Etika Keprawatan Nursing Ethics 1, 2

~ Tri Anjaswarni Harsono ~ Nursing Ethics & Decision Making

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Nursing EthicsNursing Ethics

By :Tri Anjaswarni Harsono, S.Kp.

M.Kep


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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.


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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


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


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.


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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


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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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Nurses and Physician

Disagreements about the proposed medical regimen.

Conflict regarding the scope of the nurse’s role.

Physician incompetence


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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


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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.


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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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