Chapter 8
Understanding the Concept
of Ethics
Chapter 6
Values, Ethics, and Advocacy
Ethics offers a formal process for answering the
question about what one ought to do in a given
situation. Understanding some of the basic ethical
principles and guidelines assists us in making logical
and appropriate decisions.
Understand • Morals
• The basic standards for what we consider right and
ing the
wrong that typically are based on religious beliefs,
social influences (including education), group norms,
culture, and life experiences. If we are of good moral
Concept of character, we would not steal from a neighbor or cheat
on an examination.
Ethics
• Values
• are beliefs about the worth of something, about what
matters, that act as a standard to guide one’s behavior.
• A value system is an organization of values in which each
is ranked along a continuum of importance, often leading to
a personal code of conduct. A person’s values influence
beliefs about human needs, health, and illness; the practice
of health behaviors; and human responses to illness.
• A person is not born with values; rather, values are
formed during a lifetime involving influences from the
environment, family, and culture.
• Professional values provide the foundation for nursing
practice and guide the nurse’s interactions with
patients, colleagues, and the public.
Professional Values
• Altruism is a concern for the welfare and well-being of others. In professional
practice, altruism is reflected by the nurse’s concern for the welfare of patients,
other nurses, and other health care providers.
• Human dignity is respect for the inherent worth and uniqueness of individuals
and populations. In professional practice, human dignity is reflected when the
nurse values and respects all patients and colleagues.
• Integrity is acting in accordance with an appropriate code of ethics and
accepted standards of practice. Integrity is reflected in professional practice
when the nurse is honest and provides care based on an ethical framework that
is accepted within the profession.
• Justice refers to the quality of being just or fair; conformity to truth, fact, or
sound reason; or treating like cases similarly (equity) and looks at the concepts
of moral rightness in action or attitude.
• Social justice is upholding moral, legal, and humanistic principles. This value is
reflected in professional practice when the nurse works to assure equal
treatment under the law and equal access to quality health care.
• Ethics is a systematic study of
principles of right and wrong
conduct, virtue and vice, and good
and evil as they relate to conduct
and human flourishing. The ability
to be ethical, to make decisions
Ethics and act in an ethical manner,
begins in childhood and develops
gradually.
Basic Ethical Concepts
• Autonomy
• is the right to self-determination. Professional practice reflects autonomy
when the nurse respects patients’ rights to make decisions about their
health care.
• It is important to respect client rights to make decisions about and for
themselves, even when we do not agree with those decisions.
• Autonomy is closely tied to informed consent because it requires that clients
be provided clear and sufficient information to make good decisions for
themselves.
• Beneficence
• Means doing or producing good, especially performing acts of kindness and
charity.
• Nonmaleficence
• The prevention of intentional harm.
Basic Ethical Concepts_2
• Fidelity
• refers to the obligation to be faithful to the agreements,
commitments, and responsibilities that one has made to oneself and
others, both implicitly and explicitly.
• Fidelity is the foundation of the concept of accountability that we
hear about so often in nursing today.
• Veracity
• refers to telling the truth or not intentionally deceiving or misleading
clients.
Ethical Theories
• Rights
• The discussion of ethical concepts is founded on the belief that people are entitled to certain rights
or privileges.
• Most rights are based on the concept of autonomy of the individual.
• Right to Self Determination
• This act was created because of our society’s fundamental belief in the individual’s right to decide.
• Cultural relativism
• is the principle that what an individual believes and does makes sense in terms of their own
culture. Cultural relativism embraces the notion that groups and individuals hold different sets of
values that must be respected.
• Rights of the Unborn and the Pregnant Woman
• There are many times when we grapple with whose rights should be respected. The most obvious
example of this situation occurs when we consider the rights of the unborn to life versus the right
of the mother to make choices regarding her own body.
• Rights to Privacy and Confidentiality
• is a client’s privacy rights and medical information confidentiality. Privacy may be thought of as the
right to be left alone or free from intrusion; however, it also includes the right to select desired care
based on personal values and beliefs and to have control over how sensitive information is shared.
Theories of Ethics
• Utilitarian: the rightness or wrongness of an action depends on the
consequences of the action.
• Deontologic: an action is right or wrong based on a rule, independent
of its consequences.
• For example, one nurse may believe that abortion is ethically justified in
situations that result in the best consequences for the woman, child,
and society (utilitarian argument). Another nurse may believe that
abortion is wrong based on a rule that an innocent life should never be
taken (deontologic argument).
