🛌Adult Nursing Care Unit 17 – Ethical Considerations in Adult Care

Key Ethical Principles in Adult Care

• Autonomy recognizes the right of patients to make their own informed decisions about their care and treatment
• Beneficence involves acting in the best interest of the patient to promote their well-being and prevent harm
• Non-maleficence means avoiding actions that could cause harm to the patient, following the principle of "first, do no harm"
• Justice ensures fair and equitable distribution of healthcare resources and access to care for all patients
• Veracity upholds the importance of truthfulness and honesty in communication between healthcare providers and patients
• Fidelity involves maintaining trust and loyalty in the patient-provider relationship by fulfilling commitments and responsibilities
• Respect for persons acknowledges the inherent dignity and worth of every individual, regardless of their background or circumstances
• Paternalism, while well-intentioned, involves making decisions on behalf of the patient without their input or consent (should be avoided in most cases)

Legal Framework and Patient Rights

• Healthcare providers must adhere to federal and state laws governing patient care, such as HIPAA (Health Insurance Portability and Accountability Act)
• Patients have the right to receive information about their diagnosis, treatment options, and prognosis in a way they can understand
• The right to refuse treatment allows patients to decline medical interventions, even if the provider believes it is in their best interest
• Patients can designate a healthcare proxy or surrogate decision-maker to make choices on their behalf if they become incapacitated
• Advance directives, such as living wills or durable powers of attorney, enable patients to communicate their preferences for future care
• Healthcare facilities must maintain a safe and secure environment that protects patients' physical and emotional well-being
• Patients have the right to access their medical records and request amendments if they believe there are errors or omissions

Informed Consent and Capacity

• Informed consent is a process that involves providing patients with sufficient information to make an autonomous decision about their care
  • This includes discussing the nature of the proposed treatment, its risks and benefits, and alternative options
• Patients must have decision-making capacity to provide valid informed consent
  • Capacity refers to the ability to understand the information provided, appreciate the consequences of the decision, and communicate a choice
• In situations where a patient lacks capacity, healthcare providers must turn to surrogate decision-makers or advance directives for guidance
• Exceptions to informed consent may apply in emergency situations where immediate treatment is necessary to prevent serious harm or death
• Documentation of informed consent discussions and decisions is crucial for legal and ethical purposes
• Patients have the right to withdraw consent at any time, even if they have previously agreed to a treatment plan
• Assessing capacity is an ongoing process, as a patient's ability to make decisions may fluctuate over time due to factors such as illness or medication side effects

Privacy and Confidentiality

• Healthcare providers have an ethical and legal obligation to protect patients' privacy and the confidentiality of their medical information
• The HIPAA Privacy Rule establishes national standards for safeguarding protected health information (PHI) in both electronic and physical forms
• Confidentiality extends beyond medical records to include conversations, photographs, and any other patient-related information
• Breaches of confidentiality can erode trust in the patient-provider relationship and lead to legal consequences for the healthcare facility
• Exceptions to confidentiality may apply in cases of mandatory reporting (suspected abuse or neglect) or when there is a serious threat to public health and safety
• Patients have the right to request restrictions on the use and disclosure of their PHI, although healthcare providers may not always be able to comply with these requests
• Special considerations for privacy and confidentiality may arise in situations involving minors, incapacitated adults, or individuals with mental health conditions

End-of-Life Care and Decision Making

• Advance care planning involves discussing and documenting a patient's preferences for end-of-life care before they become incapacitated
• Palliative care focuses on providing comfort, symptom management, and support for patients with serious or life-limiting illnesses
• Hospice care is a type of palliative care that specifically addresses the needs of patients who are nearing the end of life
• The principle of double effect recognizes that some treatments intended to relieve suffering (high-dose pain medication) may have the unintended consequence of hastening death
• Withholding or withdrawing life-sustaining treatments, such as ventilators or feeding tubes, may be ethically appropriate when they no longer provide benefit or align with the patient's wishes
• Physician-assisted dying, while legal in some states, remains a controversial and complex ethical issue in healthcare
• Healthcare providers must navigate the challenges of balancing patient autonomy, family dynamics, and their own moral beliefs when making end-of-life decisions

Cultural Competence and Diversity

• Cultural competence involves understanding and respecting the diverse beliefs, values, and practices of patients from different backgrounds
• Healthcare providers should strive to deliver culturally sensitive care that acknowledges the impact of factors such as race, ethnicity, religion, and language on health outcomes
• Effective communication is essential for building trust and rapport with patients from diverse cultural backgrounds
  • This may involve using professional interpreters, avoiding medical jargon, and being mindful of nonverbal cues
• Cultural humility encourages healthcare providers to engage in ongoing self-reflection and learning about the cultures and communities they serve
• Recognizing and addressing implicit biases can help prevent disparities in the quality of care provided to patients from marginalized or underserved populations
• Incorporating cultural assessments into patient care can help identify unique needs, preferences, and potential barriers to treatment adherence
• Healthcare organizations should prioritize diversity and inclusion initiatives to create a welcoming environment for both patients and staff

Ethical Dilemmas in Adult Nursing

• Ethical dilemmas arise when there are conflicting moral principles or obligations that make it difficult to determine the right course of action
• Resource allocation dilemmas occur when there are limited healthcare resources (intensive care beds) and competing patient needs
• Futility of care dilemmas involve situations where the proposed treatment is unlikely to provide meaningful benefit or may prolong suffering
• Confidentiality dilemmas can emerge when healthcare providers must balance their duty to protect patient privacy with the need to prevent harm to others
• Moral distress can occur when nurses feel constrained from acting in accordance with their ethical beliefs due to institutional policies or hierarchical pressures
• Ethical dilemmas related to patient autonomy may arise when a patient's decisions conflict with the recommendations of the healthcare team or the wishes of family members
• Navigating ethical dilemmas requires a systematic approach that involves identifying the relevant principles, gathering information, considering alternative perspectives, and seeking guidance from ethics committees or consultants when necessary

Applying Ethics in Clinical Practice

• Ethical decision-making frameworks, such as the four-quadrant approach or the MORAL model, provide structured guidance for resolving complex dilemmas
• Interdisciplinary collaboration, including input from nurses, physicians, social workers, and other professionals, can help ensure that multiple perspectives are considered in ethical deliberations
• Ethics committees and consultants serve as resources for healthcare providers seeking guidance on difficult cases or policy development
• Ongoing ethics education and training is essential for fostering a culture of ethical awareness and accountability within healthcare organizations
• Nurses can advocate for patient rights and ethical practices by speaking up when they witness or experience moral distress or ethical violations
• Reflective practice, including journaling or debriefing sessions, can help nurses process their experiences and identify areas for personal and professional growth
• Applying ethical principles consistently and transparently can help build trust with patients, families, and colleagues, ultimately improving the quality of care provided