Public Health Ethics – Decision-making Framework (Nursing)

by Heide Cygan, DNP, RN

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    00:01 In addition to understanding ethical principles, public health nurses must be able to use these principles in their decision making processes.

    00:09 Ethical decision making means making a choice that can be justified from an ethical perspective.

    00:15 And while this may seem like a pretty common sense approach, it can get very complex.

    00:20 So I'd like to introduce you to a model that can be used to guide you through the process.

    00:26 This is a framework called the decide model.

    00:28 It can be used to guide the process by which we make ethical decisions.

    00:33 So let's imagine that you're a public health nurse working in a community that has limited resources.

    00:38 A local community organization has offered to run an enrichment program at a senior center.

    00:43 This program would allow participants opportunities for nutrition services, ability specific, physical activity, and perhaps most importantly, social and emotional support.

    00:53 However, there are three senior centers in the community.

    00:57 And as the public health nurse, you have to decide which center which seniors will get this opportunity? So let's use the decide model to work through this ethical dilemma.

    01:07 So let's start with D.

    01:09 This stands for Define the problem.

    01:11 What are the key facts of the situation? Who's involved? What are their rights and duties? What are your rights and duties? For a senior enrichment program, what exactly is the problem here? Well, we've established that well, all seniors could benefit from this program, only those that one center will get the opportunity.

    01:30 So what other information do we need? We need to know how many centers are in the community? How many seniors are serviced at each of those centers? What services are currently being provided at each of the centers? What's your role as the public health nurse in this problem, and in the solution? Next is E or Ethical review? Here we ask ourselves what ethical principles have a bearing in the situation? Which principles should be given priority in making our decisions? So let's think about this one for a second.

    02:03 If we're making a decision about the distribution of services, or the distribution of a benefit, which ethical principle are we considering? Justice, specifically, we're making a decision about how we will allocate a benefit.

    02:18 Will we use distributive justice? Egalitarian? Or a restorative approach? C stands for Consider the options.

    02:28 What options do you have in the situation? What are your alternative courses of action? For our enrichment program, we need to consider all of our options.

    02:37 We could offer the program at just one of the centers as proposed, or what other solutions exist? Could the program move from center to center each week? Or is maybe transportation available to get seniors from all the centers to one location.

    02:51 Here, it's important to get creative and really think outside of the box.

    02:57 Next, we have I investigate outcomes, exploring all available options, what consequences are likely to follow from each course of action? Based on our ethical principles, which option is the most ethical? So consider here for a second, what would happen if we use distributive justice? And decided to locate this enrichment program at the senior center where there's the most need.

    03:22 How might those outcomes differ if we used in a egalitarian approach, and spread the services out to all of the centers? Or what if we use the restorative justice approach, and located the services at the senior center that missed out on the last opportunity? What might those outcomes look like? The next D stands for Decide on an action.

    03:43 This is where the public health nurse decides on the best available option.

    03:47 Having chosen the best option available, it's time to set a specific plan in place.

    03:53 Here, it's important to set clear objectives, and then act decisively to carry on our plan.

    03:58 So let's just say as the public health nurse, you decide to use a distributive justice approach, and locate the program at a center that has the greatest need for additional services.

    04:08 Now, it's time to create that plan and put that plan into action.

    04:12 An Evaluation Plan will ensure that you can measure the success of your decision.

    04:19 And finally, our second E, Evaluate results.

    04:23 Having implemented your course of action now it's time to assess how things are going.

    04:28 So how did it go? Did the seniors love the program? Did their health outcomes improve? What about the same health outcomes for seniors at the other centers who didn't get the opportunity? Would you make the same decision again? This framework isn't meant to be prescriptive.

    04:44 However, using this framework, it provides public health nurses with a structure to making well thought out ethical decisions.

    04:54 So I will leave you with this quote from Florence Nightingale In 1859 she said, "It may seem strange principle to enunciate as the very first requirement in a Hospital is that it should do the sick no harm." Now, based on what we just talked about, can you identify which ethical principle Florence Nightingale was referring to? What I'd like you to do is pause the recording and then do three things for me.

    05:21 First, identify the ethical principle Florence Nightingale was talking about.

    05:26 Secondly, write your own definition.

    05:29 Tell me in your own words, how do you define that ethical principle? And then finally third, what I'd like you to do is provide your rationale.

    05:38 Why did you pick that ethical principle? And now time for the answer.

    05:49 First of all, identifying the ethical principle.

    05:52 Here we have nonmaleficence.

    05:54 Defining the ethical principle.

    05:57 That means to do no harm.

    05:59 And our rationale.

    06:01 Well, Florence Nightingale says it right here in the quote.

    06:03 She said, "We should do the sick no harm."

    About the Lecture

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

    Included Quiz Questions

    1. Ethical review
    2. Problem definition
    3. Options consideration
    4. Outcome investigation
    1. Option consideration
    2. Ethical review
    3. Acting decisively
    4. Results evaluation
    1. Evaluating results
    2. Ethical review
    3. Deciding on an action
    4. Investigating outcomes

    Author of lecture Public Health Ethics – Decision-making Framework (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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