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8/11/2019 N246 ethics, quality of care, IOM pp.ppt
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Essentials of Nursing Leadership & Management, 4th Edition
N246 LeadershipEthics & Quality
S. Buckley, 2010
(Adapted from Nursing Leadership and Management,Whitehead, Weiss, Tappen)
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Early nursing leaders
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finances
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1960s
Technological advances allowed for thedevelopment of intensive care units
New biomedical developments
Advances in surgical techniques, such asopen heart surgery
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Reasons for new inquiries innursing
Technological advances created new questions for health-care
professionals regarding the use of technology, RN role and outcomes Changing views and perspectives on the concepts of life and death Dissatisfaction of RNs with traditional manner of learning (mentoring)
and desire to have a scientific base for practice (professionalscientists)
Interest by healthcare practitioners about application of values in
professional practices, and how to discuss these issues.
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Bioethics
A sub discipline of ethics The study of medical morality
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Concepts of EthicsEthics evolve from moral perspectives, which form
values and standards. Influenced by families,
environment, social issues, culture, religion,cognition, law.Ethical action depends, in part, on the ability of
people to recognize that a moral issue exists in agiven situation, knowing how to take appropriateethical action if and when required, and onpersonal commitment and a genuine desire toachieve a moral outcome
(Johnstone, 1999, from:Ethics in Nursing Practice, 2nded, Fry,
S.T,Johnstone, M.)
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Value Systems
definitions
A set of related values
Intrinsic values-located within, the real nature of a thing.
Extrinsic values-from without
Personal values
Professional values
Social principles, goals or standards held or accepted byan individual class, society. That which is desirable orworthy of esteem for its own sake, thing or quality havingintrinsic worth.
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Historical values ofnursing:
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Nursing today Values in nursing
today:
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Value Formation
Values are learned-therefore, influenced by
family, culture, environment, cognition. Values change with maturity and
experience
The number of values an individual holds isnot as important as what values theyconsider important
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Types of Values Personal
Cultural Religious
professional
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Values Clarification
Critical thinking Choosing
Identifying-verbalizing?
Acting
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Belief Systems These are organized ways of thinking about
why people exist within the universe
Their purpose is to explain such conceptsas:
Life and death
Good and evil
Health and illness
Individualism/rights
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ETHICS AND MORALS
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Morals An individuals own code for acceptable
behavior
Standards of goodness or rightness thatarise from an individuals conscience
They act as a guide for individual behavior
Learned Capable of making a distinction between
right and wrong in conduct
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Values Social principles, goals or standards held or
accepted by an individual class, society.That which is desirable or worthy of esteemfor its own sake, thing or quality havingintrinsic worth.
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Standards Something established for use as a rule or
basis of comparison in measuring orjudging quality, value, extent.
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Laws Rule of conduct established and enforced
by the authority, legislation or custom of agiven community, state, or other group.
May change with fluctuating social moralsand viewpoints.
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Ethics Having to do with moral standards,
conforming to the standards of conduct of a
given professional group. Impliesconformity with an elaborated, ideal code ormoral principles.
Concerned with the motivation behind thebehavior
Bioethics is the application of theseprinciples to life-and-death issues
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Ethical Theories
Deontological-based on duty to commitment, considers
the intention of the action, not the consequences of theaction. It is the individuals goodwill that determinesworthiness, not the outcome.
Teleological-(utilitarianism)-what makes an action right orwrong is its usefulness. Right encompasses actions that
have positive outcomes, wrong is composed of actionsthat result in poor outcomes. Principalism-involved in biomedical issues, integrates
ethical principles to resolve conflicts in situations.
