etik ners nursalam unair
TRANSCRIPT
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nursalam -2006
PERAN ETIK KEPERAWATAN DLM PRAKTIK KEP.
PROFESIONAL
Oleh: Nursalam
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PENGANTAR & MASALAH
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SOCIETY
The State’s Statutory Statement of the Legal Boundaries of Nursing Practice (State Nursing
Practice Acts)
Legal RegulationThe Profession’s Definition of Nature and Scope of Nursing
Practice (Scope of Practice Statement)
Professional Regulation
State Board of Nursing Rules and regulations
Licensure for Practice
Public Protection
Professional Standards of
Practice
Professional Standards, Goal,
Policies, Procedures and Protocols for Nursing Service Organizations
Professional Standars and Statements of
Educational Outcomes for Nursing Education
Programs
Certification of Individuals in General and
Specialty Practice
Accreditation of Organized Nursing
Services
Accreditation of Educational Programs
Quality Assurance
CLIENTLindberg (1990: 320)
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NURSING EDUCATION?
PENDIDIKAN AKADEMIK-PROFESI
SYARAT:
1. Kajian Ilmu dan Teknologi
2. Standar Keprofesian
3. Kesetiakwanan profesi
4. ETIK PROFESI
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WHAT’S THE ETHICAL PROBLEMS?
• lack of formal education
• lack of institutional for review dilemmas
• perceived lack of peer support
• concern about reprisals
• lack of perceive decision making authority
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TANTANGAN ETIK KEPERAWATAN
1. Dasar-dasar moral makin memudar
2. Dasar & sendi agama makin menipis
3. Perkembangan IPTEK yg meningkat
4. Golbalisasi yg menyebabkan persaingan bebas (orientasi pelayanan dari sosial - bisnis)
5. Kamajuan & perkembangan masyarakat sebagai pengguna jasa: (kesadaran hak; tk. Ekonomi yg meningkat; kesenjangan si kaya dan si miskin; IPTEK meningkat)
6. Perubahan dlm. Masyarakat perawat (kurangnya kemampuan - etik; masuknya tenaga LN)
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KONSEP – ETIK KEP.
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ETHICs
“ …. doing good and avoiding harm
(Bandman & Bandman, 1995:5)==============================================
“ … good and bad, moral duty, obligation
and values”(Lindberg, 1990: 295)
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VALUES
“ …. A belief or custom that frequently arises
from cultural or ethical background, family
adaptation, peer group ideas and ………
(Lindberg, 1990: 254).
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MORAL DEV
Performance to avoid punishment
Deference to power of certain values
Behavior to satisfy and win approval of those authority
Compliance to societal authority
National Morality
The Golden Rule
Level 1
Level 2
Level 3
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ETIK DAN HUKUM KEPERAWATAN
ETIK
“ …. doing good and avoiding harm (Bandman & Bandman, 1995:5)– Apa yang harus dilakukan manusia– apa yang seharusnya dilakukan kepada
seseorang – suatu analisa proses terhadap suatu
tindakan – berdasarkan ilmu dan nilai / norma di
masyarakat
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HUBUNGAN ETIK DGN. .
• MORAL (apa yg dinilai baik /buruk oleh
masyarakat)
• HUKUM (legalisasi sikap tindak etik)
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ETHIC Cognitive observed A
BEHAVIOR affective recorded C psychomotor measured U
Cipta : (the truth)
Rasa : (the beauty)Karsa : ( goodness)
GOOD / BAD• CRITERIA
–IN PUSPOSE–AWARENESS–HAVE KNOWLEDGE–HAVE CHOICES
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Ukuran Baik dan Buruk• Hedonisme (kenikmatan &
kepuasan rasa)
• Utilitarism (bermanfaat)
• Vitalisme (kekuatan dan kekuasaan)
• Sosialisme (masyarakat yg menentukan)
• Religiosisme (firman tuhan)
• Humanisme (hak asasi manusia)
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TEORI ETIK
1. UTILITARIANISM“ …. Greatest happiness principles “,
2. DEONOTOLOGY“ …. Ringhtness or wrongness of an action
depended on the inherent moral significance of the action”
“…. To do one’s duty was right, not to do one’s duty was wrong”
(selalu memegang janji, dan tak pernah berbohong sesuai dengan situasi)
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PERBEDAAN “SCIENTIFIC AND ETHICAL”
SCIENTIFIC
• Tujuan : menjelsakan peristiwa
• kesimpulan : benar dan salah
• adanya penjelasan dan penjabaran
ETHICAL
• Justifikasi tindakan manusia
• tidak bisa secara langsung : benar-salah
• “ obligations atau pernyataan yang harus dikerjakan
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A GOOD NURSE IS ONE WHO...
