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Public Health Ethics – 7 Principles (Nursing)

by Heide Cygan, DNP, RN

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    00:01 So today let's talk about Public Health Ethics.

    00:04 Before we get into the details, I want to remind everyone of the most recent Gallup poll results.

    00:10 Once again, we see nurses at the very top, we're the most trusted profession in the United States.

    00:16 So what does that mean for us? Well, it means a lot.

    00:19 It means that we're in a very unique position.

    00:22 A position where the general public trust us more than any other professional, including other health care workers.

    00:28 So because of this, we have a responsibility to practice in an ethical, value based manner at all times.

    00:35 Not only do we want to stay at the top of the list, but our patients are looking to us to be leaders to be leaders among other health care professionals.

    00:42 And it's important that we take this honor very seriously.

    00:45 This is especially important in public health nursing.

    00:48 Many of the communities that we work with have been treated unfairly, or unethically in the past.

    00:54 This historical context means that we may have to work a little harder to be trusted.

    00:59 So let's look at how we can do that.

    01:02 So what is ethics? Well, if you were to ask 10 different people, you'd probably get 10 different answers.

    01:10 Some people might say that ethics is a feeling A feeling of right or wrong.

    01:16 Others would say that ethics our responsibility to follow laws or rules, even when people aren't watching us.

    01:24 Others might say that ethics are related to religion.

    01:29 Well, none of these really explained what ethics are.

    01:32 If we focus on our feelings, we have to recognize that our feelings aren't always based on ethical principles.

    01:39 And while we hope that our laws are based on ethics, we cannot assume this.

    01:43 Pre civil rights laws that made slavery legal are an example of how laws are not always ethical, and ethics cannot be tied to religion is that would make us assume that only individuals who identify as being religious can be ethical.

    02:00 So how do we define ethics then? Ethics is based on standards of right and wrong.

    02:06 Ethics relate to rights obligations, benefits to society, and fairness.

    02:11 Simply put, ethics are often thought of as what we ought to do.

    02:15 So let's take some time now to explore seven different ethical principles.

    02:20 George has been working closely with Theo and his family to ensure that he gets ethical treatment as he manages his chronic liver disease.

    02:28 We'll explore what this looks like for each of the seven ethical principles.

    02:35 The first is respect.

    02:37 The principle of respect refers to treating people as unique and equal individuals.

    02:41 This principle emphasizes one's own responsibility as a member of the community, and a member of the healthcare team, And public health nursing as a result of respect, we acknowledge community members as essential and valued participants in shaping their own and their communities health outcomes.

    03:00 We treat all community members as equals on the health care team.

    03:03 We hold them and their views and high regard.

    03:06 Now remember, Theo, he has chronic liver disease.

    03:10 It's been recommended that he received frequent blood transfusions as a treatment to prolong his life.

    03:16 Let's work with him to ensure that he's being treated in an ethical manner.

    03:20 To ensure that he's treated with respect, we must make sure that he has a voice in his treatment plan.

    03:25 We must value his opinion.

    03:29 Next, we have autonomy.

    03:30 This is the freedom of choice.

    03:32 An individual's right to making their own decisions.

    03:35 Public health nurses apply autonomy by the promotion of individuals and groups rights to and involvement in decision making.

    03:43 When we work with Theo, we must ensure that his freedom does not result in harm to the well being of others.

    03:49 For example, if he needs frequent blood transfusions, will this take away resources from others? Will this do harm to others? We need to make sure that he is fully informed and his decisions are made deliberately with careful considerations of the consequences.

    04:03 Now there are times when as public health nurses, we might not accept a client's choice as one that we would make ourselves.

    04:10 However, we can respect that choice.

    04:12 Remember, it's our role to ensure that individuals and communities are given accurate information, information they need to be able to exercise autonomy, and make a choice on their own.

    04:25 Beneficence is pretty straightforward.

    04:27 It means doing good.

    04:29 Beneficence is taking action to ensure positive outcomes on behalf of our clients.

    04:34 As public health nurses, this is our goal.

    04:37 Our goal is to take action to promote positive health outcomes for communities, for individuals, for families.

    04:44 When working with Theo, we need to ensure that we're working towards those positive health outcomes, while also considering other ethical principles.

    04:52 Principles such as respect and autonomy.

    04:55 It's important that Theo's voice is heard and that he has a say in the decisions regarding his plan of care.

