Ethics in Nursing

Enie Novieastari, SKp.,MSN DKKD FIK UI

List of contents
Definition of key terms Ethics in nursing care Nurses codes of ethics Accountability and responsibility Moral reasoning and theories Ethical principles Methodology for ethical decision making Institutional ethics committee

What is ethics?
A term with many meaning Simply stated, it is concerned with how people ought to act and how they ought to be in relationship with others Concerned with establishing norms and standards for human life and conduct should be Good and bad, right and wrong, character or motives Moral and ethics, used interchangeably

Etika: asal kata ethos (Yunani kuno) dalam bentuk tunggal yang berarti: kebiasaan, adat; akhlak, watak; perasaan, sikap, cara berpikir. Dalam bentuk jamak etha yang berarti adat kebiasaan (Bertens, 2007) Etika ~ moral dalam bahasa Latin berarti kebiasaan, adat Secara etimologi etika dan moral sama arti

Menurut KBBI (1999) Etika berarti: ilmu tentang apa yang baik dan apa yang buruk dan tentang hak dan kewajiban moral (akhlak) Etik berarti: 1. kumpulan asas atau nilai yang berkenaan dengan akhlak 2. nilai mengenai benar dan salah yang dianut suatu golongan atau masyarakat Etiket berarti: 1. secarik kertas yang ditempelkan pada kemasan 2. tatacara (adat, sopan santun dsb) dalam masyarakat

Values and ethics are related Values: building blocks for personal and professional morality, influence ones ethical decision making, relationship and conduct Values are based on experience, religion, education, and culture A persons ethic flows from his/her values Ethics is a study of good conduct, character, and motives, and concerned with determining what is good or valuable for all people

Ethics in nursing care

In nursing, specific values and moral requirements are necessary to maintain integrity of the profession An ethical nurse will act and treat others in specific ways that are consistent with the nursing norms and will be guided by more than personal preferences or values

An ethic of care
Care: an action, a virtue, an affect, an ethical principle, or a way of being in the world Care as an ethic for nursing is concerned not only with the resolution of ethical dilemmas, but also with the ways people behave towards one another An ethic of care is concerned with relationship between people and with a nurses character and attitude toward others.

Nurses Code of Ethics

Nursing has developed code of ethics that describe ideals for professional conduct Codes reflect ethical principles widely accepted by members of the professions See Kode Etik Keperawatan Indonesia: - Perawat dan klien - Perawat dan praktek - Perawat dan masyarakat - Perawat dan teman sejawat - Perawat dan profesi

Accountability and responsibility

Nurse assumes responsibility and accountability for nursing care provided Responsibility: execution of duties associated with the nurses particular role Example: when administering the meds, the nurse is responsible for assessing the clients need for the drug, giving them safely and correctly, and evaluating the responses A nurse who acts in a responsible manner gains the trust of client and other professionals A responsible nurse: competent in knowledge and skills and demonstrates a willingness to perform within the ethical guidelines of the professions

Accountability means being answerable for ones own actions A nurse is accountable to self, the client, the profession, the employer, and society If a wrong dose of meds given, the nurse is accountable to the client who receive it, the physician who ordered it, the nursing service that set standard of expected performance, and the society, which demands professional excellence To be accountable, the nurse acts according to the professional code of ethics

The purpose of professional accountability:, To evaluate new professional practices and reassess existing ones To maintain standards of health care To facilitate personal reflection, ethical thought, and personal growth on the part of health care professionals To provide a basis for ethical decision making

Moral reasoning
Doing ethics involves participating in a critical thought process about right and wrong, good and bad, or thinking about situations A process that occurs in many client-nurse interaction Developing an understanding of the complex thought process (moral reasoning) involved in processing ethical situations helps nurses participate more fully in the discussions Most moral reasoning happens after an ethical situation has been recognized and before one acts on the situation

Emotions play an important role in ethical reasoning People feelings or emotions are different and change in the same person from day to day or hour to hour Feelings should be honored, acknowledged, and used as a consideration in moral reasoning without making ethics simply a discussion about the validity and sincerity of individuals feeling Ethics is concerned with developing a system of shared values in a pluralistic society

Legal considerations also affect moral reasoning It is important to consider the law, the policies, or the guidelines of policy and procedure in moral thinking Ethics and laws are often in harmony, but not always Relying on law as the primary consideration of moral standards is a form of legalism For example: refuse to act the request a terminally ill, competent client to stop treatment, because of practitioners are afraid of being sued

Ethical principles
The most fundamental principle: respect for persons The 4 other primary principles stem from this basic principle: 1. respect for autonomy 2. beneficence 3. nonmaleficence 4. justice

Autonomy: individual should have freedom to choose their own life plan and ways of being moral The principles of nonmaleficence and beneficence are viewed on a continuum ranging from not inflicting harm (nonmaleficence) to benefiting others by doing good (beneficence) Justice: treating others fairly and giving persons their due

The secondary principles: - veracity: the duty to tell the truth - confidentiality; the duty to protect privileged information - fidelity: the duty to keep promises Informed consent: promotes and respects autonomy by expanding the clients knowledge of his/her opinions Advance directives: a form of communication in which the persons can give direction on how they would like to be treated when they cannot speak for themselves

Kerangka pemecahan masalah etik

Mengembangkan data dasar Mengidentifikasi konflik Membuat tindakan alternatif Menentukan siapa yang terlibat dan siapa pengambil keputusan Mengidentifikasi kewajiabn perawat Membuat keputusan

Pengambilan keputusan etis

Menunjukkan maksud baikng relevan Mengidentifikasi semua orang yang penting Mengumpulkan informasi yang relevan Mengidentifikasi prinsip etis yang penting Mengusulkan tindakan alternatif Melakukan tindakan

References
Aiken, T.D. (2004). Legal, Ethical, and Political Issues in Nursing. 2nd Ed. Philadelphia: F.A. Davis Company. Potter, P.A. & Perry, A.G. (2005). undamentals of Nursing: Conceps, Process and Practice. 6th Ed.St.Louis,MI: Elsevier Mosby. Kozier, B., Erb, G.,Berwan, A.J., & Burke,K. (2004). Fundamentals of Nursing:Concepts, Process, and Practice. 6th Ed. New Jersey: Prentice Hall Health. Buku Kode Etik Keperawatan Indonesia (PPNI).