KODE ETIK PROFESI

KEPERAWATAN DAN
PENGARUHNYA TERHADAP
MUTU PELAYANAN

Oleh: Nursalam

Etik – Nursalam-2012

1

SISTEM REGULASI DALAM PRAKTIK KEPERAWATAN SOSIAL Regulasi Profesi Legal Regulasi Definisi Lingkup praktik State Nursing Practice Acts (UU Praktik) Standar Profesional Board Regulasi Standar professional untuk pendidikan Stndar professional. EDM diyakini dapat digunakan sebagai upaya untuk meningkatkan mutu pelayanan keperawatan. prosedur pelayanan keperawatan. teman sejawat dan masyarakat uymumnya.PENDAHULUAN Etik profesi merupakan prinsip – prinsip moral atau asas-asas yang harus diterapkan oleh perawat dalam hubungannya dengan pasien. Etik ini mengatur tentang perilaku profesional paa perawat dalam menjalankan pekerjaannya. Pelanggaran etik keperawatan diproses melalui MKEK-PPNI dan jika diperlukan diteruskan ke Departemen Kesehatan. Pelanggaran hukum diselesaikan melalui pengadilan. kebijakan. Keperawatan tujuan. Untuk menghindari pelanggaran etik dalam praktik keperawatan profesional. Dalam melaksanakan perawat harus memperhatikan dan menghindari yang disebut dengan negligence (kealpaan): commision dan ommision. Pelanggaran etik keperawatan tidak selalu berarti pelanggaran hukum. Hal ini bisa dilakukan apabila perawat dalam setiap mengambil keputusan etik selalu didasarkan pada ethical decision making dan clinical decision making (EDM). Sertifikasi pada bidang kekususan Akreditasi Akreditasi keperawatan organisasi Lisensi Program pelayanan Pendidikan keperwatan Perlindungan publik Penjaminan Mutu KLIEN Lindberg (1990: 320) Etik – Nursalam-2012 2 . maka perawat harus menerapkan prinsip / azas etik dan kode etik serta mematuhi aspek legal keperwatan yang diatur dalam KepMenkes 148/2010 dan UU Kes 36/2009. sebagaimana tercantum dalam lafal sumpah dan kode etik perawat yang disusun organisasi profesional bersama pemerintah. demikian pula sebaliknya.

TANTANGAN ETIK KEPERAWATAN 1. Dasar & sendi agama makin menipis 3. MORAL. Kamajuan & perkembangan masyarakat sebagai pengguna jasa: (kesadaran hak. Masyarakat perawat (kurangnya kemampuan . Globalisasi yg menyebabkan persaingan bebas (orientasi pelayanan dari sosial - bisnis) 5. kesenjangan si kaya dan si miskin.  MORAL (apa yg dinilai baik /buruk oleh masyarakat)  HUKUM (legalisasi sikap tindak etik) ETHIC Cognitive observed A-mati BEHAVIOR affective recorded C-catat psychomotor measured U-kur Cipta : (the truth) Rasa : (the beauty) Karsa : ( goodness) UKURAN GOOD / BAD – TINDAKAN MANUSIA  KRITERIA – Dilakukan Dengan Sengaja – Dilakukan Dengan Kesadaran – Yang Bersangkutan Telah Mengetahui – Yang Bersangkutan Mempunyai Pilihan PRINSIP & AZAS ETIK KEPERAWATAN (JABVC) 1. tk. HUKUM Etik “ …. masuknya tenaga LN) HUBUNGAN ETIK. CONFIDENTIALITY Etik – Nursalam-2012 3 . Ekonomi yg meningkat. Perkembangan IPTEK yg meningkat 4. VERACITY 5. Perubahan dlm. AUTONOMY 3. JUSTICE (Asas Keadilan) 2.etik. Dasar-dasar moral makin memudar 2. BENEFICIENCY & NON-MALEFICIENCY 4. IPTEK meningkat) 6. doing good and avoiding harm (Bandman & Bandman. 1995:5) – Apa yang harus dilakukan manusia – Apa yang seharusnya dilakukan kepada seseorang – Suatu analisa proses terhadap suatu tindakan – Berdasarkan ilmu dan nilai / norma di masyarakat Hubungan etik dgn.

