Ethical and Legal Consideration in Nursing Leadership and Management – This book covers the entire syllabus of “Leadership & Management” prescribed by the BNMC for Diploma in Nursing Science & Midwifery Students.
We tried to accommodate latest information and topics. This book is an examination setup according to the teachers’ lectures and examination questions. At the end of the book previous university questions are given. We hope in touch with the pook students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.
Ethical and Legal Consideration in Nursing Leadership and Management
Definition of Ethics:
Ethics are the rules or principles that governs conduct. They deal with what is good and bad with moral duties and obligations.
The word ethics is derived from the Greek work “Ethos” which means customs or guiding beliefs. Ethics are characteristics of a profession and are called as a “code”.
Or,
(Ref by- Capt. (Retd.) Alphonsa Jacob/Fundamentals of Nursing/Vol-1/6/28)
Ethics is a term with many meanings. Simply stated ethics is concerned with how people ought to act and how they ought to be in relation with others.
(Ref by-SN. Nanjunde Gowda/2/14)
Ethics or moral philosophy is a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct.
(Ref by-en.wikipedia.org)
Types of Ethics
There are mainly three types of ethics-
A. Bioethics: Bioethics as encompassing a number of fields and disciplines grouped broadly under the rubric *the life sciences*
B. Clinical ethics: Clinical ethics is that branch of bioethics literally concerned with ethical problems “at the bedside,” that is, ethical concerns that arise within the context of caring for actual patients, wherever they are found.
C. Nursing ethics: Nursing ethics, which is a subset of bioethics, is the formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments.
Ethical Principles in Nursing:
Ethical principle actually controls professionalism nursing practice much more than to ethical theories. Principles encompass basic premises from which rules are developed. Principle is the moral norms that nursing as a profession both demands and services to implement to everyday clinical practice.
Ethical principles that the nurse should consider when making decision are as follows-
1. Respect for person
2. Respect for autonomy
3. Respect for freedom
4. Respect for beneficence (doing good)
5. Respect for maleficence (avoiding harm to others)
6. Respect for veracity (truth telling)
7. Respect for justice (fair and equal treatment)
8. Respect for rights
9. Respect for fidelity (fulfilling promises)
10. Confidentiality (protecting privileged information)
(Ref by- BT Basavanthappe/2/76)
Purposes of Code of Ethics:
The purposes of the Code of Ethics for Nurses are:
- Identify the fundamental ethical standards and values to which the nursing profession is committed, and that are incorporated in other endorsed professional nursing guidelines and standards of conduct
- Provide nurses with a reference point from which to reflect on the conduct of themselves and others
- Guide ethical decision-making and practice, and
- Indicate to the community the human rights standards and ethical values it can expect nurses to uphold
Code of Ethics:
Professional codes of ethics are a system of rules and principles by which that profession is expected to regulate its members and demonstrate its responsibility to society.
(Ref by- Lecture)
Professional Code of Ethics of Nursing
- The ethics of nursing provides professional standards for nursing activities which protect the nurse and the patient. The international code of nursing ethics is given below.
- The fundamental responsibility of a nurse is to conserve life and 1 to promote health. Every nurse as a teacher of health by example.
- A nurse must be adequately prepared to practice nursing and be willing to continue to learn new ideas by reading and attend g and attending meetings.
- The nurse must learn to respect authority.
- The nurse must carry out the doctors order accurately and sustain confidence in the doctor, and all members of the health team.
- The nurse should report any unusual condition or symptoms to the doctor or in-charge nurse.
- The religious beliefs of a patient should be respected.
- The nurse should hold confidential all information given to her.
- When a patient requires continued nursing care, the nurse must remain with the patient until adequate relief is available.
- A patient should always be called by his full name
- Punctuality is very important for every nurse.
- Obedience is very important in observing rules and regulation
- Every nurse must have respected for authority and for rules and regulation
- Economy is important for all nurses to practice
(Ref Capt (Retd.) Alphonsa Jacob/Fundamentals of Nursing/Vol-1/6/28)
Code for Nurses by International Council of Nurses (ICN)
The ICN further states that the need for nursing is universal. Inherent in nursing is respect for life, dignity and the rights of humanity. It’s unrestricted by considerations of nationality, race colour, age, der, politics or social status. The code e has five principal elements that outline the standards of ethical duct.
A. Nurses and people
- The nurse’s primary responsibility is to people who require nursing care.
- The nurse, in providing care, respects the beliefs, values and customs of the individual.
- The nurse holds in confidence personal information and uses judgment in sharing this information
B. Nurses and practice
- The nurse carries personal responsibility for nursing practice and maintaining competence by continual learning.
- The nurse maintains the highest standards of nursing possible within the reality of a specific situation.
- The nurse uses good judgment in relation to individual competence when accepting and delegating responsibilities.
