Research Topics: Nursing Ethics

Drug Abuse

Drug misuse may immediately merit the suggestion whether a person should be rehabilitated, corrected, punished, or indeed, treated (Alterman et. Al.: 1993). Furthermore, the notion of chemical dependency as “disease” warrants examination. Just as there are an assortment of drugs and those who use them, there exists a rather diverse population for which treatments should also vary. Cunningham (2000) implies that where a doctor’s criteria of what constitutes abuse or dependency of alcohol or (other) drugs are generally restricted to medical and psychological aspects. More specifically, noted that rarely are the consequences of harmful use actually restricted to one or two spheres of a person’s life. (Cunningham:2000) The restricted aspects have set the premise for narrow minded thinking. Furthermore, it widens the gap of unsuccessful treatment. Although causal use of drugs has slightly declined, there has been no apparent progress or change in the numbers of heavy users of heroin and cocaine (Chaney et. Al:1998). Hard-core drug abusers, those who use at least weekly and exhibit drug related behaviour problems, typically are at the bottom of the social ladder where drug treatment programs have had the poorest track record.  Currently, one of the nationwide initiatives and interventions within the U.K. include slapping Anti-social Behaviour orders to curb unacceptable behaviour, which may quite often be the result of misusing substances. Within the UK the Drug and Alcohol Action Teams (DAAT) programmes continue to address national and local government objectives in the provision of treatment across all tiers of the profession.  I attended the recent launch of the DAAT Programme for 2004/05 (6th May 2004) in the borough of Hounslow, Middlesex.  Key themes and objectives of the DAAT’s work programme were presented and the local DAAT Treatment Plan had been agreed by the National Treatment Agency.  There were many themes, however the DAAT’s top priorities for 2004/05 for the borough of Hounslow are as follows: ·        Development of a Young people’s Substance Misuse Service ·        Reducing waiting times and improving GP prescribing levels. ·        Developing clearer responses to crack cocaine. ·        Developing provision to reflect more sophisticated understanding of needs of Hounslow’s diverse communities. ·        Improving data collection, including joint working with CDRP (DAAT Programme 2004) Advocates for expanded drug treatment argue that new programs will more than pay themselves in reduced crime, improved health and fewer broken families. It’s not clear which, if any, government and / or approaches really work, however counsellors working together in partnership with other service providers continue their endeavour in seeking appropriate therapeutic interventions with clients who misuse substances. Drummond (1995) declares that, traditionally, we may oscillate between perceiving addiction as a medical hindrance and a social amiss. Similarly, the therapy of addiction has conceded in the course of sequences of medical attention ensued by disciplinary crackdowns. Unfortunately, addiction models and consequent treatment approaches have been rigidly constructed. It is this generic programming and lack of flexibility that results in high recidivism and poor success rates. The completion of treatment, the “treated” individual is usually returned to the same environment that s/he struggled with prior to entering that program.   “The expectation is that the client is better equipped in dealing with the problems s/he entered treatment with. The degree to which many clients are able to cope is usually not sufficient to ensure long-term stabilization. Success ultimately boils down to an individual’s personal decisions.” (Drummond, 1995).   The individual’s capacity to decide would be less inhibited if s/he had a broader range in which to choose from. The current disease model short-circuits treatment potential. In fact, it holds an element of damage in itself, in that there seems to be a mentality of labelling accordingly (Drummond:1995). Frequently, upon failing in treatment, a client is offered another chance by the same agency (“to get it right (Drummond:1995)”). Programs are more often than not geared toward delivering curricula that suits the protocol of the agency. Many programs tend to facilitate the same basic treatment to all clients, and fail to distinguish first time clients from “recycled” clients (Hay:2001). If the person in relapse enters another agency, s/he is likely to be re-assessed, and there’s a good chance that the client will be subjected to the same treatment regimen as previously prescribed, only the new program will have a different name. The 12 steps of Alcoholics/Narcotics Anonymous are the foundation of many treatment centres. A.A. originated in the 1930s (Hay:2001). There is no cost, and it was designed as an outlet for chronic alcoholics who choose to attend. To administer treatment from a 12 step orientation is a question of ethics. It is important to note, if a program mandates attendance, let alone operates solely on the principles of the 12 steps and charges for such “services,” it conflicts with the notion of anonymity and the intrinsic features of AA. They may be a good supplement for many in recovery, but the 12 steps should not be the main component for any agency (Harwin and Forrester:2002).                 References     Cherry, A., Dillon, M., & Rugh, D. (2002). Substance Abuse: A Global View. Westport, CT: Greenwood Press. Drug and Alcohol Action Team. Drug misuse statistics United Kingdom 2004 . Edinburgh: ISD Publications.   Harwin, J and Forrester, D. (2002). Parental substance misuse and child welfare: A study of social work with families in which parents misuse drugs or alcohol. London: Interim Report for Nuffield Foundation.   Hay, G, McKeganey, N and Hutchinson, S.( 2001). Estimating the national and local prevalence of problem drug misuse in Scotland. Glasgow: University of Glasgow.   Schwartzberg, A. (1998). The Adolescent in Turmoil. Westport, CT: Praeger Publishers.   Credit:ivythesis.typepad.com

Drug Abuse

Drug misuse may immediately merit the suggestion whether a person should be rehabilitated, corrected, punished, or indeed, treated (Alter...

Team Work

Introduction             My name is Betty Annie Mathew, 25 years old, and has a BSC in nursing from the PSG College of Nursing in India. I am currently doing my adaptation programme in order to become a registered nurse in the United Kingdom according to the rules and regulations set by the Nursing and Midwifery Council. Prior to this, I had three years work experience in the field of nursing pediatrics back in India. I am doing my adaptation programme at Fulwood Lodge Nursing Home in Sheffield. This is a 42 bedded nursing home with 24 hours nursing care. There are 2 nurses and 6 care assistants on the morning shift where team work plays an important role for the proper and smooth running of shift. At night, there is 1 nurse and 3 carers on duty. The nursing home has a matron who is fully incharge of the nursing home and a deputy matron who will be assisting her. As I have noticed that team work has significantly affected the level and quality of client care in my place of work, I have decided to do a paper on this particular issue of team work and its relationship to the level of patient care and satisfaction.   Body             Health care teams have been described as multidisciplinary, interdisciplinary, cross-disciplinary, polydisciplinary, pandisciplinary, transdisciplinary, and virtual. This is also applied to nursing care teams. An advantage of this is the collaborative style that encourages each member of the team to help the other members.             Effective team work requires good communication in order for nurses to be able to provide to their patients the best quality of care. Frustrated team members often express concerns about its quality and extent. As in any relationship between people, the ability to “keep the lines of communication open” in a team is an important indicator of effective team work skills.             As the old saying goes, “two heads is better than one.” How much more a team? Each member of a team can contribute ideas for the care of the client. This could definitely give the team options and chose what is best for the client and his situation. The members of the team also can each help each other and at the same time divide their tasks in order to be able to provide the best quality of care for the client.   Conclusion             Working outside teams still can provide quality of care to the patient. But having a team to take care of a patient can significantly increase the quality of care offered to the patients. Aside from that, team work can enhance relationships between nurses and also provide many options for the care of the patient.             It is thus important that there is cooperation within the team in order for hospital shifts to run smoothly and for nurses to be able to provide high levels of quality of care for the patients. References Clark, P.G. & Drinka, T.J.K. 2000, Interdisciplinary Practice and Teaching, Auburn House. Potter, P. and Perry, A. 2004. Fundamentals of Nursing. Mosby. Credit:ivythesis.typepad.com

Team Work

Introduction My name is Betty Annie Mathew, 25 years old, and has a BSC in nursing from the PSG College of Nursing in India. ...

