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KODE ETIK PROFESI

KEPERAWATAN DAN
PENGARUHNYA TERHADAP
MUTU PELAYANAN

Oleh: Nursalam

Etik Nursalam-2012

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PENDAHULUAN

Etik profesi merupakan prinsip prinsip moral atau asas-asas yang harus diterapkan
oleh perawat dalam hubungannya dengan pasien, teman sejawat dan masyarakat
uymumnya. Etik ini mengatur tentang perilaku profesional paa perawat dalam menjalankan
pekerjaannya, sebagaimana tercantum dalam lafal sumpah dan kode etik perawat yang
disusun organisasi profesional bersama pemerintah.
Pelanggaran etik keperawatan tidak selalu berarti pelanggaran hukum, demikian pula
sebaliknya. Pelanggaran etik keperawatan diproses melalui MKEK-PPNI dan jika diperlukan
diteruskan ke Departemen Kesehatan. Pelanggaran hukum diselesaikan melalui pengadilan.
Untuk menghindari pelanggaran etik dalam praktik keperawatan profesional, maka
perawat harus menerapkan prinsip / azas etik dan kode etik serta mematuhi aspek legal
keperwatan yang diatur dalam KepMenkes 148/2010 dan UU Kes 36/2009. Dalam
melaksanakan perawat harus memperhatikan dan menghindari yang disebut dengan
negligence (kealpaan): commision dan ommision. Hal ini bisa dilakukan apabila perawat
dalam setiap mengambil keputusan etik selalu didasarkan pada ethical decision making dan
clinical decision making (EDM). EDM diyakini dapat digunakan sebagai upaya untuk
meningkatkan mutu pelayanan keperawatan.

SISTEM REGULASI DALAM PRAKTIK KEPERAWATAN

SOSIAL

Regulasi Profesi
Legal Regulasi
Definisi Lingkup praktik

State Nursing Practice


Acts (UU Praktik)

Standar
Profesional

Board Regulasi
Standar professional
untuk pendidikan
Stndar professional, Keperawatan
tujuan, kebijakan,
prosedur pelayanan
keperawatan.

Sertifikasi pada
bidang kekususan Akreditasi
Akreditasi keperawatan organisasi Lisensi
Program
pelayanan
Pendidikan
keperwatan

Perlindungan publik
Penjaminan
Mutu

KLIEN
Lindberg (1990: 320)

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TANTANGAN ETIK KEPERAWATAN
1. Dasar-dasar moral makin memudar
2. Dasar & sendi agama makin menipis
3. Perkembangan IPTEK yg meningkat
4. Globalisasi yg menyebabkan persaingan bebas (orientasi pelayanan dari sosial -
bisnis)
5. Kamajuan & perkembangan masyarakat sebagai pengguna jasa: (kesadaran hak; tk.
Ekonomi yg meningkat; kesenjangan si kaya dan si miskin; IPTEK meningkat)
6. Perubahan dlm. Masyarakat perawat (kurangnya kemampuan - etik; masuknya
tenaga LN)

HUBUNGAN ETIK, MORAL, HUKUM

Etik
. doing good and avoiding harm (Bandman & Bandman, 1995:5)
Apa yang harus dilakukan manusia
Apa yang seharusnya dilakukan kepada seseorang
Suatu analisa proses terhadap suatu tindakan
Berdasarkan ilmu dan nilai / norma di masyarakat

Hubungan etik dgn.


MORAL (apa yg dinilai baik /buruk oleh masyarakat)
HUKUM (legalisasi sikap tindak etik)

ETHIC
Cognitive observed A-mati
BEHAVIOR affective recorded C-catat
psychomotor measured U-kur

Cipta : (the truth)


Rasa : (the beauty)
Karsa : ( goodness)
UKURAN GOOD / BAD TINDAKAN MANUSIA
KRITERIA
Dilakukan Dengan Sengaja
Dilakukan Dengan Kesadaran
Yang Bersangkutan Telah Mengetahui
Yang Bersangkutan Mempunyai Pilihan

PRINSIP & AZAS ETIK KEPERAWATAN (JABVC)


1. JUSTICE (Asas Keadilan)
2. AUTONOMY
3. BENEFICIENCY & NON-MALEFICIENCY
4. VERACITY
5. CONFIDENTIALITY

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1. JUSTICE (Asas Keadilan)
equals should be treated the same and unequals should be treated differently.
Pasien harus diperlakukan sama sesuai dengan keadaan sakitnya,
tidak ada diskriminasi ( pasien, alat - alat, dll )
Models ( health care resources )
Setiap arang sama
berdasarkan jasa
keberadaan peralatan
sesuai kebutuhan

