Professional Documents
Culture Documents
PRAKTIK KEPERAWATAN
PROFESIONAL
Etik Nursalam-2010
Etik Nursalam-2010
Standar professional
untuk pendidikan
Akreditasi
Program
Pendidikan
Board Regulasi
Keperawatan
Stndar professional,
tujuan, kebijakan,
prosedur pelayanan
keperawatan.
Sertifikasi pada
bidang kekususan
keperawatan
Akreditasi
organisasi
pelayanan
keperwatan
Lisensi
Perlindungan publik
Penjaminan
Mutu
KLIEN
Level 1
Level 2
Etik Nursalam-2010
Level 3
ETHIC
BEHAVIOR
Cognitive
affective
psychomotor
observed A
recorded C
measured U
SCIENTIFIC
Tujuan : menjelsakan peristiwa
kesimpulan : benar dan salah
adanya penjelasan dan penjabaran
ETHICAL
Justifikasi tindakan manusia
tidak bisa secara langsung : benarsalah
obligations atau pernyataan yang
harus dikerjakan
Etik Nursalam-2010
Etik Nursalam-2010
2.
3.
Tujuah (7) pitfalls yang umum terjadi Pada aspek etik keperwatan dan hukum
kesehatan.
1.
2.
3.
4.
5.
6.
7.
Patient falls
Failure to follow up MD. orders/protocol
Medication error
Improper use of equipment
Failure to remove foreign objects
Failure to provide sufficient monitoring
Failure to communicate
Etik Nursalam-2010
INFORMED CONSENT
Consent : (latin: consensio, con sentio), berarti persetujuan, ijin, menyetujui, memberi ijin
kpd seseorang utk melakukan sesuatu.
Permenkes (1989).
Informed Consent: persetujuan yg diberikan oleh pasien atau keluarga atas
dasar penjelasan mengenai tindakan medik yg akan dilakukan thd pasien tsb
A. UNSUR INFORMED CONSENT
1. CAPACITY (Kemampuan Memahami Informasi)
Ciri:
- Memiliki Nilai & Tujuan
- Kemampuan berkomunikasi &
memahami informasi
- Kemampuan membuat alasan atas pilihannya dan keputusan
2. VOLUNTERINISM (sukarela)
Ciri:
- tanpa paksaan
- tanpa ancaman
3. UNSUR INFORMASI
Ciri:
Diagnosis / masalah pasien
tujuan dan lama tindakan
hasil
manfaat
potensial resiko
alternatif tindakan sesuai kemampuan
prognosa jangka pendek & panjang
B. TUJUAN I.C
1. Perlindungan pasien utk segala tindakan (tindakan yg tidak perlu o/tim tanpa
sepengetahuan pasien)
2. Perlindungan tenaga medis dan perawat akibat penyakit tidak terduga serta
dianggap merugikan pihak lain
C. FUNGSI I.C
1. Promosi dari hak otonomi perorangan
2. Proteksi dari pasien dan subjek
3. Mencegah penipuan atau paksaan
4. Rgs. Profesi kes. Introspeksi
5. Promosi dari keputusan rasional
6. Keterlibatan masyarakat (otonomi nilai sosial & pengawasan)
D. BENTUK I.C
1. Express lisan & tertulis
2. Tersirat (implied or tacit consent)
Etik Nursalam-2010
10
E. PEMBERI I.C
1. Asien dewasa (sadar & sehat mental)
2. Pasien dewasa (21 th atau sudah menikah)
3. PAsien dewasa (pengampunan) oleh orang tua
4. Pasien dewasa (ggn mental) oleh orang tua/wali
5. Pasien dibawah 21th (tidak ada ortu) oleh keluarga terdekat
F. PENGABAIAN I.C
1. Tidak ada kesempatan memintakan
2. Tidak ada waktu lagi utk menunda-nunda tindakan
3. Untuk menyelamatkan nyawa, tidak mempunyai penyakit sebelumnya
4. Melindungi keselamatan anak/bayi
5. Mencegah self-distruction
6. Melindungi kes. Masyarakat
7. Menjaga etik / aturan RS
(UU-Kes 23/1992, pasal 53)
G. KRITERIA GAWAT (I.C)
1. Shock
2. Perdarahan
3. Patah Tulang
4. Kesakitan (Pain)
(PERMENKES 585/1989: dalam hal pasien tidak sadar/pingsan serta tdk
didampingi o/ kel.
Terdekat dan sec. medik dlm keadaan gawat dan atau
darurat yg memerlukan dindakan
medik segera utk kepentingannya, tidak
diperlukan persetujuand dari siapapun)
H. I.C TIDAK SAH JIKA . .. .
1. Dengan paksaan (duress, dwang)
2. Krn memberikan informasi yg salah/berlainan
3. Dari seseorang yg belum dewasa
4. Dari seseorang yg tidak berwenang
5. Dalam keadaan tdak sepenuhnya sadar (non lucid state)
Etik Nursalam-2010
11
PERAWAT
PASIEN
KELUARGA
PROSES KEPERAWATAN
assess
analyse
plan
implement
evaluate
Etik Nursalam-2010
12
SITUATION DATA
Determine what health problems and individual person strength exist
Identify what decision need to be made
Separate the ethical component of the decisions from those issues
Identify all the individual and groups who will be affected.
