Competency 1Personal & Healthcare Values

Healthcare Ethics

Dede Carr, BS, LDAKaren Neu, MSN, CNE, CNP

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Competency:1. Describe the dimensions of values as they impact healthcare◦Define values◦Discuss the importance of values◦ Explain how values are developed◦ Identify personal values◦ Identify key values in health care◦Discuss how professional values impact performance and

behavior

Healthcare Ethics

A man without ethics is a wild beast loosed upon this world. Albert Camus

Non-violence leads to the highest ethics, which is the goal of all evolution. Until we stop harming all other living beings, we are still savages.

Thomas A. Edison

Ethics and equity and the principles of justice do not change with the calendar.

David Herbert Lawrence

Quotes

Values are freely chosen, enduring beliefs or attitudes or ideals about the worth of a person, object, idea, or action.

Values are shared by the members of a culture about what is good or desirable and what is not. Values exert major influence on the behaviors, decisions, and actions of individuals and serve as broad guidelines in all situations.

Values are the regard that something is held to deserve importance or worth, and principles or standards of behavior. (Ramont & Niedringhaus, p. 37)

Definitions of Values

All human interactions are value-based and guide our behavior and tell us right from wrong.

Values are the deepest beliefs and sentiments we subscribe to and are passed down from generation to generation. (Ramont & Niedringhaus, p. 37)

Values are that which we seek to achieve or maintain according to our life as the standard of evaluation.

Values are the motive power behind purposeful action. They are the ends to which we act. Without them, life would be impossible.

Life requires self-generated action to sustain itself. Without values, one could not act, and death would follow.

(Landauer & Rowlands)

Definitions of Values

For example, value specifies a relationship between a person and a goal.

The goal to which one aims is called the "value", but the relationship is always required. This means an object cannot be a value in itself. It only gains the title of value when a person acts to achieve or maintain it.

A value requires a person to value the object, idea, goal, and/or relationship & that particular person aims to achieve or maintain that something. In other words, this is what puts a value on the object, idea, goal, or relationship. (Landauer & Rowlands)

Definition of Values

Values are essential to ethics. Ethics is concerned with human actions, and the choice of those actions.

Ethics evaluates those actions, and the values that underlies them. It determines which values should be pursued, and which shouldn't. Ethics is a code of values.

Values are principles, standards, or qualities one considers worthwhile or desirable. (Landauer & Rowlands)

Values & Ethics

Values will vary greatly from person to person. Your values will depend on your personal judgment,

outlook, upbringing, and a variety of other factors. What principles, standards, or qualities do you

consider worthwhile or desirable? In other words, what are your personal values?

Values & Ethics

We are not born with values, but rather we develop them as we grow. Sociologist Morris Massey from the University of Colorado at Boulder describes three periods in which values are developed.

1. Imprint Period2. Modeling Period3. Socialization Period (Changing Minds Organization)

Development of Values

1. The Imprint Period Up to the age of seven, we are like sponges, absorbing

everything around us and accepting much of it as true, especially when it comes from our parents. The confusion and blind belief of this period can also lead to the early formation of trauma and other deep problems.

(Changing Minds Organization)

Development of Values

1. The Imprint Period The critical thing here is to learn a sense of right and

wrong, good and bad. This is a human construction which we nevertheless

often assume would exist even if we were not here (which is an indication of how deeply imprinted it has become).

(Changing Minds Organization)

Development of Values

2. The Modeling Period Between the ages of eight and thirteen, we copy

people, often our parents, but also other people. Rather than blind acceptance, we are trying on things like suit of clothes, to see how they feel.

We may be much impressed with religion or our teachers. You may remember being particularly influenced by junior school teachers who seemed so knowledgeable--maybe even more so than your parents. (Changing Minds Organization)

Development of Values

3. The Socialization Period Between 13 and 21, we are very largely influenced by

our peers. As we develop as individuals and look for ways to get away from the earlier programming, we naturally turn to people who seem more like us.

Other influences at these ages include the media, especially those parts which seem to resonate with our the values of our peer groups.

(Changing Minds Organization)

Development of Values

Becoming principled It's tough to have high moral values, but some

people get there. It is through the following phases:◦Pre-moral◦Conventional◦Principled

(Changing Minds Organization)

Becoming Principled with Moral Values

Pre-moral In the pre-moral state, we have no real values (we are

thus 'amoral'). Young children are pre-moral. So are psychopaths. Our basic nature tells us to be Machiavellian, doing whatever it takes to achieve our goals, even if it means hurting other people.

