UNIVERSITY OF SAINT LOUIS TUGUEGARAO College of Health and Allied Sciences Graduate School Program

In Partial Fulfillment of the Requirements for the Degree Master of Science in Nursing

Advance Foundation in Nursing

Presented to: Mrs. Flordeliza Cepeda, RN, MSN

Presented by: Karina Joy C. lingan, RN

Ethics and Human Rights Issues in Nursing Practice: Purpose: It is widely believed that nurses frequently encounter ethical issues in nursing practice. Few studies, however, have identified the types of ethical issues that practicing nurses encounter in practice, how frequently they occur, and the types of ethics education topics and resources that nurses consider helpful to ethical practice. Thus, the purpose of this study was to identify (1) the ethical issues encountered by registered nurses in their practice, (2) how frequently ethical issues occur in practice, (3) how disturbed registered nurses are by the issues, (4) how registered nurses handle ethical issues, and (5) the types of ethics education topics and resources that registered nurses perceive as helpful to their practices. Methods: A survey tool was developed, piloted, and satisfactorily tested for the psychometric properties of the 35-item ethical issues scale (EIS) in a survey of 521 nurses (internal consistency reliabilities of the three subscales of the EIS ranged from .77 to .83). A mailed survey to a 4% sample (n=564) of the 14,093 currently employed registered nurses practicing in Maine was conducted during 1998. Two mailings of the survey were done and 238 nurses participated in the survey, representing a 43% return rate. Findings: The typical nurse participant in the survey is a 43 year old female with a college degree who is employed full time as a staff nurse and has 19 years of nursing experience. Analysis of the data indicates that the most frequently occurring ethical issues for registered nurses are: protecting patients' rights and human dignity; respecting/not respecting informed consent to treatment; using/not using physical or chemical restraints; providing care with possible risk to the nurse's health; and staffing patterns that limit patient access to nursing care. Issues that are the most personally disturbing to nurses are: prolonging the living/dying process with inappropriate measures; staffing patterns that limit patient access to nursing care; and implementing managed care policies that threaten quality of care. Over 36% of the nurses surveyed reported that they encountered ethical issues in their practice 1-4 times per week or daily. In handling their most recently encountered ethical issue, more than 87% reported that they discussed the issue with nursing peers while 73% discussed the issue with nursing leadership. Eight percent of the nurses reported that they did not deal with the ethical issue at all. The majority (88%) of the nurse respondents reported that they were quite to moderately knowledgeable about ethics but also had a great or more than moderate need for ethics education in order to practice ethically. Ethics education topics identified as most helpful to nurses\ethical practices are: professional issues; patients' rights, autonomy, and informed consent; risk to nurses health; ethical decision-making; and quality of life. Implications fo Education: It is clear that significant numbers of registered nurses frequently encounter ethical issues in their practice and that they are disturbed by these and other issues less frequently encountered. Registered nurses indicate that they have a high need for ethics education in order to practice ethically and that particular ethics education topics are preferred over other topics. Since the majority of the participants in

this survey had completed their nursing education nearly 20 years ago, it is imperative that an increased focus on ethics education, through inservice and continuing education, be undertaken to assist nurses to practice ethically. Implications for Nursing Practice: Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. WHO documents, address current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. This publication from the International Council of Nurses is the essential resource for nurses seeking to understand ethical decision making, written by world experts in nursing ethics.

Implications for Research: There are several reasons why it is important to adhere to ethical norms in research. First, norms promote the aims of research, such as knowledge, truth, and avoidance of error. Second, since research often involves a great deal of cooperation and coordination among many different people in different disciplines and institutions, ethical standards promote the values that are essential to collaborative work, such as trust, accountability, mutual respect, and fairness. Third, many of the ethical norms help to ensure that researchers can be held accountable to the public. Fourth, ethical norms in research also help to build public support for research. People more likely to fund research project if they can trust the quality and integrity of research. Finally, many of the norms of research promote a variety of other important moral and social values, such as social responsibility, human rights, animal welfare, compliance with the law, and health and safety. Ethical lapses in research can significantly harm human and animal subjects, students, and the public. For example, a researcher who fabricates data in a clinical trial may harm or even kill patients, and a researcher who fails to abide by regulations and guidelines relating to radiation or biological safety may jeopardize his health and safety or the health and safety of staff and students.