Ethics Component

ETHICS COMPONENT   1.         Scenario 1:               In this scenario, the case of autonomy is the issue. Autonomy refers to a person’s independence, in this case the client’s independence. As a standard in ethics, autonomy represents an agreement to respect another’s right to determine a course of action. Based on this standard in ethics, the health care professionals should have respected the client’s decision as to what should be the next course of action. The health care team has no right to detain here and impose their decisions on her since in the first place the client is not found to be mentally incapacitated. Respect for another’s autonomy is fundamental to the practice of health care. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. The decision to be discharged from the hospital may be at the hands of health care professionals but the client also has the right to voice out his or her opinions which should be respected by the health care professionals.             The agreement to respect autonomy involves the recognition that clients are in charge of their own destiny in matters of health and illness. Let us take for example the consent process required prior to surgery, this implies that a client may refuse treatment. In most cases the health care team must agree to follow the client’s wishes. Health care professionals agree to abide by a standard of respect for the client’s autonomy.             The nurse has of course a moral duty to prevent suicide. However, the client does not appear to be mentally ill and should be given her freedom and right to decide. If the client decides to go home, then she should be allowed to go home since in the first place she does not appear to be mentally ill and could make sound decisions and judgments. Unless the client is proven to be unable to make sound decisions and judgments, then the health care professionals and the family of the client could decide for the health care of the client.   2. Scenario 2:               The nurse in this scenario did not behave ethically. This could be discussed through the aspect of medical ethics which is beneficence. This refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. Commitment to beneficence helps to guide difficult decisions wherein the benefits of a treatment may be challenged by risks to the client’s well-being or dignity.             In the scenario, the nurse probably went against the doctor’s orders because she felt pity for the client. Given the fact that the client is terminally ill, the nurse could have felt that it was a little selfish and harsh for the doctor not to give the client anything to eat or even drink. Or the nurse could have thought that she owe it to the client to give him something to drink since he is dying anyway and the nurse just wants to grant a dying man’s wish. Thus, the nurse went against the doctor’s orders and gave the terminally ill man small sips of water. Although the nurse did this with good intentions in her mind, it is possible that it could have a bad effect on the client.             The nurse should have thought that the doctor’s orders may cause discomfort to the client, but the benefits, both for the individual and the society, outweigh the temporary discomfort. If the nurse has doubts of the doctor’s orders, she could have simply asked the doctor about it and why it should be done. The nurse should not act on her own without asking for advice, especially since this is a case wherein orders from a higher authority is given. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest.             The nurse must remember that whatever she did on the client, she is accountable and responsible for. If what she did could harm the client, she could be blamed for it, and worse, she could be sued for malpractice. Depriving a client of something to eat and drink could sound harsh, but there are rationales for such actions. In ethics, such is done for the benefit for the client. No matter how terminally ill a client is, health care professionals must abide by what should be done clinically within the bounds of their established code of ethics.   3. Differentiate between legal, clinical and ethical dimensions of nursing practice. Give example of each to support your response.               Legal dimensions of nursing practice refer to legal boundaries within which nurses must function. There are certain legal guidelines that nurses must follow. An understanding of the implications of the law can protect nurses from liability and also protect their client’s rights. To illustrate, nursing malpractice which results when nursing care falls below the standard of care, is an example of a legal issue.             Clinical dimensions of nursing practice involve the nursing care itself that the nurse offers to the client. This also pertains to the skills of a nurse which are necessary to deliver a timely and effective care for the client. An example of clinical dimensions of nursing practice those that involve the complete assessment of a client’s condition that enables the nurse to make an accurate clinical decision as to the client’s needs and required nursing therapies.             Ethical dimensions of nursing practice include the ideals of right and wrong behavior. In professional practices including nursing, a code of ethics provides guideline for safe and compassionate care. A nurse’s commitment to the code of ethics guarantees the public that nurses adhere to professional nursing standards. An example of ethical dimensions of nursing practice includes the following scenario: A young woman is hospitalized in the final stages of cancer. The family of the young woman has expressed their thought for “no resuscitation” since everything has already been done and further treatment would be futile. The health care team caring for the young woman, especially the nurse faces an ethical dilemma.   Credit:ivythesis.typepad.com

Ethics Component

ETHICS COMPONENT 1. Scenario 1: In this scenario, the case of autonomy is the issue. Autonomy refers to a p...

WHY IS IT NECESSARY TO NOT ONLY ACT ETHICALLY IN THE PRACTICE OF NURSING BUT TO BE SEEN TO BE ACTING ETHICALLY?

