In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Show
Ethics, simply defined, is a principle that describes what is expected in terms of right and correct and wrong or incorrect in terms of behavior. For example, nurses are held to ethical principles contained within the American Nurses Association Code of Ethics. Ethics and ethical practice are integrated into all aspects of nursing care. The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral. The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.
The most commonly occurring ethical issues and concerns in healthcare include the allocation of scarce resources and end of life issues. Bioethics is a subcategory of ethics. Bioethics addresses ethical concerns like those that occur as the result of advancing science and technological advances. Some of the most common, current bioethical issues revolve around stem cells, cloning, and genetic engineering. Nurses have the responsibility to recognize and identify ethical issues that affect staff and patients. For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it. Many hospitals, medical centers and other healthcare facilities have multidisciplinary ethics committees that meet as a group and resolve ethical dilemmas and conflicts. Nurses should avail themselves to ethicists and ethical committees within their facility when such ethical resources and mechanisms are present in order to resolve ethical concerns and ethical dilemmas. In addition to utilizing these resources, the nurse can take appropriate actions when faced with an ethical dilemma by understanding and applying the ethical guidelines provided in the American Nurses Association's Code of Ethics, the American Medical Association's Code of Ethics, the World Medical Association's Code of Ethics, the American Nurses Association's Standards of Care and Standards of Practice, American Nurses Association's position papers such as that which describes the ethical use of narcotic analgesics at the end of life even if this medication hastens death, state board of nursing declaratory statements, and the International Nurses Association's Code of Ethics. The steps of the ethical decision making process, like the problem solving process, are:
Informing the Client and Staff Members of Ethical Issues Affecting Client CareNurses have the responsibility to identify ethical issues that affect staff members and patients; and they also have the responsibility to inform staff members and affected clients of ethical issues that can and do affected client care. For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it. Although a rare occasions, a patient may, at times, ask you to do something that is not ethical. For example, a patient may ask a nurse to assist in their suicide at the end their life or they may inquire about another patient in terms of their diagnosis. When something like this occurs, the nurse must inform the client that they cannot do it for ethical and legal reasons. Clients may also need information about ethics can affect the care that they choose or reject. For example, a client may ask the nurse about whether or not it is permissible ethically and legally to reject CPR at the end of life or to take pain medications even if it hastens their death. Practicing In a Manner Consistent with The American Nurses Association's Code of Ethics and Other Ethical CodesAs previously discussed, nurses are expected to apply the ethical guidelines provided in the American Nurses Association's Code of Ethics, the American Medical Association's Code of Ethics, the World Medical Association's Code of Ethics, the American Nurses Association's Standards of Care and Standards of Practice, American Nurses Association's position papers such as that which describes the ethical use of narcotic analgesics at the end of life even if this medication hastens death, state board of nursing declaratory statements, and the International Nurses Association's Code of Ethics. The American Nurses Association's Code of Ethics, for example, contains elements that emphasize and speak to advocacy, collaboration with others, the maintenance of client safety, the dignity and worth of all human beings, the prohibition of any discrimination, accountability, the preservation of patient rights, such as dignity, autonomy and confidentiality, and the provision of competent, safe and high quality care of nursing care. Evaluating the Outcomes of Interventions to Promote Ethical PracticeAs with all other aspects of nursing care, the outcomes of the interventions to promote ethical practice are evaluated and measured. Some of the evaluation criteria that can be used to determine and evaluate the outcomes of the interventions to promote ethical practice can include one or more of the following:
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