• Personal characteristic• Professional characteristic• Patient centeredness• Advocacy• Competence• Critical Thinking• Patient care
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ETHICAL NURSING CARE IS……..
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NILAI-NILAI ETIK
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AZAS / PRINSIP ETIK
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PRINSIP & AZAS ETIK KEPERAWATAN
• JUSTICE (Asas Keadilan)• AUTONOMY
• BENEFICIENCY & NON-MALEFICIENCY
• VERACITY
• CONFIDENTIALITY
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PRINSIP & AZAS ETIK KEPERAWATAN
1. JUSTICE (Asas Keadilan)“ …equals should be treated the same and
unequals should be treated differently”.• Pasien harus diperlakukan sama sesuai
dengan keadaan sakitnya,• tidak ada diskriminasi ( pasien, alat - alat,
dll)• Models ( health care resources )
– Setiap arang sama– berdasarkan jasa– keberadaan peralatan– sesuai kebutuhan
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PRINSIP & AZAS ETIK KEPERAWATAN
2. AUTONOMY (Asas menhormati otonomi)
“ Individuals have the right to determine their own actions “
Karakteristik :
• Sesuai dengan nilai - nilai / kepercayaan
• informasi yang cukup
• bebas dari “ coercion “
• berdasarkan alasan dan kebebasan
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Lanjutan prinsip & Azas …
3. BENEFIENCE (asas manfaat)“ Doing or promoting good “
Karakteristik : • Nonmaleficence• mencegah harm atau kesalahan • mengurangi / menghilangkan “ harm or evil “• promote “ good “
NON-MALEFICIENCY
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Lanjutan prinsip & Azas …
4. VERACITY (Asas Kejujuran)“ ….. Telling the truth “
5. CONSEQUENTIALISM (Asas konsekwensi)“ ….. When the outcome ( consequence ) is good, the action is viewed as
appropriate”
6. RESPECT FOR PERSONS (Asas perbedaan tiap individu)“ Eeach person shpuld be treated as a unique individual and as a member of the human community”
7. FIDELITY (Asas Komitmen) “ one has a moral duty to be faithful to the commitments that one makes to
others”
8. CONFIDENTIALITY - Kerahasaiaan
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KODE ETIK KEP. DI INDONESIA
(PPNI)
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CODE OF ETHICS FOR NURSES - INDONESIA
FOUR PRINCIPLES ELEMENTS:
1. Nurse* Peolple
2. Nurses and Practice
3. Nurses of the Profession
4. Nurses and co-workers
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PERAWAT DAN KLIEN 1. PPerawat dalam memberikan pelayanan keperawatan 2. mMenghargai harkat dan martabat manusia, keunikan klien,
dan tidak terpengaruh oleh pertimbangan kebangsaan, kesukuan, warna kulit, umur, jenis kelamin, aliran politik dan agama yang dianut serta kedudukan sosial.
3. PPerawat dalam memberikan pelayanan keperawatan senantiasa memelihara suasana lingkungan yang menghormati nilai-nilai budaya, adat-istiadat dan kelangsungan hidup beragama dari klien.
4. 3. Tanggung jawab utama perawat adalah kepada mereka yang membutuhkan asuhan keperawatan.
5. 4. Perawat wajib merahsiakan segala sesuatu yang diketahui sehubungan dengan tugas yang dipercayakan kepadanya kecuali jika diperlukan oleh yang berwenang sesuai dengan ketentuan hukum yang berlaku.
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PERAWAT DAN PRAKTIK 1. Perawat memelihara dan meningkatkan kompetensi dibidang keperawatan melalui belajar terus menerus.2. Perawat senantiasa memelihara mutu pelayanan keperawatan yang tinggi desertai kejujuran profesional dalam menerapkan pengetahuan serta keterampilan keperawatan sesuai dengan kebutuhan klien.3. Perawat dalam membuat keputusan didasarkan pada informasi yang adekuat dan mempertimbangkan kemampuan serta kualifikasi seseorang bila melakukan konsultasi menerima delegasi dan memberikan delegasi kepada orang lain.4. Perawat senantiasa menjunjung tinggi nama baik profesi keperawatan dengan selalu menunjukkan perilaku profesional.
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PERAWAT DAN MASYARAKAT
Perawat mengemban tanggung jawab bersama masyarakat untuk memprakarsai dan mendukung berbagai kegiatan dalam memenuhi kebutuhan kesehatan masyarakat.
PERAWAT DAN TEMAN SEJAWAT
1. Perawat senantiasa memelihara hubungan baik dengan
sesama perawat maupun dengan tenaga kesehatan lainnya, dan dalam memelihara keserasian suasana lingkungan kerja maupun dalam mencapai tujuan pelayanan kesehatan secara menyeluruh.
