Ch 6 Values, Ethics, and Advocacy

Values and Value Systems

Values are fundamental beliefs about what is important, serving as standards to guide behavior and decision-making. In health professions, understanding values is essential for ethical practice and patient care.

• Definition of Values: Beliefs about the worth of something, guiding behavior and choices.

• Value System: An organized set of values ranked by importance, forming a personal code of conduct.

• Influence: Values shape beliefs about health, illness, and appropriate health behaviors.

Example: A nurse who values patient autonomy will prioritize informed consent and respect for patient choices.

Modes of Value Transmission

Values are not innate but are learned throughout life via various social processes.

• Modeling: Learning values by observing others.

• Moralizing: Taught a complete value system by authority figures.

• Laissez-faire: Allowed to explore values independently.

• Rewarding and Punishing: Reinforcement of values through consequences.

• Responsible Choice: Encouraged to select values after considering alternatives and consequences.

Key Point: Children are not born with values; they develop them through environmental, familial, and cultural influences.

Professional Values in Health Care

Health professionals, especially nurses, are guided by a set of core professional values that inform ethical practice.

• Altruism: Concern for the welfare and well-being of others.

• Autonomy: Respect for the right to self-determination.

• Human Dignity: Respect for the inherent worth and uniqueness of individuals.

• Integrity: Acting according to ethical codes and standards.

• Social Justice: Upholding moral, legal, and humanistic rights.

Example: Integrity involves consistently acting in accordance with professional standards, even when it is challenging.

The Valuing Process

The process of valuing involves three main activities that integrate values into behavior.

• Choosing: Selecting values freely after considering alternatives and consequences.

• Prizing (Treasuring): Taking pride and finding happiness in one's values, often affirming them publicly.

• Acting: Consistently incorporating chosen values into behavior.

Ethics and Morals

Ethics is the systematic study of right and wrong conduct, while morals are personal or communal standards of right and wrong.

• Ethics: Principles guiding right and wrong, virtue and vice, and human flourishing.

• Bioethics: Ethical questions in health care, such as duties to others and the common good.

• Nursing Ethics: Subset of bioethics focusing on ethical issues in nursing practice.

• Morals: Standards of right and wrong held by individuals or communities.

Ethical Theories

Ethical decision-making is guided by different theoretical approaches.

• Utilitarian Theory: The rightness or wrongness of an action depends on its consequences.

• Deontologic Theory: Actions are right or wrong independent of their consequences.

Example: A utilitarian might justify a painful treatment if it leads to the best overall outcome, while a deontologist might oppose it if it violates a moral rule.

Principle-Based Approach to Bioethics

Beauchamp and Childress identified key principles for ethical decision-making in health care.

• Autonomy: Respecting patients' rights to make their own health care decisions.

• Nonmaleficence: Avoiding harm to patients.

• Beneficence: Acting to benefit the patient.

• Justice: Treating individuals fairly and equitably.

• Additional Nursing Principles: Fidelity (faithfulness), veracity (truthfulness), accountability, privacy, and confidentiality.

Care-Based Approach to Bioethics

This approach emphasizes the importance of caring relationships and individualized attention in ethical decision-making.

• Centrality of the caring relationship

• Promotion of dignity and respect for patients

• Attention to individual patient circumstances

• Cultivation of responsiveness and moral virtues

Ethical Conduct and Moral Agency

Ethical conduct in nursing is grounded in professional standards and values, requiring the cultivation of specific virtues and moral agency.

• Moral Agency: The capacity to act ethically and do the right thing for the right reasons.

• Nurse Virtues: Competence, compassionate caring, subordination of self-interest, self-effacement, trustworthiness, conscientiousness, intelligence, practical wisdom, humility, courage, and integrity.

Code of Ethics for Nurses

The Code of Ethics provides a succinct statement of the ethical obligations and duties of nurses, serving as a nonnegotiable standard and an expression of nursing's commitment to society.

• Guides professional conduct and decision-making

• Reflects the profession's values and responsibilities

ICN Guidelines for Applying the Code of Ethics

• Study and reflect on each standard

• Discuss with colleagues

• Use real-life examples to identify ethical dilemmas

• Collaborate to clarify and apply standards in practice, education, and research

-Bill of Rights for Registered Nurses : The Bill of Rights outlines the fundamental rights of nurses in their professional roles.

Moral Distress and Resilience

Moral distress arises when one knows the right action but is constrained from acting. Moral resilience is the ability to respond positively to such situations.

• Moral Distress: Knowing the right thing to do but being unable to act due to external constraints.

• Moral Resilience: The capacity to recover and remain strong in the face of moral adversity.

Ways to Build Resilience:

• Cultivate good relationships

• Accept change as part of life

• Maintain perspective and self-care

• View crises as manageable

Ethical Decision-Making: The Nursing Process

Nurses use a systematic process to address ethical dilemmas.

1. Assess the situation (gather data)

2. Diagnose (identify) the ethical problem

3. Plan (identify and weigh alternatives)

4. Implement the decision

5. Evaluate the decision

Ethically Relevant Considerations

• Balance of benefits and harms

• Disclosure, informed consent, and shared decision-making

• Family norms and cultural/religious variations

• Clinician-patient relationships

• Professional integrity

• Cost-effectiveness and resource allocation

• Power dynamics

  (Examples of Ethical Problems in Health Care)

  Example: Paternalism occurs when a nurse acts for a patient without consent to secure good or prevent harm.

Ethics Committees

Ethics committees serve several functions in health care organizations.

• Education

• Policy making

• Case review and consultation

• Quality improvement

• Occasionally, research

Conflicts of Commitment

Nurses must balance their primary commitment to patients with responsibilities to themselves and others.

• Primary commitment is to the patient (individual, family, group, or community)

• Nurses owe duties to themselves, including maintaining integrity and competence

• Self-care is essential to provide effective patient care

Advocacy in Nursing Practice

Advocacy involves supporting and representing patients' interests and rights in the health care system.

• Primary commitment to the patient

• Prioritizing individual patient well-being over societal interests

• Balancing patient autonomy with well-being

Areas of Concern for Patient Advocates:

• Representing patients

• Promoting self-determination

• Whistle-blowing (reporting unsafe or unethical practices)

• Political activism for patient rights