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically?   Introduction             The application of ethics in the field of medicine has significantly broadened in the past few years. This is brought about by a number of factors like the advancement in medicine which is driven about by technology. Although there is nothing wrong with this, this has posed serious threats to the practice of medicine. This does not mean that in the past the medical and health care communities have been slack in their practice of ethical behavior but rather the changes have made significant ethical implications in the field of medicine and the delivery of health care. The practice of nursing, being in the front line of medical care, has also been subject to many ethical issues.          In their daily work, nurses deal with intimate and fundamental human events such as birth, death, and suffering. They must decide the morality of their own actions own actions when they face the many ethical issues that surround such sensitive areas. For this particular paper, the question as to why it is necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically will be answered. This paper will use the author’s own perception on the matter as well as literature derived from other sources. The paper will start off with an explanation of ethics and its application in the field of medicine and health care, with emphasis on the field of nursing. Furthermore, other aspects of ethics will also be discussed so as to help provide a better understanding of the whole concept of doing what is ethically right and the importance of being seen while doing what is ethically right.   Overview of Ethics             Ethics is the study of good conduct, character, and motives. It is concerned with determining what is good or valuable for all people. Ethics is the exploration of what kind of person one “should” be or how one “should” act. A well-recognized premise of such exploration is that “ought implies can.” In other words, in saying that someone ought to do X or that X is the ethical thing for him to do, we are assuming that it is actually possible for him to do X. There is no moral obligation to do the impossible. It does not help us in acting ethically to consider whether we have a moral obligation to do something that, quite simply, we cannot do. This is true in health care as it is in other areas of our lives (, 2005).   Philosophical Constructions of Ethics             Discussions about health issues have progressed over time, just as developments in health care and society itself have progressed. The philosophical constructions that shape the discussions also have changed. Ethics began as a standard reference point for the determination of right action. It has now grown into a field of study that is filled with differences in opinion, competing systems of values, and deeply meaningful efforts to understand human interaction with new technologies.   Ethics in the Nursing Profession Medical ethics, a branch of the philosophy of ethics, deals with moral decisions in medicine. The branch of nursing ethics could be considered under the umbrella of medical ethics. The moral foundation of the nursing profession is based on the perspectives of Florence Nightingale, who described nursing as a self-defining moral practice focused on caring. This moral foundation evolves from the nurse-patient relationship. Morality in nursing practice arises from the idea that it is morally good to promote the physical and psychological well-being of patients. Nurses, however, may find it difficult to prioritize these moral nursing values over their personal values (, 2002). In the nursing profession, acts that are ethical often reflect a commitment to standards which are beyond an individual’s personal preferences – standards on which individuals, professions, and societies agree ( & , 2004). Ethics has become an important way of life in a post-modern society that does not acknowledge any fixed points of reference. Nursing is essentially a work of intimacy. The tasks of nursing require the nurse to be in close contact with clients, physically and emotionally. This kind of contact is usually not acceptable in public relationships. As a result, the work of nursing involves the negotiation of values whether those values be of the client, the physician, the employer, or other concerned groups. Maintaining their own moral integrity is central to nurses’ moral experience. Studies have documented that nurses sometimes feel they are forced to betray their own values. Their position in organizations, a lack of involvement in the decision-making process, and lack of authority seem to contribute to the experience of powerlessness in situations of moral difficulty (, 2005). Discussion and resolution of ethical issues requires critical thinking skills. Unlike the resolution of clinical problems, however, the resolution of ethical issues involves the negotiation of closely held personal values and philosophies, not facts or measurable clinical data. Resolution of ethical issues incorporates not only the nurse’s personal values but also the interpretation of the client’s personal values, based on the unique perspective of nurses ( & , 2004). Ethics guided by one’s own moral values is very important since an ability to make good decisions about one’s health care promotes healthy behaviors across the lifespan (, 2000).   Origins of Ethical Problems in Nursing             Nurses’ growing awareness of ethical problems has occurred largely because of (a) social and technological changes and (b) nurses’ conflicting loyalties and obligations.   A. Social and Technological Changes             Social changes, such as the women’s movement and a growing consumerism, also expose problems. The large number of people without health insurance, the high cost of health care, and workplace redesign under managed care all raise issues and fairness of allocation of resources.             Technology creates new issues that did not exist in earlier times. Before monitors, respirators, and parenteral feedings, there was no question as to whether to “allow” an 800-gram infant to die. Before organ transplantation, death did not require a legal definition that might still permit viable tissues to be removed and given to other living persons. Advances in the ability to decode and control the growth of tissues through gene manipulation present new potential ethical dilemmas related to cloning organisms and altering the course of hereditary diseases and biological characteristics. In line with all these, many questions arise.   B. Conflicting loyalties and obligations Because of their unique position in the health care system, nurses experience conflicts among their loyalties and obligations to clients, families, physicians, employing institutions, and licensing bodies. Client needs may conflict with institutional policies, physician preferences, needs of the client’s family, or even laws of the state. According to the nursing code of ethics, the nurse’s first loyalty is to the client. However, it is not always easy to determine which action best serves the client’s needs.   Nursing Point of View             Professional nurses play a vital role in the management of health care in both outpatient and inpatient settings. All clients interact with a nurse at some point in the health care system.             When ethical situations arise, the nurse’s point of view is unique and critical. The nurse usually interacts with clients over longer time intervals than do other health care professionals. Because nurses may be involved in intimate physical acts such as bathing, feeding, and special procedures, clients and families reveal information generally not shared with physicians and others. Details about family life, information about coping styles, personal preferences, and details about fears and insecurities are likely to come out during nursing interventions (, 1997).             On the other hand, it is important for nurses to remember that care of any one client has become multidisciplinary and often fragmented. The nursing point of view is part of a larger picture that is best built by all members of the health care team, including the client and family. When involved with ethical decisions, the nurse must also seek the opinion of other health care professionals.             Nurses who face ethical dilemmas in their practice often find their voices and point of views are not heard when it comes to collaborative decision making on the issue. Factors such as conflict within the medical team and the existence of hierarchical structures can mean the nurse at the coal face is not consulted. This is a fact in medical and health care systems and should be given solutions by their respective governing bodies.   Nursing Code of Ethics In professional practices such as nursing, a code of ethics provides guidelines for safe and compassionate care. Nurse’s commitment to a code of ethics guarantees the public that nurses adhere to professional practice standards set for their profession.   Nursing Errors, Ethics, and the Law             The ethical issues associated with nursing practice are closely tied-in to legal issues. Ethics, in a way, dictates what ought to be done and what ought not to be done. As a result of many nursing practices that failed to consider ethical considerations, some nurse and even other health care professionals face malpractice suits. However, it is important to point out that not all malpractice issues are a result of unethical behaviors. Nursing errors are a part of the nursing profession. Most often these are not deliberately done by the nurse. However, one just cannot expect the client or the family of the client to just let errors pass, especially if this significantly affects the client. When a nurse commits errors, most often this is subject to ethical considerations and the nurse will have to face legal consequences. One common error made by nurses is medication administration. Such an error will result in the nurse feeling vulnerable and upset. Not only are they concerned about how the mistake will affect the patient, they also worry about the implications on their careers if they are disciplined. By admitting to the mistake, they may be ridiculed by other nurses or even worse, lose the trust of their patients. The outcome of this distress is that often the nurse will hide the truth when the patient seems to be unaffected. Many ethical questions arise in these instances: Should the nurse tell the truth and disclose the error? Will telling the patient, cause more harm than good? If the patient isn’t ton and they find out later, will the outcome be an erosion of trust? (, 2005).             Hidden mistakes also occur in the nursing profession. This means that problems with procedures are not recognized. This eventually has an impact on the quality of care delivered to our patients. Nurses need to be supported and encouraged by management when they disclose an error. They are then in a position to learn from their mistakes and can hopefully help to identify ways in which a similar event can be avoided. This process can help to alleviate feelings of guilt associated with the event.             Surprisingly, the issue of truth telling in the health care setting is a relatively modern concept. In the past, it was considered preferable to keep unpleasant information concerning diagnosis and the progression of a disease from the patient, under the guise of protecting them from unnecessary distress. It was the health professional’s responsibility to decide whether the patient should or should not know the truth. At times, the family would insist that their loved-one should not be told of their prognosis. The patient had no autonomy at all. Modern legislation, however, recognizes the tights of a person to be given true and accurate information about their illness and treatment (, 2005).             