 everyone in today's video we are going to be talking all about nursing ethics. If you've not heard of this, where have you been? That's all I seem to have heard during my nursing career all about ethics. But what is it? Why is it? We're going to find out in this vlog. So firstly ethics is actually a Greek word for ethos and ethos means character. Ethical values are almost like a code of conduct in a way and these provide a basis of what that person's actions, intentions and motives are valued to that person. All about right or wrong actions, decision making and the consequences of those actions that you're taking. And we'll all have different morals, we'll all have different ethics, we'll all have different beliefs and cultures and it's really important that we try and get these ethics that we possess ourselves into a more neutral position that we can care for everybody and anybody regardless of what the other person might believe for example. It's really really important that sometimes we have to put our own judgments and morals aside for a patient. If they're making a decision that you might not agree with, I've talked about this before, a patient might make a decision that you're thinking oh that's a really bad decision but that doesn't make it a wrong decision. It is that patient's choice at the end of the day and it's important that you maintain your values and your ethical stance and yeah support the patient. So here are some ethical concepts for you. I've taken these from the RCNI, they do an amazing journal on this which I'll post the link below so you can have a proper read of. Avoiding harm, this should be in every decision you make. Is this decision I'm about to make going to harm my patient? It's as simple as that and this underpins good healthcare practice. And this is exactly why we always go on evidence based practice as well. The research is out there for everything we do or most things that we do. So it's really important to go by evidence based practice to make sure that that harm is completely avoided. Moral obligations and duties. So as a nurse you should always be doing the thing that's the right thing to do. This isn't the right thing to do in your mind, it's the right thing to do in nursing. So something that you might think is right might not actually be right. So this is why again it's important to follow evidence based practice. You're weighing up all of the options in your mind to put together a picture for the patient or a care plan or a management plan, something like that in place. You're getting all that evidence to do the right thing for your patient. So what is going to be the best outcome for your patient? And that leads me very nicely on to the next one. Assessing the consequences of the actions. So you are going to, when you're making a decision, again you're thinking what is the best outcome for the patient? Not for you, not for your colleagues. What is the best outcome to help this patient? And that's going to decide your consequences of your actions and hopefully prevent harm. Autonomy and rights. So as a nurse you should be able to work autonomously, I can never say this word, but that just means you can think for yourself, you can weigh up the options, you can look at the evidence research based practice, you're free from influence from other people around you, you're making that decision with or sometimes on behalf of your patient, you're acting as an advocate sometimes for your patient and you have to do that as an independent, confident, competent person. And what about rights? So what do you think, what sort of rights do you think that you have as a nurse? This is a tricky one actually because don't often think of us having rights, we always think about patients' rights and what's best for the patient. But let's just say a patient came to you and they asked for double the dose of their morphine because they wanted to kill themselves or something like that. You know that that's not right so you know that the right thing for you to do and the rights that you have is not to give that to the patient. If it's going to cause harm to the patient you don't do it and that is your right. You can't get struck off for being a safe nurse, you can't get struck off for evidence-based practice and you can't get struck off for avoiding harm to your patient. But yeah but have a little thing about that and let me know in the comments below what rights do you think that nurses have and you're more than welcome to put some funny answers, that's fine. Best interests, so we just briefly spoke about this as like acting as an advocate for your patient so you must always do what's in the best interest of your patient, not what's for you, not what's for your colleagues again, best interests for your patient and I'm going to give a little example here so as a student nurse on my very first placement that shall never be named I worked with a lovely lovely lovely lovely being a little bit sarcastic healthcare assistant who always did what was right for them, always did what's in the best interest of them, not the patient and this one day I said to a patient you know do you want to wear your own clothes today and they said yeah that'd be really really nice I'll feel a bit more human again, perfect that's what I want to hear, fantastic I've given the patient their choice and their dignity back anyway dressed the patient they looked amazing they had the shirt on they looked fabulous and you can see by their face they actually looked a little bit relieved as well they didn't have to wear those pajamas anymore anyway this healthcare assistant comes along looks at the patient looks at me and says why have you dressed this patient quite loudly in front of everybody in the bay and I said I gave him the choice and he wanted to wear his clothes and she said well it's easier for us if you put them in our hospital gowns or pajamas because now we're going to have to take it all off when we change the catheters and blah blah blah what who is that in the best interest of because it is not the patient at all and I literally just looked at her and I said well I gave the patient choice and their dignity back and I walked away did you never spoke to me again for the rest of that day because do you know what it's in my best interest to do the best that I can for my patients I'm not there to keep people happy I'm not there to please the healthcare assistants or the nurses or the doctors or the top consultants if I if I'm doing my best for my patients that is the best that I can be and that's the best that I can do and I'm giving you this advice too don't do things because someone else has told you to if it's not right don't do it next up we have values and beliefs