2. AUTONOMY (Asas menhormati otonomi)


Individuals have the right to determine their own actions
Karakteristik :
Sesuai dengan nilai - nilai / kepercayaan
informasi yang cukup
bebas dari coercion
berdasarkan alasan dan kebebasan

3. BENEFIENCE (asas manfaat) DAN NON-MALEFICIENCY (tidak merugikan)


Doing or promoting good
Karakteristik :
Nonmaleficence
mencegah harm atau kesalahan
mengurangi / menghilangkan harm or evil
promote good

4. VERACITY (Asas Kejujuran)


.. Telling the truth

5. CONFIDENTIALITY Kerahasaiaan
Perawat harus merahasiakan keadaan pasien, meskipun pasien sudah meninggal kecuali
diminta oleh institusi yang berkompeten.

6. RESPECT FOR PERSONS (Asas perbedaan tiap individu)


Eeach person shpuld be treated as a unique individual and as a member of the
human community

7. FIDELITY (Asas Komitmen)


one has a moral duty to be faithful to the commitments that one makes to others

KODE ETIK KEPERAWATAN DI INDONESIA (PPNI)


(Code Of Ethics For Nurses Indonesia)

LIMA PRINSIP:
1. Perawat dan pasien
2. perawat dan praktik
3. perawat dan masyarakat
4. perawat dan teman sejawat
5. perawat dan profesi

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PERAWAT DAN KLIEN
1. Perawat dalam memberikan pelayanan keperawatan
2. Menghargai harkat dan martabat manusia, keunikan klien, dan tidak terpengaruh
oleh pertimbangan kebangsaan, kesukuan, warna kulit, umur, jenis kelamin, aliran
politik dan agama yang dianut serta kedudukan sosial.
3. Perawat dalam memberikan pelayanan keperawatan senantiasa memelihara
suasana lingkungan yang menghormati nilai-nilai budaya, adat-istiadat dan
kelangsungan hidup beragama dari klien.
4. Tanggung jawab utama perawat adalah kepada mereka yang membutuhkan asuhan
keperawatan.
5. Perawat wajib merahsiakan segala sesuatu yang diketahui sehubungan dengan
tugas yang dipercayakan kepadanya kecuali jika diperlukan oleh yang berwenang
sesuai dengan ketentuan hukum yang berlaku.

PERAWAT DAN PRAKTIK


1. Perawat memelihara dan meningkatkan kompetensi dibidang keperawatan melalui
belajar terus menerus.
2. Perawat senantiasa memelihara mutu pelayanan keperawatan yang tinggi desertai
kejujuran profesional dalam menerapkan pengetahuan serta keterampilan
keperawatan sesuai dengan kebutuhan klien.
3. Perawat dalam membuat keputusan didasarkan pada informasi yang adekuat dan
mempertimbangkan kemampuan serta kualifikasi seseorang bila melakukan
konsultasi menerima delegasi dan memberikan delegasi kepada orang lain.
4. Perawat senantiasa menjunjung tinggi nama baik profesi keperawatan dengan selalu
menunjukkan perilaku profesional.

PERAWAT DAN MASYARAKAT

Perawat mengemban tanggung jawab bersama masyarakat untuk memprakarsai dan


mendukung berbagai kegiatan dalam memenuhi kebutuhan kesehatan masyarakat.

PERAWAT DAN TEMAN SEJAWAT

1. Perawat senantiasa memelihara hubungan baik dengan sesama perawat maupun


dengan tenaga kesehatan lainnya, dan dalam memelihara keserasian suasana
lingkungan kerja maupun dalam mencapai tujuan pelayanan kesehatan secara
menyeluruh.
2. Perawat bertindak melindungi klien dan tenaga kesehatan yang memberikan
pelayanan kesehatan secara tidak kompeten, tidak etis dan illegal.

PERAWAT DAN PROFESI

1. Perawat mempunyai peran utama dalam menentukan standar pendidikan dan


pelayanan keperawatan serta menerapkan dalam kegiatan pelayanan dan
pendidikan keperawatan.

2. Perawat berperan aktif dalam berbagai kegiatan pengembangan profesi


keperawatan.

3. Perawat berpartisipasi aktif dalam upaya profesi untuk membangun dan memelihara
kondisi kerja yang kondusif demi terwujudnya asuhan keperawatan yang bermutu
tinggi.

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INDICATOR PELANGGARAN KODE ETIK (NEGLIGENCE (4D)

D1 Duty (Nurse had specific professional duty to patient)


D2 Direlection (Nurse did not carry out his/her duty)
D3 Damage (Nurse caused injury to his/her patient)
D4 Direct Causation (The patients injury resulted from the nurses
negligent action)

Dampak terjadinya pelanggaran etik dapat dilihat dari tujuah (7) pitfalls yang umum
terjadi Pada aspek etik keperwatan dan hukum kesehatan.

