essentials of nursing leadership & management, 4th edition n246 leadership ethics & quality...
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Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition
N246 Leadership Ethics & Quality
S. Buckley, 2010
(Adapted from Nursing Leadership and Management,Whitehead, Weiss, Tappen)
Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition
In the beginning…
There were no antibiotics There were no ICUs There were no CT scanners and MRIs There were just physicians and nurses who
cared for people in sickness and in health Were there ethics?
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Early nursing leaders
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finances
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1960s
Technological advances allowed for the development of intensive care units
New biomedical developments Advances in surgical techniques, such as
open heart surgery
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Reasons for new inquiries in nursing
Technological advances created new questions for health-care professionals regarding the use of technology, RN role and outcomes
Changing views and perspectives on the concepts of life and death Dissatisfaction of RN’s with traditional manner of learning (mentoring)
and desire to have a scientific base for practice (professional scientists)
Interest by healthcare practitioners about application of values in professional practices, and how to discuss these issues.
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Bioethics
A sub discipline of ethics The study of medical morality
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Concepts of Ethics Ethics evolve from moral perspectives, which form
values and standards. Influenced by families, environment, social issues, culture, religion, cognition, law.
Ethical action depends, in part, on the ability of people to recognize that a moral issue exists in a given situation, knowing how to take appropriate ethical action if and when required, and on personal commitment and a genuine desire to achieve a moral outcome
(Johnstone, 1999, from:Ethics in Nursing Practice, 2nd ed, Fry, S.T,Johnstone, M.)
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Value Systemsdefinitions
A set of related values Intrinsic values-located within, the real nature of a thing. Extrinsic values-from without Personal values Professional values Social principles, goals or standards held or accepted by
an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.
Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition
Historical values of nursing:
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Nursing today Values in nursing
today:
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Value Formation
Values are learned-therefore, influenced by family, culture, environment, cognition.
Values change with maturity and experience
The number of values an individual holds is not as important as what values they consider important
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Types of Values Personal Cultural Religious professional
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Values Clarification
Critical thinking Choosing Identifying-verbalizing? Acting
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Belief Systems These are organized ways of thinking about
why people exist within the universe Their purpose is to explain such concepts
as: Life and death Good and evil Health and illness Individualism/rights
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ETHICS AND MORALS
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Morals An individual’s own code for acceptable
behavior Standards of goodness or rightness that
arise from an individual’s conscience They act as a guide for individual behavior Learned Capable of making a distinction between
right and wrong in conduct
Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition
Values Social principles, goals or standards held or
accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.
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Standards Something established for use as a rule or
basis of comparison in measuring or judging quality, value, extent.
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Laws Rule of conduct established and enforced
by the authority, legislation or custom of a given community, state, or other group.
May change with fluctuating social morals and viewpoints.
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Ethics Having to do with moral standards,
conforming to the standards of conduct of a given professional group. Implies conformity with an elaborated, ideal code or moral principles.
Concerned with the motivation behind the behavior
Bioethics is the application of these principles to life-and-death issues
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Ethical Theories
Deontological-based on duty to commitment, considers the intention of the action, not the consequences of the action. It is the individuals goodwill that determines worthiness, not the outcome.
Teleological-(utilitarianism)-what makes an action right or wrong is its usefulness. Right encompasses actions that have positive outcomes, wrong is composed of actions that result in poor outcomes.
Principalism-involved in biomedical issues, integrates ethical principles to resolve conflicts in situations.