so we again we've briefly spoke about this at the beginning um so your values and your beliefs should never get in the way of making these best interest decisions they should never get in the way of the patient care that you're given you know and your values and beliefs when you're working as a nurse um should always be about the patient it should always be about patient safety maintaining keeping that patient well preventing harm like we've spoke about and you should have that good ethical decision and actions as your values and beliefs emotions relationships and context now this is a tricky one because if you've got a lot going on at home you've got relationship breakdowns and you're going into work already in that mindset and that bad mood do you think that's going to affect your decisions that you make that day is it going to affect the patient care that you're giving that day because you're having a bad day the answer should be no because you shouldn't be letting anything from your home life or personal life come into effect in work you should always be thinking about the patient always keeping them safe and it can be hard if you are feeling so low inside and you've got that mentality that you don't want to be at work it can be really hard to push that aside and do the best um so it's really important if you are having struggles or anything like that to firstly speak up about it get support and get some help maybe take some time off as well so that you can recharge and come back being your best self so that you can create this positive and safe environment for your patient moral character so for this one i'm going to break it down into two sections so moral relates to your beliefs of what is right or wrong and then character is all of the qualities a person has to distinct them from one person to another person so put them both together and you have moral character so something that makes somebody um like a good person someone that may do the the right thing rather than the wrong thing depends what the right or wrong thing is that sort of thing is moral character and i just wanted to add here you know sometimes we all make mistakes sometimes we all get it wrong um it doesn't mean that you're a bad person it doesn't mean that you're less of a nurse for it you know it is life it's the way that life is sometimes we might make a decision and it might go horribly wrong but you've acted in the best interest of your patient you've followed the evidence the best evidence practice and it can still go wrong but as long as you can show your rationale behind your decisions that you're acting in the best interest of the person then don't worry you know mistakes do happen mistakes have happened to me i'm sure they've happened to you already and that's okay be kind to yourselves so as i was doing a little bit of research around ethics and nursing i found a really good like code of ethics from the american nurses association code of ethics for nurses so i'm just going to read some of them out and see what you think i've got my laptop here i will put the links below though if you want to read yourself that's fine so provision one the nurse practices with compassion and respect for inherent dignity worth and unique attributes of every person i'd say that was a good one provision two the nurses primary commitment is to the patient whether an individual family group community or population interesting um for me this is a 50-50 one because sometimes what if the family are causing the problem to the patient if that makes sense and you have to think about the safeguard and then stuff like that so yeah absolutely we will get the whole family involved in decision-making um patient care um like family meetings and hospitals and things like that um but if there was a concern obviously your whole focus isn't going to be on the the whole family provision three the nurse promotes advocates for and protects the right health and safety of the patient yes that is right provision four the nurse has authority accountability and responsibility for nursing practices decisions and takes actions consistent with the obligation to provide optimal patient care yes every nurse should take accountability for their actions 100% agree provision five oh how many other there's nine um vision five the nurse owes the same duties to self as others oh yes including the responsibility to promote health and safety preserve wholeness of character integrity maintain competence and continue personal professional growth yes i think that's one of my favorite ones because we should all be looking after ourselves as much as we look after the patients thank you thank you provision six the nurse through individual and collective effort establishes maintains and improves ethical environment of work of the work setting and conditions of employment are conducive to safe quality health care yes i think every nurse should be doing that as well absolutely agree with that one provision seven the nurse in all roles and settings advances the profession through research and scholarly inquiry professional standards development and the generation of both nursing and health policy well yeah we should be doing that we should all be following evidence-based practice and research and all that jazz so yes that is also in the uk guys provision eight the nurse collaborates with other health care professionals and the public to protect human rights promote health diplomacy and reduce health disparities yes we do that anyway provision nine last but not least guys the profession of nursing collectively through its professional organization must articulate nursing values maintain integrity of the profession and integrate principles of social justice into nursing and health policy again we do this anyway like we've got the nmc nursing code of conduct we have to follow and this talks about this at all times upholding the profession being professional social media etc absolutely so the wonderful people at the rcn have created this really good guide that i've just found and it's called this is it this is what it looks like have a look at it i'll put the links below but there's a really good thing on when to go out on placement so this talks about finding out the trust set of values and principles and how you can meet these whilst you're on placement beautiful and how do these values sort of coincide with ethics and principles of nursing that sort of thing nmc code of conduct and what the themes that you can pull out from these values find out how quality and safety are monitored and in particular how how this is going to be fed back to the staff as well so are there any audits that are done cqc reports things like that and are they reported