A Framework for Ethical Decision Making
• Identify and Clarify the Ethical Problem
• To define the ethical concern, the situation needs to be reviewed to gain as clear
a perception of the problem as possible. What is the decision to be made? Does
the decision involve a choice between good and bad? Two “goods?” Two “bads?”
Could this be damaging to someone or some group? Who are the relevant
parties to this decision? What are their values? Are there legal or institutional
concerns? Consider what ethical principles might be involved. Are those
principles in conflict? Who should assume responsibility for this decision? Is this
an individual’s decision or is it one in which a collaborative decision must be
made? What is your role and relationship to the problem? Are there time
constraints on making this decision? What other factors influence the decision?
Once a clear picture of the problem has been achieved, more information can be
gathered about the situation.
• Gather Factual Data
• It is important to have as much information about the unique situation as
possible. The facts of the situation make a difference in what options are
possible. Who are the relevant people in the situation and what are their
concerns and perspectives? Have they all been consulted? Consider whether
legal cases might affect decision-making in this case.
A Framework for Ethical Decision
Making_2
• Identify and Evaluate Options
• Most ethical problems have more than one possible solution. Consider each option’s
impact on each person involved. Also think about the impact on society as a whole if
this option were chosen. Which option does the greatest good while at the same time
doing the least harm? Which option respects the rights and dignity of all persons
involved? Is one approach more appropriate than another in this situation? Is this
approach in keeping with your own moral and ethical position? Helping others to
explore these questions requires personal involvement and interpersonal skill.
• Make a Decision
• At some point, a decision must be made. Clients and families, as well as healthcare
providers, may find this difficult and sometimes painful. Remember that no decision is
also a decision. There will never be enough time, data, or alternatives in some
situations. There may still be uncomfortable feelings no matter how thorough the
analysis or how carefully people weigh all competing claims. When dealing with these
feelings, it is helpful to plan ahead to the action that will be taken. What would a
respected and admired individual say? This strategy may be helpful to you as well as
to clients and families.
• Act and Assess
• Once a course of action is chosen, it must be carried out. This may involve working
with others or personally carrying out plans. Clients and families need ongoing support
as they carry out their decisions. Assess the outcomes as the processes go forward.
Unforeseen outcomes are common in ethical situations.
Nursing Code of Ethics
• According to the ANA (2015), people who become nurses are expected
not only to adhere to the moral norms of the profession but also to
embrace them as part of what it means to be a nurse.
• A code of ethics is a set of principles that reflect the primary goals,
values, and obligations of the profession.
• The ANA Code of Ethics for Nurses serves the following purposes:
• It is a succinct statement of the ethical obligations and duties of
every person who enters the nursing profession.
• It is the profession’s nonnegotiable ethical standard.
• It is an expression of nursing’s own understanding of its
commitment to society.
Moral Distress and Resiliency
• (
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)
• The capacity to recover, adapt, and even thrive in the face of threats,
misfortune, or challenging times is termed resilience.
• Moral resilience is the developed capacity to respond well to morally
distressing experiences and to emerge strong.
Chapter 5
Culturally Respectful Care
Concepts of Cultural Diversity and
Respect
• Cultural diversity is the coexistence of different ethnic, sex assigned at
birth, racial, and socioeconomic groups within one social unit. These groups
include, but are not limited to, people of varying religion, language, physical
size, sexual orientation, age, disability, occupational status, and geographic
location. Culture is an integral component of both health and illness because
of the cultural values and beliefs that we learn in our families and
communities. Nurses and other health care providers must be familiar with the
concepts of cultural diversity in order to understand characteristics common
to certain populations.
• Nurses must also be sensitive to cultural factors in order to provide culturally
respectful care to people from diverse backgrounds. The concept of cultural
respect enables nurses to deliver services that are respectful of and
responsive to the health beliefs, practices, and cultural and linguistic needs of
diverse patients. Cultural respect is critical to reducing health disparities and
improving access to high-quality health care.
Culture
• Culture is a shared system of beliefs,
values, and behavioral expectations that
provides social structure for daily living.
• The NIH defines culture as the
combination of a body of knowledge, a
body of belief, and a body of behavior.
Elements include personal identification,
language, thoughts, communications,
actions, customs, beliefs, values, and
institutions that are specific to ethnic,
racial, religious, geographic, or social
groups.