perawat dan praktik 3. AUTONOMY (Asas menhormati otonomi) “ Individuals have the right to determine their own actions “ Karakteristik :  Sesuai dengan nilai . alat . CONFIDENTIALITY – Kerahasaiaan Perawat harus merahasiakan keadaan pasien. VERACITY (Asas Kejujuran) “ …. meskipun pasien sudah meninggal kecuali diminta oleh institusi yang berkompeten. perawat dan teman sejawat 5. BENEFIENCE (asas manfaat) DAN NON-MALEFICIENCY (tidak merugikan) “ Doing or promoting good “ Karakteristik :  Nonmaleficence  mencegah harm atau kesalahan  mengurangi / menghilangkan “ harm or evil “  promote “ good “ 4. Perawat dan pasien 2. FIDELITY (Asas Komitmen) “ one has a moral duty to be faithful to the commitments that one makes to others” KODE ETIK KEPERAWATAN DI INDONESIA (PPNI) (Code Of Ethics For Nurses – Indonesia) LIMA PRINSIP: 1. dll )  Models ( health care resources ) – Setiap arang sama – berdasarkan jasa – keberadaan peralatan – sesuai kebutuhan 2. perawat dan masyarakat 4.  Pasien harus diperlakukan sama sesuai dengan keadaan sakitnya.alat.nilai / kepercayaan  informasi yang cukup  bebas dari “ coercion “  berdasarkan alasan dan kebebasan 3. RESPECT FOR PERSONS (Asas perbedaan tiap individu) “ Eeach person shpuld be treated as a unique individual and as a member of the human community” 7. JUSTICE (Asas Keadilan) “ …equals should be treated the same and unequals should be treated differently”..  tidak ada diskriminasi ( pasien.1. 6. perawat dan profesi Etik – Nursalam-2012 4 . Telling the truth “ 5.

3. PERAWAT DAN PRAKTIK 1. keunikan klien. Perawat berperan aktif dalam berbagai kegiatan pengembangan profesi keperawatan. Etik – Nursalam-2012 5 . Perawat senantiasa memelihara hubungan baik dengan sesama perawat maupun dengan tenaga kesehatan lainnya. Tanggung jawab utama perawat adalah kepada mereka yang membutuhkan asuhan keperawatan. 4. Perawat bertindak melindungi klien dan tenaga kesehatan yang memberikan pelayanan kesehatan secara tidak kompeten. warna kulit. Menghargai harkat dan martabat manusia. 2. Perawat berpartisipasi aktif dalam upaya profesi untuk membangun dan memelihara kondisi kerja yang kondusif demi terwujudnya asuhan keperawatan yang bermutu tinggi.PERAWAT DAN KLIEN 1. Perawat senantiasa menjunjung tinggi nama baik profesi keperawatan dengan selalu menunjukkan perilaku profesional. Perawat dalam membuat keputusan didasarkan pada informasi yang adekuat dan mempertimbangkan kemampuan serta kualifikasi seseorang bila melakukan konsultasi menerima delegasi dan memberikan delegasi kepada orang lain. Perawat senantiasa memelihara mutu pelayanan keperawatan yang tinggi desertai kejujuran profesional dalam menerapkan pengetahuan serta keterampilan keperawatan sesuai dengan kebutuhan klien. 2. 5. umur. dan dalam memelihara keserasian suasana lingkungan kerja maupun dalam mencapai tujuan pelayanan kesehatan secara menyeluruh. Perawat dalam memberikan pelayanan keperawatan senantiasa memelihara suasana lingkungan yang menghormati nilai-nilai budaya. jenis kelamin. Perawat memelihara dan meningkatkan kompetensi dibidang keperawatan melalui belajar terus menerus. 3. Perawat dalam memberikan pelayanan keperawatan 2. PERAWAT DAN MASYARAKAT Perawat mengemban tanggung jawab bersama masyarakat untuk memprakarsai dan mendukung berbagai kegiatan dalam memenuhi kebutuhan kesehatan masyarakat. aliran politik dan agama yang dianut serta kedudukan sosial. dan tidak terpengaruh oleh pertimbangan kebangsaan. 3. PERAWAT DAN TEMAN SEJAWAT 1. tidak etis dan illegal. Perawat wajib merahsiakan segala sesuatu yang diketahui sehubungan dengan tugas yang dipercayakan kepadanya kecuali jika diperlukan oleh yang berwenang sesuai dengan ketentuan hukum yang berlaku. Perawat mempunyai peran utama dalam menentukan standar pendidikan dan pelayanan keperawatan serta menerapkan dalam kegiatan pelayanan dan pendidikan keperawatan. adat-istiadat dan kelangsungan hidup beragama dari klien. 2. kesukuan. 4. PERAWAT DAN PROFESI 1.

