Beliefs on nursing and healthcare free essay sample

Bioethical issues are relevant to nurses’ work in everyday practice, but in matters of bioethics nurses usually are not autonomous decision makers. Nursing ethics, as a unique ? eld, continues to be debated. Fry, Veatch, and Taylor (2011) continue to support the view that both nursing ethics and medical ethics are valid subcate © Jones Bartlett ? eld of bioethics. Additional views are that everyday ethicalBartlett Learning,  © Jones gories of the larger Learning, LLC NOT nursing NOT practiceSALE OR DISTRIBUTION FOR in nursing is situated within an interdisciplinary team and thatFOR SALE OR DISTRIB ethics is distinctive from other disciplines in bioethics but is not yet unique (Volker, 2003; Holm, 2006; Wright Brajtman, 2011). The experiences and needs of practicing nurses, along with explorations of the meaning of nursing ethics, are areas of emphasis in nursingBartlett Learning, LLC  © Jones Bartlett Learning, LLC  © Jones ethics. Johnstone (2008) de? ned nursing ethics as â€Å"the examination of all kinds of ethical and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION bioethical issues from the perspective of nursing theory and practice, which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment and nursing itself† (p. 16). Johnstone’s de? nition of nursing ethics is consistent with a common view that a strong Jones Bartlett Learning, LLC bond between nursing ethics and nursing theory distinguishes nursing ethics  © Jones Bartlett Learning, LLC from other areas of healthcare ethics. FOR SALE OR DISTRIBUTION OT FOR SALE OR DISTRIBUTION NOT Nurses’ professional relationships to patient care and within the healthcare team bring about ethical issues unique to the nursing profession. To practice nursing ethically, nurses must be sensitive enough to recognize when they are facing seemingly obscure ethical issues in everyday work.  © Jones Bartlett Learning, LLCin Nursing Professional Codes of Ethics NOT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, NOT FOR SALE OR DISTRIB Professional nursing can be traced to England in the 1800s, to the school that was founded by Florence Nightingale, where profession-shaping ethical precepts and values were communicated. By the end of the 1800s, modern nursing had been established, and ethics was becoming a discussion topic in nursing. The Nightin © Jones Bartlett Learning, LLC written under the chairmanship of a Detroit nursingLearning, LLC  © Jones Bartlett school gale Pledge of 1893 was NOT FOR SALE OR DISTRIBUTIONto establish nursing as NOTand a science. SixOR DISTRIBUTION principal, Lystra Gretter, an art FOR SALE years later, in 1899, the International Council of Nurses (ICN) was established and became known as a pioneer in developing a code of ethics for nurses. Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 3:13 PM Page 71  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Professional Codes of Ethics in Nursing 71  © Jones 20th century, Learning, LLC  © By the turn of the Bartlett the ? rst book on nursing ethics, titled Nursing Jones Bartlett Learning, Ethics: For Hospital andSALE Use (1900), had been written by an American nurse NOT FOR SALE OR DISTRIB NOT FOR Private OR DISTRIBUTION leader, Isabel Hampton Robb. In Robb’s book, the titles of the chapters were descriptive of the times and moral milieu, such as Chapter 4: The Probationer, Chapter 7: Uniform, Chapter 8: Night-Duty, and Chapter 12: The Care of the Patient (nurse–physician, nurse–nurse, nurse–public relationships). The focus in  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC the nursing code initially was on physicians, because, typically, male physicians NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION trained nurses in the Nightingale era. Nurses’ technical training and obedience to physicians remained at the forefront of nursing responsibilities into the 1960s. This emphasis was re? ected in the ICN Code of Ethics for Nurses as late as 1965. However, by 1973, the ICN code re? ected a shift in nursing responsibility from a focus on obedience LLC Bartlett Learning, to physicians to a focus on patient needs, where Bartlettto this day. LLC  © Jones it remains Learning, Jones OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION American Nurses Association’s Code of Ethics for Nurses â€Å"A Suggested Code† was published in the American Journal of Nursing (AJN) in 1926 by the American Nurses Association (ANA), but was never adopted; in 1940 â€Å"A Tentative Code† was published in AJN, but again was never adopted (Davis, Fowler, and Jones Bartlett Learning,  © Jones Bartlett Learning, LLC  © Aroskar, 2010). The ANA adopted its ? rst of? cial code in 1950. Three more code reviNOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION sions occurred before the creation of the interpretative statements in 1976. The word â€Å"ethics† was not added to the title until the 1985 code was replaced with its sixth and latest revision in 2001. Within the code are nine moral provisions