(Changing Minds Organization)

Becoming Principled with Moral Values

Conventional Most people have conventional values, as learned from

their parents, teachers and peers. These basically say 'here are the rules to live in reasonable harmony with other people.'

The bottom line of this state is that we will follow them just so long as we think we need to. We will break our values occasionally, and especially if our needs are threatened or we are pretty sure we can get away with breaking values with nobody else knowing about it.

(Changing Minds Organization)

Becoming Principled with Moral Values

Principled When we are truly principled, we believe in our values

to the point where they are an integral and subconscious part of our person.

Right and wrong are absolute things beyond the person, for example as defined by a religion.

The test of a principled person is that they will stick to their values through thick and thin, and even will sacrifice themselves rather than break their principles.

Many great leaders were principled (Martin Luther King, Gandhi, etc.). (Changing Minds Organization)

Becoming Principled with Moral Values

As Morris stated in the Modeling Period, we copy our parents and their values. Other areas that values are learned from are:◦ Lifestyle◦ Language◦ Rules◦ Culture◦ Religion◦ Education◦ Socioeconomic status (Changing Minds Organization)

Development of Values

Not only are values important in our personal lives but also in healthcare.

Five values have been identified as key values in healthcare and they are:

1. Honesty2. Respect3. Integrity4. Responsibility5. Accountability (Hegner, Acello, & Caldwell)

Key Healthcare Values

Honesty is: A fairness and straightforwardness of conduct. An adherence to facts. Truthfulness, sincerity, frankness

(Collins English Dictionary)

Honesty is marked by or displaying integrity; upright like an honest lawyer.

Honesty is not deceptive or fraudulent, but genuine: honest weight.

Equitable; fair: honest wages for an honest day's work.

(Merriam-Webster, Incorporated)

Honesty

Should physicians not tell the truth to patients in order to relieve their fears and anxieties?

This may seem simple but in reality, it is a hard question.

Not telling the truth may take many forms, has many purposes, and leads to many different consequences.

Questions about truth and untruth in fact pervade all human communication. They are raised in families, clubs, work places, churches, and certainly in the doctor/patient relationship.

In each context, the questions are somewhat differently configured. (Drane)

Honesty-Truth Telling

Not telling the truth in the doctor-patient relationship requires special attention because patients today, more than ever, experience serious harm if they are lied to.

Not only is patient undermined, but patients who are not told the truth about an intervention experience a loss of that all important trust which is required for healing.

Honesty matters to patients. They need it because they are ill, vulnerable, and

burdened with pressing questions which require truthful answers. (Drane)

Honesty-Truth Telling

HonestyHonesty Truthfulness & integrity Others must be able to trust you at all times Must be willing to admit mistakes so they can be

corrected It is doing what you say you will do or return when

you said you would return.We need honesty in order to take the best possible

care of our patients in any healthcare setting. It is extremely important to building trusting relationships with others. (NWACC, n.d.)

RespectRespect An attitude of deference, admiration, or esteem; regard The state of being honored or esteemed Reference or relation (especially in the phrases in respect of,

with respect to) (i.e., to respect someone's rights; to respect a person's privacy)

Polite or kind regard; consideration respect for people's feelings To have an attitude of esteem towards; show or have respect for

to respect one's elders Pay proper attention to; not violate to respect client’s culture To show consideration for; treat courteously or kindly

(Collins English Dictionary)

Integrity Adherence to moral principles; honesty The quality or state of being complete; unbroken condition;

wholeness; entirety The quality or state of being unimpaired; perfect condition;

soundness The quality or state of being of sound moral principle;

uprightness, honesty, and sincerity The inherent complex of attributes that determines a

person’s moral and ethical actions and reactions; “Education has for its object the formation of character"-

Herbert Spencer(Collins English Dictionary)

Integrity

Liable to be required to give account, as of one's actions or of the discharge of a duty or trust.

Involving personal accountability or ability to act without guidance or superior authority: a responsible position within the firm.

Being a source or cause. Able to make moral or rational decisions on one's

own and therefore answerable for one's behavior. Able to be trusted or depended upon; reliable. Answerable, liable, accountable, amenable

(Merriam-Webster, Incorporated)

Responsibility

1. The obligation to carry forward an assigned task to a successful conclusion.

With responsibility goes authority to direct and take the necessary action to ensure success.

