Professional Documents
Culture Documents
Chinn, 1995
Peace requires that you do what in your heart
you know that your chosen values guide
your actions.
Learning Objectives
Describe and differentiate ethical dilemmas,
moral uncertainty, practical dilemmas, moral
distress, and moral outrage.
Describe the process of making thoughtful
decisions.
Discuss the nursing process as a decision making
model.
Discuss similarities between scientific process
and ethical decision making
Examine the process of ethical decision making.
Apply the ethical decision making process to
clinical case situations.
Introduction
Everyone makes decisions as part of eveyday
living.
Nurses constantly make decisions such as:
management of care, when to collaborate,
when to innate referrals, etc.
Often we make decisions without conscious
awareness of the process but have an innate
sense of knowing what to do.
Moral / Ethical Problems
Jameton (1984) describes 3 different types of moral
problems:
1. Moral uncertainty: nurse identifies a moral
problem but is unsure of the morally correct
action.
2. Moral distress: when two or more mutually
exclusive moral claims clearly apply and both
seem to have equal weight.
3. Moral outrage: nurse knows the morally correct
action and feels a responsibility to the patient, but
institutional or other restraints make it nearly
impossible to follow through with appropriate
action.
Making Decisions
The process follows a similar pattern in most
circumstances, includes: gathering data,
comparing options, using some criteria for
weighing the merit f each option, and making
a choice.
Evaluation of outcomes provides more data
regarding the rightness of the choice.
Nursing Process and Ethical Decision
Making
As a nurse we commonly use the nursing process
model for decision making.
Utilizing both logical thinking and intuitive
knowing.
Nursing process directs nursing practice,
standardizes nursing care, and unifies nurses.
Nursing process steps by ANA: 1) Problem
identification based on assessment of subjective
and objective data; 2) Determine desired
outcomes; 3) Development of a plan for care; 4)
Implementation of interventions; 5) Evaluation of
the outcomes and revision of the plan over time.
Ethical Decision Making
Differences of culture or values among the
various participants involved in ethical
decision making often become an important
issue.
Holistic view of people, both thinking and
feeling are credible ways of knowing have
legitimate role in ethical decision making.
Process of Ethical Decision Making
1. Gather data and identify conflicting moral
claims
2. Identify key participants
3. Determine moral perspective and phase of
moral development of key participants
4. Determine desired outcomes
5. Identify options
6. Act on the choice
7. Evaluate outcomes of action
A Guide for Decision Making
Gather Data and Identify Conflicting Moral
Claims:
What makes this situation an ethical problem?
Are there conflicting obligations, duties,
principles, rights, loyalties, values, or beliefs?
What are the issues?
What facts seem most important?
What emotions have an impact?
What are the gaps in information at this time?
Identify Key Participants: