[email protected]. clinical ethical issues many of our ethical issues arise when dealing with...
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Clinical Ethical Issues
Many of our ethical issues arise when dealing with the: -Beginning of human life -End of human life -Use of technology but there are other ethical. Often they are viewed as clinical problems but not ethical problems.
بالین اخالقی مسائل
با پرستاری که وتالش ” 8وقتی وقت کند می کار بدحال بیمار “ کند؟ می تقسیم راچگونه خود کاری
داده انجام غیراخالقی کار یک دربخش همکارتان بینید می که وقتیبکنید؟ باید چه
. اونگویند به قراراست وخانواده است العالج درگیربیماری بیماریجوابی چه پرسید خودازشما سالمتی اگربیمارازوضعیت
خواهیدداد؟
بالین اخالقی مسائل
- یک دارونما آیا هست؟ اخالقی کار بیمار به گفتن دروغ اصالاست؟ دروغ
نداردوواقعا, - رادوست بیماری که پرستاری ازنظراخالقیبکند؟ باید چه دهد ارائه اوخدماتی به تواند نمی
خوددرگیربشود؟ - درمانی گیری تصمیم بیماربایددر آیاذهنی اگرناتوان باشد؟ مسن اگر باشد؟ نوجوان اگربیمار
باشد؟دستور - این داند می که بیماری آیاپرستاربایددستورپزشکی
اجراکند؟ بیماردارد برای ای بالقوه خطر
Two ethical principles are Do No Harm and Do Good. What do we mean by Harm and Good? Health professionals have 2 basic ethical obligations: -To extend life -To lessen pain and suffering (do no harm). Can they do both in this situation when morphine may shorten patient’s life?
In the beginning…
There were no antibioticsThere were no ICUsThere were no CT scanners and MRIsThere were just physicians and nurses who cared for people in sickness and in health
1960s
Technological advances allowed for the development of intensive care unitsNew biomedical developmentsAdvances in surgical techniques, such as open heart surgery
The advances created new questions for health-care professionals
EthicsEthics deals with the “rightness” or “wrongness” of human behaviorConcerned with the motivation behind the behaviorBioethics is the application of these principles to life-and-death issues
Morals
An individual’s own code for acceptable behaviorThey arise from an individual’s conscienceThey act as a guide for individual behaviorLearned
Ethical Principles
AutonomyNonmaleficence BeneficenceJustice
FidelityConfidentialityVeracityAccountability
Autonomy
The freedom to make decisions about oneselfNurses need to respect clients’ rights to make choices about health care.
Best medical interests Best interests
More to well-being than medical well being
مخالف
Who is autonomous ?
Understand + Form Values + Make Decisions
You80 year old
80 year oldwith dementia
2 year old Drunk
Respecting autonomy
Respecting autonomy means enabling patients to make autonomous choices:oReasonable choicesoAdequate informationoClear explanationoTime to consider optionsoNot unduly pressurising oBeing non-judgemental
Nonmaleficence
Requires that no harm be caused to an individual, either unintentionally or deliberately.
This principle requires nurses to protect individuals who are unable to protect themselves.
Beneficence
This principle means “doing good” for others.Nurses need to assist clients in meeting all their needs:
BiologicalPsychologicalSocial
Justice
Every individual must be treated equallyThis requires nurses to be nonjudgmental
1- Equal share 2-Individual need
3-Individual effort
4-Societal contribution 5-Merit
6-Free market exchanges
Principles of distributive justice(Beauchamp and Childress 2001)
To each person to:
Continually increasing health care costs
می افزایش بطورمدام ودرمان سالمت های هزینهودرمان بهداشت عدالت اجرای درنحوه باید یابدکه
شود لحاظ پرسنل :وپرداخت
population increaseageing populationincrease demand for healthcarenew technologies, new procedurespersonnel and other resources
Issues of Justice
1- , ( تخت حیات ادامه وامکانات خدمات که وقتی )... , چه, است محدود و تجهیزات عمل اتاق دارو
کند؟ رادریافت امکانات این باید کسیقریب -2 مرگ که بیماری برای کردن خرج پول آیا
اوکرد؟ خرج حدباید تاچه است؟ صحیح دارد الوقوعاست؟ -3 کدام وعمومی شخصی نفع حالت بهترین
Fidelity
LoyaltyThe promise to fulfill all commitments The basis of accountability
Dignity: a Human Right?