2. Perawat bertindak melindungi klien dan tenaga kesehatan yang memberikan pelayanan kesehatan secara tidak kompeten, tidak etis dan illegal.
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PPERAWAT DAN PROFESI
1. Perawat mempunyai peran utama dalam menentukan standar pendidikan dan pelayanan keperawatan serta menerapkan dalam kegiatan pelayanan dan pendidikan keperawatan.
2. Perawat berperan aktif dalam berbagai kegiatan pengembangan profesi keperawatan.
3. Perawat berpartisipasi aktif dalam upaya profesi untuk membangun dan memelihara kondisi kerja yang kondusif demi terwujudnya asuhan keperawatan yang bermutu tinggi.
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NEGLIGENCE & MALPRACTICE
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INDICATORS MALPRACTICE – NEGLIGENCE
• Nurse had specific professional duty to patient
• nurse did not carry out his/her duty
• nurse caused injury to his/her patient
• the patient’s injury resulted from the nurse’s negligent action
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TUJUAH (7) PITFALLS YANG UMUM TJD. PADA ASPEK
ETIK KEP. & LEGAL Kes.
1. Patient falls
2. Failure to follow up MD.’ orders/protocol
3. Medication error
4. Improper use of equipment
5. Failure to remove foreign objects
6. Failure to provide sufficient monitoring
7. Failure to communicate
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HOW TO AVOID - NEGLIGENCE
PRINCIPLES
C = CHECK THE ORDER
W = WASH YOUR HANDS
I = IDENTIFY THE THE PATIENT
P = PROVIDE SAFETY & PRIVACY
A = ASSESS THE PROBLEMS
T = TEACH & TELL THE PATIENT
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INFORMED CONSENT
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INFORMED CONSENT
Consent: (latin: consensio, con sentio), berarti persetujuan, ijin, menyetujui, memberi ijin kpd seseorang utk melakukan sesuatu.
Permenkes (1989).
Informed Consent: persetujuan yg diberikan oleh pasien atau keluarga atas dasar penjelasan mengenai tindakan medik yg akan dilakukan thd pasien tsb
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UNSUR INFORMED CONSENT
1. CAPACITY (Kemampuan Memahami Informasi)
Ciri: - Memiliki Nilai & Tujuan
- Kemampuan berkomunikasi &
memahami informasi
- Kemampuan membuat alasan atas pilihannya dan keputusan
2. VOLUNTERINISM (sukarela)
ciri: - tanpa paksaan
- tanpa ancaman
3. Information …..
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Lanjutan: unsur - Informed consent ………
3. UNSUR INFORMASI
• Diagnosa / masalah pasien
• tujuan dan lama tindakan
• hasil
• manfaat
• potensial resiko
• alternatif tindakan sesuai kemampuan
• prognosa jangka pendek & panjang
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TUJUAN I.C
1. Perlindungan pasien utk segala tindakan (tindakan yg tidak perlu o/tim tanpa sepengetahuan pasien)
2. Perlindungan tenaga medis dan perawat akibat penyakit tidak terduga serta dianggap merugikan pihak lain
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FUNGSI I.C1. Promosi dari hak otonomi perorangan
2. Proteksi dari pasien dan subjek
3. Mencegah penipuan atau paksaan
4. Rgs. Profesi kes. Introspeksi
5. Promosi dari keputusan – rasional
6. Keterlibatan masyarakat (otonomi – nilai sosial & pengawasan
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BENTUK I.C1. Express – lisan & tertulis
2. Tersirat (implied or tacit consent)
- dlm keadaan biasa
- dlm keadaan gawat darurat
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PEMBERI I.C1. PAsien dewasa (sadar & sehat mental)
2. Pasien dewasa (21 th atau sudah menikah)
3. PAsien dewasa (pengampunan) – oleh orang tua
4. Pasien dewasa (ggn mental) – oleh orang tua/wali
5. Pasien dibawah 21th (tidak ada ortu) – oleh keluarga terdekat
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PENGABAIAN I.C1. Tidak ada kesempatan memintakan2. Tidak ada waktu lagi utk menunda-
nunda tindakan3. Untuk menyelamatkan nyawa, tidak
mempunyai penyakit sebelumnya4. Melindungi keselamatan anak/bayi5. Mencegah self-distruction6. Melindungi kes. Masyarakat7. Menjaga etik / aturan RS
(UU-Kes 23/1992, pasal 53)
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KRITERIA – GAWAT (I.C)
1. Shock
2. Perdarahan
3. Patah Tulang
4. Kesakitan (Pain)
(PERMENKES 585/1989: dalam hal pasien tidak sadar/pingsan serta tdk didampingi o/ kel. Terdekat dan sec. medik dlm keadaan gawat dan atau darurat yg memerlukan dindakan medik segera utk kepentingannya, tidak diperlukan persetujuand dari siapapun)
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I.C TIDAK SAH JIKA . .. .
