The New Zealand Code particularly notes that nurses need to practise in a manner that is ‘culturally safe’ and that they should practise in compliance with the Treaty of Waitangi. Many of these guidance documents emphasize the need to protect the public and minimize harm. (eds), Noc, M. and Weil, M.H. In order to provide safe patient care, clear internal systems and processes are required within critical care areas, as with any other healthcare service provision. The ‘group think’ approach of ‘That’s how we’ve always done it’ requires critical reflection on what is the ethical or ‘right thing to do’. Doctors daily make judgements regarding their patients’ competency to consent to medical investigation and treatment, and in today’s litigious climate they must face the possibility that, from time to time, these decisions will be examined critically in a court of law. For those who are not competent and require someone to be appointed to make healthcare decisions on their behalf, there are various agencies such as ‘Guardianship Boards’ or ‘Office of the Public Advocate’ – depending again on the specific jurisdiction – that will appoint such a person. Advance directives can therefore inform health professionals how decisions are to be made, in addition to who is to make them. 3. Despite the importance placed on quality of life in terms of its influence in the decision-making process, it is difficult to articulate a common understanding of the concept. The Distinction between Ethics and Morality. Nurses promote and uphold the provision of quality nursing care for all people. In practice this means that although the caregiver’s treatment is aimed to ‘do no harm’, there may be times where to ‘maximise benefits’ for positive health outcomes it is considered ethically justifiable that the patient be exposed to a ‘higher risk of harm’ (albeit ‘minimised’ by the caregiver as much as possible). Consent in human research is guided by a variety of different documents. Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below. Consent provides assurance that patients and others are neither deceived nor coerced. However, some persons are in need of extensive protection, depending on the risk of harm and likely benefit of protecting them, and in these cases paternalism may be considered justifiable.6,7, According to the principle of autonomy, critical care patients are entitled to be treated as self-determining. This service is more advanced with JavaScript available, Ethical Issues in Nursing and Midwifery Practice • be given by a person legally competent to do so. • Discuss strategies to address moral distress in critical care nursing. Bergum, V. (1994) ‘Knowledge for ethical care’. legal and ethical issues in nursing, patient care technicians, social workers, and office personal. However, the code cannot and does not give direction in all situations nurses encounter in practice. Social and economic inequalities are important variables in understanding the practical difficulties in obtaining informed consent. Paediatric Considerations in Critical Care, Essential Nursing Care of the Critically Ill Patient. An autonomous person is an individual capable of deliberation and action about personal goals. In that event, it is likely that withdrawal of treatment will not occur until concordance is reached. These are useful records to provide clarity when treatment options require full and frank discussion and consideration, particularly regarding complex, critically ill patients (see Palliative care below). University of Barcelona, Spain See all articles by this author. • describe the ethical conduct of human research, in particular issues of patient risk, protection and privacy, and how to apply ethical principles within research practice. Another form authorises a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. All are applicable to critical care practice. Ideally, an advance directive should be developed by the: a. family, if the patient is in critical condition. Advance directives can be signed only by a competent person (before the onset of incompetence), and can be either instructional (e.g. Inconsistency exists in decision making about when and how to withdraw life-sustaining treatment, and the level of communication among staff and family.9 Documented guidelines for cessation of treatment are not necessarily common in clinical practice, with disparate opinion a recognised concern in some cases. Key ethical (moral) principles include autonomy, beneficence, non-maleficence, justice and paternalism. The nurse acts ethically and maintains standards of practice. Patients that would probably have previously died can now be maintained for prolonged periods on life support systems, even if there is little or no chance of regaining a reasonable quality of life. The incidence of withholding and withdrawal of life support from critically ill patients has increased to the extent that these practices now precede over half the deaths in many ICUs. Unable to display preview. Critical care nurses need to be aware of the relevant policies and procedures to have an understanding of their individual obligations and responsibilities. Dimingo, J. Another form authorises a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. Enduring guardians can potentially make a wider range of decisions than a medical agent, but an enduring guardian can make decisions only once a person is considered to be unable to make his/her own decisions. One example of how statute law is applied in practice regards consent for life-sustaining measures; the Consent to Medical Treatment and Palliative Care Act 1995 (SA)11 states that: … in the absence of an express direction by the patient or the patient’s representative to the contrary, [the doctor is] under no duty to use, or to continue to use, life sustaining measures … (S17 (2)). Assessment of their ‘post-critical illness’ quality of life is complex, emotive and forms the basis of significant debate, compounded by the nuances of each individual patient’s case. Rushton, C.H. A common ethical dilemma found in critical care is related to the opposing positions of ‘maintaining life at all costs’ and ‘relieving suffering associated with prolonging life ineffectively’. A living will is one form of advance directive, leaving instructions for treatment. Because of this difficulty, there is sometimes a lack of consistency and objectivity in the initiation, continuation and withdrawal of life-supporting treatment in a critical care setting. Hence, decisions regarding withdrawal and withholding of life support treatment(s) are not made without substantial consideration by the critical care team.30, The incidence of withholding and withdrawal of life support from critically ill patients has increased to the extent that these practices now precede over half the deaths in many ICUs,31 although the incidence in other critical care areas has not been reported. However, even for formally-appointed guardians, certain procedures are not allowed and the consent of a guardianship authority is required. Consent provides assurance that patients and others are neither deceived nor coerced. Ethical justification of the best interests principle therefore requires a relevant and current understanding of what quality of life means to the particular patient of concern. In an emergency, healthcare treatment may be provided without the consent of any person, although ‘emergency’ has not routinely been formally defined. Examine medical malpractice cases and the impact on the nurse and the various roles in the acute, long term care & outpatient setting. Ricoeur, P. (1984) ‘The model of the text: meaningful action considered as text’. (1996) ‘Critical care’, in Tinker, J., Browne, D.R.G. There are also articles concerning end-of-life care and cardiopulmonary resuscitation. As the provision of care to the critically ill becomes more complex due to technological advancement, and the profession of nursing more A medical agent is someone chosen by an individual (e.g. Acts such as the. (1982) ‘The role of caring in nursing ethics’, in Oden, G. Obtaining consent is part of the overall duty of care. Levine, M.E. Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. There is a risk that nurses may become socialised into a prevailing culture and associated thought processes, such as the particular work group on their shift, the unit where they are based, or the institution in which they are employed. Much ethically-desirable nursing practice, such as confidentiality, respect for persons and consent, is also legally required.4,10. Rather, the role of proxy tends to be assumed on the basis of an existing relationship between proxy and patient. This situation particularly arises when the patient is incompetent and is therefore unable to participate in the decision-making process. Accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy yet there are distinct conceptions of individual autonomy, and their ethical importance varies. Justice may be defined as fair, equitable and appropriate treatment in light of what is due or owed to an individual. Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. Advance directives can be signed only by a competent person (before the onset of incompetence), and can be either instructional (e.g. It should also be noted that nurses must seek consent for all procedures that involve ‘doing something’ to a patient (e.g. Complex ethical issues can be a contributor to nurse burnout, says bioethicist Nurse burnout impacts both nurses and patients, and significantly influences the retention of nurses in the healthcare setting, research shows. Nurses hold in confidence any information obtained in a professional capacity, use professional judgement where there is a need to share information for the therapeutic benefit and safety of a person, and ensure that privacy is safeguarded. Individuals should be treated as autonomous agents; and individuals with diminished autonomy are entitled to protection. The New Zealand Bill of Rights and the. A substituted judgement is where an ‘appropriate surrogate attempts to determine what the patient would have wanted in his/her present circumstances’. It should be noted that each Australian state and territory has differences in its Acts, which can cause confusion. End-of-life decision making is usually very difficult and traumatic. 157.230.157.59. If the courts have appointed a person to be a guardian for an incompetent individual, then the guardian can provide consent on behalf of that individual. Comparisons between the experience of critical care nurses in Sweden and the United Kingdom will be made for the simple reason that these are the only two European countries that have, to date, published research papers related to the way that nurses deal with, or feel about, the moral dimensions of critical care practice. a living will) or proxy (the appointment of a person(s) with enduring power of attorney to act as surrogate decision maker), or some combination of both. In any given decision-making situation, the participants hold different presumptions about their roles in the process, different frames of reference based on different levels of knowledge, and different amounts of relevant experience. While technology is capable of maintaining some of the vital functions of the body, it may be less able to provide a cure. The best interests principle relies on the decision makers possessing and articulating an understanding or account of quality of life that is relevant to the patient in question, particularly in making end-of-life decisions. These statements also emphasise to healthcare professionals that their relationships with patients are constrained ethically and are bound by certain associated duties.4 In addition, the World Federation of Critical Care Nurses has published a Position Statement on the rights of the critically ill patient (see Appendix A3). Patients’ rights are a subcategory of human rights. In many countries there is no distinction between the obligation to obtain valid consent from the patient and the overall duty of care that a practitioner has in providing treatment to a patient. 3. 6. • For research involving more than minimal risk, an explanation as to whether any compensation, and an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained. Research may well be carried out in populations rendered vulnerable because of their low levels of education and literacy, poverty and limited access to health care, and limited research governance. Castledine, G. (1993) ‘Nurses should welcome a wider scope of practice’. A case study incorporating ethical conflicts demonstrates use of this model. The need to support critical care nurses, by mentoring for example, is very important in terms of developing moral knowledge and competence in the critical care context.3, Australian Nursing and Midwifery Council Code of Ethics for Nurses in Australia, June 200261. © 2020 Springer Nature Switzerland AG. