Introduction to the CNO Standards of Practice

1
Introduction to the CNO Standards of Practice

• Ethics
• Professionalism
• Confidentiality

2
Moral Implications of Health Promotion

• How do we think about health?
• What is the goal/aim of nursing practice?
• What is the place of nursing in society?
• How might our views lead to harm?
• How do we minimize the risk of doing harm?

3
Ethics

• Ethics is the systematic exploration of what is
  right or wrong. It is an attempt to understand or
  make sense of our moral experience. It helps to
  determine the rules that ought to govern human
  conduct, the values worth pursuing, and the
  character traits deserving development in life.
• Keatings, M. ONeil B., (2000). Ethical legal
  issues in Canadian nursing (2nd ed.)
  TorontoHarcourt

4
NURSING ETHICSA form of biomedical ethics

• It focuses on the moral questions within the
  sphere of nursing practice and the nurse-client
  relationship.

5
Ethics of Care

• The ethics of care is relational, contextual and
  empathetic (listen to the story).
• One uses inductive reasoning.
• Advocates spontaneous caring for others.
• The agent becomes part of the situation.
• The focus is on caring not justice.

6
Nursing Ethics

• The moral sense of practice.
• The commitment in the relationship is because
  one cares not because it is a duty.
• Relationships built on respect, personal dignity,
  and integrity.

7
Ethical Values

• Client well being
• Client choice
• Privacy Confidentiality
• Respect for life
• Maintaining commitments
• Truthfulness
• Fairness

8
ETHICAL FRAMEWORK

• Why an ethical framework?
• Ethical conflict/dilemma
• Ethical uncertainty
• Ethical distress

9
DILEMMAS

• Choice between equally satisfactory or
  unsatisfactory alternatives.
• Conflict between ones ethical principles one.
• No satisfactory solution.
• No absolutely correct answer.
• Caught between a rock and a hard place

10
ETHICAL CONFLICT/ ETHICAL DELEMMA

• A situation in which two or more ethical
  values/principles conflict and no matter which
  alternative one chooses there will be undesirable
  consequences.
• No win situation.

11
ETHICAL PROBLEM/ ETHICAL DISTRESS

• One clearly and undeniably knows the right/good
  thing to do but accomplishing it is extremely
  difficult.

12
Ethical Values Key to Nursing

• Nurses must uphold the moral and ethical
  standards of the profession.
• Codes give us structure and principles that guide
  our behaviours and moral reasoning.
• They define acceptable and unacceptable
  behaviours and rules of conduct.

13
Incorporate into your practice

• ICN Code for Nurses
• CNA Code of Ethics
• CNO Ethical Framework
• ANA Code of Ethics
• primary principles of autonomy,
• beneficence, nonmaleficence, justice and the
  secondary principles of veracity, fidelity and
• confidentiality.

14

• The code does not provide rules of ethical or
  moral behaviour for every circumstance.
• The code does not offer guidance about which
  values should take priority or how they can be
  balanced in practice.

15
ETHICAL DECISION MAKING

• There is no one way of resolving situations.
• Important to use a model or framework to provide
  structure that helps you think logically and
  clarify an ethical issue.

16
Key Preliminary Questions

• Is it an ethical dilemma?
• Whose dilemma is it?
• Who should decide?
• What are the key conflicting values?

17
Common Ethical Issues

• Informed Consent
• Advanced Directives
• Quality of Life
• Allocation of Scarce resources
• ( Resource Utilization)

18
ETHICS COMMITTEES

• Offer Education
• Develop and review policies
• Ensure policies are understood and followed
• Serve as resource persons and consultants

19
Behaviours of Professional Nursing

• Nurses need to choose ethical interventions that
  meet client needs
• Nurses first need to be aware of their own
  personal values beliefs
• (requires ongoing self reflection)
• Not always possible to find a resolution that
  satisfies everyone

20
PROCESS

• Assessment
• Clients beliefs, values, cultural influences,
  context, wishes
• How does the health belief model helps us?
• Examine your beliefs/values and identify the
  values of colleagues
• Consider policies,codes of ethics, relevant
  legislation

21
PROCESS

• Discuss
• Clearly state the dilemma
• Identify a broad range of options