• For nurses who practice thoughtful,
person-centered care, these elements
influence beliefs and belief systems
surrounding health, healing, wellness,
illness, disease, and delivery of health
services.
Ethnicity
• Ethnicity is a sense of identification with a
collective cultural group, largely based on
the group members’ common heritage.
• One belongs to a specific ethnic group or
groups either through birth or through
adoption of characteristics of that group.
• People within an ethnic group generally
share unique cultural and social beliefs
and behavior patterns, including language
and dialect, religious practices, literature,
folklore, music, political interests, food
preferences, and employment patterns.
• Ethnicity largely develops through day-to-
day life with family and friends within the
community.
Race
• Racial categories are typically based on specific physical characteristics
such as skin pigmentation, body stature, facial features, and hair
texture.
• Federal standards for race classification provide five categories, Native
American or Alaska Native, Asian, Black or African American, Native
Hawaiian or Other Pacific Islander, and White, and provide the
opportunity for people to identify themselves in multiple categories.
Factors Inhibiting Sensitivity to
Diversity
• When one assumes that all members of a culture, ethnic group, or race act alike,
stereotyping is at work.
• Stereotyping may be positive or negative. Negative stereotyping includes racism,
ageism, and sexism. These are mistaken beliefs that certain races, an age group,
or one biologic sex is inherently superior to others, leading to discrimination
against those considered inferior.
• When we hold attitudes toward people or associate stereotypes with them without
our conscious knowledge it is called implicit bias.
• Take the implicit bias quiz:
• [Link]
• What did you learn about any personal biases that you may not have
recognized that you hold?
Culturally Respectful Nursing Care
• Cultural Competence
• Developing an awareness of your own existence, sensations, thoughts, and environment to prevent them from
having an undue influence on those from other backgrounds
• Demonstrating knowledge and understanding of the patient’s culture, health-related needs, and culturally
specific meanings of health and illness
• Accepting and respecting cultural differences in a manner that facilitates the patient’s and family’s abilities to
make decisions to meet their needs and beliefs
• Not assuming that the health care provider’s beliefs and values are the same as the patient’s
• Resisting judgmental attitudes such as “different is not as good”
• Being open to and comfortable with cultural encounters
• Accepting responsibility for your own education in cultural competence by attending conferences, reading
professional literature, and observing cultural practices
• These elements suggest that becoming culturally competent is a life-long challenge, and that nurses should strive to
be culturally humble—recognizing what we don’t yet know about those entrusted to our care and being willing to
learn what we need to know.
• Nurses who recognize and respect cultural diversity are better equipped to exhibit cultural sensitivity and provide
nursing care that accepts the significance of cultural factors in health and illness.
• The nurse’s role is to understand the patient’s needs and to adapt care to respectfully meet those needs. A careful
merging of modern and traditional cultural beliefs is a necessary prerequisite for safe, considerate, and successful
nursing care of all patients.
Theory of Cultural Humility and Cultural
Competence
• “the recognition of diversity and power imbalances among
individuals, groups or communities, with the action of being open,
self-aware, egoless, flexible, exuding respect and supportive
interactions, focusing on both self and other to formulate a tailored
response.”
• “Cultural humility is a process of critical self-reflection and lifelong
learning, resulting in mutually positive outcomes.”
• Cultural Competence emphasizes becoming culturally competent
and integrating cultural awareness, cultural knowledge, cultural skill,
cultural encounters, and cultural desire.
Chapter 47
Spirituality
Spiritual Needs and Spirituality
• Spiritual needs underlie all religious traditions and are
common to all people regardless of whether or not they
belong to a particular religious tradition:
• Need for meaning and purpose
• Need for love and relatedness
• Need for forgiveness
• Spirituality is anything that pertains to a person’s
relationship with a nonmaterial life force or higher power.
Faith and Religion
• Faith generally refers to a confident belief in something for which
there is no proof or material evidence.
• It can involve a person, idea, or thing, and is usually followed by
action related to the ideals or values of that belief. For example,
if I have faith in my doctor, parish nurse, or healer, I am more
likely to adhere to a prescribed regimen or plan of care and to
experience benefits.
• Religion can be defined as an organized system of beliefs about a
higher power that often includes set forms of worship, spiritual
practices, and codes of conduct.
• Although it is impossible for nurses to be knowledgeable about
all religions, we are better able to meet patients’ spiritual needs
when we understand their religious beliefs and practices.