1. Dengan paksaan (duress, dwang)
2. Krn memberikan informasi yg salah/berlainan
3. Dari seseorang yg belum dewasa
4. Dari seseorang yg tidak berwenang
5. Dalam keadaan tdak sepenuhnya sadar (non lucid state)
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EDM(ETHICAL
DECISION MAKING) IN NURSING
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DECISION MAKING
• End point of using critical thinking and scientific resoning …… ethical in problem reasoning.
• Even “no decision” is decision, because , in effect, it is supports the existing state of affairs
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ETHICAL DECISION MAKING ( EDM )
PERAWAT
PASIEN KELUARGA TENAGA KES. LAINNYA
PERBEDAAN PROSES KEPERAWATAN DAN EDMM
PROSES KEPERAWATAN
• assess• analyse• plan• implement• evaluate
ETHICAL DECISION MAKING MODEL•Klarifikasi ethical dilemma•Mengumpulkan data tambahan •Identifikasi pilihan•Membuat suatu keputusan•Act ( tindakan )•Evaluate
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CRITICAL THINKING
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THE IGNORANCE TO SOMETHING /
SOMEONE IS THE ROOT OF PREJUDICE
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APA MASALAH PADA KEPERAWATAN? ….
KURANG BERPIKIR KRITIS
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WHAT IS CRITICAL THINKING
rational examination of ideas, inferences, beliefs, and actions.
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THE EXAMINATIONS
The examination covers scientific reasoning, includes nursing process, decisions making, and reasoning in contraversial issues.
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Critical Thinking in Decision Making
1. Recognizing and defining a problem
2. Gathering relevant information
3. Generating possible conclusions
4. Testing possible conclusions
5. Evaluating conclusions
6. Reaching decisions
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USE OF (C – T) IN EVERYDAY NURING PRACTICE
TWO OPTIONS:1. Determine all the possibilities2. Recognise options so that the
choices are mutually exlusive (free from repetition) and exhaustive (containing all possibilities).
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Case study
Nurse Jones either chooses to teach Mr. & Mrs. Green about colostomy care on Tuesday or not teach because she has the next day off. Ns Jones may choose to demonstrate colostomy care by doing it herself or she instruct Mr. Green as he irrigates himself in the presence Mrs. Green. Or …………
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OPTIONS
Mutually exlusive1. Teach Mr.Green
colostomy care- teach by demonstration and by return demonstration
2. Do not teach Mr. Green
- Discharge without instructions
Exhaustive Options1. Teach through the
use of AVA or 2. Refer to a clinical
nurse specialist, the visiting nurse association, home care or to the cancer society.
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FOUR TYPES OF REASONING
DEDUCTIVE
INDUCTIVE
INFORMAL OR EVERYDAY
PRACTICAL
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…. ANALYSE
• Use of language• Formulate problems• Clarify and explicate assumptions• Weigh evidence• Evaluate conclusions• Descriminate between good and bad
arguments• Seek to justify those facts and values that
result in credible beliefs and actions
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FUNCTIONS IN NURSING
1. In all daily living2. Descrimanet … uses and misuses of langauge in nursing3. Identify & formulate nursing problems4. Analyze meaning of terms in terms of indication, cause or purpose and
significance5. Analyse arguments and issues into premises and conclusions6. Examine nursing assumptions7. Report data and clues accurately8. Make and check inferences based on data, making sure that the
inferences are, at least, plausible9. Formulate and clarify beliefs10. Verify, collaborate and justify claims, beliefs, conclusions, decisions and
actions11. Give relevant reasons for beliefs and conclusions12. Formulate and clarify values judgement13. Seek reasons, certain and principles that effectively justify values
judgement14. Evaluate the soundness of concluions
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FREQUENT ARGUMENT
INDICATORS
• Because• Hence• Since
• So• Therefore
• Thus
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MINIMIZING & AVOIDING FALLACIES
1. What are the graounds in the premises to support the conclusions?
2. Are these graounds relevant to the conclusions?
3. Are the grounds contained in the premises evidentially adequate to justify the conclusions?
4. Are the assumptions on which the argument depends themselves justifiable?
5. Are the premises and conclusions of the argument clear?
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SOURCES OF DILEMMAS(ETHICAL CONFLICT )
Personal & Prof. values
Client & Prof.
