Introduction Nursing Ethics

Gugsa Nemera
(BSC, MScN, Assistant Prof, PhD )
Jimma University
School of Nursing

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 Objective
After this session, the participants
can apply fundamental ethical
principles and professional codes of
conduct in their nursing practice.

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Introduction

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 TPS

Value Attitude Moral Ethics

Belief Behavior Morality

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 KNOWN TO
BEHAVIOR OTHERS 10 %
KNOWLEDGE &
SKILLS
SEA LEVEL

IMPACT
VALUES – STANDARDS – JUDGMENTS UNKNOWN TO
ATTITUDE OTHERS 90 %
MOTIVES – ETHICS - BELIEFS

9/20/2023 JUTH -NSD office 5

www.kennisgroup.com
Value

Freely chosen, enduring beliefs or attitudes about the

worth of a person, object, idea, or action (e.g., freedom,
family, honesty, hard work)

Form a base for Behavior

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The drive of individual value
Culture

Religious
Family background

Value

Peer Societal
groups traditions

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Professional values

Often reflect and expand on personal values

• Altruism

• Autonomy

• Human dignity

• Integrity

• Social justice

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Values clarification
• The process of becoming more conscious of and naming what
one values or considers worthy.

• Nursing Values
o Strong commitment to serve
o Compassion
o Belief in the dignity and worth of each person
o Commitment to education
o Autonomy
o Value-natural way (i.e. Being nonjudgmental)

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Belief
• True assumptions or convictions about some thing.

• Bridge over to our behavior

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Attitude

• A persistent tendency to feel and behave either

favorably or unfavorably towards some objects,
persons or events

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Behavior

• Result of a person’s values, attitudes, and beliefs

• Action or reaction to a situation, group or person

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 Human conduct

Three kinds of judgment applied to human conduct:

1. Acts that a human being SHOULD perform

2. Acts that a human being SHOULD NOT perform

3. Acts that allow the human being a CHOICE of

either performing it or not performing it.

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Character

• The mental and moral qualities distinctive to an

individual

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Morality

• A personal standards of right and wrong

• An individual’s own code for acceptable behavior

• Arise from an individual’s conscience

• Learned

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 Moral distress
• Inability to follow personal moral beliefs because of
institutional or other restriction

• Distress occurs when the nurse violates a personal moral value

and fails to fulfill perceived responsibility.

Share your experiences

• How many of you felt moral distress before? why

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 Moral outrage
• Occurs when someone else in the health care setting performs an
act the nurse believes to be immoral.

• Nurses do not participate in the act.

• Nurses not responsible for wrong but perceive that they are
powerless to prevent.

SHARE YOUR EXPRIENCE

• How many of you have seen this? Why you were powerless? Any
attempt? To what extent? Were you morally, right? How ?

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 Ethics
• Comes from the Greek word “ethos,” meaning character, different thing

to different people

• The study of ideal human behaviour and ideal ways of being

• Deals with the “rightness” or “wrongness” of human behavior

• Standards of right and wrong

• Not religion or law

• Concerned with the motivation behind the behavior

• Practices , beliefs, and standards or behavior of a particular group

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 Nursing Ethics

• Deals with moral problems or challenges that the

nurse and face

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Fundamental

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Ethical Principles

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 Breakout: Brainstorming
questions

What are the

fundamental
principles of
ethics?

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Fundamental Principles of Ethics
Ethical principles Central concept
Autonomy Self-determination
Beneficence Doing good
Non-maleficence Avoiding harm
Veracity Truth-telling
Confidentiality Keeping secret
Fidelity Keeping promises
Justice Treating people fairly

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 1.Autonomy
• The freedom to make decisions about
oneself
• The right to self-determination
• Must have the capacity to make decisions
independently:
o Developmental considerations
o Health-related challenge
• Involves Informed consent

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Breakout

Informed consent?

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 Informed consent
A process by which a patient/client or
legal representative gives their consent
about the proposed intervention/care

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 Breakout

Informed consent
Who cannot give
consent?

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 Those who can't
consent

Legally underaged

Mentally
incapacitated

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 Obtaining consent:
Responsibility of
Nurses/Midwives

1. Witness

2. Accurately record all

discussions and decisions
relating to obtaining consent

3. Advocacy

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 Breakout

Informed consent
Who should obtain
consent?

A person performing a procedure

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 Breakout

Informed consent
Forms of consent?

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Forms of Consent
1. Written consent

▪ If the treatment or care is risky, lengthy

or complex

2. Verbal consent

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2.Beneficence

“Doing good” Maximizing Meeting

for others benefit Biological
Psychological
Social needs.

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 • Above all, do not harm, either
unintentionally or deliberately
3.Nonmaleficence

• Balance risk and benefit

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 Implies “truthfulness”

Nurses need to be truthful to their

clients

4.Veracity
Nurses must not withhold the whole
truth from patients, even if they believe
the truth will cause distress.