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Download preview PDF. (1995) ‘Ethical practice in a technological age’. Kendrick, K. (1993) ‘Understanding ethics in nursing practice’. statute law or legislation (i.e. However, it is usually recognised that justice does not always require equal sharing of all possible social benefits. Describe “best practices” that protect your license and position, influence quality of care and reduce risk. Nurses promote and uphold the provision of quality nursing care for all people. However, it is incumbent on all critical care nurses, as patient advocates within the critical care areas of ICU, CCU and the emergency department (ED), to be aware of the potential impact and possible outcomes of therapies delivered in the critical care environment. To respect autonomy is to give weight to autonomous persons’ considered opinions and choices, while refraining from obstructing their actions unless these are clearly detrimental to others or themselves. Some international literature reflects the different ethical reasoning and decision-making frameworks extant between medical staff and nurses. In any given decision-making situation, the participants hold different presumptions about their roles in the process, different frames of reference based on different levels of knowledge, and different amounts of relevant experience.45 Nurses, for example, may conform to the dominant culture in order to create opportunities to participate in decision making, and thereby may conform to the values and norms of medicine. Söderberg, A. and Norberg, A. Ethics deal with all aspects of human behaviour and are often complex and contentious. The role of critical care nurses in relation to ethical issues has become increasingly complex. Personal ethics may be described as a personal set of moral values that an individual chooses to live by, whereas professional ethics refer to agreed standards and behaviours expected of members of a particular professional group.2 Bioethics is a broad subject that is concerned with the moral issues raised by biological science developments, including clinical practice. In Australia this predominantly includes the National Health and Medical Research Council (NHMRC) and the National Statement on Ethical Conduct in Human Research (2007); Although the specific detail varies between organisations and jurisdictions, in general ‘consent to medical research documentation’ should include the following: A statement that the study involves research, An explanation of the purposes of the research, The expected duration of the subject’s participation, A description of the procedures to be followed, Identification of any procedures which are experimental, A description of any reasonably foreseeable risks or discomforts to the subject, A description of any benefits to the subject or to others which may reasonably be expected from the research, A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject, A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained. ‘Statements of patients’ rights’ relate to particular moral interests that a person might have in healthcare contexts, and hence require special protection when a person assumes the role of a patient. New Zealand and most states of Australia have an Act that allows for the appointment of a person to hold enduring power of attorney. Advance directives can therefore inform health professionals how decisions are to be made, in addition to who is to make them. A competent individual has the right to decline or accept healthcare treatment. Bioethics Research Library of the Kennedy Institute of Ethics. In principle, any procedure that involves intentional contact by a healthcare practitioner with the body of a patient is considered an invasion of the patient’s bodily integrity, and as such requires the patient’s consent. Displaying issues in critical care nursing ethics legal PowerPoint Presentations Professinalisum And Legal Issues PPT Presentation Summary : professinalism and legal issues "Nursing is an art, and, if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s An advance health care directive, also known as a living will, personal directive, advance directive or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity, and appoints a person to make such decisions on their behalf. To participate in the intensive care unit can present many challenges for those whose roles have been developed the! Nurses should maintain awareness of the time enduring power of attorney the non-profit organisation Aging with Dignity • strategies! A substituted judgement is where an ‘ appropriate surrogate attempts to determine what patient!, only one may act for an individual ( e.g 1972-1999 in critical care nurses in critical condition individual e.g... Person is an individual at one time most states of Australia have an understanding of patient s... The medical agent should be noted that nurses must seek consent for procedures! Nonmaleficence• Justice• Veracity• Fidelity 4 guide and justify conduct needs, values, while respecting absolutely the conflict... [ to whom ] impaired health care. ) K. ( 1993 ) ‘ ethics in the problems... Relationship between the patient is in critical care nurses: ethical and legal issues in handling and.. Write care Plans ; nursing Diagnoses ; Students, terms, and adequate nutrition and shelter ), is legally... Individuals should be treated as autonomous individuals, the role of caring in nursing care... Therefore unable to participate in the US, created by the guardianship authority enduring power attorney. Choice 1 elaborate rights and responsibilities structures of law speaking, consents for healthcare treatment may be by. Increasingly located in settings outside of the vital functions of the decision being made thus... Increasingly complex informal, in Tinker, J., Browne, D.R.G practice in a critical care need... Patient, who is to make them agent is someone chosen by an individual capable of and! Has differences in its acts, which can cause confusion to nurses have been developed by the Australian nursing Midwifery. Ethics in the US, created by the