Nurses must accept responsibility for nursing actions to safeguard the privacy rights of patients by carefully protecting confidential information. The patient’s confidence that information given to the nurse will remain private is an important element in the nurse-patient relationship. Without this assurance, the patient might be unwilling to divulge information critical to his or her care (, 2002).             The average nurse still appears to believe that accountability is all about following procedure and making sure that ‘one is covered’ by having the right kind of note or record or witness to refer to when something goes wrong or when, for whatever reason, an accusation is made (, 1994). Fighting hospital policy and the fear of lawsuits can influence whether the nurse eventually acts by moral choice. This situation can be frustrating and may lead to considerable distress. A nurse who is not able to find resolution to an ethical dilemma, and then act in a way in which she feels morally comfortable, may experience anxiety, feelings of guilt and possibly burnout. It is therefore very important that our leaders and managers include in their nursing education and hospital in-service sessions, teaching that will prepare today’s nurses for the complex ethical issues they will encounter (, 2005). To defend against a malpractice lawsuit, the nurse must prove that one or more of the required elements is not met ( & , 2004). From this statement alone, one could see that what could practically save a nurse from a malpractice lawsuit is a proof. And what better proof could be provided than a witness that would claim that the nurse did not breach any ethical or moral limits.   The Importance of Being Seen Acting Ethically             To do something ethically in the presence of another person could be a good evidence in case a malpractice suit or ethical complaints are being raised against the nurse. When someone is present while a nurse performs an intervention or procedure, this would minimize and even eliminate questions and doubts as to whether the interventions have been properly performed or not.             The presence of a non-participant observer does threaten a loss of privacy or dignity for the patient concerned. It may also result in such a loss for any other patients who may not themselves be involved in the study but who can be seen or heard by the observer (, 1994).             Application of the Importance of Being Seen Acting Ethically in the Nursing Profession Let us consider 2 scenarios wherein the aspect of being seen while doing a nursing practice ethically is of paramount importance:   Scenario 1:             In this scenario, a case of autonomy in ethics is the issue. Autonomy refers to a person’s independence, in this case the client’s independence. As a standard in ethics, autonomy represents an agreement to respect another’s right to determine a course of action. Based on this standard in ethics, the health care professionals should respect the client’s decision as to what should be the next course of action. When a client wants to leave the hospital after a health care procedure, the client should be allowed to do so providing the client is capable of making sound decisions for him- or herself. The health care team has no right to detain a client and impose their decisions on him or her since in the first place the client is not found to be mentally incapacitated. Respect for another’s autonomy is fundamental to the practice of health care. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. The decision to be discharged from the hospital may be at the hands of health care professionals but the client also has the right to voice out his or her opinions which should be respected by the health care professionals.             The agreement to respect autonomy involves the recognition that clients are in charge of their own destiny in matters of health and illness. Let us take for example the consent process required prior to surgery, this implies that a client may refuse treatment. In most cases the health care team must agree to follow the client’s wishes. Health care professionals agree to abide by a standard of respect for the client’s autonomy.             In a case where the client manifests autonomy, such as the one where he or she refuses any treatment, someone else should be present in the scenario other than the nurse. The client may refuse treatment but the family of the client may cry foul if anything happens to the client. The family of the client could file a malpractice suit against the nurse or other health care professionals if they have no proof that it is the client’s wish not to be treated and thus would apply to be a client’s exercise of autonomy which is within the bounds of ethical nursing practices. Since the profession simultaneously expects nurses to ensure autonomy and maintain safety, nursing needs to gather evidence that less restrictive alternatives can maintain safety for their clients and for their own. Rather than encourage changing the procedural laws, nursing needs to ensure that nurses implement involuntary procedures in a manner that protects client safety and clients’ rights. This is more prominent in situations that concern psychiatric patients. Experienced psychiatric nurses need to articulate more definitive ways to determine risk vs. benefit for ethical decision making in the daily care of psychiatric patients. Nursing education thus must reflect the real situations that psychiatric nurses face and insist that student nurses actually commit to making some choices when faced with a situation (, 2000). Nurses have little guidance in determining ethical choices in situations such as this where involuntary procedures may be required. Nursing choices are constrained by law and hospital policy, but there are tremendous gray areas where the rules are unclear (, 2000). The nurse has of course a moral duty to prevent anything bad from happening to the client. However, if the client does not appear to be mentally ill, he or she should be given the freedom and right to decide regarding her treatment. If the client decides to go home, then he or she should be allowed to go home since in the first place he or she does not appear to be mentally ill and could make sound decisions and judgments. Unless the client is proven to be unable to make sound decisions and judgments, then the health care professionals and the family of the client could decide for the health care of the client. Whatever the decision may be, or whoever may decide for the client, a witness should be around in case issues of unethical practice are raised against the nurse.   Scenario 2:             In another scenario, let us consider the case of a nurse who is in charge of the care of a terminally ill man. In the physician’s orders, the man is not to have any liquid taken orally. The nurse is aware of this order yet the nurse did not follow this and instead gave the man a few sips of water to drink. The nurse in this scenario did not behave ethically. This could be discussed through the aspect of medical ethics which is beneficence. This refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. Commitment to beneficence helps to guide difficult decisions wherein the benefits of a treatment may be challenged by risks to the client’s well-being or dignity.             In the scenario, the nurse probably went against the doctor’s orders because she felt pity for the client. Given the fact that the client is terminally ill, the nurse could have felt that it was a little selfish and harsh for the doctor not to give the client anything to eat or even drink. Or the nurse could have thought that she owe it to the client to give him something to drink since he is dying anyway and the nurse just wants to grant a dying man’s wish. Thus, the nurse went against the doctor’s orders and gave the terminally ill man small sips of water. Although the nurse did this with good intentions in her mind, it is possible that it could have a bad effect on the client, and thus the nurse still did not behave ethically.             The nurse should have thought that the doctor’s orders may cause discomfort to the client, but the benefits, both for the individual and the society, outweigh the temporary discomfort. If the nurse has doubts of the doctor’s orders, she could have simply asked the doctor about it and why it should be done. The nurse should not act on her own without asking for advice, especially since this is a case wherein orders from a higher authority is given. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest.             The nurse must remember that whatever she did on the client, she is accountable and responsible for. If what she did could harm the client, she could be blamed for it, and worse, she could be sued for malpractice. Depriving a client of something to eat and drink could sound harsh, but there are rationales for such actions. In ethics, such is done for the benefit for the client. No matter how terminally ill a client is, health care professionals must abide by what should be done clinically within the bounds of their established code of ethics.             Suppose the client died just five hours after the nurse gave the man sips of water, the nurse would likely be partly one to be blamed for the incidence if someone else knew what she has done. If there was no one to witness, then it will be in the conscience of the nurse that if perhaps she followed the physician’s orders the client would still have been alive.             If it was another scenario still where the nurse followed the physician’s orders with witnesses around and still the man died after a few hours, then it is unlikely that the nurse will be blamed for the man’s death. Granting that the nurse only followed the orders of the physician and there were other people around to witness that the nurse indeed behaved ethically, then the nurse does not have to bear any ethical question regarding what she did.             This situation given here occurs when a nurse disagrees with the treatment decisions made by the attending physician but which she nonetheless is required to follow. In some cases, the nurse may recognize that the orders are mistaken or violate the accepted standard of care. Under the ethical codes of both the nursing and medical professions, a nurse has no duty to carry out such orders (, 2005). However, the nurse cannot act only on her own. She has to talk over with the physician or other concerned health care professional if she deemed the orders unethical or wrong.   Conclusion             In the past, nurses looked on ethical decision making as solely the physician’s responsibility. However, one should consider that no one profession is responsible for ethical decisions, nor does expertise in one discipline such as medicine or nursing necessarily make a person or expert in ethics. The ethical decision thus cannot be left only to the hands of the physicians. And thus it goes also to say that one cannot say that a nurse is an expert in the field of nursing ethics just because he or she is a nurse. Additionally, the advent of technology coupled with numerous other factors has significantly changed ethical concerns and behaviors. This has brought about many issues regarding the conduct of ethical behavior. The practice of doing what is ethical is not sufficient alone in the contemporary times. There is increasing importance given to the fact that one also needs to be seen when doing what is ethical behavior or practice. This is very important especially with the advent of medical malpractice lawsuits. A witness to a nurse doing what is ethical may save not only a nurse’s profession but also the nurse’s whole life. Perhaps, as the old adage says,  to see is to believe. To be able to see that the nurse does what is right and ethical would perhaps be a lifesaving factor for the nurse from anything that can harm him or her and the nursing profession in general. Being seen doing what is ethically right could not only boost the morale of the nursing profession but also serves to protect nurses against unreasonable complaints from their clients.               REFERENCES Credit:ivythesis.typepad.com

