Ethical Principles in Community Health Nursing

ETHICAL PRINCIPLES IN
COMMUNITY HEALTH NURSING

 Ethics – philosophical ideals of right and
wrong behavior
 The philosophical study of moral values and
rules.
 The science of human duty in terms of what is
right and wrong, true or false.
Principles Ethical Reasoning
 Autonomy  Paternalism
 Beneficence  Respect for Persons
 Nonmaleficence  Sanctity of Life
 Confidentiality  Veracity
 Double Effect
 Fidelity
 Justice
Autonomy
 Definition: “autos” = self, “nomos” = rule
 Individual rights
 Privacy
 Freedom of choice
 Autonomy—agreement to respect another's
right to self-determine a course of action;
wishes to be intubated during an exacerbation of
COPD, or deciding when he/she wishes
Beneficence & Nonmaleficence
 Duty to do good  Duty: NOT TO CAUSE

 goodness, kindness, harm
charity  Duty: PREVENT harm
 Includes  Duty: REMOVE harm
nonmaleficence  More binding than
 Centerpiece for caring beneficence
 Beneficence-  Example: An elderly
compassion; taking patient falls at home
positive action to help and has a fractured hip.
others; desire to do In the emergency
good; core  room, the nurse acts to
 principle of our patient provide pain medication
advocacy. as soon as possible in an
act of beneficence
  Example: When this elderly person above
Nonmaleficence- avoidance
received pain medication (an act of
of harm or hurt; core of  beneficence) there are complications that
medical oath and nursing could arise. Practitioners recognize that
using
ethics.  a narcotic may cause confusion. When
 Often in modern times, obtaining the consent for her hip surgery,
nonmaleficence extends to we want
 to make certain that the patient is alert
making sure you are doing no enough to understand the risks and benefits
harm in of the
 the beneficent act of using  procedure. We must balance the
beneficence of providing the medication
technology to extend life or quickly with the
in using experimental  possible maleficence of obtaining a consent
treatment s that have not when patient does not have the capacity to
 make the decision for surgery
been well tested
Confidentiality
 Keep privileged information private
 Exceptions
 Protecting one person’s privacy harms another or
threatens social good (direct threat to another
person)
 Drug abuse in employees, elder and child abuse
Double Effect
 Some actions can be morally justified even though

consequences may be a mixture of good and evil
 Must meet 4 criteria:
 The action itself is morally good or neutral
 The agent intends the good effect and not the evil (the evil may be
foreseen but not intended)
 The good is not achieved by the evil
 There is no favorable balance of good over evil
Fidelity
 Duty to be faithful to one’s commitments
 includes implicit and explicit promises
 Make a promise, follow thru
 Implicit – those promises that are implied, not
verbally communicated
 Like when pt comes into the hospital, they expect to
be cared for
 Explicit – those that we verbally communicate
 Like if you tell them you’ll be back with pain meds,
you’d better come back
 Example: A patient asks the nurse not to reveal the fact that she is
dying or give her
 diagnosis to his family. The nurse asks why she does not want her
family advised. The
 patient explains that her family is very emotional and has stated
they would do everything
 to keep her alive, even if it required long-term mechanical
ventilation. The patient has
 explained multiple times that she does not want mechanical
ventilation. The nurse
 recognizes that keeping of this information in confidence, while
supporting the family, is
 an example of exercising fidelity
Justice
 this principle refers to  Example: A hospital
an equal and fair
 distribution of resources,
organization wishes to donate
based on analysis of low or no-cost pediatric dental
benefits and burdens of  services to the community.
decision. Justice There are openings for 45
 implies that all citizens
children per month. Justice
have an equal right to
 requires a fair method, that is
the goods distributed,
regardless of what free from bias, to determine
 they have contributed or
who will receive these
who they are.  services
Paternalism
 When one individual assumes the right to make
decisions for another
 Healthcare professionals make decisions about
diagnosis, therapy, and
 prognosis for the patient. Based upon the health
care professional’s belief about what is
 in the best interest of the patient, he/she chooses
to reveal or withhold patient information
 in these three important arenas.
 Limits freedom of choice
Respect for Persons
 Closely tied to autonomy
 Promotes ability of individuals to make
autonomous choices and should be treated
accordingly
 Autonomy is preserved thru advanced
directives.
Sanctity of Life
 Life is the highest good
 All forms of life, including mere biologic
existence, should take precedence over
external criteria for judging quality of life
 If life is the highest good, is it ethical to keep
a brain dead person alive?
Veracity
 The obligation to tell the truth and not to lie or
deceive others
Population-based Ethical Principles
In Public Health
 Consequentialism- What are the goodness or
badness of the consequences. The consequences
of a particular action form the basis for any valid
moral judgment about that action
 Utilitarianism- This theory supports what is best
for most people. The value of the act is
determined by its usefulness, with the main
emphasis on the outcome or consequences.
..
19
 Deontology- This theory judges the morality of an
action based on the action's adherence
 to rules. Whether an action is ethical depends on
the intentions behind the decisions
 rather than the outcomes that result . For example,
we have begun not to use restraints on older people
for their safety
 and to think of other measures. We do this because
restraining someone against his or
 her will could not be considered a universal law.
Community / Public Health Ethical
Principles cont…
Communitarian ethics - What can I
do to make society better or does
what I am doing improve society?
◦.
21
The Ethical Principle of Justice
 Social justice: the principle that all persons are

entitled to have their basic needs met regardless
of economic status, class, gender, race, ethnicity,
religion, citizenship, age, sexual orientation,
disability or health. (PHN Scope and Standards, 2007)
 Distributive justice- resources should be given
first to those who need it the most
 Egalitarian justice- equal distribution to
everyone regardless of need (Socialism)
 Restorative justice – payback those previously
harmed by injustice-i.e. Native Americans
22
Ethics and Professional Practice
 ANA Code of ethics & ICN  Euthanasia
Code  Assisted suicide
 TX BON Rules & Regs  Death
 NCSBN Professional  Disasters
Boundaries
 Informed consent
 Durable power of attorney
for healthcare guardian
Nurses responsibilities
 Practice with in the scope of nursing practice actd

 Observe agency policies and procedures
 Establish standards using EBP
 Always prefer patient welfare
 Be aware of relevant laws and understand limits
 Ensure patient safety
 Proper reporting and recording
 Following the standards of care and referral services
 Update yourself by attending CNE/ISE

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ETHICAL PRINCIPLES IN

COMMUNITY HEALTH NURSING

 Duty to do good  Duty: NOT TO CAUSE

 Some actions can be morally justified even though

 Social justice: the principle that all persons are

 Practice with in the scope of nursing practice actd

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