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Ethical Principles Autonomy Nonmaleficence Beneficence Justice Fidelity Confidentiality Veracity Accountability
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Autonomy
The freedom to make decisions about oneself
Nurses need to respect clients’ rights to make choices about health care
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Nonmaleficence
Requires that no harm be caused to an individual, either unintentionally or deliberately
This principle requires nurses to protect individuals who are unable to protect themselves
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Beneficence This principle means “doing good” for
others Nurses need to assist clients in meeting all
their needs Biological Psychological Social
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Justice
Every individual must be treated equally This requires nurses to be nonjudgmental
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Fidelity
Loyalty The promise to fulfill all commitments The basis of accountability (moral concept that
involves acceptance by a professional nurse of the consequences of a decision or action)
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Confidentiality Anything stated to nurses or health-care
providers by clients must remain confidential
The only times this principle may be violated are: If clients may indicate harm to themselves or
others If the client gives permission for the information
to be shared
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Veracity
This principle implies “truthfulness” Nurses need to be truthful to their clients Veracity is an important component of
building trusting relationships
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Accountability
Individuals need to be responsible for their own actions
Nurses are accountable to themselves and to their colleagues
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Ethical Codes These are formal statements of the rules of
behavior for a particular group of individuals
Ethical codes are dynamic Most professions have a “code of ethics” to
guide professional behavior
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Organizational Ethics
Focus on the workplace Ethical culture makes a difference Senior leadership must promote an ethical
culture-do they?
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Ethical Dilemmas
Occur 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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Ethical decision making Consider cause, variables, precipitating events
and implications Reflect upon one’s own perspective and values Explore options for action: ANA code of ethics, facility standard and ethics,
nurse practice act (BRN), legal issues, rights. Select appropriate plan. Understand
consequences of the plan. Implement Evaluate results
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Current Ethical Issues
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Issues to Consider
Assisted suicide Technology issues-as RN, as patient. Gene therapies, genetic counseling “Designer babies”, fertility issues, fetal success Organizational climate Family planning Social responsibility Immigration policies Resource management. Stem cell research DNR status
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Conclusion
An issue is not an ethical issue for the nurse unless he or she has been asked
Always gather the facts prior to decision-making
Consider your personal beliefs and values
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Quality issues What is it?? The degree of excellence that distinguishes
one thing from another Relates to education and practice;
professionals perceive that they are providing high-quality nursing education and patient care.
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Why do we need it? * current health care system is fragmented,
poorly organized, inefficient use of resources.
*New technologies, availability of information (it), decreasing resources, increasing chronic disease states mandate a change.
* consumer dissatisfaction with current system
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Quality improvement Also known as performance improvement,
focuses on processes or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change or improve the quality of care.(Saunders NCLEX review, 5th edition, Silvestri, L.,2011)
Essentials of Nursing Leadership & Management, 4th EditionEssentials of Nursing Leadership & Management, 4th Edition
Professional organizations that focus on quality * Joint commission on Accreditation of
Healthcare Organizations (JACHO) * American Nurses Association (ANA) *Institute of Medicine (IOM)
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IOM essential competencies Provide patient centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Use informatics
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Aims of IOM quality of care Safe Effective Patient centered Timely Efficient equitable
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IOM- cost of inefficiency 44,000-98,000 die each year $17-29 billion in total costs
Nursing errors:
*Medication
*knowledge
*procedure
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Continuous Quality improvement (CQI)
Identify indicators Collect ongoing data on indicators Analyze and evaluate data Implement change (utilize evidence based practice)
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How to monitor quality of care Guidelines Protocols Algorithms Standards of care Critical pathways
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How does structured care methodologies work? Link process of care (issue) and outcome Determine method of measurement Clarify responsibilities of interdisciplinary
team Facilitate communication among team
members Document, apply systematic approach to
measurement.
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Root cause analysis Process of learning from consequences; Determine influences, establish linked chains
of influences, determine necessary influences, analyze root (initial) cause.
Currently used to analyze errors and mistakes; attempts to evaluate series of events that may lead to errors (safety errors) and determine causative reason for error (process), rather than punitively blame a person
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Risk management part of QA Identify potential problems, risks Incident investigation Sentinel events Anticipate outcome, prevent recurrence
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conclusion To enhance quality of care; Think critically Plan and report outcomes Make introductory rounds Plan partnership with the client Communicate plan Evaluate progress