00:01
In addition to understanding
ethical principles,
public health nurses must be
able to use these principles
in their decision making processes.
00:09
Ethical decision making means
making a choice that
can be justified
from an ethical perspective.
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And while this may seem like a
pretty common sense approach,
it can get very complex.
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So I'd like to introduce you
to a model
that can be used to guide you
through the process.
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This is a framework
called the decide model.
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It can be used to guide the process
by which we make ethical decisions.
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So let's imagine that
you're a public health nurse
working in a community
that has limited resources.
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A local community organization
has offered to run
an enrichment program
at a senior center.
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This program would allow
participants opportunities
for nutrition services,
ability specific, physical activity,
and perhaps most importantly,
social and emotional support.
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However, there are three senior
centers in the community.
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And as the public health nurse,
you have to decide which center
which seniors will
get this opportunity?
So let's use the decide model to
work through this ethical dilemma.
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So let's start with D.
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This stands for
Define the problem.
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What are the key facts
of the situation?
Who's involved?
What are their rights and duties?
What are your rights and duties?
For a senior enrichment program,
what exactly is the problem here?
Well, we've established that well,
all seniors could benefit
from this program,
only those that one center
will get the opportunity.
01:30
So what other
information do we need?
We need to know how many
centers are in the community?
How many seniors are serviced
at each of those centers?
What services are currently being
provided at each of the centers?
What's your role as the public
health nurse in this problem,
and in the solution?
Next is E or Ethical review?
Here we ask ourselves
what ethical principles
have a bearing in the situation?
Which principles should be given
priority in making our decisions?
So let's think about
this one for a second.
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If we're making a decision about
the distribution of services,
or the distribution of a benefit,
which ethical principle
are we considering?
Justice, specifically,
we're making a decision about
how we will allocate a benefit.
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Will we use distributive justice?
Egalitarian?
Or a restorative approach?
C stands for Consider the options.
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What options do you have
in the situation?
What are your alternative
courses of action?
For our enrichment program, we need
to consider all of our options.
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We could offer the program at just
one of the centers as proposed,
or what other solutions exist?
Could the program move from
center to center each week?
Or is maybe
transportation available
to get seniors from all the
centers to one location.
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Here, it's important to get creative
and really think outside of the box.
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Next,
we have I investigate outcomes,
exploring all available options,
what consequences are likely to
follow from each course of action?
Based on our ethical principles,
which option is the most ethical?
So consider here for a second,
what would happen
if we use distributive justice?
And decided to locate
this enrichment program
at the senior center where
there's the most need.
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How might those outcomes differ if
we used in a egalitarian approach,
and spread the services
out to all of the centers?
Or what if we use the
restorative justice approach,
and located the services
at the senior center
that missed out on
the last opportunity?
What might those
outcomes look like?
The next D stands for
Decide on an action.
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This is where the
public health nurse decides
on the best available option.
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Having chosen
the best option available,
it's time to set a
specific plan in place.
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Here, it's important to
set clear objectives,
and then act decisively
to carry on our plan.
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So let's just say as
the public health nurse,
you decide to use a
distributive justice approach,
and locate the program at a
center that has the greatest need
for additional services.
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Now, it's time to create that plan
and put that plan into action.
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An Evaluation Plan will ensure
that you can measure the success
of your decision.
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And finally, our second E,
Evaluate results.
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Having implemented
your course of action
now it's time to assess
how things are going.
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So how did it go?
Did the seniors love the program?
Did their health outcomes improve?
What about the same
health outcomes for seniors
at the other centers
who didn't get the opportunity?
Would you make the
same decision again?
This framework isn't
meant to be prescriptive.
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However, using this framework,
it provides public health nurses
with a structure
to making well thought out
ethical decisions.
04:54
So I will leave you with this quote
from Florence Nightingale
In 1859 she said,
"It may seem strange principle
to enunciate
as the very first requirement
in a Hospital
is that it should do the sick
no harm."
Now, based on what
we just talked about,
can you identify which
ethical principle
Florence Nightingale
was referring to?
What I'd like you to do
is pause the recording
and then do three things for me.
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First,
identify the ethical principle
Florence Nightingale
was talking about.
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Secondly,
write your own definition.
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Tell me in your own words,
how do you define
that ethical principle?
And then finally third,
what I'd like you to do
is provide your rationale.
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Why did you pick that
ethical principle?
And now time for the answer.
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First of all,
identifying the ethical principle.
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Here we have nonmaleficence.
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Defining the ethical principle.
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That means to do no harm.
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And our rationale.
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Well, Florence Nightingale
says it right here in the quote.
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She said,
"We should do the sick no harm."