Nursing Leadership &
Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 23
Ethical Dimensions of Patient
Care
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Objectives

Upon completion of this chapter, the reader should be
able to:
• Define ethics.
• Relate historical and philosophical influences to the ethical
basis for professional nursing practice.
• Develop a personal philosophy of professional nursing.
• Analyze ethical principles and theories as a basis for
professional nursing practice.
• Discuss participation on ethics committees in hospitals.
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Objectives
• Apply a model for ethical decision making to an ethical
dilemma.
• Examine ethical issues encountered in practice including
cost containment, use of technology, and patients’ rights.
• Incorporate a personal ethic of social responsibility and
service into professional practice.
• Promote an ethical culture within the practice setting.
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Definition of Ethics
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Ethics is the system of moral rules and principles that
becomes the standard for professional conduct.
Morals pertain to the distinction between right and
wrong and evolve with the stages of development.
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Historical and Philosophical Influences
on Nursing Practice
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Social need
Religious and spiritual considerations
Women’s influences
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Philosophy
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Philosophy is the rational investigation of the truths
and principles of knowledge, reality, and human
conduct.
Personal philosophies stem from an individual’s
beliefs and values.
A professional nurse’s personal philosophy impacts on
the individual’s philosophy of nursing.
A combination of one’s nursing philosophy and the
organizational philosophy of nursing form a
foundation for ethical behavior in the practice setting.
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Ethical Theories
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Utilitarianism focuses on providing benefits to the
greatest number.
Deontology focuses on duties or the means rather than
focusing on the end to a goal.
Character ethics focuses on traits of a person that
promote goodwill. These traits can be cultivated
through moral reasoning.
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Ethical Principles
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Autonomy refers to convictions of independence, selfgoverning, and the belief that individuals have a right
to self-determination.
The ethical principle of beneficence states that nurses
must act in ways that benefit the patient.
Nonmaleficence obligates nurses to protect patients
from deliberate harm or from uninformed participation
in procedures or research.
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Respect for Human Dignity and
Confidentiality
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Respect for human dignity ensures that patient
participation is voluntary and free of coercion.
Both from a legal as well as an ethical perspective,
nurses have a professional responsibility to
judiciously protect patient information of a
confidential nature.
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Ethics Committees
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These are interdisciplinary committees that help
health care organizations develop ethical guidelines.
They review situations referred by health care staff.
Nurses play an essential role on ethics committees and
must be active participants.
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Ethical Decision Making
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Nurse managers must make decisions at times that
challenge the values the nurse personally holds.
Values are ideals, standards, principles, beliefs,
objects, and behaviors that give meaning and direction
to life. Clarifying values assists nurse managers in
making decisions.
Model for ethical decision making: MORAL decisionmaking model
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Ethical Issues Encountered in Practice
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These include issues related to:
• Technology
• Cost containment
• Patients’ rights/patient advocacy
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Social Responsibility and Service in
Professional Nursing
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Nursing competencies include embracing a personal
ethic of social responsibility and exhibiting ethical
behavior in all professional activities.
Questions can arise as to which aspects of society
nurses owe their loyalty.
Ethical leadership and management are essential.
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Social Responsibility and Service in
Professional Nursing
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Nurses can ensure that ethical principles are adhered
to throughout all practice settings.
Nurse leaders are responsible for creating an ethically
principled environment and for upholding the
standards of conduct set by the profession.
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