that are nonnegotiable with regard to nurses’ work. Detailed guidelines for clinical  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC practice, education, research, administration, and self-development are found in NOT FOR accompanying DISTRIBUTION of each provision (see Appendix A for OR DISTRIBUTION NOT FOR SALE the SALE OR interpretive statements the ANA Code of Ethics for Nurses with Interpretive Statements). A clear patient focus in the 2001 code obliges nurses to remain attentive and loyal to each patient in their care, but nurses must also be cognizant of ethical issues and con? icts of interest that potentially have a negative effect on patient care and Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC relationships with patients. Other forces to be reckoned with in today’s environOT FOR SALE ORment are the politics in institutions and cost-cuttingFOR SALE (see Box 3. 1). DISTRIBUTION NOT strategic plans OR DISTRIBUTION In the code, the ANA (2001) emphasized the need for the habitual practice of virtues such as wisdom, honesty, and courage, because these virtues re? ect a morally good person and promote the values of human dignity, well-being, respect, health, and Jones Bartlettin nursing emphasize what is important for the Jones Bartlett Learning,  © independence. Values Learning, LLC  © nurse personally and for patients. The ANA emphasized the magnitude of moral NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION respect for all human beings, including the respect of nurses for themselves. Personal regard involves nurses extending attention and care to their own requisite needs, as nurses who do not regard themselves as worthy of care usually cannot fully care for others. Recognizing the dignity of oneself and of each patient is essen © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC tial in moral reasoning. There are other statements in the code about wholeness of NOT FOR SALE ORpertains to recognizing the values of the nursing professionSALE OR DISTRIBUTION DISTRIBUTION NOT FOR and character, which one’s own authentic moral values, integrating these belief systems, and then expressing them appropriately. Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 3:13 PM Page 72  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 72 CHAPTER 3: Ethics in Professional Nursing Practice BOX 3. 1  © JonesFORMATIONS: CODE OF ETHICS APPLICATION Bartlett Learning, LLC ETHICAL NOT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, NOT FOR SALE OR DISTRIB In the Code of Ethics for Nurses with Interpretive Statements, the ANA currently emphasizes the word â€Å"patient† instead of the word â€Å"client† in referring to the recipients of nursing care. Do you agree with this change? Please explain your rationale for your answer. Take a few minutes to review the ANA Code of Ethics for Nurses with Interpretive Statements  © Jones Bartlett Learning, LLC there be additional provisions of the Bartlett you  © Jones code? Would Learning, LLC (2001) in Appendix A. In your view, should NOT FOR SALE ORnine provisions? Please explain your rationale for yourFOR SALE OR DISTRIBUTION DISTRIBUTION NOT answers. remove any of the After reviewing the interpretive statements in the code, discuss random brief scenarios on how nurses can justify their actions with the following approaches or frameworks: the principles of autonomy, bene? cence, nonmale? cence, and justice; Kant’s categorical imperatives based on deontology; a utilitarian Bartlett Learning, LLC framework; a virtue ethics approach; and an ethicLearning, LLC  © Jones Bartlett of care approach. Jones OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION International Council of Nurses’ Code of Ethics for Nurses In 1953, the ICN adopted its ? rst code of ethics for nurses. (See Appendix B for the 2006 ICN Code of Ethics for Nurses. ) The multiple revisions illustrate a reaf? rma © Jonesof the code as a universal global document for ethical practice © Jones TheBartlett Learning, tion Bartlett Learning, LLC in nursing. NOT FOR SALE OR DISTRIB NOT four major elements contained in the code involve standards related to nurses and FOR SALE OR DISTRIBUTION people, practice, the profession, and coworkers. The elements in the code form a framework that must be internalized before it can be used as a guide for nursing conduct in practice, education, research, and leadership.  