situation to gain clear perception of the problem (ask what decision to be made, does decision involve a choicee between good and bad, time constrains,,,,,,,
- 3. 2. Gather factual data: collect much information, secreening data is affected by the background of the indiviiduls. Thus seeking other viewpoint may help everyone involved to see the situation more clearly.
- 4. 3. Identify and evaluat options: most ethical problems would have more than one possible solution all satisfactory or all non satisfactory. - For each option consider its impact on each person involved. - Chose the option which benefits of all, least harm, respect all rights and degnisity, keeping your moral and ethical positiion,
- 5. 4. Make a decision: paitient, family and care giver should make decision evene if it is painful, even decising not to mak decision is a decision. Some times uncomforatble feeling would result although there was thouroogh analysis
- 6. • 5. act and assess: once course of action is taken, it should be carried out, support the family duirng the stage of carrying the deciosn, continue to asses the outcome, use the situation as a foundation from which to grow and develop. • -ask yourself:what have I learned from this experince that will be useful in the future? What wou I change???????
- 7. Specific ethical issues related to the profession of nursing 1. Commitment to the patient 2. Commitment to your employer 3. Commitment to your colleagues 4. Commitment to personal excellance 5. Commitent to nursing profession
- 8. Commitment to the patient • Nursing committed to well being of patient • ANA and ICN code of etthics point nurse obligation to fulfil this comitment. • Patients must be approached as a unique individuals who deserve concern, respect and culturally copetement care that evolve from EBP.
- 9. Commitment to your employer • Once you have accepted the a positon in a helathcare organization, you have acccepted the responsiblities the postion include. a. Responsible to work ethics: arrive to work on time, if to be late; inform your supervisor, do not abuse breaks and sickleave, be prepared for three shifts even on weekends and holidays, no persoanl business duirng work shifts,,,,
- 10. b. Responsible for use of supply: pilfering is stealing object in a small amount e.g adhesive bandagies, pens,,,,,,,,,,,,,, it increase the cost load in the hospitals • It include operating machien is knowledgable manner reduce the cost
- 11. • It has been suggested that strategy to improve the nurse shortage is to improve the quality of working environment e.g: relationship with colleagues. • It is by collaborative approach, positive attitude, respond to others in pleasant, be sensitive and supportive, complement other if the do good, provide assistance when needed, support the new staff and show care when following other staff. Commitment to your collegies
- 12. • Ask the staff to show respect and tolerance to each other as they are from different generations • All should work to create positive work environment.
- 13. Commitment to personal excellence • It is responsibility to maintaining competence. • Your careful self evaluation for strength and weakness helps to protect the patient from poor and inadequate care. • Do not hesitate to ask for training if needed • Formal (shared with manager) and informal evaluation could be used • Use format Display 8.3 self evaluation plan to evaluate yourself, then plan to be made to achieve the goals of training needs (by workshops, courses, independence reading,,,.
- 14. Commitment to nursing profession • It is to be concerned with personal performance in nursing • Peer evaluation could be used to maintain high quality nursing care and not simply noting errors or deficiency. This is ethical, professional obligation.
- 15. Formal Evaluation • It comes under quality assurance or improvement. • Quality assurance is planned program of evaluation that include ongoing monitoring of the give care and its outcomes. • All type of evaluation first call for criteria to be used in the evaluation. It may refer to the process, outcome, or both
- 16. • There is two types of criteria used in evaluation: process criteria and outcome criteria • Process criteria is to evaluate nursing action (complete and appropriate) • Outcome criteria is specific observable patient behavior after nursing care ( desired result of the care).
- 17. • Informal evaluation: is example is peer observation of other’s performance • It could be affected by poor relationship. • Tow nurses may use different approach in evaluation but they could reach to a positive result. • Share it with others as the like to hear it and it create positive climate for personal growth.
- 18. • Addressing substandrd care: concern with welfare of patient requires acknowledgment of existence of substandard care. • If you have question about the a medical care given to patient, ask supervisor, check procedure manual before taking an action to report it.
- 19. • If you see your colleague providing poor patient care, the effective solution is by going directly to the person involved and discuss what you have observed. It is in private place and a soon as the situation occur. • The nurse would give rational for it and you can get different view after his/her explanation.
