Chapter 4

Ethics in Community Health Nursing

Practice

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 Objectives
 Describe a brief history of the ethics of nursing in
community health.
 Discuss ethical decision-making processes.
 Compare and contrast ethical theories and
principles, virtue ethics, ethics of care, and feminist
ethics.
 Describe how ethics is part of the core functions of
nursing in community health.
 Analyze codes of ethics for nursing and for public
health.
 Apply the ethics of advocacy to nursing in
community health.

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 Introduction
 The work of nurses in public health involves
ethical activities.
 Rights-based versus community-based ethical theory
 Ethics is a body of knowledge and, as such, is
more than “being a good person.”
 Basing your actions on ethical principles is a part of
clinical decision making and practice

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 History
 Hippocratic oath
 1893: Nightingale pledge
 1950: Code for Professional Nurses
 1960s: Bioethics emerge in nursing curricula
 Late 1960s: Bioethics movement
 Hastings Center
 2001: Code of Ethics for Nurses with Interpretive
Statements
 2005: most recent version of the ICN Code of Ethics for
Nurses
 2008: Nursing and Health Care Ethics: A legacy and a
Vision

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 Ethical Decision Making
 Ethical Decision Making
 Ethical Issues
 Ethical Dilemmas

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 Ethical Decision-Making
Frameworks
 Use problem-solving processes.
 Provide guides for making sound ethical
decisions that can be morally justified.
 Remember that when all is said and done we
each make our own decisions.
 Factors affecting this framework:
• Growing multiculturalism of the American society
• Moral distress

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 Generic Ethical Decision-Making
Framework
 Identify the ethical issues and dilemmas.
 Place them within a meaningful context.
 Reformulate ethical issues and dilemmas, if
needed.
 Consider appropriate approaches to actions or
option (utilitarianism, deontology, principlism, virtue
ethics, ethic of care, feminist ethics).
 Make decision and take action.
 Evaluate the decision and the action.
• The steps of a generic ethics framework are often nonlinear,
and with one exception, they do not change substantially.

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 Ethical Issues and Ethnicity
Conflicts
 Situations in which ethnic diversity can be
judged in relationship to cultural standards:
 Situations that place persons at direct risk of harm,
whether psychological or physical
 Situations where ethnic cultural standards conflict
with professional standards
 Situations where the greater community’s values are
jeopardized by specific ethnic values
 Situations where specific ethnic community customs
are annoying but not problematic for the greater
community

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 Ways to Handle Moral Distress
 Identify the type(s) of situations that lead to
distress.
 Communicate that concern to your manager and
examine ways to work toward addressing the
stressor.
 Seek support from colleagues.

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 Ethics: Definition, Theories,
Principles
 Ethics
 Consequentialism
 Utilitarianism
 Deontology
 Primary Principles
 Respect for autonomy
 Nonmaleficence
 Beneficence
 Distributive or social justice

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 Virtue Ethics
 One of the oldest ethical theories
 Asks “What kind of person should I be?”
 Virtues are acquired excellent traits of character
that dispose humans to act in accordance with
their natural good.

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 Caring and the Ethic of Care
 Caring in nursing, the ethic of care, and feminist
ethics are all interrelated and converged
between the mid-1980s and early 1990s.
 Nurses have written about caring as the essence
of or the moral ideal of nursing.
 Caring and the ethic of care is a core value of
nursing in community health.

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 Feminist Ethics
 Feminine Ethic
 Feminist Ethics
 Feminists

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 Ethics and the Core Functions
 Assessment
 Competency in research, measurement, and analysis techniques
 Virtue ethics; moral character
 “Do no harm”
 Policy Development
 Achieve public good
 Service to others over service to self
 What is ethical is also good policy
 Assurance
 All persons should receive essential personal health services
 Providers should be competent to provide care and be available

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 Nursing Codes of Ethics
 ANA’s Code of Ethics for Nurses With
Interpretive Statements
 Emphasizes political action as the mechanism to
effect social justice and reform regarding
homelessness, violence, and stigmatization.

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 Public Health Codes of Ethics
 The 12 principles incorporate the
ethical tenets of:
 Contains 12  Preventing harm

statements that  Doing no harm

 Promoting good
address the moral
 Respecting both individual and
standards that community rights
delineate public  Respecting autonomy,
diversity, and confidentiality
health’s values, goals, when possible
and obligations  Ensuring professional
competency
 Trustworthiness
 Promoting advocacy for
disenfranchised persons
within a community

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 Advocacy and Ethics
Definitions, Codes, Standards
 Advocacy: the act of pleading for or supporting
a course of action on behalf of a person, group,
or community.
 Public health nurses have a moral mandate to
establish ethical standards when advocating for
health care policy.

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 Conceptual Framework for
Advocacy
Social Justice Market Justice
 Oriented to community  Oriented to person
 Emphasizes shared  Key values: self-
responsibility and determination, self-
interconnection and discipline, self-interest,
cooperation among and personal efforts to
individuals in a achieve one’s desired
community beliefs
 Government involvement  Focus on individual moral
is necessary behavior

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Practical Framework for Advocacy
 Places the advocate’s core skills within the context
of six ethical principles for effective advocacy
 Ethical Principles for Effective Advocacy
 Act in the client’s (group’s, community’s) best interests
 Act in accordance with the client’s (group’s, community’s)
wishes and instructions
 Keep the client (group, community) properly informed
 Carry out instructions with diligence and competence
 Act impartially, and offer frank, independent advice
 Maintain client confidentiality

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 Advocacy and Bioterrorism
 September 11, 2001 attack
 Ethical issues arise with the threat, action, and
aftermath of terrorism
 Can be difficult to balance goals for the protection of
the population and protection of the individual
 Moral obligation to respond

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Advocacy and Health Care Reform
 Need to advocate for reform that includes ethical
considerations
 Access to consistent, effective, efficient health care
for all people
 Affordable Care Act of 2010

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