Values
Values among Health Behavior
+ +
Janice, B. Lindberg (1990: 311)
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STRATEGYE-D-M
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STRATEGIES TO COPE ETHICAL DILEMMAS
THEORIES VALUES SITUATIONAL
DATA+ +
Janice, B. Lindberg (1990: 311)
FORMULA
Utilitarism
Deontological
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SITUATION DATA
•Determine what health problems and individual person strength exist
•Identify what decision need to be made
•Separate the ethical component of the decisions from those issues
•Identify all the individual and groups who will be affected.
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ACCOUNTABILITY
• means responsibility or the obligations to account for one’s behavior or act
• Objective: - Assume responsibility for his or her own
actions- Demonstrate self-discipline in meeting
commitments and obligations (appointment)
- Prepare in advance for clinical experience- Reposrt unsafe client-patient practice
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•All nursing practice involves EDM
•Person centered care demands a willingness to confront ED
•Personal & professional values influence ED
•Persons (care givers and clients) can be assisted to achieve higher levels of moral reasoning
•There is no one correct ethical theory
ASSUMPTIONS
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Dasar pengambilan keputusan etik
KlarifikasiDelima etik
UU KES23/1992 danUU 8/1999
PPNI
KODE ETIKPROFESI
TEORI – PRINSIP ETIK
NILAI-NILAI(Agama, budaya,
Dll)
Institusi
Masalah Etik Pulta
Identifikasi Pilihan
Keputusan Pelaksanaan
LANGKAH KEPUTUSAN ETIK
Evaluasi
SOLUSI
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MODEL ETHICAL DECISION MAKING (EDM)MODEL ETHICAL DECISION MAKING (EDM)
NURSES
NURSING CARE STANDAR
Level 1
PATIENT CARE
BY OTHER HEALTH TEAM
NURSING ETHICS
SATISFY PATIENT &FAMILY
SOLUTION PROB. SOLVING
Ethical Problem
Six steps for EDM
Level 2
ETIHIC COMMITE
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SIX STEP’S IN EDM
1. CLARIFY THE ETHICAL DILEMMA
2. GATHER ADDITONAL DATA
3. IDENTIFY OPTIONS
4. MAKE DECSION
5. ACT
6. EVALUATE
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APPLICATION OF EDM(ETHICAL DECISION MAKING)
IN NURSING CARE PRACTICE
1. MENTAL HEALTH2. MATERNITY & INFANT
3. PEDIATRICS 4. ADULT / MED.SUG
5. ELDERLY
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KASUS - MATERNITAS Kasus: Pelanggaran Etik & Legal
(Jawa Pos , Rabu 29 September 2004)RS Evasari Jakarta
SUSTER TIDUR, BAYI TEWAS!Pasien (Heston dan Ashdiane-suami) melaporkan ke
polisi, krn suster melarang permintaan pasien utk dilakukan Caeser. Jam 17.00 ketuban pecah, tetapi tetap dianggap biasa oleh suster. Jam 19.00 pasien merasa mulas yg amat sangat. Permintaan suaminya (Heston) agar istrinya ditolak oleh suster. Pukul 02.00 (23/9/04) pasien merasakan ada sesuatu yg mengalir di bagian bawah perutnya. Diapun segera membangunkan perawat yg sedang tidur nyenyak. 1 jam kemudian, begitu dokter datang langsung dibawa ke ruang operasi. Namun, bayi yg dilahirkan dlm keadaan kritis. Jam 17.00 bayi meninggal.
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CASE STUDY
Eleanor Gift,age 68 years, is schedule for triple bypass surgery. Martha Blake, RN, is the nurse doing her preoperative teaching the evening before the procedure is scheduled. It is apparent to Miss Bake that Mrs. Gift doesnot want to have surgery. She express great apprehension about procedure and generally feells quite negative about the outcome. The surgeon, however, has convinced Mrs. Gist and her family that she must undergo the surgery to survive. Although far from comfortable with situation, Mrs. Gift is resigned to undergo the impending surgery in the morning. What is the nurse’s responsibility in the situation?
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Case – KMB: Ethical dilemmas
Miss Corbin, RN, work on surgiucal floor. She has just assisted in the transfer of Mr. Hudson (patient) to his room from the postanesthesia unit after surgery and notice that he was resting comfortably. Miss Corbin
sees a nurse colleague (X) drawing up a pain medication. The nurse colleagues returns to the
medicine room 10 minutes later with empty syringe. Miss Corbin asks, Who needed pain medication?” Mr.
Hudson, the colleagues (X) replies. “He was in pain after surgery.” Confused, Miss Corbin checks Mr. Hudson’s (Patients) room and learns from his wife
that she has not asked for or received pain medication. What should Nurse do now?
