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~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Nursing EthicsNursing Ethics
By :Tri Anjaswarni Harsono, S.Kp.
M.Kep
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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ObjectivesAfter studying, the students will be able to
Describe the term of values, ethics and moral ethicsDescribe five common modes of value transmissionDescribe the ethical theoriesDescribe the seven ethical values in nursingDescribe the eight ethical principles in nursingDescribe the basic moral concepts Use the ethical concepts in the professional nursing ethic.
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Definition of Values A Value defined as a personal belief about
worth that acts as a standard to guide one’s behavior.
A value system is an organization of values in which each value is ranked along a continuum of importance ; a value system often operates as a personal code of conduct.
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Attitude and Beliefs An attitude is a feeling or an emotion, generally including positive or negative judgment, toward persons, objects, or
ideas. Beliefs refer to a special class of
intellectual attitudes based primarily on faith as opposite to fact.
Attitudes and Beliefs also influence human behavior
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A person’s values influence beliefs about : human need, health and illness The practice of health behavior
Human responses to illness
Nurses who work effectively with clients are sensitive to how a client’s values and their own values influence their
interaction.
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Common Modes of Value Transmission
Modeling Moralizing
Laissez-faire Rewarding and punishing
Responsible choice
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Definition of Ethics & Moral Ethics is
a system dealing with professional standards of
behavior related to what is right and wrong.
Morals, although similar in meaning to ethics, usually refers
to personal standards
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Ethics & Moral (Cont.)
Ethics is that science which studies the morality of human acts through the medium of natural reasonEthics teaches us how to judge accurately the moral goodness or badness of human action
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Nursing EthicsIs an expression of how nurses
ought to conduct themselves.
Refers to the ethical standards that govern and guide nurses in
everyday practice such as “ being truthful with clients”, “respecting
client confidentiality” and “advocating on behalf of the
client”
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Ethical Theories
Didasarkan pada norma dan aturan utk melakukan tindakan menitik beratkan pada hasil akhir tindakan.Benar jika suatu tindakan menghasilkan akibat yg baik / memberikan kebahagiaan yg cukup besar dan tdk menimbulkan bahaya.Salah jika tindakan menghasilkan akibat yg buruk / menimbulkan bahaya
Utilitarianism Theory
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Deontology TheoryBerasal dari norma atau aturan mengenai kewajiban umat manusia yg saling ketergantungan shg mempunyai komitmen & rasa tanggung jawab untuk memenuhi kewajiban thd orang lainTidak / bukan menitik beratkan pada hasil akhir atau akibat suatu tindakan
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Ethical Values Aesthetics Altruism Equality Freedom
Human DignityJusticeTruth
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ValuesAesthetic
Altruism
Equality
Freedom
Qualities of objects, events, and persons that provide satisfaction
Concern for the welfare of other
Having the same rights, privileges, or status
Capacity to exercise choice
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ValuesHuman DignityInherent worth and uniqueness of an individualJusticeUpholding moral and legal principleTruthFaithfulness to fact or reality
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AestheticAttitudes & Personal Qualities
AppreciationCreativityImaginationSensitivity
Professional BehaviorAdapts the environmentCreates a pleasant work environment for self & othersPromotes a positive image of nursing
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AltruismAttitudes & Personal
Qualities CaringCommitmentCompassion GenerosityPerseverance
Professional Behavior
Gives full attention to the clientAssists other personnel in providing careExpresses concern about social trends & issues that have implication for health care
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EqualityAttitudes & Personal Qualities
AcceptanceAssertivenessFairnessSelf esteemTolerance
Professional BehaviorProvide nursing care based on the individual’s needs / personal characteristicInteract with other provider in a nondiscriminatoryExpresses ideas about the improvement of the nursing and health care
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FreedomPersonal
Quality Confidence Hope Independenc
e Openness Self direction Self Discipline
Professional Behavior Honor individual’s
right to refused treatment
Support the right of other provider to suggest alternatives to the plan
Encourages open discussion of controversial issues in the profession
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Human DignityPersonal Quality Consideration Empathy Humaneness Kindness Respectfulnes
s Trust
Professional Behavior
Safeguards the individual’s right to privacy
Maintains confidentiality of client & staff
Threats others with respect
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JusticePersonal
Quality Integrity Morality Objectivity
Professional BehaviorActs as a health care advocateAllocates resources fairlyReport incompetent, unethical, & illegal practice objectively & factuality
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TruthPersonal Quality Accountability Authenticity Honesty Rationality Reflective ness
Professional Behavior
Documents nursing care accurately & honestly
Obtains data to make sound judgment before reporting of organization policies
Participates in professional efforts to protect the public from misinformation about nursing
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Ethical Principles
Autonomy Justice Beneficence Veracity
Confidentiality Non maleficence Fidelity Avoiding Killing
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AutonomyBerhub. Dg kemerdekaan atau
kebebasan klien (independence)Hak utk memilih bagi seseorang (the
client’s freedom of choice)Self-determinationPenerapan informed consent
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Justice
Memperlakukan orang lain secara adil tanpa membedakan status sosial, ras,
agama, dsb.Merupakan prinsip moral utk berlaku adil
bagi semua individu
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Beneficience
Prinsip berbuat kebaikan / baik (promote good)
The nurse should doUpaya kebajikan perawat
untuk menyelesaikan pekerjaan yg terbaik utk klien
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Veracity
Truthfulness (kebenaran / sifat yg sebenarnya) Kejujuran dlm
menyampaikan hal yg sebenarnya.Kewajiban perawat mengatakan yg
sebenarnya didasarkan pd otonomi seseorang
Truthful communication are necessary to establish and maintain trusting
relationships.
