Prepared By

Hanan Saca-Hazboun
Lecturer
Faculty of Nursing and Health Science
Bethlehem University
 The objectives
To identify and describe the nurses duty of
care in the emergency care settings.

To apply ethical principles and rules using

case-studies, and to test ethical decision-
making processes.
Ethics is the study
of decisions
and
the bases of those
decisions.
CODE OF ETHICS FOR
EMERGENCY NURSES
 CODE OF ETHICS
 1   The Emergency Nurse provides care with
compassion and respect for human dignity
and the uniqueness of the individual.
 2   The Emergency Nurse maintains
competence within, and accountability
for, emergency nursing practice.
 3   The Emergency Nurse acts to protect the
individual when health care and safety are
threatened by the incompetent, unethical or
illegal practice of any person.
 4   The Emergency Nurse exercises sound
judgement in accepting responsibility,
delegating, and seeking consultation.  
 CODE OF ETHICS

 5   The Emergency Nurse respects the

individual's right to privacy and
confidentiality.
 6   The Emergency Nurse continues to study,
implement, and promote scientific
knowledge.
 7   The Emergency Nurse collaborates with
other health professionals and the public in
meeting community and national health
needs.
Difference between ethics and law
 Ethics is internal to an individual, looks to the good
of an individual rather than society as a whole, and
concerns the "why" of one's actions.

 Law: compromise rules and regulations pertinent to

society as a whole, is external to oneself and
concerns one's actions and conduct.
 Ethics and Law
 Ethics what is right
and what is wrong

 Low: consensus can be

enforced
 The utilitarian approach

 Seeks the greatest good for the

greatest number and focuses
primarily on consequences of action -
frequently used in justifying decisions
made in the health care delivery
system.
 The formalist or deontologic
approach

 Concerned with determination of

duties and obligations using moral
principles and rules, such as respect
for the individual and telling the truth.
 The Rawisian approach

 No one should benefit unless all

person's benefit from a proposed
action, always considering the least
fortunate.
 
 General Ethical Concepts
1. Autonomy: it is the personal freedom and the right to
choose what will happen to one's own person.

2. Beneficence: the actions one takes should promote

good, acting in the best interest of the patients.

3. Nonmaleficence: one should do no harm

4. Veracity: telling the truth and incorporates the concept

that individuals should always tell the truth.
 General Ethical Concepts
5. Rationing: or limiting available resources, is closely related to the
concept of justice.

6. Justice: the principle of treating all persons equally and fairly,

refers to fairness in the allocation of resources in regard to health
care delivery.

7. Paternalism: allows one person to make decisions for another

and often is seen as a negative or undesirable principle.

8. Fidelity: keeping one's promise or commitments.

9. Respect for others: the highest principle and incorporates all

other principles.
Moral model for ethical decisions
making

 Massage the dilemma

 Outline the options
 Resolve the dilemma
 Act by applying the chosen option
 Look back and evaluate the entire
process
 Scenario
The department staffs were doing
resuscitation for Mr. G., 34 year old man,
who was mentally retarded. Later, after 5
minutes, a 55 years old well-known
businessman, a father of 3 children, came
to the emergency room with MI. He
shortly needed cardiac resuscitation. The
emergency team, needed the cardiac
shock machine that has been used by the
team who are resuscitating Mr. G.
 
 Scenario
Mrs. A, 74 years old, was admitted to the
emergency department by the EMT staff.
Patient was unconscious, had kussmaul's
respiration. When Neurologist assessed
her, she had neurological deficit and first
diagnosis was brain stem injury. The
patient was placed on ventilator
regardless of knowing she will not benefit.
 
 Scenario
A 38 years old female was admitted for
incomplete miscarriage with severe
bleeding. Her hemoglobin was 7.8. A
blood transfusion was ordered and the
patient refused stating she is a member
of Jehovah's witness and they can't get
blood.  
 Scenario
A 9 years old female was brought to the
emergency department due to vaginal
bleeding due to falling down on a hard
material. When the patient was
assessed, she had a tear and laceration
in the vulva. MD thought it is a sexual
violence, shall we inform or not.
 
 
 Scenario

One evening, a 65 years old male patient

came to emergency department
complaining of shortness of breath.
While Ahmad, RN, who has worked in
the emergency center for several years
was working with him, patient went into
respiratory arrest, and Ahmad intubated
the patient successfully. Thus, the
hospital policy forbids the intubation of
patients by nurses.
If the emergency care
professional understands
the basic concepts of
ethics and how those
concepts relate to law, a
framework for decision
making can enhance the
care patients receive.
Good decision-making … seems to require
human sensitivity, illuminating and useful
principles, access to pertinent information,
methods of weighing and balancing options -
reasons and feeling, private meditation and
public discussion, god sense and good
sensibilities.