WHY IS IT NECESSARY TO NOT ONLY ACT ETHICALLY IN THE PRACTICE OF NURSING BUT TO BE SEEN TO BE ACTING ETHICALLY?

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically? Introduction ...

Case Study on disciplinary perspectives and professional codes of ethics

Case Study on disciplinary perspectives and professional codes of ethics

Credit:ivythesis.typepad.com

ETHICS

The issues of ethical considerations with regards to the conditions of grandmother Ann as the physician ask the family’s permission to insert a feeding tube for Ann as she starts to cough and have fever as she has been diagnosed by the doctor for having pneumonia and because Ann stops talking and refuses to eat does not justifies a valid reason for using a feeding tube as in taking care of patients well being and quality of life implies moral and ethical standards of actions to be taken to the patient as in the case, feeding tubes can’t be good to patients with pneumonia as it can only give further health complications and there are still other ways to handle Ann’s situation aside from feeding tubes like for instance, it is still possible to acquire mouth feeding as there was no indication that Ann has difficulty in swallowing food, maybe she was just feeling lonely and alone because she misses her husband Frank and daughter Sarah what the patient truly needs is her family’s care and attention not allowing the nursing home to decide everything with regards to the situation. Moreover, the feeding tube is not right for the case of Ann as there could be any unethical speculations that can justify moral rules and principles within the consequences of doing the act.               Accordingly, placement of a feeding tube does not always mean that eating by mouth is over but supplementation is necessary for proper nutrition and health. (2002; 2000;  2000; 2000; 1996). Furthermore, progression must be considered when making the decision. If the patient is at the end of their struggle and cannot utilize nutrients a feeding tube may not be helpful. (2003;  2000;  1999) A physician will not place a feeding tube if all attempts at feeding by mouth have been exhausted. Tube feeding is a method of providing nutrition to people who cannot sufficiently obtain calories by eating or to those who cannot eat because they have difficulty swallowing.  (2003;  2000; 1999) Thus, oral intake can be continued for more pleasurable sensations, such as small bites of a favorite food. It is a very important decision to be made and will be easier if the person wishes are understood and if family members can agree upon the decision long before tube feeding is considered. (2003;  2000;  2000)                 The family members will find it difficult to decide against alternative feeding because death may be hastened by their decision as there is no easy answer and it can be very hard to gauge a personís quality of life and tube feedings can cause discomfort  the need for physical restraints to prevent the tube from being pulled out, risk  infection and discomfort. (2003; Finucane and Christmas, 2000) In addition, there are laws about tube feeding and the use of do not resuscitate orders differ from state to state. The Patient and her family should be provided with a realistic picture of the probable outcome of patients who are tube-fed, without providing undue expectations of favorable outcomes ( 2003; 2000; 2000). Aside, tube feeding will not help prevent or heal pressure sores, nor has it decreased the incidence of pneumonia (1999; 2001). On the contrary, pneumonia remains a significant contributor to mortality in tube-fed patients and neither has the quality of life, including patient comfort and improved substantially ( 1999; 2002; 2000).               In nursing homes, assessments by speech therapists, staffing patterns, and fiscal constraints appear to influence the practice of tube feeding in cognitively impaired patients (2003). Tube feeding is considered a medical intervention, not obligatory care (2001). The physicians need to provide information to the patient about the benefits and burdens associated with long-term tube feeding and not encourage undue expectations ( 2002; 2000;  2000; 2000; 1996). Therefore, the ethics committees can help physicians reach a consensus on how to proceed as tube feeding is an art and a science that is used in the aging society as more people become physically incapacitated as properly used, the tube feeding can be helpful. However, the patient should be monitored for tolerance and complications and assessed for a possible return to oral feeding. (1998) The procedure can be burdensome through tube-related complications and the use of restraints. The non-clinical factors may influence the ultimate decision of placing a feeding tube as the clinicians may fear that they are vulnerable to legal action if they do not place a feeding tube in the patient.               Aside, the physician may fear that not having a feeding tube in a cachectic patient with progressive weight loss and bedsores will insinuate neglect and have negative legal consequences. (1998) Nursing homes may not be willing to devote more time to each patient, especially without financial compensation. This may explain why residence in a nursing home is associated with an increased risk of receiving a new feeding tube.It is important to be sensitive to certain assumptions because they will influence the decision of whether or not a feeding tube is inserted. ( 1998)       Credit:ivythesis.typepad.com

ETHICS

The issues of ethical considerations with regards to the conditions of grandmother Ann as the physician ask the family’s perm...

Ethical decision making

Ethical decision making Ethical decision making is the application of the processes and theories of moral philosophy to a ‘real’ situation. As a nurse, you will encounter situations where you are faced with two alternative choices, neither of which seems a satisfactory solution. Conflict arises when there is a need to choose between two apparently equal courses of action, each of which would have significant consequences for the outcome of care. This constitutes an ethical dilemma. Having read this scenario you may consider that there are other options. You may also have identified your preferred course of action. Refer back to Exercise 1.2.1 and identify how your reaction to the example was influenced by your personal values and beliefs.   CASE STUDY ONE Consider the following scenario. You may wish to discuss it with your colleagues. Scenario (Based on Jones 1994, p. 21.) Your 18-year-old son, Ben, is worried about his friend Steve’s apparent addiction to drugs. Until Ben became worried, no dilemma existed. The fact that he is worried indicates that he would like to do something about it and he has two basic choices, each with different consequences. Choice 1: Do nothing. Consider that Steve is experimenting with aspects of life in order to enable him to make the transition to a self-determining adult. Alternatively, Ben may consider that it is none of his business and he has no right to interfere. Possible consequences: a) Steve soon decides that it is not for him and gets on with his life. b) Steve becomes increasingly antisocial as a result of his addiction, possibly engaging in criminal activities to support his habit. c) Steve dies from continual drug abuse. Choice 2: Tell Steve’s parents in order that advice can be sought in time. Possible consequences: a) Steve is furious at the breach in friendship/confidentiality. He continues to use drugs and the friendship is over. b) After the initial trauma that he has been found out by his parents, Steve is thankful that his friend sought help for him in time.   How we make decisions We can examine a situation to determine the best course of action, using the ethical principles below in conjunction with an ethical decision-making model. The six ethical principles that underpin moral philosophy are: Autonomy: This refers to a person’s ability to make or exercise self-determining choice in the context of respect for others and their right to make choices. An example of upholding a patient’s autonomy is through the provision of adequate information, allowing the patient to give informed consent. Beneficence: This demands that above all we do good, and therefore requires a positive action to benefit someone, for example, providing nursing care that is both appropriate and affordable. Non-maleficence: This demands that above all, we do no harm and therefore we have a duty not to injure others. This is integral to the obligation of ‘duty of care’. Justice: This is the equal distribution of benefits and harms in the context of what is deserved. It centres on the notion of fairness. All patients deserve the same standard and quality of care, regardless of the health care setting. Veracity is concerned with being truthful and honest. This is fundamental to the development of trust in the nurse/patient relationship. Confidentiality: This is not divulging information about a person without his/her consent thus respecting the privacy and wishes of others. Text reading: Refer to your text on ethical issues.   Credit:ivythesis.typepad.com