2. The obligation for the proper custody, care, and safekeeping of property or funds entrusted to the possession or supervision of an individual. See also accountability. (Dictionary of Military & Associated Terms)

The social force that binds you to the courses of action demanded by that force;

“We must instill a sense of duty in our children; every right implies a responsibility; every opportunity, an obligation; every possession, a duty"- John D. Rockefeller Jr.

(Collins Thesaurus of the English Language)

Responsibility

An obligation or willingness to accept responsibility for one's actions is accountability.

The obligation to bear the consequences for failure to perform as expected (Merriam-Webster, Incorporated)

Accountability is: Responsibility to someone or for some activity A form of trustworthiness; The trait of being answerable to someone for

something or being responsible for one's conduct; (Merriam-Webster,

Incorporated)

Accountability

Professional Values

Professional Accountability Professional accountability applies to everyone

involved in health care. Accountability is a legal obligation; in health care it is also an ethical and moral responsibility. Within the realm of professional accountability, there are many factors.

A professional healthcare worker has the responsibility to practice within his/her scope of care, calling upon his/her knowledge and skills to make decisions in the best interest of the patient. (Moore)

Professional Accountability The level of responsibility and accountability

depends on professional levels. ◦The Charge Nurse has more responsibility then the staff

nurse, the RN has more responsibility then the LPN, the LPN has more responsibility than the nursing assistant, and therefore their levels of professional judgment and practice are different. Their levels of professional accountability are not different. (Moore)

Professional nursing is based on altruism, integrity, accountability and social justice.

Judgments and practice that are based with those ethical values will always be in the best interest of the patient, no matter what the professional level.

The definition of altruism: individuals have the ethical obligation to serve others without self-interest.

The healthcare worker who comes from an altruistic place will make decisions that are in the best interest of the patient, a patient advocate. (Moore)

.

Professional Accountability

A healthcare worker’s first priority is accountability.

** This is what keeps trust in relationships. If you want to be a model of accountability for your team,

then here are the things which you can do to earn your teammates' trust.

1. Think before promising to take a specific task on yourself. 2. It is a good idea not to operate on automatic pilot when

asked to take a project-related responsibility upon yourself, especially if it will involve much time and effort.

(Lane)

AccountabilityWays to Earn Teammate’s Trust

3. You should only make those promises which you are able and willing to keep.

4. You should only agree to assume responsibilities which you have committed yourself to do.

(Lane)

AccountabilityWays to Earn Teammate’s Trust

◦ If your boss insists that you take on a new responsibility, be sure to ask questions to obtain more information.

◦Respond only when you are able to make a reasoned, informed decision, taking into account the time commitment, the specific tasks required, the kind of support available, etc. (Lane)

AccountabilityWays to Earn Teammate’s Trust

5. Accountability works best when there is regular communication, which includes updates about a project and your individual responsibilities.

6. Accountability also requires negotiating. Don't assume that you must commit yourself to a request as

it is presented. (Lane)

AccountabilityWays to Earn Teammate’s Trust

7. Accountability also means avoiding making assumptions when you are part of a team effort. You may at times feel as though you are the only one

who is following through to fulfill a responsibility; Or you may feel that another team member should

be aware of your feelings.(Lane)

AccountabilityWays to Earn Teammate’s Trust

Respect for each client, as a unique individual, is an ethical principle. This uniqueness is demonstrated in differences in age, race, religion, gender, culture, sexual preference, attitudes, background, and responses to illness.

You may find these differences make the patient so different from you, that dealing with the patient is challenging or difficult.

If you respect each patient as a valuable person, you learn to accept and work with each one in the best way possible. (Hegner, Acello, & Caldwell, p. 37)

Respect

Confidentiality means keeping private things private. As a healthcare provider, you will probably learn a

great deal of confidential information about your clients.

You may learn about the resident’s state of health, finances, and family relationships.

(Hegner, Acello, & Caldwell, p. 11)

Confidentiality

You are both legally and ethically obligated to keep this information confidential.

This means you should not tell anyone other than members of the healthcare team anything about your residents/patients. Your residents have to trust you, and talking about them betrays this trust. Review the HIPAA Law.

(Hegner, Acello, & Caldwell, p. 11)

Confidentiality

The ethical considerations between you and your patient are of the greatest importance, because there needs to be trust and comfort felt by the patient.

Effectively establishing and maintaining professional boundaries is essential when providing quality healthcare.