Bandman & Bandman (1997: 410)
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CASE STUDY
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KRITERIA – GAWAT (I.C)
1. Shock
2. Perdarahan
3. Patah Tulang
4. Kesakitan (Pain)
(PERMENKES 585/1989: dalam hal pasien tidak sadar/pingsan serta tdk didampingi o/ kel. Terdekat dan sec. medik dlm keadaan gawat dan atau darurat yg memerlukan dindakan medik segera utk kepentingannya, tidak diperlukan persetujuand dari siapapun)
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1. CONTINUE OR STOP TREATMENT
A severe asphyxia patient was in ICU for a couple days and there was no progression. Patient's family knew that the patient was still alive because of ventilator assistance. The family decided to stop the ventilator. "Let the patient die. We could not afford for the cost." It was a dilemma for me. I believed the treatment must be continued because I had duties to help the patient to survive. If the patient would die, it was not our will. But, I had to follow the patient's family. Why didn't they want to continue the treatment? Even though the possibility of surviving for the patient was low, I did not want to disconnect the tube. It seemed like I killed the patient
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2. Who should get the ventilator?
There were two patients, head injury and brain tumor patients, admitted to ICU. Head injury patient was coma, had high level of PCO2, and RR 32 times per minutes. Brain tumor patient was also coma, RR 26 times per minutes, and sometimes he had apnea attack. They needed ventilator at the same time. We just had only one ventilator. At that time, it was difficult to decide which patient should get the ventilator. Which patient I had to help first?
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3. Want to take an action but beyond authority
I had a situation when the patient's blood pressure was dropped and I wanted to take action to help the patient immediately but I could not do it without reporting to doctor first…I had to wait for order from doctor because it was beyond my responsibility
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4. Tell or not to tell the truth
A patient's husband asked me not tell his wife that their baby died during caesarian section. He was afraid it would make his wife's condition worse. So at that time it was difficult for me to make a decision. Then his wife came to me and asked about her baby. It was difficult whether or not to tell the truth to her. Her husband asked me not to tell her. He wanted to tell his wife at their home. If I didn't tell her, I felt guilty because it conflicted with my values. Meanwhile, doctor also suggested not to tell the patient because he was worried that she would be shock and it would affect her condition.
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5. Act as patient advocate versus maintaining relationships with the
health team
…patient was poor and could not afford the prescribed drug. I was in a difficult situation whether I administered the drug or not. If I didn't administer it, it was doctor's order and he might be angry with me and it would produce bad relationship with him. I needed to talk to doctor about this and asked him to prescribe another drug that could be afforded by the patient, but I was afraid…
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KASUS - MATERNITAS Kasus: Pelanggaran Etik & Legal
(Jawa Pos , Rabu 29 September 2004)RS Ev - Jakarta
SUSTER TIDUR, BAYI TEWAS!Pasien (Heston dan Ashdiane-suami) melaporkan ke
polisi, krn suster melarang permintaan pasien utk dilakukan Caeser. Jam 17.00 ketuban pecah, tetapi tetap dianggap biasa oleh suster. Jam 19.00 pasien merasa mulas yg amat sangat. Permintaan suaminya (Heston) agar istrinya ditolak oleh suster. Pukul 02.00 (23/9/04) pasien merasakan ada sesuatu yg mengalir di bagian bawah perutnya. Diapun segera membangunkan perawat yg sedang tidur nyenyak. 1 jam kemudian, begitu dokter datang langsung dibawa ke ruang operasi. Namun, bayi yg dilahirkan dlm keadaan kritis. Jam 17.00 bayi meninggal.
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THANK YOU !
WASSALAM WR.WB.
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PRAKTIK KEPERAWATANPRAKTIK KEPERAWATAN TINJAUAN ASPEK ETIK DAN HUKUM TINJAUAN ASPEK ETIK DAN HUKUM
KESEHATAN KESEHATAN PERMASALAHAN DAN SOLUSINYAPERMASALAHAN DAN SOLUSINYA
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Praktik Keperawatan
Tindakan mandiri perawat melalui kolaborasi dengan sistem klien dan
tenaga kesehatan lain dalam memberikan asuhan keperawatan
sesuai lingkup wewenang dan tanggung jawabnya pada berbagai
tatanan pelayanan, termasuk praktik keperawatan individual dan
berkelompok
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Hukum Kesehatan
Semua ketentuan hukum yang berhubungan langsung dengan
pemeliharaan/pelayanan kesehatan dan penerapannya.