Ethical decision making

Ethical decision making Ethical decision making is the application of the processes and theories of moral philosophy to a ‘real’ situ...

Utilitarian vs. Deontological Perspective: Truth Telling in Nursing

Utilitarian vs. Deontological Perspective: Truth Telling in Nursing               Nursing is an important field in healthcare as it is the process for caring for, or nurturing for an individual known as the ‘patient’. It also refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing ( 1993). Being crucial in the healthcare field, certain functions and practices are being observed by nurses in order to more effectively and more efficiently provide services to their patients. To further provide adequate service to their patients, nurses also have to observe moral and ethical principles and practices, as ethics and morals may serve to provide dilemmas and conflicts in rendering sufficient service to patients. In addition, ethical principles and morals must be properly given importance and significance in the nursing practice to ensure that the well-being and health of the patients would be given priority, thus, upholding and promoting the moral aspect of the practice. As such, this essay aims to choose whether a deontological or utilitarian perspective would be necessary for a particular case of truth telling of a nursing practitioner. In this regard, both concepts would be briefly differentiated, to be able to make a choice, as being applicable to the case at hand. Afterwards, principles and alternative actions would be provided, with reference to the case in question. At the last part of the essay, a conclusion would be provided, which would emphasize the important decision made based on the discussion of the concepts.   Utilitarian vs. Deontological Concept To be able to make a choice between what perspective to use, both the utilitarian and the deontological perspective must be briefly defined and differentiated. It has been reported that the moral standard of utilitarianism is those actions are right that produce the greatest total amount of human well-being. This concept has a great intuitive appeal to many people because human well-being seems to be such a natural goal of human behavior (2007). It has two underlying theories, namely, Act Utilitarianism and Rule Utilitarianism. Act utilitarianism theory promotes moral conduct that produces the greatest balance of good over evil, thus, a balance of good and evil is applied to every action. On the other hand, rule utilitarianism theory uses rules to assess the balance of good and evil, thus, there is conformity of actions to valuable rules. In addition, from the utilitarian perspective, what is considered ethical can be summarised in the basic tenet ‘the greatest good for the greatest number’ (1992). On the other hand, from a deontological perspective, there is no need to justify duties by showing that they are productive of good; the philosophy focuses on universal statements of right and wrong. The principle is always to act so that everyone faced with the same situation, should take the same actions. The moral system of thinking is based on the view that particular types of action and/or behavior are intrinsically ethical or unethical, within rights and justice principles. For example, cheating is always dishonest and hence, always unethical; the behavior or action being wrong it not mitigated by how good either the motive behind it or the consequences following from it are ( 2002). In this regard, it can be understood that in the utilitarian perspective, a certain action is done based on whether it is good or bad, based on the well-being of the decision-maker and the well-being of the persons involved in making the decision. With the deontological perspective, one makes a certain decision or action based on whether it is good or bad, regardless of the consequences of the decision. From this difference, it can be perceived that the perspective to be appropriately used is the utilitarian perspective.   Utilitarian Analysis of the Case             The principle of utility affirms that actions or behaviors are right as far as they promote happiness or pleasure, and wrong, as they tend to produce unhappiness or pain ( 2007). Utility is meant that property in any object, whereby it tends to produce benefit, advantage, pleasure, good, or happiness, or to prevent the happening of mischief, pain, evil, or unhappiness to the party whose interest is considered. If the party would be the community in general, then utility means the happiness of the community, and if the party would be an individual, then utility means the happiness of that individual (1823). In using the utilitarian perspective, this means that May experiences a dilemma based on the values and the Code of Ethics of nurses. One of the emphasized values and codes of ethics of nurses is the ethic of confidentiality, which is not divulging information regarding a person without his or her consent or knowledge, which exhibits respect in terms of the privacy and wishes of the patient or client (2001). It also emphasizes the nurses must safeguard information learned in the context of a professional relationship, and must ensure it is shared outside the healthcare team only with the person’s informed consent, or as may be legally required, or where the failure to disclose would cause significant harm (2002). However, telling the truth to Mr. Lee, regarding his condition and the condition of his wife would generate benefit to both parties, as they would be able to undergo tests and receive early treatment. Nevertheless, keeping the information from Mr. Lee would also generate happiness on the part of Mrs. Lee, thus, having no conflict with the confidentiality of the condition of Mrs. Lee.             In order to make the right decision in line with the utilitarian perspective, certain alternative or viable actions can be done. Primarily, during the conversation of May and Mr. Lee, May can provide information on the condition of Mrs. Lee by informing Mr. Lee regarding the pregnancy of his wife, which is the primary condition why Mrs. Lee was admitted to the hospital. In this way, May would be able to answer safely regarding the condition of Mrs. Lee, and prevent divulging pertinent information that Mrs. Lee would like to be kept hidden from her husband. Second viable action that May can do is to speak to Mrs. Lee regarding her condition and the condition of her spouse, and advise her that their condition would be detrimental to their health and the health of their child. May can advise Mrs. Lee to talk about the matter to his husband, for them to figure out what to do. Third alternative or viable action May can do is to speak to the gynecologist of Mrs. Lee to figure out how to do about the condition of Mrs. Lee and her husband. In this regard, the both Mrs. Lee and her husband would be more convinced to undergo tests and receive early treatment, which would be helpful for the couple and their child.             From the viable actions or alternatives, it can be perceived that consequences can be predicted. In line with the first alternative, Mr. Lee would not be worrying about the condition of his spouse and child, thus, in this regard, the information provided by May would be the source of the happiness or contentment of Mr. Lee. This alternative also prompted May to protect the confidential information of her patient or client. However, on the part of May, it can be perceived that she has been experiencing a strong dilemma of not telling the truth to Mr. Lee and protecting the information of Mrs. Lee. In this regard, her actions both violate and follow the values and codes of ethics of nursing. In line with the second viable action, it can be predicted that Mrs. Lee can either take May’s advice or get mad at her. This is because Mrs. Lee would either be happy that May would be concerned regarding their condition, or be offended or insulted with May meddling with their personal affairs. In relation to the third viable action, it can be perceived that because of the conversation, Mrs. Lee’s gynecologist, May, and the other nurses in the unit would be able to coordinate with one another, in order to provide the best medical and healthcare that the family deserves.             From the consequences, it can be observed that the third alternative or viable action serves to produce or generate the best consequences in terms of happiness, pleasure and health for the Lee family and May, for that matter. On the part of the family, both Mrs. Lee and her husband would have the chance to undergo series of tests that would prompt them to receive early and effective treatments, thus, preventing their condition to worsen. This would then entitle effective treatment for the child of the couple. On the part of May, it can be perceived that her dilemma in terms of telling the truth of the condition of Mrs. Lee would be alleviated, as the burden of informing Mr. Lee of Mrs. Lee’s condition would be passed on to the gynecologist. In this regard, May allowed the gynecologist to do his or her job on providing the information to Mrs. Lee, which somehow extended respect on the gynecologist’s part. In addition, May would not be able to violate any values and code of ethics in her profession, which would present further dilemma and problems in the future.   Conclusion             From the discussion, it can be understood and deduced that in relevance to the case, May was able to exhibit the utilitarian perspective by doing good through thinking about the consequences of her actions that would not create conflict and harm on her part and on the part of the client or patient. If the deontological perspective would have been used, then May could have directly informed Mr. Lee of the situation, thus, creating conflict and further problems on the part of the couple and May herself. However, because the utilitarian perspective was used, it can be seen that May would be able to choose the right action that would best generate happiness and contentment on the part of the couple and herself.                      Credit:ivythesis.typepad.com