1. Patient falls
2. Failure to follow up MD. orders/protocol
3. Medication error
4. Improper use of equipment
5. Failure to remove foreign objects
6. Failure to provide sufficient monitoring
7. Failure to communicate

BAGAIMANA MENGHINDARI NEGLIGENCE


C = CHECK THE ORDER
W = WASH YOUR HANDS
I = IDENTIFY THE PATIENT
P = PROVIDE SAFETY & PRIVACY
A = ASSESS THE PROBLEMS
T = TEACH & TELL THE PATIENT

EDM (ETHICAL DECISION MAKING) IN NURSING

DECISION MAKING
End point of using critical thinking and scientific resoning ethical in problem
reasoning.
Even no decision is decision, because , in effect, it is supports the existing state of
affairs

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STRATEGY E-D-M

FORMULA DASAR PENGAMBILAN KEPUTUSAN ETIK

LEGAL
UU KES
36/2009 dan
KepMenkes
148/2010 SOLUSI LANGKAH PENGAMBILAN
KEPUTUSAN

1 3
ETIK Masalah Klarifikasi 2 Identifikasi
AZAS & KODE ETIK Etik Delima etik Pulta Pilihan

6 5 4
NILAI-NILAI Evaluasi Pelaksanaan Keputusan
(Agama, budaya,
Dll)

Institusi

CONTOH KASUS EDM


1. CONTINUE OR STOP TREATMENT
A severe asphyxia patient was in ICU for a couple days and there was no progression.
Patient's family knew that the patient was still alive because of ventilator assistance. The
family decided to stop the ventilator. "Let the patient die. We could not afford for the
cost." It was a dilemma for me. I believed the treatment must be continued because I
had duties to help the patient to survive. If the patient would die, it was not our will. But, I
had to follow the patient's family. Why didn't they want to continue the treatment? Even
though the possibility of surviving for the patient was low, I did not want to disconnect the
tube. It seemed like I killed the patient

2. WHO SHOULD GET THE VENTILATOR?


There were two patients, head injury and brain tumor patients, admitted to ICU. Head
injury patient was coma, had high level of PCO2, and RR 32 times per minutes. Brain
tumor patient was also coma, RR 26 times per minutes, and sometimes he had apnea
attack. They needed ventilator at the same time. We just had only one ventilator. At that
time, it was difficult to decide which patient should get the ventilator. Which patient I had
to help first?

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3. WANT TO TAKE AN ACTION BUT BEYOND AUTHORITY
I had a situation when the patient's blood pressure was dropped and I wanted to take
action to help the patient immediately but I could not do it without reporting to doctor
firstI had to wait for order from doctor because it was beyond my responsibility

4. TELL OR NOT TO TELL THE TRUTH


A patient's husband asked me not tell his wife that their baby died during caesarian
section. He was afraid it would make his wife's condition worse. So at that time it was
difficult for me to make a decision. Then his wife came to me and asked about her baby.
It was difficult whether or not to tell the truth to her. Her husband asked me not to tell her.
He wanted to tell his wife at their home. If I didn't tell her, I felt guilty because it conflicted
with my values. Meanwhile, doctor also suggested not to tell the patient because he was
worried that she would be shock and it would affect her condition.

5. ACT AS PATIENT ADVOCATE VERSUS MAINTAINING RELATIONSHIPS WITH THE


HEALTH TEAM
Patient was poor and could not afford the prescribed drug. I was in a difficult situation
whether I administered the drug or not. If I didn't administer it, it was doctor's order and
he might be angry with me and it would produce bad relationship with him. I needed to
talk to doctor about this and asked him to prescribe another drug that could be afforded
by the patient, but I was afraid

6. Deligatioan
Miss Corbin, RN, work on surgiucal floor. She has just assisted in the transfer of Mr. Hudson
(patient) to his room from the postanesthesia unit after surgery and notice that he was
resting comfortably. Miss Corbin sees a nurse colleague (X) drawing up a pain medication.
The nurse colleagues returns to the medicine room 10 minutes later with empty syringe.
Miss Corbin asks, Who needed pain medication? Mr. Hudson, the colleagues (X) replies.
He was in pain after surgery. Confused, Miss Corbin checks Mr. Hudsons (Patients) room
and learns from his wife that she has not asked for or received pain medication. What
should Nurse do now?
Bandman & Bandman (1997: 410)

7. Autonomy dan Negligence


SUSTER TIDUR, BAYI TEWAS!
Pasien (Heston dan Ashdiane-suami) melaporkan ke polisi, krn suster melarang permintaan
pasien utk dilakukan Caeser. Jam 17.00 ketuban pecah, tetapi tetap dianggap biasa oleh
suster. Jam 19.00 pasien merasa mulas yg amat sangat. Permintaan suaminya (Heston)
agar istrinya ditolak oleh suster. Pukul 02.00 (23/9/04) pasien merasakan ada sesuatu yg
mengalir di bagian bawah perutnya. Diapun segera membangunkan perawat yg sedang
tidur nyenyak. 1 jam kemudian, begitu dokter datang langsung dibawa ke ruang operasi.
Namun, bayi yg dilahirkan dlm keadaan kritis. Jam 17.00 bayi meninggal.

