BScN 2030: Nursing concepts across the lifespan 1

Week 12: Student Deck

Care of the Client/Family Experiencing Complex Caregiving Needs
Cognitive Alterations, Ethics, Social Support

NURSING VALUES AND ETHICS

Value
A strong personal belief

An ideal that a person or group believes has merit

Influences behaviour

Reflects cultural and social influences, relationships, and personal needs

Varies among people; develops and changes over time

(Astle et al., 2024)

 Family experience

Moral development
Value
Formation Cultural, ethnic, and religious
communities (cultural values)

Individual experiences

(Astle et al., 2024)

Quick Check!
Which statement about a person’s values is true?
A. They are the same throughout the person’s life.
B. They are based on the person’s language.
C. They are often culturally based.
D. They are seldom influenced by the environment.
Value Clarification

The process of appraising

Values may change, and a
one’s values helps a person
person may modify attitudes
decide priorities and make
and behaviour.
decisions.

Relational communication is
Values may conflict between
important for resolving
people and between societies.
conflict.

(Astle et al., 2024)

Personal Reflection

Values clarification
Very important to identify one’s Leads to better understanding of
Plays a key role in communication
own values and beliefs others

Need to be aware of the values of employers, patients,

physicians, and other groups

(Astle et al., 2024

Values
Clarification
Questions • Personal Reflection:
Recall a situation in your personal or professional
experience in which you felt uncomfortable,
believing that your beliefs and values were being
challenged, or believed your values differed from
others.

How did you react

How did you handle it
Were you satisfied with the end result
 Ethics
• The study of good conduct, character, and motives
• Ethics is the study of philosophical ideals of what is beneficial or valuable
for all.
• Philosophical ideals of right and wrong
• A reflection of what matters most to people or professions
• Nurses in Canada guided by the Canadian Nurses Association’s
Code of Ethics (2017)
• A code of ethics provides a foundation for professional nursing. Such a code
promotes accountability, responsibility, and advocacy.
• Ethical problems arise from differences in values, from technological
advances, from end-of-life experiences, and from changes in work
environments.
• A standard process for thinking through ethical dilemmas, including critical
thinking skills, helps health care providers resolve conflict or uncertainty
about correct actions.
• Astle et al., 2024

Image: unsplash.com
 Statement of the ethical values of nurses
and nurses’ commitments to persons with
health care needs
Intended for nurses in all contexts

Code of
Ethics Provides guidance when nurses are
working through an ethical challenge

Includes responsibility, accountability, and

advocacy
(Astle et al., 2024)
 Canadian Nurses Association
Code of Ethics*
Primary nursing values
central to nursing. Code
outlines professional values
& ethical commitments:
Nursing 1. Providing Safe,
Compassionate, Competent
Codes of and Ethical Care
2. Promoting Health and Well-
Ethics Being
3. Promoting and Respecting
Informed Decision Making
4. Honouring Dignity
5. Maintaining Privacy and
Confidentiality
6. Promoting Justice
7. Being Accountable
CNO Code of Conduct (2024)
Principles*:
1. Nurses respect clients’
dignity.
2. Nurses provide inclusive and
culturally safe care by practicing
cultural humility
3. Nurses provide safe and
competent care
4. Nurses work respectfully
with the health care team to
best meet clients’ needs.
5.Nurses act with integrity in
clients’ best interest.
6.Nurses maintain public
confidence in the nursing
profession
10
Quick Check!
A nursing code of ethics
A. Provides specific ways to behave with patients
B. Has definite guidelines for decision making
C. Permits nurses to decide what is best for their patient
D. Provides guidance for relationships, behaviour, and
decision making
Quick Check!
If a nurse decides to withhold a medication because it
might dangerously lower a patient’s blood pressure, the
nurse is practising which principle?
A. Responsibility
B. Accountability
C. Competency
D. Moral behaviour
 Ethical Dilemma: When two or more ethical values apply to a
situation, but these values support diverging courses of action, an
ethical conflict or dilemma exists. Nurses may experience ethical
uncertainty when faced with a situation in which they are unsure of
what values apply or even where the moral problem is.

