N246 ethics, quality of care, IOM pp.ppt

8/11/2019 N246 ethics, quality of care, IOM pp.ppt

1/56

Essentials of Nursing Leadership & Management, 4th Edition

N246 LeadershipEthics & Quality

S. Buckley, 2010

(Adapted from Nursing Leadership and Management,Whitehead, Weiss, Tappen)


2/56


3/56



4/56



5/56



6/56


Early nursing leaders


7/56



8/56



9/56


finances


10/56


1960s

Technological advances allowed for thedevelopment of intensive care units

New biomedical developments

Advances in surgical techniques, such asopen heart surgery


11/56


Reasons for new inquiries innursing

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 RNs with traditional manner of learning (mentoring)

and desire to have a scientific base for practice (professionalscientists)

Interest by healthcare practitioners about application of values in

professional practices, and how to discuss these issues.


12/56


Bioethics

A sub discipline of ethics The study of medical morality


13/56


Concepts of EthicsEthics 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 agiven situation, knowing how to take appropriateethical action if and when required, and onpersonal commitment and a genuine desire toachieve a moral outcome

(Johnstone, 1999, from:Ethics in Nursing Practice, 2nded, Fry,

S.T,Johnstone, M.)


14/56


Value Systems

definitions

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 byan individual class, society. That which is desirable orworthy of esteem for its own sake, thing or quality havingintrinsic worth.


15/56


Historical values ofnursing:


16/56


Nursing today Values in nursing

today:


17/56


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 isnot as important as what values theyconsider important


18/56


Types of Values Personal

Cultural Religious

professional


19/56


Values Clarification

Critical thinking Choosing

Identifying-verbalizing?

Acting


20/56


Belief Systems These are organized ways of thinking about

why people exist within the universe

Their purpose is to explain such conceptsas:

Life and death

Good and evil

Health and illness

Individualism/rights


21/56


ETHICS AND MORALS


22/56


Morals An individuals own code for acceptable

behavior

Standards of goodness or rightness thatarise from an individuals conscience

They act as a guide for individual behavior

Learned Capable of making a distinction between

right and wrong in conduct


23/56


Values Social principles, goals or standards held or

accepted by an individual class, society.That which is desirable or worthy of esteemfor its own sake, thing or quality havingintrinsic worth.


24/56


Standards Something established for use as a rule or

basis of comparison in measuring orjudging quality, value, extent.


25/56


Laws Rule of conduct established and enforced

by the authority, legislation or custom of agiven community, state, or other group.

May change with fluctuating social moralsand viewpoints.


26/56


Ethics Having to do with moral standards,

conforming to the standards of conduct of a

given professional group. Impliesconformity with an elaborated, ideal code ormoral principles.

Concerned with the motivation behind thebehavior

Bioethics is the application of theseprinciples to life-and-death issues


27/56


Ethical Theories

Deontological-based on duty to commitment, considers

the intention of the action, not the consequences of theaction. It is the individuals goodwill that determinesworthiness, not the outcome.

Teleological-(utilitarianism)-what makes an action right orwrong is its usefulness. Right encompasses actions that

have positive outcomes, wrong is composed of actionsthat result in poor outcomes. Principalism-involved in biomedical issues, integrates

ethical principles to resolve conflicts in situations.


28/56


Ethical Principles

Autonomy

Nonmaleficence Beneficence Justice Fidelity

Confidentiality Veracity Accountability


29/56


Autonomy

The freedom to make decisions aboutoneself

Nurses need to respect clients rights to

make choices about health care


30/56


Nonmaleficence

Requires that no harm be caused to anindividual, either unintentionally ordeliberately

This principle requires nurses to protectindividuals who are unable to protectthemselves


31/56


Beneficence This principle means doing good for

others

Nurses need to assist clients in meeting alltheir needs

Biological

Psychological

Social


32/56


Justice

Every individual must be treated equally

This requires nurses to be nonjudgmental


33/56


Fidelity

Loyalty

The promise to fulfill all commitments

The basis of accountability (moral concept thatinvolves acceptance by a professional nurse ofthe consequences of a decision or action)


