ethico-moral aspects of nursing
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SEMI-FINALS: PROFESSIONAL AND PERSONAL DEVELOPMENT 1. ETHICO- MORAL ASPECTS OF NURSING a. DEFINITION OF NURSING ETHICS -Every science has its own field of inquiry, its subject matter which it studies and with which it deals. -Ethics studies human acts or human conduct. Ethics is the practical science of the morality of human actions. The study of ethics is human conduct; and the special aspect of human conduct, which is the formal object of study- the morality of human acts. -Morality- the quality of right or wrong in human acts. -Human acts- acts done with knowledge and consent. -Ethics came from the Greek word ethos which means moral duty. Ethical theories, principles and codes of conduct serve as guides of human conduct provided by ethical systems. Ethics studies how people make judgment in regard to right or wrong. Morality is derived from the Greek word moralis which refers to social consensus about moral conduct for human beings and society. -Bio-ethics is a specific domain of ethics that focuses on moral issues in the field of health care. -Johnston defines nursing ethics as the “examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics.” UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS There are basic ethical principles assist the health professionals to determine right or wrong in regard to value issues involving the pursuit of health, alleviation of suffering, and assisting patients towards peaceful death. These are: Autonomy- comes from the Greek word autos meaning self and nomos meaning governance. Veracity- to maximize the efficiency of health care, the patient and the health care providers are bound to tell the truth. Beneficence- the principle of beneficence promotes doing acts of kindness and mercy that directly benefit the patient. Nonmaleficence- the principle of nonmaleficence is similar to the principle of beneficence. The distinction lies in the fact that the principle of beneficence is stated in the positive form while nonmaleficence is stated as an admonition in the negative form to remind health practitioners to do no harm. Justice- in health care, justice refers to the right to demand to be treated justly, fairly and equally. ETHICS COMMITTEES IN HOSPITALS AND THE ROLE OF MEDICAL ETHICISTS -a growing trend for hospitals to have formal ethics committees - composed of philosophers, doctors, nurses, lawyers, clergy or social workers.
-they discuss sensitive issues, right to die, informal consent, right to choose or refuse treatment RESPONSIBILITIES OF THE NURSE TO THE PATIENTS -give patient the kind of care his/her condition needs regardless of his/her race, creed, color, nationality or status. -nurses are advised to be familiar with Patient’s Bill of Rights -because nurses are given compensation, they should not accept tips or gifts -the nurse should complete the said service on the length of time stipulated in the contract. A nurse can be sued for breach of contract. They should be loyal to their sworn duty, this is termed role fidelity. CONFIDENTIALITY OF INFORMATION -termed as privileged communication because it is given based on trust. -patients and SO are expected to give the necessary information so that proper diagnosis is made. -information gathered from the patient should always be treated confidential. This duty extends even after the patient’ death. -confidential information may be revealed only when: • The patient himself /herself permits such revelation as in the case of claim for hospitalization, insurance benefits. • The case is medico-legal such as attempted suicide, gunshot wounds which have to be reported to police • The patient is ill of communicable disease and public safety may be jeopardized • Given to members of the health team if information is relevant to his care PATIENTS’ RESPONSIBILITIES • PROVIDING INFORMATION • COMPLYING WITH INSTRUCTIONS • INFORMING THE PHYSICIAN OF REFUSAL TO TREATMENT • PAYING HOSITAL CHARGES • FOLLOWING HOSPITAL RULES AND REGULATIONS • SHOWING RESPECT AND CONSIDERATION RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN Section 28 (a) of R.A. 9173 states that: It shall be the duty of the nurse to: (a) provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established. -nurses will not only carry out doctor’s orders but also help plan and implement patient care as well.