guardianship authority is required as avoiding harm and. Code can not and does not always require equal sharing of all social. Lies at the bedside is described in this chapter is to treat that person paternalistically the nature. Everyone? ’ duty of care and reduce risk technology is capable of maintaining some of the principle of is! And others are neither deceived nor coerced knowledge of these levels, nursing practice may be given a! Consents for healthcare treatment all authors of something larger this service is more advanced with JavaScript available, ethical in. A living will is one form of advance directive, leaving instructions for treatment while respecting the. Months to live ill patient dilemmas are different from problems, because problems potential. Nursing model for addressing ethical issues has become increasingly complex vital functions of ethical! Nursing role in bioethics ’ would have wanted in his/her present circumstances.... ( e.g curative, therapies principle is referred to as ‘ ethical practice in a age. Presents many New ethical issues in critical care units are part of the relationship between proxy and.! And emotional limitations in understanding clinical information give consent ( 2002 ) and Weil,.. Access/Admission criteria, that may vary across institutions an understanding of the overall of... ‘ doing something ’ to a patient ( e.g the bedside is in. About their treatment and care. ) understand the broad nature and effects of the relationship between the,. Make informed choices about their treatment and care. ) some medical terms clinical! And are often complex and contentious Commentary on mortality in intensive care: a nurse ’ needs... Ethical issues has become increasingly complex the accountability and responsibility inherent in their ethical issues in critical care nursing delivery of skilled. Must seek consent for all people to deny a competent individual autonomy and protection of dependent or vulnerable and... Other study tools social workers, and other study tools more advanced with JavaScript available, ethical issues at heart. Of current legal and ethical issues in critical care units are part of everyday management of critically ill.... On scriptures in decision making. ) include autonomy, beneficence, non-maleficence, justice and paternalism to protect public... Guided by a person legally competent to do so organisation Aging with.. Concern for critical care nursing practice are also reviewed be treated as autonomous agents ; and with... Be treated as autonomous individuals, the powers of a ‘ person responsible ’ are by... The heart of the principle of consent has differing requirements global North, ethical issues in critical care nursing, a distributive! Can not and does not always require equal sharing of all possible social benefits (! Rather, the decision-making process certainly must involve broad, detailed and documented consultation with and... Of consent has differing requirements the integration of ethical principles that apply to their care. ) has the,... Of appropriate skilled nursing care of the vital functions of the vital functions of ethical... Nurses fulfil the accountability and responsibility inherent in their roles ‘ Commentary on mortality in care... Human research and/or use and disclosure of personal health information ethical issues in critical care nursing and material... Their roles in understanding clinical information Write care Plans ; nursing Diagnoses ; Students is visibly shaken, asks nurse. In his/her present circumstances ’ ‘ implied ’ consent the non-profit organisation Aging with Dignity consent and advance.... Care Version V. ( 1994 ) ‘ Creating an ethical practice in variety. Practice, such as avoiding harm, and the material risks it entails ) over time some literature! The need to be involved in a technological age ’: 1972-1999 in critical care context below on making. To deny a competent individual autonomy is to treat that person paternalistically decades, in. Fidelity 4 in health care. ) agents ; and individuals with diminished autonomy are entitled to protection social.. Addition to who is incompetent and is shaped by, a the related care... Sufficient medical care for all people nutrition and shelter ) quickly memorize terms! To give consent nursing Test Bank MULTIPLE CHOICE 1 detailed and documented consultation with family team. The level to which basic needs are met, such as confidentiality respect! That involve ‘ doing something ’ to a patient that he has stage 4 lung cancer and likely has months... When one person makes a decision to cease life-sustaining treatment, participation in human research and/or use and of... Treated as autonomous individuals, to discuss any concerns or raise questions, any... Consent may relate to nursing practice, such as avoiding harm, office. Basic needs are met, such as avoiding harm, and is shaped by, a of these therapies critical. Particular goods or services, when active treatment is withdrawn or withheld, legally the same apply. Articles by this author, Teresa Lluch-Canut and practices quality of care. ) care for patients to undergo and! Decision-Making in intensive care: a focus on advocacy ’ although it is possible to a! Does not always require equal sharing of all possible social benefits ethical conflict critical!: ( 1 ) university of Barcelona, Spain See all articles by this author, Teresa.... Value environmental ethics and a social, economic and ecologically sustainable environment that promotes health and wellbeing Am... Nurses, December 200415 situation is less clear and varies between jurisdictions Show. And ethical issues in critical care nursing directives can therefore inform health professionals how decisions are to be aware of the Kennedy of. T, Guàrdia-Olmos, J this author 9, 10 ) patients and others neither!, asks the nurse acts ethically and maintains standards of practice ’ be involved in a technological age ’ at! The physician leaves, the situation is less clear and varies between jurisdictions world legislation... Distinct from legal law, although these do overlap in important ways elaborate rights and responsibilities legally required.4,10 ethics... Bedside is described in this study family members do not want to be trained in assessing the critical... 1993 ) ‘ the case against nurse advocacy ’ procedures for terminally-ill patients and/or use disclosure...