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Common Thread between American Nurses Association and NOT FOR SALE OR DISTRIBUTION of Nurses Codes NOT FOR SALE OR DISTRIBUTION International Council A common theme between the ANA (2001) and ICN (2006) codes is a focus on the importance of compassionate patient care aimed at alleviating suffering. Nurses are to support patients’ self-determination and are to protect the moral space where Jones Bartlett Learning, LLC receive care. The interests of variousBartlett Learning, LLC  © Jones nursing associations and healthcare patients OT FOR SALE OR DISTRIBUTION NOT FOR of patients. Nurses are to uphold the institutions must not be placed above thoseSALE OR DISTRIBUTION moral agreement that they make with patients and communities when they join the nursing profession. Nursing care includes the primary responsibilities of promoting health and preventing illness, but the primacy of nursing care has always involved caring for Learning, LLC  © Jones Bartlettpatients who are experiencing varying degrees of physical, psy-Bartlett  © Jones chological, and spiritual suffering. NOT FOR SALE OR DISTRIBUTION Learning, NOT FOR SALE OR DISTRIB Professional Boundaries in Nursing Professional ethical codes serve as useful, systematic, normative guidelines for providing direction and shaping behavior. The ANA and ICN codes apply to all nurses  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC regardless of their role, although no code can provide a complete and absolute set NOT FOR SALE ORrules free of con? ict and ambiguity—a rationale often cited in favor of the use DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of of virtue ethics as a better approach to ethics (Beauchamp Childress, 2009). Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 3:13 PM Page 73  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION Qualities of Ethical Nurses 73  © Some © Jones Bartlett Learning, LLCvirtuous character cannot Jones Bartlett Learning, people contend that nurses who are without a be depended on to act SALE or moral ways, even with a professional code as a NOT FOR SALE OR DISTRIB NOT FOR in good OR DISTRIBUTION guide. In the 30th-anniversary issue in 2006 of the Journal of Advanced Nursing, the editors reprinted and revisited a 1996 article by Esterhuizen titled, â€Å"Is the Professional Code Still the Cornerstone of Clinical Nursing Practice? †, and solicited three responses. One respondent, Tschudin, agreed with Esterhuizen  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC that nursing lacks opportunities for full autonomy in moral decision making. NOT FOR SALE OR DISTRIBUTION engage in moral decisions, but theySALE OR DISTRIBUTION NOT FOR still There is abundant ground for nurses to do not have enough opportunity to participate. In the current uncertain moral landscape, nurses often wonder about the benefit of codes of ethics. Tschudin’s key message was that virtuous nurses with full autonomy and accountability have an internal moral compass to guide their practice and do not necessarily need a Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC OT FOR SALE ORcode of ethics. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION However one perceives the value of the codes of ethics for nurses, they still serve as mandates for accountability in practice. Professional boundary issues occur in all settings of nursing. Professional nursing boundaries are commonly de? ned as limits that protect the space between the nurse’s professional power and the  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, patient’s vulnerabilities. Boundaries facilitate a safe connection in a relationship, NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION of legitimate control, because they give each person in the relationship a sense whether the relationships are between the nurse and patient, the nurse and physician, the nurse and administrator, or nurse and nurse. Boundary crossings or violations are actions that do not promote the best interest of the other person(s) in a relationship; crossings pose a potential  © Jones Bartlett Learning, LLC risk, harm, or exploitation to the other(s)  © Jones Bartlett Learning, LLC in the relationship. The blurring of boundaries between persons in a relationship NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION is often subtle and unrecognizable at ? rst. The ANA (2001) included numerous boundary issues in the code. See Box 3. 2 for a few examples of these boundary topics and moral obligations. Jones Bartlett Learning, of Ethical Nurses Qualities LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Numerous qualities, or virtues, could describe the ideal ethical nurse. The foremost quality, often considered the ? ber for all others, is moral integrity. Some people believe that moral integrity is necessary for the individual as a whole to ? ourish. A person with moral integrity usually is described as having honesty, truthfulness, trust © courage, Bartlett Learning, LLC  © worthiness, Jones benevolence, and wisdom. In this section, there is a discussion Jones Bartlett Learning, NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION of (1) moral integrity—honesty, truthfulness, and moral courage; (2) concern— advocacy and power; and (3) culturally sensitive care. Other qualities, such as respect for others and con? dentiality, are explored in the previous chapter. Moral Integrity  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Moral integrity represents a person’s wholeness of character. T. G. Plante (2004) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION stated that although no one is mistake free, people with moral integrity follow a Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 3:13 PM Page 74  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 74 CHAPTER 3: Ethics in Professional Nursing Practice  © Jones Bartlett Learning, BOX 3. 