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Ethical Principles
Autonomy
Nonmaleficence Beneficence Justice Fidelity
Confidentiality Veracity Accountability
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Autonomy
The freedom to make decisions aboutoneself
Nurses need to respect clients rights to
make choices about health care
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Nonmaleficence
Requires that no harm be caused to anindividual, either unintentionally ordeliberately
This principle requires nurses to protectindividuals who are unable to protectthemselves
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Beneficence This principle means doing good for
others
Nurses need to assist clients in meeting alltheir needs
Biological
Psychological
Social
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Justice
Every individual must be treated equally
This requires nurses to be nonjudgmental
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Fidelity
Loyalty
The promise to fulfill all commitments
The basis of accountability (moral concept thatinvolves acceptance by a professional nurse ofthe consequences of a decision or action)
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Confidentiality Anything stated to nurses or health-care
providers by clients must remain
confidential The only times this principle may be
violated are:
If clients may indicate harm to themselves orothers
If the client gives permission for the informationto be shared
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Veracity
This principle implies truthfulness
Nurses need to be truthful to their clients
Veracity is an important component ofbuilding trusting relationships
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Accountability
Individuals need to be responsible for theirown actions
Nurses are accountable to themselves andto their colleagues
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Ethical Codes These are formal statements of the rules of
behavior for a particular group ofindividuals
Ethical codes are dynamic
Most professions have a code of ethics to
guide professional behavior
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Organizational Ethics
Focus on the workplace
Ethical culture makes a difference Senior leadership must promote an ethical
culture-do they?
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Ethical Dilemmas
Occur when a problem exists betweenethical principles
Deciding in favor of one principle usuallyviolates another
Both sides have goodness and badness
associated with them
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Ethical decision making Consider cause, variables, precipitating events
and implications
Reflect upon ones own perspective and values Explore options for action: ANA code of ethics, facility standard and ethics,
nurse practice act (BRN), legal issues, rights.
Select appropriate plan. Understandconsequences of the plan. Implement Evaluate results
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Current Ethical Issues
f &
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Issues to Consider
Assisted suicide Technology issues-as RN, as patient. Gene therapies, genetic counseling Designer babies, fertility issues, fetal success
Organizational climate Family planning Social responsibility Immigration policies Resource management. Stem cell research DNR status
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Conclusion
An issue is not an ethical issue for the
nurse unless he or she has been asked Always gather the facts prior to decision-
making
Consider your personal beliefs and values
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Quality issues What is it??
The degree of excellence that distinguishesone thing from another
Relates to education and practice;professionals perceive that they areproviding high-quality nursing educationand patient care.
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Why do we need it? * current health care system is fragmented,
poorly organized, inefficient use ofresources.
*New technologies, availability ofinformation (it), decreasing resources,
increasing chronic disease states mandatea change.
* consumer dissatisfaction with current
system
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Quality improvement Also known as performance improvement,
focuses on processes or systems thatsignificantly contribute to client safety andeffective client care outcomes; criteria areused to monitor outcomes of care and to
determine the need for change or improvethe quality of care.(Saunders NCLEX review, 5thedition, Silvestri, L.,2011)
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Professional organizations that focus onquality * Joint commission on Accreditation of
Healthcare Organizations (JACHO)
* American Nurses Association (ANA)
*Institute of Medicine (IOM)
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IOM essential competencies Provide patient centered care
Work in interdisciplinary teams Employ evidence-based practice
Apply quality improvement
Use informatics
Essentials of N rsing Leadership & Management 4th Edition
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Aims of IOM quality of care Safe
Effective Patient centered
Timely
Efficient
equitable
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IOM- cost of inefficiency 44,000-98,000 die each year
$17-29 billion in total costsNursing errors:
*Medication
*knowledge*procedure
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Continuous Quality improvement (CQI)
Identify indicators Collect ongoing data on indicators
Analyze and evaluate data
Implement change
(utilize evidence based practice)
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How to monitor quality of care Guidelines
Protocols Algorithms
Standards of care
Critical pathways
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How does structured care methodologieswork? Link process of care (issue) and outcome
Determine method of measurement Clarify responsibilities of interdisciplinary
team
Facilitate communication among teammembers
Document, apply systematic approach to
measurement.
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Root cause analysis Process of learning from consequences;
Determine influences, establish linkedchains of influences, determine necessaryinfluences, analyze root (initial) cause.
Currently used to analyze errors andmistakes; attempts to evaluate series ofevents that may lead to errors (safetyerrors) and determine causative reason for
error (process), rather than punitively
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Risk management part of QA
Identify potential problems, risks Incident investigation
Sentinel events
Anticipate outcome, prevent recurrence
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conclusion To enhance quality of care;
Think critically Plan and report outcomes
Make introductory rounds
Plan partnership with the client
Communicate plan
Evaluate progress