CNO: Ethics• Ethical dilemmas may conflict with the nurse's personal values,
beliefs etc
• Nurses encounter ethical conflict, uncertainty and distress in their
everyday practice.
• Continuous changes in the health care system, in areas such as
technology and in values, contribute to these ethical dilemmas.
• Can cause distress and confusion for patients, caregivers, healthcare
providers
Image:unsplash.com

College of Nurses of Ontario; Astle et al., 2024

How to Analyze an Ethical Dilemma

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7

Determine Gather all Examine and Verbalize the Consider Reflect on the Evaluate the
whether the relevant determine your problem. possible outcome. action and the
issue is an information. own values on courses of outcome.
ethical the issues. action.
dilemma.

(Astle et al., 2024)

Ethical Issues in Nursing Practice
• Patient care issues
 Futile care
 Advance care planning
 Medical assistance in dying (MAID)
• Issues of safety and ethics in the work environment
 Social networking and safety
 Working with a healthcare team to promote safe care
• Moral distress
• Moral integrity
• Moral residue
(Astle et al., 2024)
Moral Distress and Ethical Climate
Moral Distress
• The phenomenon of stress associated with ethical dimensions of healthcare practice
Ethical Climate
• A type of organizational work climate defined as the shared perception of ethically correct
behaviour and how ethical issues should be handled in the organization.

• Ethical climate and levels of moral distress were significantly correlated.

• Examining the nature of moral distress in relation to the ethical climate has potential
benefits for both nurses and patients. Given the current and future shortages of registered
nurses, attention to moral distress and the development of positive ethical climates is
paramount to the evolution of quality work environments and quality patient outcomes.

(Helmers et al., 2020 & Ricciardelli et al., 2022)

Care Burden, Economic Stress and Social
Support
• A concept signifying the physical, psychological, social, or financial reactions
Care Burden that could be experienced while giving care.

Economic Stress • Three broad categories: direct, indirect, and psychosocial costs.

• Plays an important role in individuals developing convenient coping strategies

Social Support against the difficulties of life and the adverse effects of stress.
• (The Ontario Caregiver Organization)

(Göriş et al., 2016; Essue et al., 2020: Ontario Caregivers Organization, 2022)
References
• Astle, B. J., Duggleby, W., Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A., (2024). Canadian fundamentals of nursing (7th ed.). Elsevier, Canada
• Canadian Nurses Association (2017). Code of Ethics for Registered Nurses
• College of Nurses of Ontario. (2023). Code of Conduct. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf
• Essue, B. M., Iragorri, N., Fitzgerald, N., & de Oliveira, C. (2020). The psychosocial cost burden of cancer: A systematic literature review. Psycho-Oncology (Chichester,
England), 29(11), 1746–1760. https://doi.org/10.1002/pon.5516
• Göriş, S., Kılıç, Z. , Elmal, F., Tutar, N. & Takcı, Ö. (2016). Care Burden and Social Support Levels of Caregivers of Patients with Chronic Obstructive Pulmonary Disease.
Holistic Nursing Practice, 30(4), 227-235. doi: 10.1097/HNP.0000000000000153.
• Helmers A, Palmer KD, Greenberg RA. Moral distress: Developing strategies from experience. Nursing Ethics. 2020;27(4):1147-1156. doi:10.1177/0969733020906593
• Ricciardelli, R., Johnston, M. S., Bennett, B., Stelnicki, A. M., & Carleton, R. N. (2022). “It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral
Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada. International Journal of Environmental Research and Public Health, 19(3), 1454.
https://doi.org/10.3390/ijerph19031454
• Szabo, S., Lakzadeh, P., Cline, S., Palma dos Reis, R., & Petrella, R. (2019). The clinical and economic burden among caregivers of patients with Alzheimer’s disease in
Canada. International Journal of Geriatric Psychiatry, 34(11), 1677–1688. https://doi.org/10.1002/gps.5182
• The Ontario Caregiver Organization (2022). Spotlight Report
• Ventovaara P, Sandeberg MA, Räsänen J, Pergert P. Ethical climate and moral distress in paediatric oncology nursing. Nursing Ethics. 2021 Sep;28(6):1061-1072. doi:
10.1177/0969733021994169