- 20. • If the person disagree because it in not in the best interest of the patient, discuss it with you immediate supervisor. • Remember your attitude when approaching other is crucial. i.e: your facial expression, tone of voice this is to be accepted more.
- 21. 1.A basic pattern of action in these situation is: a. the information you have should be based on your observation not by gossip b. Know the formal and informal reporting system is the malpractice to be reported to licensing board or to the supervisor c. Report to the supervisor the dates, the situation, and action you took, and what you saw. d. You may or may not be involved in the follow up action (the supervisor might decide to follow the staff him or herself).
- 22. 2.Alternative approach for Action • If there no satisfactory solution to the situation, tell your supervisor your opinion of taking the problem to higher authority. • Or contacting the designated committee in the hospital by writing report explaining what has happened. • If you failed to have an action done; Another solution is to discuss the issue with a person who has influence to the system • Final alternative solution is apply you resignation letter as working in environment which has poor practice cause conflicts with your values.
- 23. 3.Personal risks in reporting • Remember you may be labeled as a troublemaker, • You may not be promoted as you are against the system • Losing the job is another risks • But remember, role of change agent is not an easy job
- 24. 4.Whistleblowing • It is an effort made by a member or past member of an organization to warn the public about a serious wrongdoing or danger created by an organization. • Remember that whistleblowing has a risk because it is exposing the public to the unethical and incompetent healthcare provider.
- 25. Before going for whistleblowing consider: • Consider contacting an attorney before taking any steps • Learn about policies or board of nursing for the consequences • Be certain of your facts and make it well document • Follow your healthcare organization’s chain to continue your concern • Be professional when dealing with others
- 26. Recommending a care provider • If some body asks you about a specific doctor and you do not have an idea about it, say that you do not know • You could say “I prefer to see Dr. N or Dr. D rather than Dr. X”. Do not tell the reasons and do not say I do not know if you know who is the expert.
- 27. The chemically impaired professional • He is the person whose practice has deteriorated because of chemical abuse, e.g: alcohol and drugs. • Addiction is defined as a compulsive need for and use of habit forming substance e.g: heroin, nicotine or alcohol and well defined physiological symptoms upon withdrawal.
- 28. • Dependency is strong desire and impaired control over the use of substance despite the consequence associated with continued us. • There is a strong possibility that if you remain active in the profession, at some time you might find yourself working with chemically impaired colleagues.
- 29. Chemical impairment in healthcare professionals • Studies explored the probable use of alcohol among nursing students • Among health care professionals, the prevalence of all substance was 32%. • With emergency nurse 3.5 times as marijuana or cocaine. Oncology and administration nurses twice as likely to engage in drinking and psychiatric nurses most likely to smoke.
- 30. the causes for these were: 1. Frequent shift change 2. Staffing shortages leading to over time working 3. Musculoskeletal injuries and pain 4. Frustration, anxiety, and depression
- 31. Recognizing the chemically impaired nurse • The following are their characteristics: 1. Mood swings 2. Inappropriate behaviors 3. Frequent days off for improbable reasons 4. Non compliance with acceptable procedures 5. Deteriorating appearance
- 32. 6. Inconsistence job performance 7. Inadequate documentation 8. Unusual prescribing practices 9. Alcohol breath 10. Poor judgment or concentration 11. Dishonesty 12. Missed appointment 13. Boundary violations
- 33. Reporting the chemically impaired colleague • If you know any staff is chemically impaired identify the rules in you country • You could follow the channel of communication for reporting it • You should have reasons and evidence to prove your concerns e.g: data, time, situation occurred,,,,,,,,,,,,, • You should not confront with the suspected staff.
- 34. Boundary violation • It refers to the situation where the nurse move beyond a professional relationship and become personally involved with a patient and patient’s life. • It represent violation of trust relationship • Nurse should denied boundaries to the relationship not to be a friend to the patient.
- 35. Early indications for Boundary violation are: 1. Spending extra time unnecessarily with the patient 2. Visiting the patient when not on duty 3. Meeting patients in isolated area 4. Showing favoritism
- 36. • If you discovered such action: 1. Document the behavior, noting dates, times, and name of individuals involved, 2. Keep your documents in an objective data 3. Then share it with your immediate supervisors