Values

Week 5
Ethical dimensions of nursing and health care
Values
Values are ideals or concepts that give meaning to an individual’s life. Values are derived most commonly from societal norms, religion, and family orientation and serve as the framework for making decisions and taking action in daily life. People’s values tend to change as their life situations change, as they grow older, and as they encounter situations
that cause value conflicts. For example, before the 1950s, pregnancy outside of marriage was unacceptable, and unmarried women who were pregnant were shunned and generally separated from society.
Today this situation is more widely accepted, and it is not uncommon to see pregnant high school students attending classes.
Values are usually not written down; however, at some time in their professional careers, it may be important for nurses to make lists of their values.
This value clarification process requires that nurses assess, evaluate, and then determine a set of personal values and prioritize them.
This will help them make decisions when confronted with situations in which the client’s values differ from the nurse’s values. Value conflicts that often occur in daily life can force an individual to select a higher-priority value over a lower-priority one. For example, a nurse who values both career and family may be forced to decide between going to work and staying home with a sick child
Morals
Morals are the fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development. An individual’s moral orientation is often based on religious beliefs although societal influence plays an important part in this development. The word moral comes from the Latin word mores, which means
“customs” or “values.” Moral behavior is often manifested as behavior in accordance with a group’s norms customs,
or traditions.
A moral person is generally someone who responds to another person in need by providing care and who maintains a level of responsibility in all relationships. In many situations in which moral convictions differ, it is difficult to find a rational basis for proving one side right over the other.
For example, animal rights activists believe that killing animals for sport, their fur, or even food is morally wrong. Most hunters do not even think of the killing of animals as a moral issue at all.

Ethics
The term ethics has its origins in the Greek word ethos, which is generally translated as “quality” or “character.” It is a branch of traditional Western philosophy known as moral philosophy that studies moral behavior in humans and how humans should act toward each other individually and in groups.

Ethics, as a system of beliefs and behaviors, goes beyond the law, which has as its primary underlying principle the preservation of society. Ethics is more focused on the quality of the society and its long-term survival.

Similar to the legal system, ethical systems are only needed when there is a group of people living together. A hermit living in a cave on a mountain by himself does not need laws or ethical systems.
Primitive societies that were composed of a small number of individuals had to have some basic laws for survival, such as not killing each other, and some basic ethical principles, such as distributive justice— for example, all members of the tribe get the same amount of food. As society increases in size and becomes more complex, there is a need for more laws and a stronger ethical system.
Ethical nursing principles:
Autonomy
Autonomy is the right of self-determination, independence, and freedom. It refers to the client’s right to make health-care decisions for himself or herself, even if the health-care provider does not agree with those decisions.
As with most rights, autonomy is not absolute, and under certain conditions, limitations can be imposed on it. Generally these limitations occur when one individual’s autonomy interferes with another individual’s rights, health, or wellbeing.
For example, a client generally can use his or her right to autonomy by refusing any or all treatments. However, in the case of contagious diseases (e.g., tuberculosis) that affect society, the individual can be forced by the health care and legal systems to take medications to cure the disease.
The individual can also be forced into isolation to prevent the disease from spreading.

Justice
Justice is the obligation to be fair to all people. The concept is often expanded to what is called distributive justice, which states that individuals have the right to be treated equally regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief. The principle of justice underlies the first statement in the American
Nurses Association (ANA) Code of Ethics for Nurses (2014): “The nurse in all professional relationships practices with
compassion and respect for the inherent dignity, worth, and uniqueness of each individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

Fidelity
Fidelity is the obligation of an individual to be faithful to commitments made to himself or herself and to others. In health care, fidelity includes the professional’s faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of the profession. Fidelity is the main support for the concept of accountability, although conflicts in fidelity might arise from obligations owed to different individuals or groups.

Beneficence
Beneficence, one of the oldest requirements for health-care providers, views the primary goal of health care as doing good for clients under their care. In general, the term good includes more than providing technically competent care for clients.
Good care requires that the health-care provider take a holistic approach to the client, including the client’s beliefs, feelings, and wishes, as well as those of the client’s family and significant others.
The difficulty in implementing the principle of beneficence is in determining what exactly is good for another and who can best make the decision about this good

Nonmaleficence

Nonmaleficence is the requirement that healthcare providers do no harm to their clients, either intentionally or unintentionally. In a sense, it is the opposite side of the concept of beneficence, and it is difficult to speak of one term without referring to the other. In current health-care practice, the principle of Nonmaleficence is often violated in the short term to produce a greater good in the long-term treatment of the client. For example, a client may undergo painful and debilitating surgery to remove a cancerous growth to prolong his life.

Veracity
Veracity is the principle of truthfulness. It requires the health-care provider to tell the truth and not to intentionally deceive or mislead clients. As with other rights and obligations, limitations to this principle exist. The primary limitation occurs when telling the client the truth would seriously harm (principle of Nonmaleficence) the client’s ability to recover or would produce greater illness. Although the principle of veracity is not a law, it is one of the basic foundations for the trusting
relationship between nurse and client that underlies any successful therapeutic relationship.

NURSING CODES OF ETHICS
A code of ethics is a hallmark of mature professions. A code of ethics is a social contract through which the profession informs society of the principles and rules by which it functions. Ethical codes shape professional self-regulation, serving as guidelines to the members of the profession, who then meet their responsibility as trustworthy, qualified, and accountable caregivers.
Codes of ethics, however, are useful only to the extent that they are known and upheld by the members of the profession in practice.

American Nurses Association’s Code of Ethics for Nurses
Ethical practice has been a priority for nurses in America since the late nineteenth century.
International council of nurses code of ethics for nurses: preamble Nurses have four fundamental responsibilities: to promote health, To prevent illness, to restore health and to alleviate suffering. The Need for nursing is universal.
Inherent in nursing is respect for human rights, including cultural Rights, the right to life and choice, to dignity and to be treated with Respect. Nursing care is respectful of and unrestricted by considerations Of age, color, creed, culture, disability or illness, gender,
Sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the family and The community and coordinate their services with those of related groups.



Relationship of nursing research To nursing theory and practice
Relationships among nursing research, practice, and theory are circular. As mentioned earlier, research ideas are generated from three sources: (1) clinical practice, (2) literature, and (3) theory Questions about how best to deal with patient problems regularly arise in clinical situations. As shown in the earlier example of Mrs. Abney, the elderly lady who could not find her room, problems often can be “solved” for the present. However, when the same questions recur, long-term answers may be needed. Research develops solutions that can be used with confidence in different situations.
Published articles about nursing research often generate interest in further studies. If there is published research on particular nursing care problem, other researchers may be stimulated to investigate the subject further and refine the solutions.



PROFESSIONAL NURSING: CONCEPTS & CHALLENGES 2014