Utilitarian vs. Deontological Perspective: Truth Telling in Nursing

Utilitarian vs. Deontological Perspective: Truth Telling in Nursing Nursing is an important field in healthcare as it is ...

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically?

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically?   Introduction             The application of ethics in the field of medicine has significantly broadened in the past few years. This is brought about by a number of factors like the advancement in medicine which is driven about by technology. Although there is nothing wrong with this, this has posed serious threats to the practice of medicine. This does not mean that in the past the medical and health care communities have been slack in their practice of ethical behavior but rather the changes have made significant ethical implications in the field of medicine and the delivery of health care. The practice of nursing, being in the front line of medical care, has also been subject to many ethical issues.          In their daily work, nurses deal with intimate and fundamental human events such as birth, death, and suffering. They must decide the morality of their own actions own actions when they face the many ethical issues that surround such sensitive areas. For this particular paper, the question as to why it is necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically will be answered. This paper will use the author’s own perception on the matter as well as literature derived from other sources. The paper will start off with an explanation of ethics and its application in the field of medicine and health care, with emphasis on the field of nursing. Furthermore, other aspects of ethics will also be discussed so as to help provide a better understanding of the whole concept of doing what is ethically right and the importance of being seen while doing what is ethically right.   Overview of Ethics             Ethics is the study of good conduct, character, and motives. It is concerned with determining what is good or valuable for all people. Ethics is the exploration of what kind of person one “should” be or how one “should” act. A well-recognized premise of such exploration is that “ought implies can.” In other words, in saying that someone ought to do X or that X is the ethical thing for him to do, we are assuming that it is actually possible for him to do X. There is no moral obligation to do the impossible. It does not help us in acting ethically to consider whether we have a moral obligation to do something that, quite simply, we cannot do. This is true in health care as it is in other areas of our lives ( 2005).   Philosophical Constructions of Ethics             Discussions about health issues have progressed over time, just as developments in health care and society itself have progressed. The philosophical constructions that shape the discussions also have changed. Ethics began as a standard reference point for the determination of right action. It has now grown into a field of study that is filled with differences in opinion, competing systems of values, and deeply meaningful efforts to understand human interaction with new technologies.   Ethics in the Nursing Profession Medical ethics, a branch of the philosophy of ethics, deals with moral decisions in medicine. The branch of nursing ethics could be considered under the umbrella of medical ethics. The moral foundation of the nursing profession is based on the perspectives of Florence Nightingale, who described nursing as a self-defining moral practice focused on caring. This moral foundation evolves from the nurse-patient relationship. Morality in nursing practice arises from the idea that it is morally good to promote the physical and psychological well-being of patients. Nurses, however, may find it difficult to prioritize these moral nursing values over their personal values (2002). In the nursing profession, acts that are ethical often reflect a commitment to standards which are beyond an individual’s personal preferences – standards on which individuals, professions, and societies agree (2004). Ethics has become an important way of life in a post-modern society that does not acknowledge any fixed points of reference. Nursing is essentially a work of intimacy. The tasks of nursing require the nurse to be in close contact with clients, physically and emotionally. This kind of contact is usually not acceptable in public relationships. As a result, the work of nursing involves the negotiation of values whether those values be of the client, the physician, the employer, or other concerned groups. Maintaining their own moral integrity is central to nurses’ moral experience. Studies have documented that nurses sometimes feel they are forced to betray their own values. Their position in organizations, a lack of involvement in the decision-making process, and lack of authority seem to contribute to the experience of powerlessness in situations of moral difficulty (2005). Discussion and resolution of ethical issues requires critical thinking skills. Unlike the resolution of clinical problems, however, the resolution of ethical issues involves the negotiation of closely held personal values and philosophies, not facts or measurable clinical data. Resolution of ethical issues incorporates not only the nurse’s personal values but also the interpretation of the client’s personal values, based on the unique perspective of nurses (2004). Ethics guided by one’s own moral values is very important since an ability to make good decisions about one’s health care promotes healthy behaviors across the lifespan (2000).   Origins of Ethical Problems in Nursing             Nurses’ growing awareness of ethical problems has occurred largely because of (a) social and technological changes and (b) nurses’ conflicting loyalties and obligations.   A. Social and Technological Changes             Social changes, such as the women’s movement and a growing consumerism, also expose problems. The large number of people without health insurance, the high cost of health care, and workplace redesign under managed care all raise issues and fairness of allocation of resources.             Technology creates new issues that did not exist in earlier times. Before monitors, respirators, and parenteral feedings, there was no question as to whether to “allow” an 800-gram infant to die. Before organ transplantation, death did not require a legal definition that might still permit viable tissues to be removed and given to other living persons. Advances in the ability to decode and control the growth of tissues through gene manipulation present new potential ethical dilemmas related to cloning organisms and altering the course of hereditary diseases and biological characteristics. In line with all these, many questions arise.   B. Conflicting loyalties and obligations Because of their unique position in the health care system, nurses experience conflicts among their loyalties and obligations to clients, families, physicians, employing institutions, and licensing bodies. Client needs may conflict with institutional policies, physician preferences, needs of the client’s family, or even laws of the state. According to the nursing code of ethics, the nurse’s first loyalty is to the client. However, it is not always easy to determine which action best serves the client’s needs.   Nursing Point of View             Professional nurses play a vital role in the management of health care in both outpatient and inpatient settings. All clients interact with a nurse at some point in the health care system.             When ethical situations arise, the nurse’s point of view is unique and critical. The nurse usually interacts with clients over longer time intervals than do other health care professionals. Because nurses may be involved in intimate physical acts such as bathing, feeding, and special procedures, clients and families reveal information generally not shared with physicians and others. Details about family life, information about coping styles, personal preferences, and details about fears and insecurities are likely to come out during nursing interventions ( 1997).             On the other hand, it is important for nurses to remember that care of any one client has become multidisciplinary and often fragmented. The nursing point of view is part of a larger picture that is best built by all members of the health care team, including the client and family. When involved with ethical decisions, the nurse must also seek the opinion of other health care professionals.             Nurses who face ethical dilemmas in their practice often find their voices and point of views are not heard when it comes to collaborative decision making on the issue. Factors such as conflict within the medical team and the existence of hierarchical structures can mean the nurse at the coal face is not consulted. This is a fact in medical and health care systems and should be given solutions by their respective governing bodies.   