8. Autonomy & Informed Concent


Eleanor Gift,age 68 years, is schedule for triple bypass surgery. Martha Blake, RN, is the
nurse doing her preoperative teaching the evening before the procedure is scheduled. It is
apparent to Miss Bake that Mrs. Gift doesnot want to have surgery. She express great
apprehension about procedure and generally feells quite negative about the outcome. The
surgeon, however, has convinced Mrs. Gist and her family that she must undergo the
surgery to survive. Although far from comfortable with situation, Mrs. Gift is resigned to
undergo the impending surgery in the morning. What is the nurses responsibility in the
situation?

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CONTOH PENERAPAN EDM PADA KASUS NO. 8

TAHAP 1: CLARIFY ETHICAL DILLEMA


Many questions are not answered in this case study. Clearly the decision regarding having
surgery should be made by the one most affected (i.e. Mrs. Gift). Others are affected by her
decision, however. There is no information given about her family or how involeved they are
in her health care. Other care givers also may play a significance role. The ethical principle
of autonomy is important in this scenario. Unfortunately, time is quite short because Mrs.
Gifts surgery is scheduled in the morning.

TAHAP2: GATHERING ADDITIONAL DATA


The nurse need to know information from Mrs. Gifts medical history related to the extent of
her cardiovascular disease. It is also important to know what she has been told about the
surgery and her need for it. Has she ben given the necessary information to allow her to
make an information decision?
We can also gather the data from ansewering questions on 5W and 1 H

TAHAP3: IDENTIFY OPTION


The following nursing actions are options for the nurse in this situation:
Continue preoperative teaching under the assumption that surgery will take place as
schedule
Continue preoperative teaching and let the increased knowledge b e used as an
additional tool to assist Mrs, Gift in decicion making
Etc
Principelly, the options can be divided into 3 options possibles
1. should be attack
2. can be avoided
3. compromise

Alternative Suitability Feasibility Flexibility


Total

Alternative A 1 1 3
5
Alternative B 3 2 1
6
Alternative C 3 3 2
8
Alternative D 2 2 1
5

Rate each alternative on scale of 1 3 for its

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Suitability: whether the alternative is ethical or pratical. Is it appropriate in
scale or importance? An adequate response? Too extreme?
Feasibility: how many resources will be needed to solve the problem, how
likely will it solve the problem, How likely will it solve the problem?
Flexibility: ability to respond to unintended consequences, or opennes to new
possibilities?

TAHAP 4: MAKE A DECISION


Choose one of the options. In this situation, it seems most appropriate the explore Mrs. Gift
concerns and feelings about the surgery. It is important to determine if patients truly feels the
surgery is in the best interest and if she has made an autonomous decision.

TAHAP 5: IMPLEMENTATION
Once a decision is made, it is important to implement the action. In this situation, the nurse
decides to explore patients concerns and determine if an autonomous decisions was made
by the patient.

TAHAP6: EVALUATION
The step is important, even though it may seem obvious. It is necessary to evaluate the
implications of the decision that was made. The nurse must determine if the action
implemented accomplished what was intended. Evidence that the intervention was
succesfull would include a decrease in Mrs. Gifts anxiety level and negative feelings about
the probable outcome of the surgery.

DAFTAR PUSTAKA

Bandman, LE & Bandman B. 1995. Nursing Ethics Through the Life Span. 3rd ed.
Norwalk: Appleton & Lange.

Chitty, KK. 1997. Professional Nursing. Concepts and Challenges. 2nd ed. Philadelphia:
W.B. Saunders Co.

Edge RS & Groves JR. 2004. Ethics of Health Care. A guide for Clinical Practice.
2nd.ed. Philadelphia: Delmar Publishers.

Nursalam. 2008. Proses dan Doukumentasi Keperawatan. Edisi 2. Jakarta: Salemba


Medika

Nursalam. 2011. Manajemen Keperawatan: Aplikasi dalam praktik keperawatan


profesional. Edisi 3. Jakarta: Salemba Medika

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