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ETIKA KEPERAWATAN
Merupakan kesadaran dan pedoman yang mengatur prinsip-prinsip moral dalam melaksanakan kegiatan profesi keperawatan, sehingga mutu dan kualitas pelayanan profesi keperawatan tetap terjaga dengan cara yang terhormat dan bersusila sesuai dengan martabat dan tradisi luhur jabatan keperawatan.
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Aspek Etik Sistem Etik Azas EtikKode Etik
Aspek Hukum UU No. 23 Tahun 1992 PP No. 32 Tahun 1996 KEP MENKES No. 1239 Tahun 2001
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Aspek Etik Praktik Keperawatan
1. Berorientasi kewajiban (Absolutisme) menerima kehidupan moral yang ideal, dengan menurut apa yang diperintahkan oleh Tuhan serta menghindari apa yang dilarang oleh Tuhan.
2. Berorientasi Akibat (Relativisme) Menekankan kepada akibat atau hasil dari tindakan kita prinsipnya adalah melakukan apa yang terbaik untuk orang banyak dalam suatu tindakan dan dalam keadaan tertentu.
a. SISTEM ETIK
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b. Asas Etik
1. Asas Keadilan2. Asas Menghormati3. Asas Manfaat4. Asas Kejujuran5. Asas Tidak Merugikan6. Asas Kerahasiaan
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c. Kode Etik Keperawatan
Pasal 1Perawat dalam melaksanakan pengabdiannya senantiasa berpedoman kepada tanggung jawab yang bersumber dari adanya kebutuhan akan keperawatan individu, keluarga, dan masyarakat.
Pasal 3Perawat dalam melaksanakan kewajibannya bagi individu, keluarga, dan masyarakat senantiasa dilandasi dengan rasa tulus ikhlas sesuai dengan martabat dan tradisi luhur keperawatan.
Pasal 10Perawat senantiasa memelihara hubungan baik antara sesama perawat dan tenaga kesehatan lainnya, baik dalam memelihara keserasian lingkungan kerja maupun dalam mencapai tujuan pelayanan kesehatan secara menyeluruh.
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Aspek Hukum Dalam Praktik Keperawatan
I. UU No. 23 tahun 1992 tentang kesehatanPasal 32 Ayat 4Pelaksanaan pengobatan dan atau keperawatan berdasarkan ilmu kedokteran dan atau ilmu keperawatan hanya dapat dilaksanakan oleh tenaga kesehatan yang mempunyai keahlian dan kewenangan untuk itu.Pasal 53 Ayat 1Tenaga kesehatan berhak memperoleh perlindungan hukum dalam melaksanakan tugas sesuai dengan profesinya.Pasal 53 Ayat 2Tenaga kesehatan dalam melaksanakan tugasnya berkewajiban untuk memenuhi standart profesi dan menghormati hak pasien.
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II. Peraturan Pemerintah RI No. 32 tahun 1996 tentang Tenaga KesehatanPasal 4 Ayat 1
Tenaga kesehatan hanya dapat melakukan upaya kesehatan setelah tenaga kesehatan yang bersangkutan memiliki ijin dari menteri
III. Kepmenkes 1239 / 2001 terkait dengan praktik perawatBab III Pasal 8
1. Perawat dapat melaksanakan praktik keperawatan pada sarana pelayanan kesehatan, praktik perorangan dan atau berkelompok.
2. Perawat yang melaksanakan praktik keperawatan pada sarana pelayanan kesehatan harus memiliki SIK
3. Perawat yang melaksanakan praktik perorangan/berkelompok harus memiliki SIPP
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Bab IV pasal 15Perawat dalam melaksanakan praktik keperawatan berwenang untuk :
a. Melaksanakan asuhan keperawatan yang meliputi pengkajian, penerapan diagnosa keperawatan, perencanaan, melaksanakan tindakan keperawatan dan evaluasi keperawatan
b. Tindakan keperawatan sebagaimana dimaksud pada butir a meliputi : Intervensi keperawatan, observasi keperawatan, pendidikan dan konseling kesehatan ;
c. Dalam melaksanakan asuhan keperawatan sebagaimana dimaksud huruf a dan b harus sesuai dengan standart asuhan keperawatan yang ditetapkan oleh organisasi profesi
d. Pelayanan tindakan medik hanya dapat dilakukan berdasarkan permintaan tertulis dari dokter
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Bab IV Pasal 17
Perawat dalam melakukan praktik keperawatan harus sesuai dengan kewenangan yang diberikan, berdasarkan pendidikan dan pengalaman serta dalam memberikan pelayanan berkewajiban mematuhi standar profesi
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Bab IV Pasal 19
Perawat dalam melakukan praktik keperawatan harus senantiasa meningkatkan mutu pelayanan profesinya dengan mengikuti perkembangan ilmu pengetahuan dan teknologi melalui pendidikan dan pelatihan sesuai dengan bidang tugasnya, baik diselenggarakan oleh pemerintah maupun organisasi profesi.
