1. Ethical Decision
Making
Katelyn Taylor, Debrisha Johnson,
Tanasha Varino, Rhonda Hyde
D’Andra Humphrey, Pam Moore
Britni Anderson, Katherine Washington
NURG 5820
Fall 2013

2. What is Ethical
Decision Making?
(Hamric &
Delgado, 2009)
The
identification, deliberation
and resolution of difficult
moral problems
With increasing demands
on health care
providers, there are
increasing restrictions that
battle the APNs fundamental
values
We must recognize moral
dilemmas when they arise
and hold ourselves
accountable to our values
and ethical codes
―Ethical decision making
reflects both the art and

3. Ethical Decision
Making in Hamric’s
Core Competencies
of APN framework
(Hamric, et al., 2009)
Advance clinical practice
presents numerous ethical
issues
APN must be able to
adequately deal with ethical
problems
Ethical decision making
transitions the APN from a
technical role to a role that
blends clinical knowledge with
humanistic and spiritual
knowledge

4. Ethical Decision Making in Hamric’s Core
Competencies of APN framework cont’d
 Ethical Decision making is seen in the APN
expanded collaboration skills
 Provides APNs with knowledge to reduce power
struggles, communicate effectively with
interdisciplinary team, and facilitate consensus
within the team when dealing with ethically difficult
situations
(Hamric et
al., 2009)

5. Ethical Decision Making in Hamric’s Core
Competencies of APN framework cont’d
 Occurs in 4 Phases (knowledge
development, Knowledge application, creating an
ethical environment, and promoting social justice
within the healthcare system)
 Not entirely linear
 Competence in each phase depends on acquisition
of skills and knowledge gained in the previous
phase
 Considered an evolutionary process in APN role
development
(Hamric et al., 2009)

6. Traits of Ethical
Decision Making
(Nasman,Nystrom, Eri
ksson, 2012)
A trait is a quality or
characteristic….a feature
 Quality of care
 optimizing the good and
minimizing the evil in care
 act out of human love and
mercy
 Virtue
 manifestation of the
absolute Good
 Humility
 Holistic Decisions

7. Traits of Ethical Decision Making
cont’d
 Veracity and Justice
 Systematic Approach/Structure
 ―Ethical decision making requires a systematic
approach and a schema to make practical ethical
judgments‖ (Fasser, Erdman, Scott, & Waters, 2007
p. 35)
 Evidenced Based
 research-based care,as well as a care where caring
is made visible, truthful, good, and beautiful—that is
quality!
(Nasman et
al., 2012)

8. Because of these traits:
the right things
at the right time will be done
and for the right reasons
Which is:
ETHICAL DECISION MAKING!
(Nasman et al., 2012)

9. The virtues permeate the nurse’s
becoming, being, and doing. Living the
virtues helps the nurse to transform the
values into deeds, deeds that have the
patient’s best interest in mind, making use
of evidence-based nursing as an art in the
ethical act of caring.
(Nasman, et al., 2012)

10. Phases
(Hamric &
Delgado, 2009)
 Phase 1: Knowledge
Development - Moral
Sensitivity
 Phase 2: Knowledge
Application – Moral
Action
 Phase 3: Creating an
Ethical Environment
 Phase 4: Promoting
Social Justice Within the
Health Care System

11. Alternatives to ethical approaches
 Casuistry
 Direct analysis
 Practical
 Narrative Ethics
 Full context
 All parties considered
 Virtue-Based Ethics
 Moral decision
 Feminist Ethics
 Women and minorities
considered
 Balance of power
 Care-Based Ethics
 Connection
 Interdependent
(Hamric & Delgado, 2009)

12. Strategies to resolve ethical
conflicts
(Hamric &
Delgado, 2009)
 Collaboration
 Perspectives
 Interaction and
consensus
 Decision and
planning
 Compromise
 Accommodation
 Coercion
 Avoidance