-if medical orders were not carried out for some reason, such shall not only be brought to the attention of the physician but also noted properly in the patient’s chart. -in case the patient has a complaint against the physician, this shall be tactfully brought to the latter’s attention. -nurses shall remember that any medical act relegated to them is illegal because it is specified in the Medical Law that any licensed nurse who does this, even if supervised, can be held for illegal practice of medicine. RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES -nurses are expected to be able to get along smoothly with their colleagues. If one has a grievance this should be brought to the attention of the proper authority rather than talk about it with others who may not be able to help. -situations, such as when nurses see their colleagues neglect their duties or are incompetent shall be brought to the attention of the immediate supervisor or appropriate authority within the agency setting before any life could be endangered. -Constructive criticism is always welcome but not fault- finding. RESONSIBILITIES OF NURSES TO THEMSELVES -when nurses are on duty, they shall try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They shall wear uniforms that are neither too short nor tight-fitting that will tend to restrict movements, nor expose unnecessarily any part of the body. Use of anti-perspirant is advised most especially during hot summer months. Male nurses are likewise advised to be clean shaven, with hair clipped close to the nape instead of flowing to the shoulders. -the use of uniform shall be specified in the policy of the hospital. It shall be worn only when on duty. Dining in public, shopping, or going to the market while in uniform is discouraged. Nurses’ caps are only worn on duty. Jewelry such as earrings, necklaces or bracelets is not worn while on duty. However, wedding rings, school pins/rings may be worn. LIVING WILLS OR ADVANCE DIRECTIVES -not yet widely used in the Philippines but used extensively in the United States. -the patient designates a health care representative, usually a member of the family or family physician to make decisions for him/her when he/she is unable, due to physical or mental incapacity, to make his/her own health care decision. -this living will is signed by the patient. It is witnessed by two other persons who declare that the patient signed the will, that the latter appears to be of sound mind. The witnesses must be 18 years of age or older.
-they discuss sensitive issues, right to die, informal consent, right to choose or refuse treatment RESPONSIBILITIES OF THE NURSE TO THE PATIENTS -give patient the kind of care his/her condition needs regardless of his/her race, creed, color, nationality or status. -nurses are advised to be familiar with Patient’s Bill of Rights -because nurses are given compensation, they should not accept tips or gifts -the nurse should complete the said service on the length of time stipulated in the contract. A nurse can be sued for breach of contract. They should be loyal to their sworn duty, this is termed role fidelity. CONFIDENTIALITY OF INFORMATION -termed as privileged communication because it is given based on trust. -patients and SO are expected to give the necessary information so that proper diagnosis is made. -information gathered from the patient should always be treated confidential. This duty extends even after the patient’ death. -confidential information may be revealed only when: • The patient himself /herself permits such revelation as in the case of claim for hospitalization, insurance benefits. • The case is medico-legal such as attempted suicide, gunshot wounds which have to be reported to police • The patient is ill of communicable disease and public safety may be jeopardized • Given to members of the health team if information is relevant to his care PATIENTS’ RESPONSIBILITIES • PROVIDING INFORMATION • COMPLYING WITH INSTRUCTIONS • INFORMING THE PHYSICIAN OF REFUSAL TO TREATMENT • PAYING HOSITAL CHARGES • FOLLOWING HOSPITAL RULES AND REGULATIONS • SHOWING RESPECT AND CONSIDERATION RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN Section 28 (a) of R.A. 9173 states that: It shall be the duty of the nurse to: (a) provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established. -nurses will not only carry out doctor’s orders but also help plan and implement patient care as well.
-if medical orders were not carried out for some reason, such shall not only be brought to the attention of the physician but also noted properly in the patient’s chart. -in case the patient has a complaint against the physician, this shall be tactfully brought to the latter’s attention. -nurses shall remember that any medical act relegated to them is illegal because it is specified in the Medical Law that any licensed nurse who does this, even if supervised, can be held for illegal practice of medicine. RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES -nurses are expected to be able to get along smoothly with their colleagues. If one has a grievance this should be brought to the attention of the proper authority rather than talk about it with others who may not be able to help. -situations, such as when nurses see their colleagues neglect their duties or are incompetent shall be brought to the attention of the immediate supervisor or appropriate authority within the agency setting before any life could be endangered. -Constructive criticism is always welcome but not fault- finding. RESONSIBILITIES OF NURSES TO THEMSELVES -when nurses are on duty, they shall try to look neat and attractive. Female nurses are advised to use moderate make-up and have a neat hairstyle. They shall wear uniforms that are neither too short nor tight-fitting that will tend to restrict movements, nor expose unnecessarily any part of the body. Use of anti-perspirant is advised most especially during hot summer months. Male nurses are likewise advised to be clean shaven, with hair clipped close to the nape instead of flowing to the shoulders. -the use of uniform shall be specified in the policy of the hospital. It shall be worn only when on duty. Dining in public, shopping, or going to the market while in uniform is discouraged. Nurses’ caps are only worn on duty. Jewelry such as earrings, necklaces or bracelets is not worn while on duty. However, wedding rings, school pins/rings may be worn. LIVING WILLS OR ADVANCE DIRECTIVES -not yet widely used in the Philippines but used extensively in the United States. -the patient designates a health care representative, usually a member of the family or family physician to make decisions for him/her when he/she is unable, due to physical or mental incapacity, to make his/her own health care decision. -this living will is signed by the patient. It is witnessed by two other persons who declare that the patient signed the will, that the latter appears to be of sound mind. The witnesses must be 18 years of age or older.