ACCOUNTABILITY
Means responsibility or the obligations to account for ones behavior or act
Objective:
Assume responsibility for his or her own actions
Demonstrate self-discipline in meeting commitments and obligations
(appointment)
Prepare in advance for clinical experience
Reposrt unsafe client-patient practice
ASSUMPTIONS
All nursing practice involves EDM
Person centered care demands a willingness to confront ED
Personal & professional values influence ED
Persons (care givers and clients) can be assisted to achieve higher levels of
moral reasoning
There is no one correct ethical theory
Etik Nursalam-2010
13
LEGAL
UU KES
36/2009 dan
KepMenkes
148/2010
ETIK
AZAS & KODE ETIK
NILAI-NILAI
(Agama, budaya,
Dll)
SOLUSI
Masalah
Etik
LANGKAH PENGAMBILAN
KEPUTUSAN
1
Klarifikasi
Delima etik
6
Evaluasi
2
Pulta
3
Identifikasi
Pilihan
Pelaksanaan
Keputusan
Institusi
Etik Nursalam-2010
14
15
he was resting comfortably. Miss Corbin sees a nurse colleague (X) drawing up a pain
medication. The nurse colleagues returns to the medicine room 10 minutes later with
empty syringe. Miss Corbin asks, Who needed pain medication? Mr. Hudson, the
colleagues (X) replies. He was in pain after surgery. Confused, Miss Corbin checks Mr.
Hudsons (Patients) room and learns from his wife that she has not asked for or
received pain medication. What should Nurse do now?
Bandman & Bandman (1997: 410)
7. Autonomy dan Negligence
SUSTER TIDUR, BAYI TEWAS!
Pasien (Heston dan Ashdiane-suami) melaporkan ke polisi, krn suster melarang
permintaan pasien utk dilakukan Caeser. Jam 17.00 ketuban pecah, tetapi tetap
dianggap biasa oleh suster. Jam 19.00 pasien merasa mulas yg amat sangat.
Permintaan suaminya (Heston) agar istrinya ditolak oleh suster. Pukul 02.00 (23/9/04)
pasien merasakan ada sesuatu yg mengalir di bagian bawah perutnya. Diapun segera
membangunkan perawat yg sedang tidur nyenyak. 1 jam kemudian, begitu dokter
datang langsung dibawa ke ruang operasi. Namun, bayi yg dilahirkan dlm keadaan
kritis. Jam 17.00 bayi meninggal.
8. Autonomy & Informed Concent
Eleanor Gift,age 68 years, is schedule for triple bypass surgery. Martha Blake, RN, is the
nurse doing her preoperative teaching the evening before the procedure is scheduled. It
is apparent to Miss Bake that Mrs. Gift doesnot want to have surgery. She express great
apprehension about procedure and generally feells quite negative about the outcome.
The surgeon, however, has convinced Mrs. Gist and her family that she must undergo
the surgery to survive. Although far from comfortable with situation, Mrs. Gift is resigned
to undergo the impending surgery in the morning. What is the nurses responsibility in
the situation?
CONTOH PENERAPAN EDM PADA KASUS NO. 8
TAHAP 1: CLARIFY ETHICAL DILLEMA
Many questions are not answered in this case study. Clearly the decision regarding
having surgery should be made by the one most affected (i.e. Mrs. Gift). Others are
affected by her decision, however. There is no information given about her family or how
involeved they are in her health care. Other care givers also may play a significance
role. The ethical principle of autonomy is important in this scenario. Unfortunately, time
is quite short because Mrs. Gifts surgery is scheduled in the morning.
TAHAP2: GATHERING ADDITIONAL DATA
The nurse need to know information from Mrs. Gifts medical history related to the
extent of her cardiovascular disease. It is also important to know what she has been told
about the surgery and her need for it. Has she ben given the necessary information to
allow her to make an information decision?
We can also gather the data from ansewering questions on 5W and 1 H
TAHAP3: IDENTIFY OPTION
The following nursing actions are options for the nurse in this situation:
Etik Nursalam-2010
16
Continue preoperative teaching under the assumption that surgery will take place
as schedule
Continue preoperative teaching and let the increased knowledge b e used as an
additional tool to assist Mrs, Gift in decicion making
Etc
Principelly, the options can be divided into 3 options possibles
1. should be attack
2. can be avoided
3. compromise
Suitability
Feasibility
Flexibility
Total
Alternative A
Alternative B
Alternative C
Alternative D
Alternative
Etik Nursalam-2010
17
TAHAP 5: IMPLEMENTATION
Once a decision is made, it is important to implement the action. In this situation, the
nurse decides to explore patients concerns and determine if an autonomous decisions
was made by the patient.
TAHAP6: EVALUATION
The step is important, even though it may seem obvious. It is necessary to evaluate the
implications of the decision that was made. The nurse must determine if the action
implemented accomplished what was intended. Evidence that the intervention was
succesfull would include a decrease in Mrs. Gifts anxiety level and negative feelings
about the probable outcome of the surgery.
DAFTAR PUSTAKA
Bandman, LE & Bandman B. 1995. Nursing Ethics Through the Life Span. 3rd ed.
Norwalk: Appleton & Lange.
Chitty, KK. 1997. Professional Nursing. Concepts and Challenges. 2nd ed. Philadelphia:
W.B. Saunders Co.
Edge RS & Groves JR. 2004. Ethics of Health Care. A guide for Clinical Practice.
2nd.ed. Philadelphia: Delmar Publishers.
Nursalam. 2008. Proses dan Doukumentasi Keperawatan. Edisi 2. Jakarta: Salemba
Medika
Etik Nursalam-2010
18