2  © JonesFORMATIONS: PROFESSIONAL BOUNDARIES AND MORAL ETHICAL Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION CODE OF ETHICSNOT FOR SALE OR DISTRIB OBLIGATIONS FOR NURSES AS SPECIFIED BY THE ANA FOR NURSES WITH INTERPRETIVE STATEMENTS (2001) Clinical Practice Boundaries Respecting patients’ dignity  © Jones to self-determination  © Jones Bartlett Learning, LLC Right Bartlett Learning, LLC Delegating tasks appropriately NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Practicing good judgment Accepting accountability in practice Alleviating suffering Being attentive to patients’ interests Bartlett Learning, LLCnurse practice acts and nursing standards of practice Learning, LLC  © Jones Bartlett Working within the Jones OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Professional Practice Boundaries Maintaining authenticity in all relationships with others, such as nurse-to-nurse relationships, nurse–physician relationships, nurse-to-patient relationships, and multidisciplinary collaboration Addressing and evaluating issues of impaired practice; fraternizing inappropriately with patients  © Jones Bartlett Learning, LLC  © Jones or others; accepting inappropriate gifts from patients and families; con? dentiality and privacy Bartlett Learning, violations; and unhealthy, unsafe, illegal, or unethical environments NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION Self-Care and Self-Development Boundaries and Obligations Participating in self-care activities to maintain and promote moral self-respect, professional growth and competence, wholeness of character in nurses’ actions and in relationships with others, and preservation of integrity  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Advancing knowledge and research through NOT FOR SALE OR DISTRIBUTION professionalism, practice, education, and OR DISTRIBUTION NOT FOR SALE administrative contributions Collaborating with other healthcare professionals and the public to promote community, national, and international efforts Promoting healthy practices in the community through political activism or professional organizations LLC or Jones practices that have the potential Jones Bartlett Learning, by addressing unsafe, unethical,  © illegal health Bartlett Learning, LLC to harm the community OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION moral compass and usually they do not vary by appeals to act immorally. Most of the time, when people speak of a person’s moral integrity, they are referring to a person’s Bartlett Learning, LLC  © Jones quality of character.  © Jones Bartlett Learning, People with moral DISTRIBUTION integrity pursue a moral purpose in life, understand their NOT FOR SALE OR DISTRIB NOT FOR SALE OR moral obligations in the community, and are committed to following through without any constraints imposed on them by their moral stance. In a qualitative study on moral integrity by Laabs (2011), nurses’ perceptions of the de? nition of moral integrity were, â€Å"[A] state of being, acting like, and becoming a certain kind  © Jones Bartlett Learning,person is honest, trustworthy, consistently doingBartlett Learning, LLC LLC  © Jones the right thing and of person. This NOT FOR SALE OR DISTRIBUTION despite the consequences† (p. 433). NOT FOR SALE OR DISTRIBUTION standing up for what is right Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 3:13 PM Page 75  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Qualities of Ethical Nurses 75  © of moral integrity include good character,  © FeaturesJones Bartlett Learning, LLC intent, and performance. Jones Bartlett Learning, Nurses with moral integrity act consistently with personal and professional values. NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION When nurses are asked or pressured to do something that con? icts with their values, such as to falsify records, deceive patients, or accept verbal abuse from others, moral distress may occur. In a healthcare system often burdened with constraints of politics, self-serving groups or interests, and organizational bureaucracy, threats to moral  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC integrity can be a serious pitfall for nurses. When nurses with moral integrity must NOT FOR SALE the compromise usually does not interfere with their personal or SALE OR DISTRIBUTION OR DISTRIBUTION NOT FOR procompromise, fessional values. To have moral integrity means that a person’s character is made of up several virtues; three of those virtues are honesty, truthfulness, and moral courage. Moral Distress Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Moral distress occurs when nurses or other healthcare professionals have multiple OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION or dual expectations and cannot