Nursing Values and Ethics: Foundations and Applications in Practice

Nursing Values and Ethics

Introduction

This study guide explores the foundational concepts of values and ethics in nursing, emphasizing their formation, clarification, and application in professional practice. Understanding these principles is essential for ethical decision-making and effective patient care.

Values

Definition and Importance

• Value: A strong personal belief or ideal that a person or group believes has merit.

• Values influence behavior and reflect cultural, social, and personal needs.

• They vary among individuals and evolve over time.

Values Formation

Values are shaped by multiple factors throughout life:

• Family experience: Early upbringing and family beliefs.

• Moral development: Growth in understanding right and wrong.

• Cultural, ethnic, and religious communities: Shared cultural values and traditions.

• Individual experiences: Personal life events and choices.

Values Clarification

Values clarification is the process of appraising one’s values to decide priorities and make decisions. This process:

• Helps individuals modify attitudes and behaviors as values change.

• Addresses conflicts between people and societies.

• Relational communication is crucial for resolving value conflicts.

Values Clarification Questions

• Describe a situation where your values were challenged.

• Reflect on your physical and emotional responses.

• Identify personal and others’ values involved.

• Analyze arguments and power relationships.

• Consider freedom of expression and possible changes to your response.

Personal Reflection

• Identifying one’s own values and beliefs is essential for understanding others.

• Awareness of values of employers, patients, physicians, and other groups is necessary for effective communication.

Ethics

Definition and Scope

• Ethics: The study of good conduct, character, and motives.

• Involves philosophical ideals of right and wrong.

• Reflects what matters most to individuals and professions.

• Nurses in Canada are guided by the Canadian Nurses Association’s Code of Ethics (2017).

Nursing and Ethics

Code of Ethics

• Statement of ethical values and nurses’ commitments to persons with health care needs.

• Intended for nurses in all contexts.

• Provides guidance during ethical challenges.

• Includes principles of responsibility, accountability, and advocacy.

Principles for Code of Ethics (CNA 2017, ICN 2021)

• Responsibility: Ability to distinguish between right and wrong.

• Accountability: Accepting responsibility or accounting for one’s actions.

• Advocacy: Acting on behalf of others, especially those unable to speak for themselves.

Canadian Nurses Association Code of Ethics (2017)

Primary Nursing Values	Responsibility Statements
Providing safe, compassionate, competent, and ethical care	Ensuring patient safety and quality care
Promoting health and well-being	Supporting holistic health
Promoting and respecting informed decision making	Upholding patient autonomy
Honouring dignity	Respecting patient worth
Maintaining privacy and confidentiality	Protecting patient information
Promoting justice	Ensuring fairness and equity
Being accountable	Taking responsibility for actions

Ethical Endeavours Related to Broad Societal Issues

• Nurses address social inequities and broader elements of social justice related to health and well-being.

Principles of Bioethics

Core Principles

Principle	Definition
Autonomy	Ability to make informed personal choices
Beneficence	Doing or promoting good for others
Nonmaleficence	Avoidance of harm or hurt
Justice	Fairness, such as unbiased allocation of resources

Ethical Analysis and Nursing

Ethical Dilemma

• Occurs when there is a conflict between two sets of human values.

• Causes distress and confusion for patients and caregivers.

• Requires descriptive, conceptual, and normative analysis.

• Documentation of the ethical process can take various forms.

Steps to Analyze an Ethical Dilemma

1. Determine whether the issue is an ethical dilemma.

2. Gather all relevant information.

3. Examine and determine your own values on the issue.

4. Verbalize the problem.

5. Consider possible courses of action.

6. Reflect on the outcome.

7. Evaluate the action and the outcome.

Ethical Decision-Making Framework

• Information & Identification: Concerns, people/population, ethical components.

• Clarification & Evaluation: Ethical principles, social expectations, legal requirements, values clarification.

• Action & Review: Range of actions, anticipated consequences, professional codes of ethics.

Ethical Issues in Nursing Practice

Patient Care Issues

• Futile care: Continuing treatment with little or no benefit to the patient.

• Advance care planning: Preparing for future health care decisions.

• Medical assistance in dying (MAID): Legal and ethical considerations in end-of-life care.

Work Environment Issues

• Social networking and safety: Maintaining professional boundaries online.

• Teamwork for safe care: Collaborating to promote patient safety.

• Moral distress: Experiencing discomfort when unable to act according to one’s ethical beliefs.

• Moral integrity: Adhering to ethical principles despite challenges.

• Moral residue: Lingering feelings after unresolved ethical issues.

Case Scenario: Ethical Dilemma in Practice

Situation

Mr. John Doe, a 75-year-old male with advanced dementia, is admitted to the hospital with a urinary tract infection. He is confused, agitated, and frequently tries to remove his IV line. His daughter, his primary caregiver, insists that he should not be restrained under any circumstances.

Ethical Dilemma

• Nursing staff are concerned about Mr. Doe’s safety due to his attempts to remove his IV line, which is essential for his treatment.

• They must also respect the wishes of his daughter and consider the ethical implications of using restraints.

Nursing Assessment and Ethical Considerations

• Assess Mr. Doe’s cognitive status and risk of harm.

• Evaluate the necessity and alternatives to restraints.

• Consider patient autonomy, dignity, and informed decision-making.

• Communicate with family and interdisciplinary team.

• Document all assessments and decisions.

Potential Nursing Interventions

• Implement non-restrictive safety measures (e.g., close monitoring, environmental modifications).

• Educate family about risks and benefits of interventions.

• Advocate for patient’s rights and preferences.

• Collaborate with health care team to develop an ethical care plan.

Summary

• Values and their formation

• Values clarification and personal reflection

• Ethics and the Code of Ethics

• Principles of bioethics

• Ethical dilemmas and decision-making frameworks

• Contemporary ethical issues in nursing practice

Additional info: Concepts such as moral distress, integrity, and residue are important in understanding the psychological impact of ethical dilemmas on health professionals. The principles of bioethics are foundational in both nursing and psychology, especially in areas of health psychology and clinical decision-making.