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Confidentiality
Prinsip menjaga kerahasiaan klien (client’s privacy)
The nurse respect all privileged information about client
Merupakan prinsip moral yg menjelaskan kewajiban perawat
utk tetap setia pada komitmennya, yaitu mempertahankan hubungan
saling percaya
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Non Maleficence
Do no intentional harm (prinsip melakukan tindakan tanpa
bahaya) atau tidak membunuh / prinsip tidak menimbulkan kerugian bagi orang lain
The basis for most nursing
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Fidelity
Good faith to keep promises made to the client
(komitmen / mempertahankan janji dg klien)
Loyality to the client – care provider relationships.
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Avoiding KillingMenekankan pada kewajiban
perawat utk menghargai kehidupan
Kewajiban perawat menghargai eksistensi kemanusiaan yg
memp. Konsekuensi melindungi dan mempertahankan
kehidupan dengan berbagai cara.
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Basic Moral ConceptsJameton, 1984 in Taylor, Lillis, LeMone, 1989
Five Basic Moral Concepts
Respect for Persons (empathy, listening & understanding)
Justice Values Right
Responsibility
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Problems in Clinical Practice
Ethical Issue Ethical ProblemEthical Dilemma
Bio Ethic
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MORAL & ETHICAL PROBLEMS&
DECISION MAKING
By : Tri Anjaswarni Harsono, S.Kp. M.Kep.
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ObjectivesAfter studying this topic, the students will be able to :Describe moral & ethical problems in clinical practiceDescribe Type of Moral and Ethical ProblemsDescribe ethical dilemmas in nursingDescribe Process for resolving the ethical Problems / process of Ethical or moral Decision Making
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Problems in Clinical Practice
Ethical Issue Ethical ProblemEthical Dilemma
Bio ethic
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Ethical Issue
One in which one or more moral norms or principles are present, but do not
create a problem
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Ethical Problem
One in which two or more moral norms or principles create a challenge about
what to do
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Ethical Dilemma Problem that involves two or more morally correct courses of action, but you can’t do both.It is difficult to determine the right decision or actionA difficult problem that seems to have no satisfactory solutionA choice between equally unsatisfactory alternativesAn ethical dilemma exists when the moral claims conflict with another (What should I do or What is the right thing to?)
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Three Type of Moral and Ethical Problems
Jameton (1984) in Taylor, Lillis, LeMone (1989)
Moral Uncertainty, where the nurse is unsure of which moral principles or value apply.
Moral Dilemma, where two or more clear moral principles apply but support mutuality inconsistent courses of action.
Moral Distress, where the nurse knows the right thing to do but institutional constraints make it nearly impossible to pursue the right action
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Type of Moral and Ethical Problems /
Dilemmas In Nursing (Cont.)
Nurses and Clients Nurses and Physician
Nurses and Other Nurses Nurses and Institutional
arise because of conflicts between :
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Conflicts areas are explored
Personal value systemsPeer’s and other professionals’
behaviorPatients’ rights
Institutional & societal issue
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Type of Moral and Ethical Problems (Cont.)
Nurses and Clients
Difficulty identifying primary client
Paternalism Deception Confidentiality Informed consent Conflict between the
client’s and nurse’s interest
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Type of Moral and Ethical Problems (Cont.)
Nurses and Physician
Disagreements about the proposed medical regimen.
Conflict regarding the scope of the nurse’s role.
Physician incompetence
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Type of Moral and Ethical Problems (Cont.)
Nurses and Other Nurses
Nurse and Institutional
Claim of loyaltyNurse
incompetence
Inconsistent Rules
Policy
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How To Make The Best Decisions ?
Ethical & Moral TheoryEthical Value & Principles
Basic Moral ConceptsProblems in clinical practice
Process for resolving the ethical problems
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Ethical Decision Making
Nursing Process
Assess
Analyze & diagnoses Plan Implement Evaluate
Ethical Decision Making Model Clarify the ethical
dilemma Gather additional data Identify option Make a decision Act Evaluate
Comparison of Nursing Process And Ethical Decision Making Model
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Process for resolving the ethical
Problems Step I : Identify The problem (Clarify
the ethical dilemma) Step II : Gather additional data Step III: Identify option Step IV : Make a decision Step V : Act Step VI : Evaluate
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Process (Cont.)
What is the specific issue ? State the problem Clearly
Who owns the problem and should actually make the decision ?
Who is affected by the dilemma ? Determine the ethical principle or theory related
to the dilemma ! Are there value conflict ?
Step I : Identify The Problem
(Clarify The Ethical Dilemma)
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Step IIGather additional data
Gathered many facts about the situation as possible
describe the situation that gives rise to the problem : main people involved (view & interest), client overall nursing, medical and social situation, relevant legal, administrative, and staff consideration.
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Step III : Identify Option
List all alternatives to solve the problem Give reason on each alternatives Consider immediate consequences to the
people involved as well as long term consequences to the institution / society
Brainstorm with others and consider every possible alternative.
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Step IV : Make Decision
Think through the option that are identify and determine each options’ impact.Ethical principles and theory may help determine the significance of each option.
Choose a course of action that best reflect your considered judgment, consultation with an institutional ethics committee or other staff may be helpful.
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Step V : Act
Once a course of action has been determined, the decision must be carry out
Implementing the decision usually involves working collaboratively with others.
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Step VI : Evaluate It is important for decision makers to
determine the impact this decision. If the action accomplishes its
purpose, the ethical dilemma should be resolved.
If the dilemma has not been resolved, additional deliberation is needed.
How can you improve the decision process next time.
~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making
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Factors Affecting Decision Making Process
Personal values (client, nurse, other professional)
Institutional Values Social values
Individual purpose Institutional Purposes Nurse’s Knowledge
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