13. Sense making
(Caughron et al., 2011)
 Problem recognition
 Situation developing
 Information gathering
 Relevant information
 Determining preconceived
ideas vs. truth
 Information integration
 Pattern identified
 Solution determined
―ethical decision making is the
pattern of results bearing on the
relationship between sensemaking
and ethical decision making‖ (p.
364)

14. Ethical Decision-
making in APRN
practice
Example #1:
Organ procurement and a
patient's wishes
(Buppert, 2012)

15. Ethical Decision-
making in APRN
practice cont’d
(Buppert, 2012)
Example #1
Steps:
 1. Ethical analyses
2. Gather information

16. Ethical Decision-
making in APRN
practice cont’d
(Buppert, 2012)
Example #1
Steps:
3. Structure a plan
4. Make a decision

17. Ethical decision-
making in APRN
practice
(Fernbach, 2011)
Example #2
Do I Consent to Have My
Child Immunized or Not?
 Role of the NP
 Parental reasons
 Responses to parent

18. Ethical decision-
making in APRN
practice cont’d
(Fernbach, 2011)
Ethical principles
 Autonomy
 Beneficence
 Non-maleficence

19. Research example
1
(Young, 2010)
Not providing medications
that violate moral principles
Advantages in evoking
ethical decision making
Agreement within literature
Limited right to refuse to
participate in therapies that
threaten their values and
beliefs
Referring to a clinician
who provides these services

20. Cont’d
There are a number of advantages in allowing nurses
to evoke these ethical situations as reasons for
participating in certain procedures:
 In general society does not want a clinician to
forsake their own morals when entering a
profession, the community usually embraces this
concept
 Ethical decision making allows professionals to
exercise autonomy and independent judgment
(Young, 2010)

22. Cont’d
 a successful process does not always result in a
satisfactory outcome‖ (p. 337)
 the outcome may leave ―moral residue‖, and continue to
trouble those involved
 ―the outcome may reveal the need for changes within the
institution or healthcare system on a state or federal
level‖ (p. 337)
 the APN must deliberate and reflect on the outcome, and
formulate how similar situations could be anticipated and
resolved in the future
(Hamric & Delgado, 2009)

23. References
 Buppert, C.P. (2012). Resolving ethical dilemmas. In R. Shuster
(Ed.), Nurse practitioner's business practice and legal guide. (pp.
487-488). Sudbury, MA: Jones & Barlett Learning.
 Caughron, J. J., Antes, A. L., Stenmark, C. K., Thiel, C.
E., Wang, X., & Mumford, M. D. (2011). Sensemaking Strategies
for Ethical Decision Making. Ethics & Behavior, 21(5), 351-366.
doi:10.1080/10508422.2011.604293
 Fasser, C. McGuire, A., Erdman, K., Scott, S., Waters,V. (2007).
The ethics workup: a case-based approach to ethical decision-
making instruction. Journal of Physician Assistant Education, 18
(1), 34-41.
 Fernbach, A. (2011). Parental rights and decision making
regarding vaccinations: Ethical dilemmas for the primary care
provider. Journal Of The American Academy Of Nurse
Practitioners, 23(7), 336-345. doi:10.1111/j.1745-
7599.2011.00627.x

24. References cont’d
 Hamric, A., & Delgado, S. (2009). Ethical decision making. In
In Hamric, A.B., Spross, J.A. & Hanson, C.M (Eds.). Advanced
Practice Nursing: an integrative approach (4th ed.) (pp. 315-
346). St. Louis, MO: Saunders.
 Nasman, Y.. Nystrom, L., Eriksson, K. (2012). From values to
virtue:the basis for quality of care. International Journal for
Human Caring, 16 (2), 50-56.
 Ulrich, C., Danis, M., Ratcliffe, S., Garrett-
Mayer, E., Koziol, D., & Soeken, K. (2006). Ethical conflict in
nurse practitioners and physician assistants in managed care.
Nursing Research, 55(6), 391-401.
 Young, A. (2010). Professionalism and ethical issues in nurse
prescribing. Nurse Prescribing, 8(6), 284-290)

25. Link to video
 http://youtu.be/E4_Z6kHbjpw