In the beginning…

1. N246 Leadership Ethics & QualityS. Buckley, 2010(Adapted from Nursing Leadership and Management,Whitehead, Weiss, Tappen)

2. In the beginning… • There were no antibiotics • There were no ICUs • There were no CT scanners and MRIs • There were just physicians and nurses who cared for people in sickness and in health • Were there ethics?

6. Early nursing leaders

9. finances

10. 1960s • Technological advances allowed for the development of intensive care units • New biomedical developments • Advances in surgical techniques, such as open heart surgery

11. Reasons for new inquiries in nursing • Technological advances created new questions for health-care professionals regarding the use of technology, RN role and outcomes • Changing views and perspectives on the concepts of life and death • Dissatisfaction of RN’s with traditional manner of learning (mentoring) and desire to have a scientific base for practice (professional scientists) • Interest by healthcare practitioners about application of values in professional practices, and how to discuss these issues.

12. Bioethics • A sub discipline of ethics • The study of medical morality

13. Concepts of Ethics Ethics evolve from moral perspectives, which form values and standards. Influenced by families, environment, social issues, culture, religion, cognition, law. Ethical action depends, in part, on the ability of people to recognize that a moral issue exists in a given situation, knowing how to take appropriate ethical action if and when required, and on personal commitment and a genuine desire to achieve a moral outcome (Johnstone, 1999, from:Ethics in Nursing Practice, 2nd ed, Fry, S.T,Johnstone, M.)

14. Value Systemsdefinitions • A set of related values • Intrinsic values-located within, the real nature of a thing. • Extrinsic values-from without • Personal values • Professional values • Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.

15. Historical values of nursing:

16. Nursing today • Values in nursing today:

17. Value Formation • Values are learned-therefore, influenced by family, culture, environment, cognition. • Values change with maturity and experience • The number of values an individual holds is not as important as what values they consider important

18. Types of Values • Personal • Cultural • Religious • professional

19. Values Clarification • Critical thinking • Choosing • Identifying-verbalizing? • Acting

20. Belief Systems • These are organized ways of thinking about why people exist within the universe • Their purpose is to explain such concepts as: • Life and death • Good and evil • Health and illness • Individualism/rights

21. ETHICS AND MORALS

22. Morals • An individual’s own code for acceptable behavior • Standards of goodness or rightness that arise from an individual’s conscience • They act as a guide for individual behavior • Learned • Capable of making a distinction between right and wrong in conduct

23. Values • Social principles, goals or standards held or accepted by an individual class, society. That which is desirable or worthy of esteem for its own sake, thing or quality having intrinsic worth.

24. Standards • Something established for use as a rule or basis of comparison in measuring or judging quality, value, extent.

25. Laws • Rule of conduct established and enforced by the authority, legislation or custom of a given community, state, or other group. • May change with fluctuating social morals and viewpoints.

26. Ethics • Having to do with moral standards, conforming to the standards of conduct of a given professional group. Implies conformity with an elaborated, ideal code or moral principles. • Concerned with the motivation behind the behavior • Bioethics is the application of these principles to life-and-death issues

27. Ethical Theories • Deontological-based on duty to commitment, considers the intention of the action, not the consequences of the action. It is the individuals goodwill that determines worthiness, not the outcome. • Teleological-(utilitarianism)-what makes an action right or wrong is its usefulness. Right encompasses actions that have positive outcomes, wrong is composed of actions that result in poor outcomes. • Principalism-involved in biomedical issues, integrates ethical principles to resolve conflicts in situations.

28. Ethical Principles • Autonomy • Nonmaleficence • Beneficence • Justice • Fidelity • Confidentiality • Veracity • Accountability

29. Autonomy • The freedom to make decisions about oneself • Nurses need to respect clients’ rights to make choices about health care

30. Nonmaleficence • Requires that no harm be caused to an individual, either unintentionally or deliberately • This principle requires nurses to protect individuals who are unable to protect themselves

31. Beneficence • This principle means “doing good” for others • Nurses need to assist clients in meeting all their needs • Biological • Psychological • Social

32. Justice • Every individual must be treated equally • This requires nurses to be nonjudgmental

33. Fidelity • Loyalty • The promise to fulfill all commitments • The basis of accountability (moral concept that involves acceptance by a professional nurse of the consequences of a decision or action)

34. Confidentiality • Anything stated to nurses or health-care providers by clients must remain confidential • The only times this principle may be violated are: • If clients may indicate harm to themselves or others • If the client gives permission for the information to be shared

35. Veracity • This principle implies “truthfulness” • Nurses need to be truthful to their clients • Veracity is an important component of building trusting relationships

36. Accountability • Individuals need to be responsible for their own actions • Nurses are accountable to themselves and to their colleagues

37. Ethical Codes • These are formal statements of the rules of behavior for a particular group of individuals • Ethical codes are dynamic • Most professions have a “code of ethics” to guide professional behavior

38. Organizational Ethics • Focus on the workplace • Ethical culture makes a difference • Senior leadership must promote an ethical culture-do they?

39. Ethical Dilemmas • Occur when a problem exists between ethical principles • Deciding in favor of one principle usually violates another • Both sides have “goodness” and “badness” associated with them

40. Ethical decision making • Consider cause, variables, precipitating events and implications • Reflect upon one’s own perspective and values • Explore options for action: • ANA code of ethics, facility standard and ethics, nurse practice act (BRN), legal issues, rights. • Select appropriate plan. Understand consequences of the plan. • Implement • Evaluate results

41. Current Ethical Issues

42. Issues to Consider • Assisted suicide • Technology issues-as RN, as patient. • Gene therapies, genetic counseling • “Designer babies”, fertility issues, fetal success • Organizational climate • Family planning • Social responsibility • Immigration policies • Resource management. • Stem cell research • DNR status

43. Conclusion • An issue is not an ethical issue for the nurse unless he or she has been asked • Always gather the facts prior to decision-making • Consider your personal beliefs and values

44. Quality issues • What is it?? • The degree of excellence that distinguishes one thing from another • Relates to education and practice; professionals perceive that they are providing high-quality nursing education and patient care.

45. Why do we need it? • * current health care system is fragmented, poorly organized, inefficient use of resources. • *New technologies, availability of information (it), decreasing resources, increasing chronic disease states mandate a change. • * consumer dissatisfaction with current system

46. Quality improvement • Also known as performance improvement, focuses on processes or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change or improve the quality of care.(Saunders NCLEX review, 5th edition, Silvestri, L.,2011)

47. Professional organizations that focus on quality • * Joint commission on Accreditation of Healthcare Organizations (JACHO) • * American Nurses Association (ANA) • *Institute of Medicine (IOM)

48. IOM essential competencies • Provide patient centered care • Work in interdisciplinary teams • Employ evidence-based practice • Apply quality improvement • Use informatics

49. Aims of IOM quality of care • Safe • Effective • Patient centered • Timely • Efficient • equitable

50. IOM- cost of inefficiency • 44,000-98,000 die each year • $17-29 billion in total costs Nursing errors: *Medication *knowledge *procedure