A patient always has the right to know

about diagnoses and care options

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5.
Confidentiality
Anything stated to nurses by
patients must remain
confidential
Safeguarding the client’s
information, health
records, and privacy
Maybe violated if it
o May inflict harm to
themselves or others

o Permits for the information to

be shared

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6.Fidelity

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keeping a promise to fulfill all
commitments

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 7. Justice

• Every individual must be treated

equally, fairly, and consistent with the
rights of the individual

• Patients should not be discriminated

against based on personal
characteristics, beliefs, or values

• This requires nurses to be

nonjudgmental
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 Ethical/Moral dilemmas

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 Ethical/Moral
dilemmas
• A situation that requires an individual to
choose between two equally unfavorable
alternatives, neither of which resolves
the situation in an ethically acceptable
fashion

• Conflict between one individual’s rights

and those of another or between one
individual’s obligation and the rights of
another

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Ethical Dilemmas

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 Ethical Dilemmas

• Occurs when a problem exists

between ethical principles

• Deciding in favor of one principle

usually violates another

• Both sides have “goodness” and

“badness” associated with them

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Moral/ethical dilemma Example#1

• Treating or terminating impaired fetuses with

Down’s syndrome or spina bifida?

• Right to keep confidentiality and right to keep the

public from hazards

• Should we tell the truth always?

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Moral/ethical dilemma Example#2: Sophie’s choice

• Sophie is jailed at a Nazi concentration camp with

her two young children. One day, she is confronted
by a Nazi soldier who offers her the following
choice: He says, “I am going to shoot one or both of
your children. You tell me which one to shoot, or I
will shoot them both.” What should you do if you
are Sophie?
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Do have any moral dilemmas you
encounter in everyday life?

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How do you
resolve a moral
dilemma?

• What sorts of duties,

preferences, or values
do you appeal to?

• Is it always a matter of
the consequences or
results?

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 Ethical Decision-
Making Process

The process of choosing the best

alternative for achieving the best results
or outcomes compliance with individual
and social values, morals, and regulations

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 Ethical Decision-Making
Process Framework
1. Step One: Describe the problem
2. Step Two: state the Ethical dilemma
3. Step Three: Clarify Values
4. Step Four: Gather your information
5. Step Five: Review Code of Ethics and ethical principles
6. Step Six: Determine the options
7. Step Seven: Select a course of action
8. Step Eight: Put your plan into action.
9. Step Nine: Evaluate the results.

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 Clinical Ethics Grid system/model
1. Review the ethical principles
2. Medical indications:
• Patient medical problem, history, diagnosis, and goals
of treatment.
3. Patient preference for treatment
4. Quality of life:
• What are the prospects, with or without treatment, for a
return to the patient's normal life?
5. Contextual factors:
• Are there family issues that might influence treatment
decisions

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Potential Malpractice Situation in Nursing
1. Medication error( violating the 5’s )

2. Forgetting surgical materials inside operation site

3. Injuring patient with therapeutic appliances

4. Failure to rescue patient fall

5. Ignoring a client's complaints

6. Incorrectly identifying clients

7. Mishandling of client’s property( jewelry, money, eye

glasses and dentures)
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Legal Safeguards For Nursing Practice

• Having legal contract

• Documentation ,record Keeping and reporting

• Work in according to scope of practice stated in NPA

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 Maintaining Standards of Nursing

1. Standards of Care 2. Standards of Performance

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NURSING STANDARDS OF CARE

“Nursing Standards of Care”

pertain to professional nursing
activities that are demonstrated
by the nurse through the nursing
process

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 Nursing standards of care
1. Standard I: Assessment
2. Standard II: Nursing Diagnosis/Problem Identification
3. Standard III: Outcome Identification
4. Standard IV: planning
5. Standard V: Implementation/intervention
 Standard V-A: Intervention-Therapeutic Alliance
 Standard V- B: Intervention-Counseling
 Standard V-C: Intervention- Self-Care Activities
 Standard V-D: Intervention- Psychobiological Interventions
 Standard V-E: Intervention- Health Teaching
 Standard V-F: Intervention- Case Management
 Standard V-G: Intervention-Health Promotion and Health Maintenance
 Standard V-H: Intervention-Therapeutic Environment, As Appropriate

6. Standard VI: Evaluation

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Standards of Professional
Performance

Standard 1: Standard 2: Standard 3: Standard 4:

quality of care performance education collegiality
appraisal

Standard 5: Standard 6: Standard 7:

collaboration research resource
utilization
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 Nurse Practice Act (NPA)
• A rule and regulation which is developed by board/council of nurses
and affirmed by the parliament to makes decision on nursing for
nurses

• Most important legal statute or legislative act for regulating nursing

practice.

• Define nursing practice and establishes the standards of nursing

profession.

• Can be presented in general statement which needs interpretative

statement

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 NPA
• Ethiopia has no NPA but governed by health

professional act? developed by FMoH

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 Nursing code of ethics
A system of principles concerning actions of
nurses in his/her relationship with:
❖Patients

❖Patients’ family members

❖Other health care providers

❖Policy makers

❖Society as a whole

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 Principles of nurses’ Code of Conduct
1. Quality and excellence
2. Continuous professional development
3. Human rights
4. Equitable access to quality healthcare
5. Compliance with Code of ethics and conduct
6. Honesty and integrity
7. Relationships with others
8. Information
9. Informed consent
10. Confidentiality
11. Conflict with moral and ethical beliefs
12. Delegation to and supervision of staff

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 Top 10 Qualities of a Professional and Ethical Nurse

1. Communication skills
2. Emotional stability
3. Empathy
4. Flexibility
5. Good attention to detail
6. Interpersonal skills
7. Physical endurance
8. Problem solving skills
9. Quick response
10. Respect
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