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Bab IV Pasal 20
(1) Dalam keadaan darurat yang mengancam jiwa seseorang/pasien, perawat berwenang untuk melakukan pelayanan kesehatan diluar kewenangan sebagaimana dimaksud dalam pasal 15.
(2) Pelayanan dalam keadaan darurat sebagaimana dimaksud pada ayat
(1) ditujukan untuk penyelamatan jiwa.
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Kewenangan PerawatKewenangan Perawat
Hak dan otonomi Perawat untuk Melaksanakan Asuhan Keperawatan berdasarkan :- Kemampuan- Tingkat Pendidikan- PosisiDisarana Kesehatan
Tujuan :1. Memberikan kejelasan batasan hak2. Mencegah terjadinya Malpraktik3. Memberikan suatu kepastian hukum dan
perlindungan hukum
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Kewenangan Perawat :1. Melaksanakan pengkajian keperawatan2. Merumuskan diagnosis keperawatan3. Menyusun rencana tindakan keperawatan4. Melaksanakan tindakan keperawatan (termasuk tindakan medik
yang dapat dilakukan perawat)5. Melaksanakan evaluasi terhadap tindakan6. Mendokumentasikan hasil keperawatan7. Melakukan kegiatan konseling kesehatan kepada sistem klien8. Melaksanakan tindakan medis sebagai pendelegasian berdasarkan
kemampuannya9. Melakukan tindakan diluar kewenangan dalam kondisi darurat yang
mengancam nyawa sesuai ketentuan yang berlaku (Standing Order) di sarana kesehatan
10.Dalam kondisi tertentu, dimana tidak ada tenaga yang kompeten, perawat berwenang melaksanakan tindakan kesehatan diluar kewenangannya
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Permasalahan1. Praktik Keperawatan belum dipahami secara benar dan baik
oleh para perawat maupun oleh pihak-pihak lain.2. Penataan Standar profesi dan kompetensi bagi perawat belum
sepenuhnya dilakukan.3. SK Menkes 1239 Tahun 2001 yang mengatur tentang registrasi
dan praktek perawat dapat menimbulkan multi persepsional.4. Kecemburuan sosial dalam praktik oleh perawat di masyarakat
dapat memunculkan masalah baru dalam bidang hukum.5. Kedekatan perawat dalam struktur sosial masyarakat lebih
menguntungkan bagi masyarakat untuk meminta bantuan kesehatan.
6. Keterbatasan pola pikir masyarakat dalam memilih tenaga kesehatan yang sesuai.
7. Belum tertatanya hubungan kemitraan antara PPNI dengan pihak-pihak yang berwenang memberikan perlindungan hukum bagi perawat.
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Solusi1. Kemampuan perawat dalam meningkatkan pemahaman,
pengetahuan dan pelaksanaan praktik keperawatan harus terus di tingkatkan.
2. Pengaturan standar profesi dan kompetensi perawat segera diwujudkan.
3. Perlu amandemen SK Menkes 1239 pada pasal-pasal tertentu agar didapatkan kejelasan dalam mempersepsikan aturan yang ada, serta peningkatan status KepMenKes menjadi UU.
4. Perawat perlu memikirkan pembelajaran kepada masyarakat tentang bagaimana dan kemana minta bantuan kesehatan apabila sedang mengalami gangguan kesehatan.
5. Peningkatan kemitraan antara Organisasi Profesi PPNI dengan StakeHolder.
6. Perawat perlu meningkatkan kesadaran hukum dan bekerja sesuai keahlian dan kewenangan serta memiliki SIP, SIK, SIPP.
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Simpulan1. Agar praktik keperawatan dapat dilaksanakan sesuai dengan
kaidah profesi maka pelayanan keperawatan harus diberikan oleh perawat yang kompeten. Semakin banyak perawat yang kompeten, tentunya semakin besar pula konstribusi perawat terhadap penyelesaian masalah kesehatan masyarakat.
2. Kalau perawat dan keperawatan ingin dihargai dan diakui keberadaannya, maka pelayanan keperawatan harus dilaksanakan dengan BENAR dan BAIK.
3. Sudah saatnya Organisasi Profesi PPNI membuka diri membangun kemitraan dengan StakeHolder agar Organisasi ini betul-betul dapat mengantarkan anggotanya memasuki pintu gerbang profesi yang sebenarnya serta mampu mewujudkan keperawatan sebagai sebuah profesi.