By :
Objectives
After studying, the students will be able to
Describe the term of values, ethics and
moral ethics
Describe five common modes of value
transmission
Describe the ethical theories
Describe the seven ethical values in nursing
Describe the eight ethical principles in
nursing
Describe the basic moral concepts
Use the ethical concepts in the
professional nursing ethic.
~ Tri Anjaswarni Harsono
Definition of Values
A Value defined as a personal belief about
worth that acts as a standard to guide ones
behavior.
A value system is an organization of values
in which each value is ranked along a
continuum of importance ; a value system
often operates as a personal code of
conduct.
~ Tri Anjaswarni Harsono
Nursing Ethics
Is an expression of how nurses ought
to conduct themselves.
Refers to the ethical standards that
govern and guide nurses in everyday
practice such as being truthful
with clients, respecting client
confidentiality and advocating on
behalf of the client
~ Tri Anjaswarni Harsono
Ethical Theories
Utilitarianism Theory
Didasarkan pada norma dan aturan utk
melakukan tindakan menitik beratkan pada
hasil akhir tindakan.
Benar jika suatu tindakan menghasilkan
akibat yg baik / memberikan kebahagiaan
yg cukup besar dan tdk menimbulkan
bahaya.
Salah jika tindakan menghasilkan akibat yg
buruk / menimbulkan bahaya
~ Tri Anjaswarni Harsono
10
Deontology Theory
Berasal dari norma atau aturan
mengenai kewajiban umat
manusia yg saling
ketergantungan shg mempunyai
komitmen & rasa tanggung
jawab untuk memenuhi
kewajiban thd orang lain
Tidak / bukan menitik beratkan
pada hasil akhir atau akibat
suatu tindakan
~ Tri Anjaswarni Harsono
11
Ethical Values
Aesthetics
Altruism
Equality
Freedom
Human Dignity
Justice
Truth
12
Values
Aesthetic
Altruism
Equality
Freedom
13
Values
Human Dignity
Inherent worth and
uniqueness of an individual
Justice
Upholding moral and legal
principle
Truth
Faithfulness to fact or reality
14
Aesthetic
Attitudes &
Personal Qualities
Appreciation
Creativity
Imagination
Sensitivity
Professional Behavior
Adapts the
environment
Creates a pleasant
work environment for
self & others
Promotes a positive
image of nursing
15
Altruism
Attitudes &
Personal Qualities
Caring
Commitment
Compassion
Generosity
Perseverance
Professional Behavior
Gives full attention to
the client
Assists other
personnel in providing
care
Expresses concern
about social trends &
issues that have
implication for
health care
16
Equality
Attitudes &
Personal Qualities
Acceptance
Assertiveness
Fairness
Self esteem
Tolerance
Professional
Behavior
Provide nursing care
based on the individuals
needs / personal
characteristic
Interact with other
provider in a
nondiscriminatory
Expresses ideas about
the improvement of the
nursing and health care
17
Freedom
Personal Quality
Confidence
Hope
Independence
Openness
Self direction
Self Discipline
Professional Behavior
Honor individuals right
to refused treatment
Support the right of
other provider to
suggest alternatives to
the plan
Encourages open
discussion of
controversial issues in
the profession
18
Human Dignity
Personal Quality Professional
Consideration
Behavior
Safeguards the
Empathy
individuals
right
to
Humaneness
privacy
Kindness
Maintains
Respectfulness
confidentiality of
client & staff
Trust
19
Justice
20
Truth
Personal Quality
Accountability
Authenticity
Honesty
Rationality
Reflective ness
Professional
Behavior
Documents nursing
care accurately &
honestly
Obtains data to make
sound judgment
before reporting of
organization policies
Participates in
professional efforts
to protect the public
from misinformation
about nursing
21
Ethical Principles
Autonomy
Justice
Beneficence
Veracity
Confidentiality
Non
maleficence
Fidelity
Avoiding Killing
22
Autonomy
Berhub. Dg kemerdekaan atau
kebebasan klien (independence)
Hak utk memilih bagi seseorang (the
clients freedom of choice)
Self-determination
Penerapan informed consent
23
Justice
Memperlakukan orang lain secara adil
tanpa membedakan status sosial, ras,
agama, dsb.
Merupakan prinsip moral utk berlaku adil
bagi semua individu
24
Beneficience
Prinsip berbuat kebaikan / baik
(promote good)
The nurse should do
Upaya kebajikan perawat untuk
menyelesaikan pekerjaan yg
terbaik utk klien
25
Veracity
Truthfulness (kebenaran / sifat yg
sebenarnya)
Kejujuran dlm
menyampaikan hal yg sebenarnya.