The right to life Freedom from
degrading treatment
The right to liberty
The right to respect for
private and family life
Freedom of thought, conscience and religion
Freedom of expression
The right to peaceful enjoyment
of your property
The right not to be discriminatedagainst in any of these
rights or freedoms
Confidentiality
Anything stated to nurses or health-care providers by clients must remain confidential
The only times this principle may be violated are:
- If clients may indicate harm to themselves or others
- If the client gives permission for the information to be shared
Veracity
This principle implies “truthfulness”Nurses need to be truthful to their clientsVeracity is an important component of building trusting relationships
Accountability
Individuals need to be responsible for their own actions.Nurses are accountable to themselves and to their colleagues.
Ethical CodesThese are formal statements of the rules of behavior for a particular group of individuals.Ethical codes are dynamic. Most professions have a “code of ethics” to guide professional behavior. The Code of Ethics for Nurses. Why have a code? What does it say? What purpose does it serve?
• ICN code for nurses was formed in 1933. • While the international code of nursing ethics
accepted in 1953.• In 1973 the new ICN code of ethics was approved. It
identifies four major responsibilities of the nurse:• Promote health.• Prevent illness.• Restore health.• Alleviate suffering.
Ethical Dilemmas
Occur when a problem exists between ethical principles.Deciding in favor of one principle usually violates another.Both sides have “goodness” and “badness” associated with them.
برائت نامه ورضايت نامه
يعني امضاء مدركي كه بيمار قبل از تن دادن به هرگونه درماني از كليه خطرات عمل ، راههاي درماني و جايگزين و خطرات آن توسط پزشك
.)تلویحی, اظهاری,رضایت آگاهي يابد.درمواردخاص(
يعني چنانچه بيمار در طي درمان دچار برائت عوارض يا نقص عضوي گرديد ، پزشك در
صورتيكه بر اساس موازين فني و علمي اقدام كرده باشد مقصر نيست
تفاوت رضایت و برائت؟
رضایت گرفته باشد، در صورت بروز فقطاگر پزشک مرگ، نقص عضو یا خسارت مالی، ضامن است ولی اکر
نیز تحصیل کرده باشد، عهده دار خسارت پدید برائت.آمده نیست
اصل برائت است که موجب سقوط ضمان می فقط
شود. البته در صورت قصور پزشکی، برائتی که قبل از .درمان گرفته شده، باعث سقوط ضمان نیست
Barriers to Patient Satisfaction
• Wait Times• Overcrowding• Interruptions of caring• Consultants • Radiology &Laboratory… • Patient expects something from you
Common Patient Complaints• Too little time for patient interaction• Does not listen• Does not explain well• Shows no sympathy• Does not understand • Incompetent
Demographics affecting satisfaction
• Age—older pts more satisfied• Ethnicity—minorities less satisfied• Gender—females less satisfied • Socioecominc—lower socioecomic less
satisfied• Heath status—Chronic illness less satisfied
Increasing Patient Satisfaction
• Greet the patient with a hand shake & a smile
• TALK to your patient, not at them• Listen to what they have to say• Give them the opportunity to ask
questions• Don’t be afraid to apologize & tell patient
why they had to wait for x, y, z.• Listen to your support staff
How can you affect satisfaction?
• COMMUNICATE• Utilize as well as listen to Patient
Advocates • Put yourself in the patient’s shoes• positive patient interaction
The Communication Circle
41
The communication cycle involves an exchange of messages through verbal and nonverbal means.
MESSAGE
FEEDBACK
NOISESourceSource ReceiverReceiver