- The nurse, when acting in a professional capacity, should at all times maintain standards of personal conduct that would reflect credit upon the profession.
C. Nurses and society
- The nurse shares with other citizens the responsibility for initiating and supporting actions to meet the health and social needs of the public.
D. Nurses and co-workers
- The nurse sustains a co-operative relationship with colleagues in nursing and other fields.
- The nurse takes appropriate actions to safeguard the patient when their care is endangered by a colleague or another person.
E. Nurses and the profession
- The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education.
- The nurse is active in developing a core of professional knowledge.
- The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing.
(Ref by-BT Basavanthappa/2/504)
Importance of Study Ethics in Nursing Education
- Nurses will encounter ethical problems frequently in their work.
- Ethics is central to nursing
- Multidisciplinary input is important.
- Ethical knowledge is necessary for professional acceptance.
- Ethical reasoning is necessary for nursing to be taken seriously by other discipline
- Ethical proficiency is essential for providing holistic care
- Nurses should be advocates for patients
- Studying ethics will help to make better decisions
- Perceive the difference between good and evil, right and wrong.
- Understand abstract moral principles.
- Reason and apply moral principles to make decisions, weigh alternatives and plan ways to achieve goals.
- Decides and choose freely.
- Act according to choice (this assumes both the power and the capacity to act).
- Morals refer to established rules in situations where a decision about right and wrong must be made.
- If morals reflect the ‘is’ of human behavior, then ethics is a term used to reflect the “should’ of human behavior.
(Ref by: BT Basavanthappa/2/64-65)
Ethical Dilemma:
An ethical dilemma is a situation that requires an individual to make a choice between two equally unfavorable alternatives. (Catalona, 2000)
Or,
Ethical dilemma is defined as situations requiring a choice between two equally desirable or understanding alternatives.
Nurses in Clinical and Functional Specialties Faces Ethical Dilemmas:
➤ Need to ration patient care to conserve scarce ill recourses.
➤ Need to make treatment and care decisions for terminally ill patients.
➤ Need to obtain patients informed consent for care and treatment orders and measures. Such as:
- Do not resuscitate order,
- Withholding/withdrawing nutrition and fluids.
- Starting/discontinuing life assisted suicide,
➤ Response to patient request for assisted suicide.
➤ Need to balance the patients need for confidentiality and privacy against society’s needs for protection from unreasonable risk.
➤ Need to protect autonomy rights of children and incompetent adults concerning consent for research participation.
➤ Need to protect justice rights of patients who participate in random trials of experimental treatment
Definition of Decision Making:
According to John (1993)
“Decision making as managerial functions, means making a choice among alternatives to problem”.
Or,
“Decision making is identifying a problem, searching for alternative solution & selecting the alternative that best achieve the decision maker’s objective”.
Ethical Decision Making
Ethical decision making in bioethics incorporates processes of niorul reasoning by which healthilo care professionals are able to satisfactorily work through the moral dilemmas and obligations A with which they must deal.
Examples:
- A nurse who believes abortions are unethical feels she cannot give care to a woman who chooses to have abortion. However, the nurse subscribes to the code for nurse, which states that she provides services for her patients without consideration for the nature of health problem.
- An alert, middle aged adult prefers to die rather than live with the deteorating affects and slow death with cancer. Her husband implores nurses and physicians sto provide care that helps his wife continue to live
Tools for Decision Making:
While the basic principles might be the same, there are dozens of different techniques and tools that can be used when trying to make a decision. Among some of the more popular options, which often use graphs, models or charts,
1. Decision matrix
2: T-Chartr
3. Decision tree
4.Multi-votings
5. Pareto analysis
6. Cost-benefit
7. Conjoint analysis
A. Decision matrix: A decision matrix is used to evaluate all the options of a decision. When using the matrix, create a table with all of the options in the first column and all of the factors that meng affect the decision in the first row. Users then score each option and weigh which factors are of more importance. A final score is then tallied to reveal which option is the best.
B. T-Chart: This chart is used when weighing the plusses and minuses of the options. It ensures that all the positives and negatives are taken into consideration when making a decision.
C. Decision tree. This is a s a graph or model that involves contemplating each option and the outcomes of each. Statistical analysis is also conducted with this technique.
D. Multi-voting: This is used when multiple people are involved in making a decision. It helps A whittle down a large list options to a smaller one to the eventual final decision.
E. Pareto analysis: This is a technique used when a large number of decisions need to be made. This helps in prioritizing which ones should be made first by determining which decisions will have the greatest overall impact.
F. Cost-benefit: This technique is used when weighing the financial ramifications of e each possible alternative as a way to come to a final decision that makes the most sense from an economic perspective.