Kewajiban perawat mengatakan yg
sebenarnya didasarkan pd otonomi
seseorang
Truthful communication are necessary to
establish and maintain trusting
relationships.
26
Confidentiality
Prinsip menjaga kerahasiaan klien
(clients privacy)
The nurse respect all privileged
information about client
Merupakan prinsip moral yg
menjelaskan kewajiban perawat utk
tetap setia pada komitmennya, yaitu
mempertahankan hubungan saling
percaya
27
Non Maleficence
Do no intentional harm (prinsip
28
Fidelity
Good faith to keep promises
made to the client (komitmen /
mempertahankan janji dg klien)
Loyality to the client care
provider relationships.
29
Avoiding Killing
Menekankan pada kewajiban
30
31
Problems in Clinical
Practice
Ethical Issue
Ethical Problem
Ethical Dilemma
Bio Ethic
~ Tri Anjaswarni Harsono
32
33
&
DECISION MAKING
By :
34
Objectives
After studying this topic, the
students will be able to :
Describe moral & ethical problems in
clinical practice
Describe Type of Moral and Ethical
Problems
Describe ethical dilemmas in nursing
Describe Process for resolving the
ethical Problems / process of Ethical
or moral Decision Making
~ Tri Anjaswarni Harsono
35
Problems in Clinical
Practice
Ethical Issue
Ethical Problem
Ethical Dilemma
Bio ethic
~ Tri Anjaswarni Harsono
36
Ethical Issue
One in which one or more moral
norms or principles are
present, but do not create a
problem
~ Tri Anjaswarni Harsono
37
Ethical Problem
One in which two or more
moral norms or principles
create a challenge about what
to do
~ Tri Anjaswarni Harsono
38
Ethical Dilemma
Problem that involves two or more morally
correct courses of action, but you cant do
both.
It is difficult to determine the right
decision or action
A difficult problem that seems to have no
satisfactory solution
A choice between equally unsatisfactory
alternatives
An ethical dilemma exists when the moral
claims conflict with another (What should I
do or What is the right thing to?)
~ Tri Anjaswarni Harsono
39
Three Type of
Moral and Ethical Problems
Jameton (1984) in Taylor, Lillis, LeMone (1989)
40
Type of
Moral and Ethical Problems /
Dilemmas In Nursing
(Cont.)
arise because of conflicts
between :
Nurses and Clients
Nurses and Physician
Nurses and Other Nurses
Nurses and Institutional
~ Tri Anjaswarni Harsono
41
42
Type of
Moral and Ethical Problems (Cont.)
Nurses and
Clients
Difficulty identifying
primary client
Paternalism
Deception
Confidentiality
Informed consent
Conflict between the
clients and nurses
interest
43
Type of
Moral and Ethical Problems (Cont.)
Nurses and
Physician
Disagreements
about the proposed
medical regimen.
Conflict regarding
the scope of the
nurses role.
Physician
incompetence
44
Type of
Moral and Ethical Problems (Cont.)
Nurses and
Other Nurses
Claim of loyalty
Nurse
incompetence
Nurse and
Institutional
Inconsistent
Rules
Policy
45
How To Make
The Best Decisions ?
Ethical & Moral Theory
Ethical Value & Principles
Basic Moral Concepts
Problems in clinical practice
Process for resolving the ethical
problems
~ Tri Anjaswarni Harsono
46
47
Process for
resolving the ethical
Problems
Step I
48
Process (Cont.)
Step I :
Identify The Problem
(Clarify The Ethical Dilemma)
What is the specific issue ? State the problem
Clearly
Who owns the problem and should actually make
the decision ?
Who is affected by the dilemma ?
Determine the ethical principle or theory related
to the dilemma !
Are there value conflict ?
~ Tri Anjaswarni Harsono
49
Step II
Gather additional data
Gathered many facts about the situation as
possible
describe the situation that gives rise to the
problem : main people involved (view &
interest), client overall nursing, medical
and social situation, relevant legal,
administrative, and staff consideration.
~ Tri Anjaswarni Harsono
50
51
52
Step V : Act
Once a course of action has been
determined, the decision must be
carry out
Implementing the decision usually
involves working collaboratively
with others.
~ Tri Anjaswarni Harsono
53
Step VI : Evaluate
It is important for decision makers to
determine the impact this decision.
If the action accomplishes its
purpose, the ethical dilemma should
be resolved.
If the dilemma has not been resolved,
additional deliberation is needed.
How can you improve the decision
process next time.
~ Tri Anjaswarni Harsono
54
55
56