1. Failure to communicate BAGAIMANA MENGHINDARI NEGLIGENCE C = CHECK THE ORDER W = WASH YOUR HANDS I = IDENTIFY THE PATIENT P = PROVIDE SAFETY & PRIVACY A = ASSESS THE PROBLEMS T = TEACH & TELL THE PATIENT EDM (ETHICAL DECISION MAKING) IN NURSING DECISION MAKING  End point of using critical thinking and scientific resoning …… ethical in problem reasoning. Failure to remove foreign objects 6. because . Improper use of equipment 5.INDICATOR PELANGGARAN KODE ETIK (NEGLIGENCE (4D)  D1 – Duty (Nurse had specific professional duty to patient)  D2 – Direlection (Nurse did not carry out his/her duty)  D3 – Damage (Nurse caused injury to his/her patient)  D4 – Direct Causation (The patient’s injury resulted from the nurse’s negligent action) Dampak terjadinya pelanggaran etik dapat dilihat dari tujuah (7) pitfalls yang umum terjadi Pada aspek etik keperwatan dan hukum kesehatan.’ orders/protocol 3. Medication error 4.  Even “no decision” is decision. Failure to provide sufficient monitoring 7. Failure to follow up MD. Patient falls 2. in effect. it is supports the existing state of affairs Etik – Nursalam-2012 6 .

I believed the treatment must be continued because I had duties to help the patient to survive. budaya. Brain tumor patient was also coma. At that time. it was not our will. But. Why didn't they want to continue the treatment? Even though the possibility of surviving for the patient was low. We could not afford for the cost." It was a dilemma for me. It seemed like I killed the patient 2. "Let the patient die. had high level of PCO2. and sometimes he had apnea attack. Which patient I had to help first? Etik – Nursalam-2012 7 . WHO SHOULD GET THE VENTILATOR? There were two patients.STRATEGY E-D-M FORMULA DASAR PENGAMBILAN KEPUTUSAN ETIK LEGAL UU KES 36/2009 dan KepMenkes 148/2010 SOLUSI LANGKAH PENGAMBILAN KEPUTUSAN 1 3 ETIK Masalah Klarifikasi 2 Identifikasi AZAS & KODE ETIK Etik Delima etik Pulta Pilihan 6 5 4 NILAI-NILAI Evaluasi Pelaksanaan Keputusan (Agama. Patient's family knew that the patient was still alive because of ventilator assistance. They needed ventilator at the same time. Dll) Institusi CONTOH KASUS EDM 1. RR 26 times per minutes. If the patient would die. I had to follow the patient's family. and RR 32 times per minutes. I did not want to disconnect the tube. We just had only one ventilator. head injury and brain tumor patients. CONTINUE OR STOP TREATMENT A severe asphyxia patient was in ICU for a couple days and there was no progression. The family decided to stop the ventilator. it was difficult to decide which patient should get the ventilator. Head injury patient was coma. admitted to ICU.

Meanwhile. however. bayi yg dilahirkan dlm keadaan kritis.3. 5. He wanted to tell his wife at their home. RN. 8. I needed to talk to doctor about this and asked him to prescribe another drug that could be afforded by the patient. Miss Corbin checks Mr. doctor also suggested not to tell the patient because he was worried that she would be shock and it would affect her condition. Who needed pain medication?” Mr. Namun. Autonomy dan Negligence SUSTER TIDUR. Jam 19. It is apparent to Miss Bake that Mrs. What should Nurse do now? Bandman & Bandman (1997: 410) 7. Mrs. I was in a difficult situation whether I administered the drug or not. What is the nurse’s responsibility in the situation? Etik – Nursalam-2012 8 .” Confused. He was afraid it would make his wife's condition worse. Jam 17. Hudson’s (Patients) room and learns from his wife that she has not asked for or received pain medication. has convinced Mrs. Miss Corbin asks.age 68 years. RN. Hudson (patient) to his room from the postanesthesia unit after surgery and notice that he was resting comfortably. Permintaan suaminya (Heston) agar istrinya ditolak oleh suster. If I didn't tell her. Deligatioan Miss Corbin. Then his wife came to me and asked about her baby. It was difficult whether or not to tell the truth to her. I felt guilty because it conflicted with my values. Jam 17. BAYI TEWAS! Pasien (Heston dan Ashdiane-suami) melaporkan ke polisi. the colleagues (X) replies. ACT AS PATIENT ADVOCATE VERSUS MAINTAINING RELATIONSHIPS WITH THE HEALTH TEAM Patient was poor and could not afford the prescribed drug. krn suster melarang permintaan pasien utk dilakukan Caeser. Martha Blake. If I didn't administer it. She has just assisted in the transfer of Mr. is the nurse doing her preoperative teaching the evening before the procedure is scheduled.00 pasien merasa mulas yg amat sangat.00 bayi meninggal. Diapun segera membangunkan perawat yg sedang tidur nyenyak.00 ketuban pecah. Her husband asked me not to tell her. Gift doesnot want to have surgery. WANT TO TAKE AN ACTION BUT BEYOND AUTHORITY I had a situation when the patient's blood pressure was dropped and I wanted to take action to help the patient immediately but I could not do it without reporting to doctor first…I had to wait for order from doctor because it was beyond my responsibility 4. She express great apprehension about procedure and generally feells quite negative about the outcome. Hudson. TELL OR NOT TO TELL THE TRUTH A patient's husband asked me not tell his wife that their baby died during caesarian section. begitu dokter datang langsung dibawa ke ruang operasi. Miss Corbin sees a nurse colleague (X) drawing up a pain medication. Although far from comfortable with situation. Gist and her family that she must undergo the surgery to survive. work on surgiucal floor. Gift is resigned to undergo the impending surgery in the morning. tetapi tetap dianggap biasa oleh suster. “He was in pain after surgery. but I was afraid 6. 1 jam kemudian. Pukul 02. is schedule for triple bypass surgery. Autonomy & Informed Concent Eleanor Gift.00 (23/9/04) pasien merasakan ada sesuatu yg mengalir di bagian bawah perutnya. So at that time it was difficult for me to make a decision. The nurse colleagues returns to the medicine room 10 minutes later with empty syringe. The surgeon. it was doctor's order and he might be angry with me and it would produce bad relationship with him.