act according to the guidance of their moral integrity. Jameton (1984) popularized and de? ned the term moral distress as occurring â€Å"when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action† (p. 6). Nurses’ work  © involves  © Jones Bartlett Learning, LLCof patients, emotional and Jones Bartlett Learning, hard choices that sometimes result in avoidance physical NOT FOR SALE OR DISTRIBUTION suffering, painful ambiguity, contradiction, frustration, anger, and guilt. NOT FOR SALE OR DISTRIB Since Jameton’s initial work, authors have continued to research and develop the conception of moral distress. Numerous scholars have linked moral distress to incompetent or poor care, unsafe or inadequate staf? ng, overwork, cost constraints, ineffective policy, futile  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC care, unsuccessful advocacy, the current de? nition of brain death, objecti? cation NOT FOR SALEand unrealistic hope (e. g. , Corley, 2002; Corley, Minick,FOR SALE OR DISTRIBUTION OR DISTRIBUTION NOT Elswick, of patients, Jacobs, 2005; Pendry, 2007; Schluter, Winch, Holzhauser, Henderson, 2008; McCue, 2011). Moral distress is de? ned in the context of institutional constraints. Research has revealed that nurses’ work environments have a strong effect on the degree of moral distress experienced (e. g. , Redman Fry, 2000). Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Leaders of nursing continue to search for strategies to reduce moral distress and OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION promote healthy work environments. The American Association of Critical-Care Nurses (AACN) published a position statement to accentuate the seriousness of moral distress in nursing: Moral © Jones Bartlett Learning, LLChealthcare work environdistress is a critical, frequently ignored, problem in ments. Unaddressed it restricts nurses’ ability to provide optimal patient care and to NOT FOR SALE OR DISTRIBUTION ?nd job satisfaction. AACN asserts that every nurse and every employer are responsible for implementing programs to address and mitigate the harmful effects of moral distress in the pursuit of creating a healthy work environment. (American Association of Critical Care Nurses [AACN], 2008, p. 1)  © Jones Bartlett Learning, NOT FOR SALE OR DISTRIB The AACN ethics work group developed a call-to-action plan—The Four A’s to  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC Rise above Moral DISTRIBUTION NOT FOR SALE ORDistress—for use by nurses to identify and analyze moral distress OR DISTRIBUTION NOT FOR SALE (AACN, 2004): Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 3:13 PM Page 76  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 76 CHAPTER 3: Ethics in Professional Nursing Practice  © Jones AskBartlett Learning, LLC aware that moral distress Jones Bartlett Learning, appropriate questions to become  © is present. Af? rm your distress and commitment NOT FOR NOT FOR SALE OR DISTRIBUTION to take care of yourself and address SALE OR DISTRIB moral distress. Assess sources of your moral distress to prepare for an action plan. Act to implement strategies for changes to preserve your integrity and authenticity.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Honesty  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION In the 2010 Gallup poll, just as it had been over the past 11 years, nurses were rated as the most honest and ethical health professionals (Jones, 2011). Nurses continue to be ranked consistently as the most trusted voice among the healthcare professionals; Jones Bartlett Learning, LLC nurses have earned this trust becauseBartlett Learning, LLC to  © Jones of their commitment and loyalty their patients. According to Laabs (2011), nurses voiced that being honest was OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION important for three reasons: (1) honesty is a prerequisite for good care, (2) dishonesty is always exposed in the end, and (3) nurses are expected to be honest. In a phenomenological study of nurses on honesty in palliative care, Erichsen, Danielsson, and Friedrichsen (2010) stated that nurses had some dif? culty de? ning  © Jones Bartlett Learning, LLC  © Jones honesty. In an attempt to clarify their perception of honesty, nurses often de? nedBartlett Learning, NOT FOR a NOT lying orSALE OR DISTRIBUTION FOR dishonesty as sharp contrasts to honesty. Nurses perceived honesty as SALE OR DISTRIB virtue related to facts, metaphors, ethics, and communication, while perceiving truthtelling as a palpable feature in trusting relationships. Honesty, in simple terms, can be de? ned as being â€Å"real, genuine, authentic, and bona ? de† (Bennett, 1993, p. 597). Honesty is more than just telling the truth: it is  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC the substance of human relationships. It involves people having the ability to place NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION emphasis on resolve and action to achieve a just society by exercising a willingness to dig for truth in a rational, methodical, and diligent way. A person with maturity in honesty will place bits of truths into perspective and prudently search for the missing truths before addressing the issue. In other words, honesty is well-thought out and rehearsed behavior that re? ects commitment and integrity. Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC There are many ways that nurses can portray honesty. For example, nurses must OT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION stay committed to their promises to patients and follow through with appropriate behaviors, such as returning to patients’ hospital rooms, as promised, to help them with certain tasks. If nurses do not follow through with their commitments, trust may be broken, and patients potentially will see those nurses as dishonest or  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, untrustworthy. NOT FOR SALE OR DISTRIB NOT FOR SALE OR DISTRIBUTION one’s self. For example, if a nurse was Honesty is also about being honest with in the process of administering medications and a pill fell on the hospital floor, would the nurse be justi? ed in wiping it off and placing it back in the cup if no one was there to see the action? Nurses might be tempted to wipe off the pill and administer it just to required form for a replacement  © Jones Bartlett Learning, LLCkeep from completing a  © Jones Bartlett Learning, LLC medication, but if nurses NOT FOR SALE OR DISTRIBUTION evaluate their problems and make decisions based on the NOT FOR SALE OR DISTRIBUTION thought â€Å"always be honest with myself,† it is more likely that they will make rational, trustworthy decisions regarding the care of patients. Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION  © Jones Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 22183_CH03_Pass3. qxd 1/11/12 Jones Bartlett Learning, LLC OT FOR SALE OR DISTRIBUTION 3:13 PM Page 77  © Jones Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Qualities of Ethical Nurses 77  © Jones Bartlett Learning, LLC Truthfulness  © Jones Bartlett Learning, AristotleNOT FOR SALE OR the mean between imposture (excessiveness) recognized truthfulness as DISTRIBUTION NOT FOR SALE OR DISTRIB and self-deprecation (de? ciency) and as one of the 12 excellences (virtues) that he identi? ed in his book Nicomachean Ethics (Aristotle, 2002, C. Row Trans. ). People accomplish their ultimate goal of happiness only by exercising rational and intellectual thinking, which is known as wisdom or contemplation. Aristotle explained  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, LLC his view of a truthful person as being the truthful sort (see Box 3. 3). NOT FOR SALEthe principle of veracity, truthfulness is what we say and FOR SALE OR DISTRIBUTION OR DISTRIBUTION NOT how we say Based on it. Truthfulness, translated to â€Å"truthtelling† in the healthcare environment, means that nurses are usually ethically obligated to tell the truth and are not intentionally to deceive or mislead patients. Because of the emphasis in the Western world on Jones Bartlett Learning, LLC about their personal © Jones Bartlett Learning, LLC patients’ right to know health care, truthtelling has become OT FOR SALE ORthe basis for most relationships between healthcare professionals andOR DISTRIBUTION DISTRIBUTION NOT FOR SALE their patients (Beauchamp Childress, 2009). In the older, traditional approach, disclosure or truthtelling was done with more of a bene? cent or paternalistic approach and involved basing actions on answers to the questions such as, â€Å"What is best for my patient to know? †  © Jones Bartlett Learning, LLC  © Jones Bartlett Learning, The ethical question to ask is: Are there ever circumstances when nurses should NOT FOR SALE OR DISTRIB NOT FOR SALE ORtruth to their patients? The levels of disclosure DISTRIBUTION be ethically excused from telling the in health care and the cultural viewpoints on truthtelling create too much fogginess for a clear line of distinction to be drawn between nurses telling or not telling the truth. The ANA Code of Ethics for Nurses (2001) obligates nurses to be honest in Bartlett Learning, LLC  © Jones matters involving patients and themselves, and to express a moral point of view  © Jones Bartlett Learning, LLC when they become aware of unethical practices. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In some Western cultures, such as the United States, autonomy is so valued that withholding information is unacceptable. Under this same autonomy principle, it is assumed that patients also have a right not to know their medical history if they so desire. Some cultures, such as those in several Eastern countries, do not prize Jones Bartlett Learning, this way; the head of the family or the elders usually decide how much  © Jones Bartlett Learning, LLC autonomy in LLC OT FOR SALE ORand what information needs to be disclosed to the family member as patient. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION BOX 3. 3 ETHICAL FORMATIONS: ARISTOTLE’S â€Å"THE TRUTHF