Introduction: Values, Ethical Dilemmas, and the ANA Nursing Code of Ethics

by Samantha Rhea, MSN, RN

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    00:01 Let's discuss the topic of ethics, values in nursing care.

    00:05 Now, while in your nursing practice or maybe even in your clinical rotation.

    00:10 You may face an ethical dilemma, so, we're going to discuss a little bit about this today.

    00:16 So, before we get started, let's define actually what we're talking about, between values morals and ethics.

    00:24 When we talk about values, Really, we define that as our own personal principles and ideas, that, really help us decide what's right and what's wrong.

    00:33 Now, this is different from morals, where this is where actual beliefs, that are formed out of our core values.

    00:40 In this context, helps, drive the rules that govern our behavior.

    00:45 And lastly ethics are those moral principles, that help direct our behavior and how we apply their morals.

    00:54 Many times, as a practicing nurse, we are going to face ethical dilemmas.

    00:59 So the ANA code of ethics has provided us a framework to help us guide through those ethical dilemmas, when we need to make a decision.

    01:08 So, we're going to take a look at some nursing attributes, to make sure we keep ethics at the forefront of our care.

    01:14 Now, at the top of this graphic, you see commitment to the client.

    01:18 Now, this seems to make a lot of sense, but many times, we have our own personal values and beliefs, that can sometimes impede the client's actual needs.

    01:28 So this is a key piece to remember, that we have to remain committed to the client.

    01:34 Now, promoting and advocating for the health and wellness of the client, is really important in regards to ethics.

    01:41 And the advocacy piece is a typical action, that, we may need for an ethical dilemma.

    01:48 Now next we are responsible and accountable for all the care that we give.

    01:54 Here's something we may not think about, but engaging in advancing nursing practice.

    02:00 Now, this can mean from advancing our degree, for example.

    02:04 Or just making sure that our knowledge base, is current with the current nursing practice and the populations we serve.

    02:13 Now, holistically nursing is something that we look at the dignity and uniqueness of the individual and interdisciplinary and collaborating with our health care team, to promote wellness is important in regards to ethical care.

    02:30 Now, when we're speaking about ethical dilemmas, something to keep in mind, that these actually occur, when values are going to conflict.

    02:37 Now, to resolve these the opinions the facts and the values have to be identified and separated.

    02:46 Because practice requires nurses to respect the value of others, but also do our best to respect our own personal values.

    02:56 So, as a practicing nurse, there are many times, that you're going to run into a healthcare ethical dilemma.

    03:02 Here are four big topics, that you may face in your practice.

    03:06 The first one being quality of life.

    03:09 This is going to include end of life care, cancer therapy, physician assistant suicide and do not resuscitate.

    03:17 One example of this, is many times, this is where the nurse has to advocate for their patient.

    03:24 Such as with cancer therapy, sometimes the patient may decide that they do not want to pursue treatment.

    03:30 However, the family members may feel otherwise.

    03:33 Again, this is where advocacy for your patient must be the forefront, for their client’s needs.

    03:40 Next, is genetic screening.

    03:42 This could be detection of a gene, that may not be causing symptoms or for which there is no cure.

    03:48 This may come into play with maternal nursing for example.

    03:52 Now, care at the end of life.

    03:54 This is something personally as a nurse that I have seen and had to navigate through this ethical dilemma.

    04:00 So, sustaining care when interventions are unlikely to sustain life.

    04:06 Now, some of our interventions as you can imagine, can be invasive and as a nurse, this is things that we consider, when we're performing these on our client.

    04:15 Also, as a nurse many times we're thinking about these interventions, may really result in a poor quality of life, to help keep the patient alive.

    04:25 And that's something personally and many nurses out there may have faced.

    04:29 And lastly is just access to health care.

    04:33 Ensuring that all individuals, have a right to care and for health and wellness and even just the resources they need, to treat their illness.

    04:43 So, talking about moral distress, this can be described as the anguish experience, when a person feels unable that they can't act according to their own values.

    04:53 So, this is something we need to be aware of, and how do we alleviate this.

    04:58 Well, if we provide interdisciplinary ethics education, this can give us the knowledge base, of how to better prepare, how to navigate these situations.

    05:07 Also, just sharing those stories, with about professional perspectives and increasing that inner collaborative practice.

    05:15 And again that's going to give you more perspectives, in regards to an ethical dilemma.

    05:20 Now, addressing clinical situations that bring about moral distress.

    05:24 If you recall, we talked about those four big domains of healthcare dilemmas, that can be really important to talk about this beforehand, because there's a good chance that you're going to face these in your practice.

    05:36 And of course, engaging in constructive conversations with peers or someone that you trust.

    05:44 Now, let's talk about interprofessional collaboration.

    05:47 Many times, when we're facing an ethical dilemma, we've got to remember that we have many people around us.

    05:54 So, building a consensus about a specific patient case, can help us make a decision and guide us when we need to do so.

    06:02 Also, a nurse's point of view offers a unique voice, in the resolution of these dilemmas, but often, these decisions are made by collaborating with others.

    About the Lecture

    The lecture Introduction: Values, Ethical Dilemmas, and the ANA Nursing Code of Ethics by Samantha Rhea, MSN, RN is from the course Ethics and Legalities in Nursing Practice.

    Included Quiz Questions

    1. Personal principles and ideas that help establish judgment between right and wrong
    2. Actual beliefs that form a person’s core principles
    3. It is a rule that governs a person's behavior
    4. Moral principles that direct a person’s behavior
    1. Quality of life
    2. Care at the end of life
    3. Access to care
    4. Genetic screening
    1. The nurse is caring for a client who is unresponsive and on life-support. The client’s spouse wants to discontinue life-support, but the client’s parents request to continue life-support.
    2. The nurse wants to spend time with their client who just received a cancer diagnosis to provide emotional support, but six other clients need immediate care.
    3. The client has end-stage renal disease and is no longer responding to treatment. They are ready to apply for hospice care, but their spouse wants to pursue alternative treatment options.
    4. The client with terminal cancer has always stated that they would apply for physician-assisted suicide if treatment was no longer working. They are confident in their decision and are supported by their family.

    Author of lecture Introduction: Values, Ethical Dilemmas, and the ANA Nursing Code of Ethics

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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