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• are instructions that indicate health - the designation must be in writing and
care intervention to initiate or must be signed and dated by the person
withhold, or that designate someone making the designation and two
who will act as a surrogate in making witnesses other than the designated
such decisions in the event that we lose surrogate
decision making capacity
- The designating person may revoke the
• Can be considered as a kind of designation any time by changing the
informed consent for future person named as surrogate or by
interventions destroying the document
• It supports people in making decisions - The authority of the surrogate does not
on their own behalf and help to ensure become effective until it has been
that patients have the kind of end-of- determined that the person has lost
life care they want decision-making capacity – authority is
effective only for the duration of the
• Types of Advance Directives loss of decision making capacity
• 1. Living wills – are legal documents Nursing Role and Responsibilities in
giving directions to health care
Advance Directive
providers related to withholding or
withdrawing life support if certain - Ensuring that patients have an
conditions exist. opportunity to complete advance
directives and in interpreting and
• - they guide decisions by indicating a following through with patient’s wishes
person’s desire regarding life sustaining
as expressed through these directives
interventions; however they also raise
issues of concern as the directives may - The need to know state’s statutes that
be vague and address only guide and given advance directives
interventions a person does not want (
in some states only the terminally ill or - The need to know policies and
those whose death is imminent is procedures regarding advance
allowed to make living wills) directives of the workplace
Everyone makes decisions as part of • What are the gaps in information at this
everyday living. Some decisions seem time?
routine, other decisions like which job 2. Identify Key Participants
to accept or whether to marry call for
more deliberation. - Identify the key persons involved in
the decision making process and
- The process of decision making in ethics delineate each person’s role.
follows a procedure that is similar to Determining rights, duties, authority,
the scientific process. “ A comparison context and capabilities of decision
between the giving of good reasons in makers is a critical component of the
science, which is called explanation and process. The focal question is, “Whose
the giving of good reasons in ethics, decision is this to make?”. Identification
which is called moral justification of the principal decision maker is
PROCESS OF ETHICAL DECISION sometimes all that is needed to
MAKING facilitate the process
When the patient’s wishes are in III. The nurse promotes, advocates
conflict with others, the nurse seeks for and strives to protect the
to help resolve the conflict- where health, safety and rights of the
conflict persists, the nurse’s patient.
commitment remains to the
identified patient. • No one should be the subject of
medical or genetic
• Conflict of Interest for Nurses experimentation, even if it is
therapeutic, unless the person
Nurses must examine the conflicts or surrogate first has given free
arising between their own personal and informed consent.
and professional values, the values
and interest of others who are • The nurse "must be alert to and
responsible for care and health care take appropriate action
decisions, as well as those of regarding any instances of
patients. Nurses strive to resolve incompetent, unethical, illegal
such conflicts in ways that ensure or impaired practice by any
patient safety, guard the patient’s member of the health care
best interest and preserve the team or the health care system
professional integrity of the nurse. or any action on the part of
others that places the rights or
• Collaboration – is not just cooperation, best interests of the patient in
but it is the concerted effort of jeopardy"
individuals and groups to attain a
shared goal (addressing health needs).
• The Code of Ethics makes an personal risk to advocate for the
interesting distinction between patient.
questionable practice and
impaired practice, • Responsibility "refers to the
specific accountability or
acknowledging the difference
between such things as a self- liability associated with the
medicating nurse under a great performance of duties of a
deal of stress, a colleague who particular role"
is overtly incompetent due to • What exactly are nurses
drug abuse, or a clinically responsible for, other than
incompetent practitioner. providing good patient care?
• Provisions 4-6: Duty and Loyalty • They are responsible for
• IV. The nurse is responsible and assessing their own
competence, and seeking
accountable for individual nursing
practice and determines the remedies when certain
appropriate delegation of tasks responsibilities fall outside their
consistent with the nurse's obligation to competency.
provide optimum patient care • Nurses do this by seeking
• Each nurse is individually accountable educational resources, and
and responsible for his or her own collaborating with others,
practice. What is the difference including nurse educators.
between accountability and • All nurses are required to
responsibility? Accountability "means to continually assess and improve
be answerable to oneself and others for their own competence through
one's own actions continuing education, self-
• "for judgments made and actions taken study, networking, and formal
in the course of nursing practice, programs.
irrespective of health care organizations • 5. The nurse owes the same duties to
policies or providers' directives," self as to others, including the
• Nurses act under a code of ethical responsibility to preserve integrity and
conduct that is grounded in moral safety, to maintain competence, and to
principles of fidelity, and respect for continue personal and professional
dignity, worth and self-determination of growth.
patients” • Addresses duties to self in a very new
• When policies of the hospital or actions and compelling way. In addition to
by physicians are not in the patient’s physical health, continuing education
best interest, nurses may have to take a and financial security, the code also
includes wholeness of character, maintaining an ethical
identity and integrity environment.