Advocacy & Moral Judgement

Definition/Etiology:

• Advocacy
  • Respecting and supporting the basic values, rights, and beliefs of the patient
    • Support and respect the values, beliefs, and rights of the patient even when they do not align with the nurse’s own personal values
• Moral agency
  • ability to serve as a moral agent in identifying and resolving ethical and clinical concerns
    • Require an understanding of ethics.
• Ethics
  • system of valued behaviors and beliefs that govern proper conduct to ensure the protection of an individual’s rights, which involves judgments that help to differentiate right from wrong or indicate how things ought to be

Noticing: Assessment & Recognizing Cues:

• Ethical Decision Making Terms
  • Confidentiality
    • The nurse has a duty to maintain confidentiality of all patient information, both personal and clinical, in the work setting and off duty in all venues, including social media or any other means of communication
  • Autonomy
    • The right of patients to make decisions about their medical care without their health care provider trying to influence the decision
  • Nonmaleficence
    • Do no Harm

Interpreting: Analyzing & Planning:

• Moral Distress
  • Moral distress occurs when one knows the right thing to do but cannot do the right thing due to internal and external obstacles.
  • Moral distress contributes to nurses’ dissatisfaction, resulting in burnout and actual loss of nurses to the profession
• Avoid Ethical Dilemmas
  • An ethical dilemma is a situation that requires a choice between two or more equally undesirable alternatives.
  • Technology vs quality of life
  • Full Code to DNR

Responding: Patient Interventions & Taking Action:

• Informed Consent
  • The nurse’s role in obtaining informed consent varies with the situation, institution, and state law. Nurses should
    explain all nursing care procedures to patients and families. If a patient refuses the procedure or care, this must be
    honored.
• Advanced DIrectives
  • DNR: does not apply to medications and therapies given to prevent suffering and provide comfort.
• Declaration of Death
  • Cardio/Pulmonary Death -Consent of family or surrogate is not required.
  • Determination of brain death requires family or surrogate consent and a request for a second opinion is an option.
• Organ Donation
  • Likelihood of donation variables
    • Anglo-American ethnicity
    • Any religious affiliation
    • Discussion of donation initiated by family, physician, or a member of an organ procurement team
    • Death caused by gunshot or suicide
    • Presence of signed donor card
• EMTALA
  • The Emergency Medical Treatment and Labor Act (EMTALA) was enacted in 1986 to require hospitals participating in Medicare to screen and stabilize patients or to provide protected transfers for medical reasons
  • ERs CANNOT refuse care

Reflecting: Evaluating Patient Outcomes:

• Ethical Nurses Evaluate Outcomes
  • Veracity
    • obligation to tell the truth and not deceive or mislead.
  • Fidelity
    • obligation to be loyal to agreements and responsibilities that an individual has accepted.
    • Fidelity is one of the key elements of accountability.
  • Ethical Laws/Codes
    • Practice within scope of State Practice Act
    • American Nurses Association (ANA) Ethical Code for Nurses

Linchpins (Key Points):

• Notice – Ethical Decision Situations
• Interpret – Moral Distress & Ethical Dilemmas
• Respond – Ethical Interventions
  • Related to Informed consent, Advanced Directives, Declaration of Death, Organ Donation, and EMTALA
• Reflect – Veracity, Fidelity and Ethical Laws/Codes