should be attack 2. Clearly the decision regarding having surgery should be made by the one most affected (i. It is also important to know what she has been told about the surgery and her need for it.CONTOH PENERAPAN EDM PADA KASUS NO. compromise Alternative Suitability Feasibility Flexibility Total Alternative A 1 1 3 5 Alternative B 3 2 1 6 Alternative C 3 3 2 8 Alternative D 2 2 1 5 Rate each alternative on scale of 1 – 3 for its Etik – Nursalam-2012 9 . There is no information given about her family or how involeved they are in her health care. Mrs. 8 TAHAP 1: CLARIFY ETHICAL DILLEMA Many questions are not answered in this case study.e. Unfortunately. Gift’s medical history related to the extent of her cardiovascular disease. TAHAP2: GATHERING ADDITIONAL DATA The nurse need to know information from Mrs. Gift’s surgery is scheduled in the morning. 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: • 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). however. The ethical principle of autonomy is important in this scenario. Gift in decicion making • Etc • Principelly. Other care givers also may play a significance role. can be avoided 3. time is quite short because Mrs. Others are affected by her decision. the options can be divided into 3 options possibles 1.

Edge RS & Groves JR. Gift concerns and feelings about the surgery. the nurse decides to explore patient’s concerns and determine if an autonomous decisions was made by the patient.  Suitability: whether the alternative is ethical or pratical.B. LE & Bandman B. or opennes to new possibilities? TAHAP 4: MAKE A DECISION Choose one of the options. TAHAP6: EVALUATION The step is important. 2011. Manajemen Keperawatan: Aplikasi dalam praktik keperawatan profesional. Professional Nursing. Gift’s anxiety level and negative feelings about the probable outcome of the surgery. Nursing Ethics Through the Life Span. 2004. KK. 2nd ed. Proses dan Doukumentasi Keperawatan. 1997. The nurse must determine if the action implemented accomplished what was intended. 2nd. 1995. It is important to determine if patients truly feels the surgery is in the best interest and if she has made an autonomous decision. it seems most appropriate the explore Mrs. Concepts and Challenges. Philadelphia: Delmar Publishers. A guide for Clinical Practice. Ethics of Health Care. even though it may seem obvious. Jakarta: Salemba Medika Etik – Nursalam-2012 10 . Jakarta: Salemba Medika Nursalam. it is important to implement the action. Edisi 2. Norwalk: Appleton & Lange. It is necessary to evaluate the implications of the decision that was made. Edisi 3. 2008. How likely will it solve the problem?  Flexibility: ability to respond to unintended consequences.ed. how likely will it solve the problem. Philadelphia: W. DAFTAR PUSTAKA Bandman. In this situation. Saunders Co. Evidence that the intervention was succesfull would include a decrease in Mrs. TAHAP 5: IMPLEMENTATION Once a decision is made. Nursalam. In this situation. Is it appropriate in scale or importance? An adequate response? Too extreme?  Feasibility: how many resources will be needed to solve the problem. Chitty. 3rd ed.