back to the nurses have a look at the recent patient surveys that that have been done what's good what's bad what can be improved have a look at that because that'll sort of guide you as well and what sort of area you're looking at when you're on placement have a look around are these people that you're working with upholding the trust values have a look is there any actions that can be taken from this and if there are any actions that you've noticed how do you bring that up in placement who do you speak to you know because these conversations can be difficult it's really hard to go somewhere where they've worked for years and years and years and sometimes they don't realize what's going on and what's happening because they're just doing the same thing they're an autopilot every single day so they don't realize sometimes what's happening or the change needs to be made for example so those conversations can be really hard so think about what you might say to somebody or management or setting up a meeting with staff to talk about it how would you deal with that and when you go back to university and you're moving on to your next placement keep these principles and values in mind how do they differ between trusts and placements is a really good thing and you'll find actually there are some similarities and there are some themes that run through everybody's trusts and values and a lot of it is about best care and patient safety and actually on this pdf file there's really good reflective questions for students about episodes of care so maybe this could be something that you could fill out whilst you're on placement and at the end of your placement you could hand it to the manager because i mean you're not going to see them again and you don't have to work with these people again but if there's stuff there that i mean it talks about what what's what stood out for you what positive things that's a really good thing to feedback to people what have you noticed from the values of the trust that have been implemented in that practice again really good stuff to be putting in there are there any areas that are concerning or could be improved on again a really nice question you know it's not targeting anyone it's not causing trouble you're just putting areas for improvement i think this is a really good document if you've got any concerns or anything on placements and you don't feel confident enough to speak up this is really good way to do it i think i think print this out fill it out and hand it in put it on the desk or something to the manager when you leave and you can probably just do it anonymously as well just drop it in and then it's planted that seed then for them to think oh i need to look at this i'm on it guys so going back to the RCNI and ethics whatever i'm speaking about there's a really good case scenario here and i just want to run through it with you because it's a really really good one and it does make you think so this case scenario i'm going to read it from a screen again because maybe i'll do it this way so i'm not looking that over there i don't know how to do this guys i see this is why i don't plan vlogs or have a script because it just goes wrong so george age 70 recently underwent abdominal surgery when it was discovered that he had a carcinoma of the stomach so cancer in the stomach it was not possible to remove this tumor and there was an evidence of secondary cancerous growth in the liver so this is spreading it's getting worse for the guy george's family has been informed of the prognosis they have requested that he george should not be told the truth until it's absolutely necessary what would you do now the thing for me this poses more questions to me than anything else and the answer isn't here it just there is a lot of questions um but my question would be okay firstly does george have capacity has he got capacity to understand the information you're giving him and is this information going to cause way more distress than necessary to this patient so if this patient has capacity they understand fully what's going on this i'm sorry you cannot withhold information from your patient um it's all about you know we spoke about ethics and truth telling and the rights and best interests of the patient is it in the best interest of the patient yes because this patient needs to make a decision this patient needs to make a decision about their care they're going to receive the treatment that they're going to receive they're going to um have to make the decision about maybe end of life care putting a do do not attempt resuscitation in place if that's what they wanted there's a hundred and one things that this patient needs to be um involved with and you can't withhold this information just because the family aren't happy with it um however on the flip side if this patient was you know they had later stages of dementia they're not going to fully understand this information um it's going to cause way more distress than necessary and you've got the family as the um power of attorney and things like that then you might think slightly different about it i know i would definitely think slightly different about it and i'd be weighing up these options with the family with my colleagues with the consultants as well to make the best decision and the best interests of that patient that's just my thoughts around it my thoughts might not be right they might be wrong who knows but yeah again comment below let me know what you think about this scenario what would you do what is what is the best thing for this patient in this scenario and also my last question for this is why have the family been told but not george yet why is that what's happened there um surely the patient should be the first one to know unless again they've got power of attorney they've got dementia they haven't got capacity then you would might go to the family member instead but i want to know why why why's the family been told has confidentiality been broken in this case um those little things okay i think i've covered enough on ethics i think i've covered as much as i can without boring you to death but i think it's a really really interesting discussion actually and some really good food for thought as well along with it think about what you do in your practice think about what ethical decisions that you might have to make have a think about different scenarios like george and how you would handle them but most of all think about just being a good nurse always act in the best interest of your patient the safest way possible and if as long as you're doing that and you can rationalize every single decision you make you're on to a winner guys so go out there keep be amazing you've got this