G. Conjoint analysis: This is a method used by business leaders to determine consumer preferences when making decisions.
Ethical Principles of Decision Making:
The principles of ethical decision making are-
1. No-maleficence
2. Beneficence
3. Autonomy
4. Justice
5. Fidelity
6. Paternalism
7. Principles of totality and integrity
1. No-maleficence
Nurses have to remain competent in their field Ito avoid causing suffering or injury to patients. This is the core of nursing ethics, and all healthcare professionals take this oath. No maleficence! also encompasses reporting any suspected abuse An example of no-maleficence: If an incompetent, or chemically impaired, health care practitioner is taking care of patients, a nurse should report the abuse to protect the patient.
2. Beneficence
This is the core principle of doing good and patient advocacy. To have compassion, take positive actions to help others and follow through on the desire to do good. Nurses concentrate on ensuring that their clients receive the best treatment to achieve optimal results.
An example of beneficence: If a nursing home patient falls and fractures his hip, a nurse should provide him pain medication as quickly as possible.
3. Autonomy
Clients are given the right of self-determination, independence and the ability to self-direct. They are entitled to decide what will happen to them. Because of this, competent adults have the ability to either refuse or consent to treatment. All nurses are required to respect their clients’ wishes, even when they do not agree with them.
4. Justice
All clients must be treated fairly and equally. Nurses face issues of justice every day as they organize care for their clients: They must decide how much time they have to spend with each client, taking patient needs into consideration, and then fairly distributing the resources accordingly.
An example of justice: If a hospital organization decides to donate no-cost eye exams and hearing tests to 10 elementary schoolchildren each month, a fair, unbiased method must be used to determine which children receive these services,
5. Fidelity
This principle stands for many things, including dedication, loyalty, truthfulness, advocacy and fairness to patients. Nurses are encouraged to keep their commitments, based on their virtue of caring.
An example of fidelity: A patient requests that a nurse not reveal his terminal diagnosis to his family.
The patient explains that his family would probably disregard his wishes and keep him alive no matter the circumstances. The nurse must recognize the obligation to keep this information in confidence and still support the patient’s family.
6. Paternalism
Health care professionals’ beliefs about what is best for patients may affect the decisions they make about their patients’ diagnosis, prognosis or therapy. The nurse may choose to withhold information from the patient and family members.
An example of paternalism: A health care professional withholds a diagnosis of psoriasis of the liver because the patient voices her fear of receiving that very diagnosis, stating that she will commit suicide because she feels psoriasis is a death sentence.
7. Principles of totality and integrity
These principles state that the entire person needs to be taken into consideration when deciding which therapies, medications or procedures a patient should undergo. For example, if a therapeutic procedure is likely to harm the patient or cause undesirable side effects, the patient’s benefit from the procedure must be proportionately justified
Models of Ethical Decision Making:
There are various models for ethical decision making. Perhaps the easiest ethical decision making model to remember and to implement in practice is the MORAL model.
1. M: Massage the dilemma: Identify and define the issues in the dilemma. Consider the opinions of all the major players in the dilemma as well as their values system.
2. O: Outline the opinion: Examine all opinions including those less realistic and conflicting. This stage is designed only for considering opinions or not for making final decision.
3. R: Resolve the dilemma: Review the issues and opinions applying the basic principles of ethics to each opinion. Decide the best opinion based upon the views of all those concerned in the dilemma.
4. A: Act by applying chosen action: this step is usually the most difficult as it requires actual implementation. While the previous steps had only allowed for dilemma the decision.
5. L: Look back and evaluate the entire process: it including the implementation. No process is complete without a thorough evaluation. Ensure that those involved are able to follow through on the final option. If not a second decision may be required and process must start again the initial step.
(Ref by- BT Basavanthappa/Nursing Administration/24/836)
Moral/Ethical Agency & Agent:
Ethical agency is an individual’s ability to make moral judgments based on some commonly held notion of right and wrong and to be held accountable for these actions. A ethical agent is “a being who is capable of acting with reference to right and wrong.
Essential Elements of Moral/Ethical Agency:
A. Ethical sensibility: Ability to recognize the ethical moment when an ethical challenge.
B. Ethical responsiveness: Ability and willingness to respond to ethical challenges.
C. Ethical reasoning and discernment: Knowledge of and ability to use sound theoretical and practical approaches to “thinking through” ethical challenges, to to ultimately decide how to aru aapila respond to this particular situation after identifying and critiquing alternative courses of action; these approaches are used to inform as well as to justify moral behavior.
D. Ethical accountability: Ability and willingness to accept responsibility for one’s ethical behavior and to learn from the experience of exercising ethical agency.
E. Ethical character: Cultivated dispositions that allow one to act as one believes one ought to act.
F. Ethical valuing: Valuing in a conscious and critical way that which squares with good ethical character and ethical integrity .
G. Transformative ethical leadership: Commitment t and proven ability to create a culture that facilitates the exercise exercise of of ethical ethical agency, agency, a a culture culture in in which which people people do the right thing because it is the right thing to do.
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