34/56


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 orothers

If the client gives permission for the informationto be shared


35/56


Veracity

This principle implies truthfulness

Nurses need to be truthful to their clients

Veracity is an important component ofbuilding trusting relationships


36/56


Accountability

Individuals need to be responsible for theirown actions

Nurses are accountable to themselves andto their colleagues


37/56


Ethical Codes These are formal statements of the rules of

behavior for a particular group ofindividuals

Ethical codes are dynamic

Most professions have a code of ethics to

guide professional behavior


38/56


Organizational Ethics

Focus on the workplace

Ethical culture makes a difference Senior leadership must promote an ethical

culture-do they?


39/56


Ethical Dilemmas

Occur when a problem exists betweenethical principles

Deciding in favor of one principle usuallyviolates another

Both sides have goodness and badness

associated with them


40/56


Ethical decision making Consider cause, variables, precipitating events

and implications

Reflect upon ones 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. Understandconsequences of the plan. Implement Evaluate results


41/56


Current Ethical Issues

f &


42/56


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

E ti l f N i L d hi & M t 4th Editi


43/56


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



44/56


Quality issues What is it??

The degree of excellence that distinguishesone thing from another

Relates to education and practice;professionals perceive that they areproviding high-quality nursing educationand patient care.



45/56


Why do we need it? * current health care system is fragmented,

poorly organized, inefficient use ofresources.

*New technologies, availability ofinformation (it), decreasing resources,

increasing chronic disease states mandatea change.

* consumer dissatisfaction with current

system



46/56


Quality improvement Also known as performance improvement,

focuses on processes or systems thatsignificantly contribute to client safety andeffective client care outcomes; criteria areused to monitor outcomes of care and to

determine the need for change or improvethe quality of care.(Saunders NCLEX review, 5thedition, Silvestri, L.,2011)



47/56


Professional organizations that focus onquality * Joint commission on Accreditation of

Healthcare Organizations (JACHO)

* American Nurses Association (ANA)

*Institute of Medicine (IOM)



48/56


IOM essential competencies Provide patient centered care

Work in interdisciplinary teams Employ evidence-based practice

Apply quality improvement

Use informatics

Essentials of N rsing Leadership & Management 4th Edition


49/56


Aims of IOM quality of care Safe

Effective Patient centered

Timely

Efficient

equitable

Essentials of Nursing Leadership & Management 4th Edition


50/56


IOM- cost of inefficiency 44,000-98,000 die each year

$17-29 billion in total costsNursing errors:

*Medication

*knowledge*procedure



51/56


Continuous Quality improvement (CQI)

Identify indicators Collect ongoing data on indicators

Analyze and evaluate data

Implement change

(utilize evidence based practice)



52/56


How to monitor quality of care Guidelines

Protocols Algorithms

Standards of care

Critical pathways



53/56


How does structured care methodologieswork? Link process of care (issue) and outcome

Determine method of measurement Clarify responsibilities of interdisciplinary

team

Facilitate communication among teammembers

Document, apply systematic approach to

measurement.



54/56


Root cause analysis Process of learning from consequences;

Determine influences, establish linkedchains of influences, determine necessaryinfluences, analyze root (initial) cause.

Currently used to analyze errors andmistakes; attempts to evaluate series ofevents that may lead to errors (safetyerrors) and determine causative reason for

error (process), rather than punitively



55/56


Risk management part of QA

Identify potential problems, risks Incident investigation

Sentinel events

Anticipate outcome, prevent recurrence



56/56


conclusion To enhance quality of care;

Think critically Plan and report outcomes

Make introductory rounds

Plan partnership with the client

Communicate plan

Evaluate progress

Documents

N246 ethics, quality of care, IOM pp.ppt