    05:00 What does doing good mean to him in this scenario? Does he see prolonging his life as doing good? Next we have nonmaleficence. This means to do no harm.

    05:12 This is avoiding or preventing harm to others as a consequence of our choices and actions.

    05:17 These include our personal and our professional choices and actions.

    05:21 Nonmaleficence involves taking steps to avoid negative consequences for all of those around us.

    05:27 Now, when working with Theo, we must ensure that our actions that are intended to help don't do more harm than good.

    05:34 This is a decision that we need to include the Owen.

    05:36 From his perspective, what does this mean? What treatment would be more harmful or beneficial for him? Maybe he would prefer to not receive blood transfusions, would rather spend his remaining days at home with his family.

    05:51 Justice refers to treating people fairly, it means the fair distribution of both benefits and costs among all society's members.

    05:59 The principle of justice seeks to improve equity.

    06:03 When we consider our treatment plan with Theo, we must understand if the treatment will result in equal benefit and cost for him and others.

    06:10 What are those consequences? There are several types of justice that are important to public health nurses.

    06:16 So let's take a look at those.

    06:18 When we discuss justice, there are three different views and allocation of what it means to distribute both benefits and costs across society.

    06:26 The first approach is distributive justice.

    06:28 From this perspective, benefits should be given first to those who need them the most.

    06:33 decisions based on this approach help individuals and communities who are most in need.

    06:38 Even if that means withholding goods or benefits from others who also may be deserving, but have less need.

    06:45 By talking to Theo, we understand that this is one of his main concerns.

    06:49 He's concerned that there are other people who need blood transfusions more than he does.

    06:53 He's worried about the distribution of this resource.

    06:58 On the other hand, a egalitarian justice promotes decisions based on equal distribution to benefits to everyone regardless of their need.

    07:07 So no matter the need, everyone gets the same benefit.

    07:11 Well, Theo's concerned about distributive justice, the nurses explained to him that everyone deserves this treatment, the treatment of blood transfusions, regardless of whether or not Theo thinks others deserve it more.

    07:25 The third type of justice, restorative justice.

    07:28 Restorative justice states that benefits should go primarily to those who've been wronged by a prior injustice.

    07:34 Oftentimes, we see this type of justice through programs that are in place to compensate victims for their injury, or families for their loss.

    07:43 This is seen as a beginning step to restore justice.

    07:47 Now, Theo's chronic liver disease is a result of an occupational exposure to a harmful chemical.

    07:52 His company is paying for him to receive the blood transfusions as his treatment.

    07:57 This is an example of restorative justice.

    08:01 And then finally, we have social justice.

    08:04 This refers to the fair and equitable distribution of wealth, economic opportunity, and access to privileges in our society.

    08:12 This is the idea that everyone deserves equal economic, political and social rights and responsibilities.

    08:18 This is really Theo's biggest concern.

    08:21 Before agreeing to this treatment, he wants to make sure that everyone who needs this treatment has fair access to it.

    08:30 Okay, just a couple more left.

    08:32 Here we have veracity.

    08:34 This means telling the truth.

    08:36 The idea here is that individuals and communities deserve to be given accurate information in a timely manner.

    08:43 When we make sure that Theo has accurate, truthful information, this increases the opportunity for him to have greater involvement in the decision making process.

    08:54 And lastly, we have fidelity.

    08:56 This is keeping one's promises, following through and doing what you say you will do.

    09:02 Public health nurses must be faithful to their professional responsibilities by providing high quality safe care in the community.

    09:09 Again, we accomplish this by doing what we say we will do.

    09:13 When we're working with Theo it's important to stand by his decision.

    09:16 Once his decision has been made we support, Theo.

    09:19 We carry out the plan as intended the way that we've promised, Theo, we will.


    About the Lecture

    The lecture Public Health Ethics – 7 Principles (Nursing) by Heide Cygan, DNP, RN is from the course Public Health Nursing Models and Theories (release in progress).


    Included Quiz Questions

    1. Respect
    2. Autonomy
    3. Beneficence
    4. Justice
    1. Autonomy
    2. Beneficence
    3. Nonmaleficence
    4. Justice
    1. Nonmaleficence
    2. Justice
    3. Respect
    4. Fidelity
    1. Restorative
    2. Distributive
    3. Social
    4. Egalitarian

    Author of lecture Public Health Ethics – 7 Principles (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN


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