Nursing Ethics

By :

Tri Anjaswarni Harsono, S.Kp. M.Kep

~ Tri Anjaswarni Harsono ~ Nursing
Ethics & Decision Making

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

Attitude and Beliefs

An attitude is a feeling or an emotion,
generally including positive or negative
judgment, toward persons, objects, or
ideas.
Beliefs refer to a special class of
intellectual attitudes based primarily on
faith as opposite to fact.
Attitudes and Beliefs also influence human
behavior
~ Tri Anjaswarni Harsono

A persons values influence beliefs about :

human need, health and illness
The practice of health behavior
Human responses to illness

Nurses who work effectively with clients

are sensitive to how a clients values and
their own values influence their
interaction.
~ Tri Anjaswarni Harsono

Common Modes of Value

Transmission
Modeling
Moralizing
Laissez-faire
Rewarding and punishing
Responsible choice

~ Tri Anjaswarni Harsono

Definition of Ethics & Moral

Ethics is
a system dealing with professional
standards of behavior related to
what is right and wrong.
Morals, although similar in
meaning to ethics, usually refers
to personal standards
~ Tri Anjaswarni Harsono

Ethics & Moral (Cont.)

Ethics is that science which
studies the morality of human
acts through the medium of
natural reason
Ethics teaches us how to judge
accurately the moral goodness
or badness of human action
~ 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

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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

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Ethical Values
Aesthetics
Altruism
Equality
Freedom

Human Dignity
Justice
Truth

~ Tri Anjaswarni Harsono

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Values
Aesthetic

Qualities of objects, events, and

persons that provide satisfaction

Altruism

Concern for the welfare of other

Equality

Having the same rights,

privileges, or status

Freedom

Capacity to exercise choice

~ Tri Anjaswarni Harsono

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Values
Human Dignity
Inherent worth and
uniqueness of an individual
Justice
Upholding moral and legal
principle
Truth
Faithfulness to fact or reality

~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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Human Dignity
Personal Quality Professional
Consideration
Behavior
Safeguards the
Empathy
individuals
right
to
Humaneness
privacy
Kindness
Maintains
Respectfulness
confidentiality of
client & staff
Trust

Threats others with

respect

~ Tri Anjaswarni Harsono

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Justice

Personal Quality Professional Behavior

Integrity
Acts as a health
care advocate
Morality
Allocates resources
Objectivity
fairly
Report incompetent,
unethical, & illegal
practice objectively
& factuality
~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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Ethical Principles
Autonomy
Justice
Beneficence
Veracity

Confidentiality
Non
maleficence
Fidelity
Avoiding Killing

~ Tri Anjaswarni Harsono

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Autonomy
Berhub. Dg kemerdekaan atau
kebebasan klien (independence)
Hak utk memilih bagi seseorang (the
clients freedom of choice)
Self-determination
Penerapan informed consent

~ Tri Anjaswarni Harsono

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Justice
Memperlakukan orang lain secara adil
tanpa membedakan status sosial, ras,
agama, dsb.
Merupakan prinsip moral utk berlaku adil
bagi semua individu

~ Tri Anjaswarni Harsono

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Beneficience
Prinsip berbuat kebaikan / baik
(promote good)
The nurse should do
Upaya kebajikan perawat untuk
menyelesaikan pekerjaan yg
terbaik utk klien

~ Tri Anjaswarni Harsono

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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.

~ Tri Anjaswarni Harsono

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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

~ Tri Anjaswarni Harsono

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Non Maleficence
Do no intentional harm (prinsip

melakukan tindakan tanpa bahaya)

atau tidak membunuh / prinsip
tidak menimbulkan kerugian bagi
orang lain
The basis for most nursing

~ Tri Anjaswarni Harsono

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Fidelity
Good faith to keep promises
made to the client (komitmen /
mempertahankan janji dg klien)
Loyality to the client care
provider relationships.

~ Tri Anjaswarni Harsono

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Avoiding Killing
Menekankan pada kewajiban

perawat utk menghargai kehidupan

Kewajiban perawat menghargai
eksistensi kemanusiaan yg memp.
Konsekuensi melindungi dan
mempertahankan kehidupan dengan
berbagai cara.

~ Tri Anjaswarni Harsono

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Basic Moral Concepts

Jameton, 1984 in Taylor, Lillis, LeMone, 1989

Five Basic Moral Concepts

Respect for Persons
(empathy, listening & understanding)
Justice
Values
Right
Responsibility
~ Tri Anjaswarni Harsono

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Problems in Clinical
Practice
Ethical Issue
Ethical Problem
Ethical Dilemma
Bio Ethic
~ Tri Anjaswarni Harsono

32

~ Tri Anjaswarni Harsono

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MORAL & ETHICAL PROBLEMS

&

DECISION MAKING

By :

Tri Anjaswarni Harsono, S.Kp. M.Kep.

~ Tri Anjaswarni Harsono

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

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Ethical Issue
One in which one or more moral
norms or principles are
present, but do not create a
problem
~ Tri Anjaswarni Harsono

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Ethical Problem
One in which two or more
moral norms or principles
create a challenge about what
to do
~ Tri Anjaswarni Harsono

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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

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Three Type of
Moral and Ethical Problems
Jameton (1984) in Taylor, Lillis, LeMone (1989)

Moral Uncertainty, where the nurse is unsure

of which moral principles or value apply.
Moral Dilemma, where two or more clear
moral principles apply but support mutuality
inconsistent courses of action.
Moral Distress, where the nurse knows the
right thing to do but institutional constraints
make it nearly impossible to pursue the right
action
~ Tri Anjaswarni Harsono

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

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Conflicts areas are

explored
Personal value systems
Peers and other professionals
behavior
Patients rights
Institutional & societal issue
~ Tri Anjaswarni Harsono

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

~ Tri Anjaswarni Harsono

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

~ Tri Anjaswarni Harsono

44

Type of
Moral and Ethical Problems (Cont.)
Nurses and
Other Nurses

Claim of loyalty
Nurse
incompetence

Nurse and
Institutional

Inconsistent
Rules
Policy

~ Tri Anjaswarni Harsono

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

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Ethical Decision Making

Comparison of Nursing Process And Ethical
Decision Making Model
Nursing Process
Assess

Analyze & diagnoses

Plan
Implement
Evaluate

Ethical Decision Making

Model
Clarify the ethical
dilemma
Gather additional data
Identify option
Make a decision
Act
Evaluate

~ Tri Anjaswarni Harsono

47

Process for
resolving the ethical
Problems
Step I

: Identify The problem (Clarify

the ethical dilemma)
Step II : Gather additional data
Step III: Identify option
Step IV : Make a decision
Step V : Act
Step VI : Evaluate
~ Tri Anjaswarni Harsono

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

Step III : Identify Option

List all alternatives to solve the problem
Give reason on each alternatives
Consider immediate consequences to the
people involved as well as long term
consequences to the institution / society
Brainstorm with others and consider every
possible alternative.
~ Tri Anjaswarni Harsono

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Step IV : Make Decision

Think through the option that are identify
and determine each options impact.
Ethical principles and theory may help
determine the significance of each option.
Choose a course of action that best reflect
your considered judgment, consultation
with an institutional ethics committee or
other staff may be helpful.
~ Tri Anjaswarni Harsono

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

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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

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Factors Affecting Decision

Making Process
Personal values (client, nurse, other
professional)
Institutional Values
Social values
Individual purpose
Institutional Purposes
Nurses Knowledge
~ Tri Anjaswarni Harsono

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~ Tri Anjaswarni Harsono

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