(Hegner, Acello, & Caldwell, p. 11)

Professional Boundaries

Professional boundaries provide limits that enable the healthcare provider to interact with others in a professional setting & give priority to clients’ needs rather than one’s own needs.

Boundaries ensure a secure and therapeutic environment where the healthcare provider and the client are mutually respected. (Hegner, Acello, & Caldwell, p. 11)

Professional Boundaries

"Boundaries are mutually understood, unspoken physical and emotional limits of the relationship between the patient and the nurse."

When these limits are altered, what is allowed in the relationship becomes ambiguous and possibly unethical.

(Farber, as cited in Holland)

Professional Boundaries

The health and well-being of patients depends upon a collaborative effort between the nurse and the patient. 

Patients are extremely vulnerable to boundary violations because they trust healthcare workers as their health care providers.  They come to healthcare workers in a time of need, presenting with physical, and often emotional, distress.  Some patients demand continuous attention, but are unaware of their insatiable neediness.

(Farber, as cited in Holland)

Professional Boundaries

Ethical & Competent Knowledgeable & Caring Committed & Giving of dignity Representative of high standards Professional (behaviors or attitudes) Skilled & caringResponsible, trustworthy, truthful

Other required professional behaviors:Attending in-services, maintaining state certification Following chain of command & scope of practice Being a team player Asking for assistance if needed Being a mandated reporter (Weiss)

Professionalism as a Certified Nursing AssistantCarrying out patient/client/resident care in a manner that is:

Assist clients to meet psychosocial, spiritual, & cultural needs

Following the Client’s Bill of Rights * Right to be treated with dignity & respect * Right to feel secure & recognized as an unique individual * Right to love & be loved * Right to feel a sense of accomplishment & good about themselves * Right to follow personal beliefs

Give nursing care on the same level to all patients regardless of their racial or religious beliefs. Show equal courtesy and respect to all patients. (Weiss)

Nursing Assistants’ Ethical Responsibilities

Ethical behavior of the healthcare worker/nursing assistant includes responsibilities to the employer:

Reporting to work on time Reliably fulfilling assignments Notifying supervisor when ill Working as a team member Doing one’s job to the best of his/her ability according

to JOB DESCRIPTION Conserving supplies/equipment (Weiss)

Responsibility to the Employer

Drane, J. F. ( 2002). Honesty in medicine: Should doctors tell the truth. Retrieved from http://www.bioetica.uchile.cl/doc/honesty.htm

Hegner, B.R., Acello, B., & Caldwell, E. (2004). Nursing assistant: A nursing process approach (9th ed.). Clifton Park, NY: Thompson Delmar Publishing

Holland, K. (2011, April), Professional Boundaries in Nursing. Retrieved from http://www.nursetogether.com/Career/CareerArticles/CareerArticle/tabid/102/itemId/2080/Professional-Boundaries-in-Nursing.aspx

Landauer, J. & Rowlands, J. (2001). Importance of philosophy: Values. Retrieved from http://www.importanceofphilosophy.com/Ethics_Values.html

Lane, A. (2009). The importance of accountability. Retrieved from http://EzineArticles.com/3471801

References

The American Heritage Dictionary. (2000).The American Heritage Dictionary of the English Language (4th ed.). Retrieved from http://www.thefreedictionary.com/honest

Changing Minds Organization. (2002-2011). Values development. Retrieved from http://changingminds.org/explanations/values/values_development.htm

College of Registered Nurses of British Columbia (CRNBC). (2011). Practice standard principles. Retrieved from https://www.crnbc.ca/Standards/ClientRelationships/Pages/Default.aspx

Collins English Dictionary. (2009). Honesty. Retrieved from http://dictionary.reference.com/browse/honesty http://www.thefreedictionary.com/integrity

Collins Thesaurus of the English Language. (2002). Collins Thesaurus of the English Language (2nd ed.).Retrieved from http://www.thefreedictionary.com/responsibility

References

Merriam-Webster, Incorporated (2011). Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/honesty

Moore, C. (2011). Professional accountability. Retrieved from http://www.bellaonline.com/articles/art57183.asp

North West Arkansas Community College Faculty (NWACCF). (n.d.) Personal qualities of a healthcare worker. [Power Points]. Retrieved from faculty.nwacc.edu/tbriggs/Intro%20to%20Med%20Pro%20Files/Unit% 203.ppt

Weiss, T.C. (2009, July 21). Certified Nursing Assistant Code of Ethics. Retrieved from http://www.disabled-world.com/disability/caregivers/cna-code-ethics.php

References