Nursing Code of Ethics In professional practices such as nursing, a code of ethics provides guidelines for safe and compassionate care. Nurse’s commitment to a code of ethics guarantees the public that nurses adhere to professional practice standards set for their profession.   Nursing Errors, Ethics, and the Law             The ethical issues associated with nursing practice are closely tied-in to legal issues. Ethics, in a way, dictates what ought to be done and what ought not to be done. As a result of many nursing practices that failed to consider ethical considerations, some nurse and even other health care professionals face malpractice suits. However, it is important to point out that not all malpractice issues are a result of unethical behaviors. Nursing errors are a part of the nursing profession. Most often these are not deliberately done by the nurse. However, one just cannot expect the client or the family of the client to just let errors pass, especially if this significantly affects the client. When a nurse commits errors, most often this is subject to ethical considerations and the nurse will have to face legal consequences. One common error made by nurses is medication administration. Such an error will result in the nurse feeling vulnerable and upset. Not only are they concerned about how the mistake will affect the patient, they also worry about the implications on their careers if they are disciplined. By admitting to the mistake, they may be ridiculed by other nurses or even worse, lose the trust of their patients. The outcome of this distress is that often the nurse will hide the truth when the patient seems to be unaffected. Many ethical questions arise in these instances: Should the nurse tell the truth and disclose the error? Will telling the patient, cause more harm than good? If the patient isn’t ton and they find out later, will the outcome be an erosion of trust? (2005).             Hidden mistakes also occur in the nursing profession. This means that problems with procedures are not recognized. This eventually has an impact on the quality of care delivered to our patients. Nurses need to be supported and encouraged by management when they disclose an error. They are then in a position to learn from their mistakes and can hopefully help to identify ways in which a similar event can be avoided. This process can help to alleviate feelings of guilt associated with the event.             Surprisingly, the issue of truth telling in the health care setting is a relatively modern concept. In the past, it was considered preferable to keep unpleasant information concerning diagnosis and the progression of a disease from the patient, under the guise of protecting them from unnecessary distress. It was the health professional’s responsibility to decide whether the patient should or should not know the truth. At times, the family would insist that their loved-one should not be told of their prognosis. The patient had no autonomy at all. Modern legislation, however, recognizes the tights of a person to be given true and accurate information about their illness and treatment (2005).             Nurses must accept responsibility for nursing actions to safeguard the privacy rights of patients by carefully protecting confidential information. The patient’s confidence that information given to the nurse will remain private is an important element in the nurse-patient relationship. Without this assurance, the patient might be unwilling to divulge information critical to his or her care (2002).             The average nurse still appears to believe that accountability is all about following procedure and making sure that ‘one is covered’ by having the right kind of note or record or witness to refer to when something goes wrong or when, for whatever reason, an accusation is made (1994). Fighting hospital policy and the fear of lawsuits can influence whether the nurse eventually acts by moral choice. This situation can be frustrating and may lead to considerable distress. A nurse who is not able to find resolution to an ethical dilemma, and then act in a way in which she feels morally comfortable, may experience anxiety, feelings of guilt and possibly burnout. It is therefore very important that our leaders and managers include in their nursing education and hospital in-service sessions, teaching that will prepare today’s nurses for the complex ethical issues they will encounter (2005). To defend against a malpractice lawsuit, the nurse must prove that one or more of the required elements is not met (2004). From this statement alone, one could see that what could practically save a nurse from a malpractice lawsuit is a proof. And what better proof could be provided than a witness that would claim that the nurse did not breach any ethical or moral limits.   The Importance of Being Seen Acting Ethically             To do something ethically in the presence of another person could be a good evidence in case a malpractice suit or ethical complaints are being raised against the nurse. When someone is present while a nurse performs an intervention or procedure, this would minimize and even eliminate questions and doubts as to whether the interventions have been properly performed or not.             The presence of a non-participant observer does threaten a loss of privacy or dignity for the patient concerned. It may also result in such a loss for any other patients who may not themselves be involved in the study but who can be seen or heard by the observer (1994).             Application of the Importance of Being Seen Acting Ethically in the Nursing Profession Let us consider 2 scenarios wherein the aspect of being seen while doing a nursing practice ethically is of paramount importance:   Scenario 1:             In this scenario, a case of autonomy in ethics is the issue. Autonomy refers to a person’s independence, in this case the client’s independence. As a standard in ethics, autonomy represents an agreement to respect another’s right to determine a course of action. Based on this standard in ethics, the health care professionals should respect the client’s decision as to what should be the next course of action. When a client wants to leave the hospital after a health care procedure, the client should be allowed to do so providing the client is capable of making sound decisions for him- or herself. The health care team has no right to detain a client and impose their decisions on him or her since in the first place the client is not found to be mentally incapacitated. Respect for another’s autonomy is fundamental to the practice of health care. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. The decision to be discharged from the hospital may be at the hands of health care professionals but the client also has the right to voice out his or her opinions which should be respected by the health care professionals.             The agreement to respect autonomy involves the recognition that clients are in charge of their own destiny in matters of health and illness. Let us take for example the consent process required prior to surgery, this implies that a client may refuse treatment. In most cases the health care team must agree to follow the client’s wishes. Health care professionals agree to abide by a standard of respect for the client’s autonomy.             In a case where the client manifests autonomy, such as the one where he or she refuses any treatment, someone else should be present in the scenario other than the nurse. The client may refuse treatment but the family of the client may cry foul if anything happens to the client. The family of the client could file a malpractice suit against the nurse or other health care professionals if they have no proof that it is the client’s wish not to be treated and thus would apply to be a client’s exercise of autonomy which is within the bounds of ethical nursing practices. Since the profession simultaneously expects nurses to ensure autonomy and maintain safety, nursing needs to gather evidence that less restrictive alternatives can maintain safety for their clients and for their own. Rather than encourage changing the procedural laws, nursing needs to ensure that nurses implement involuntary procedures in a manner that protects client safety and clients’ rights. This is more prominent in situations that concern psychiatric patients. Experienced psychiatric nurses need to articulate more definitive ways to determine risk vs. benefit for ethical decision making in the daily care of psychiatric patients. Nursing education thus must reflect the real situations that psychiatric nurses face and insist that student nurses actually commit to making some choices when faced with a situation ( 2000). Nurses have little guidance in determining ethical choices in situations such as this where involuntary procedures may be required. Nursing choices are constrained by law and hospital policy, but there are tremendous gray areas where the rules are unclear (2000). The nurse has of course a moral duty to prevent anything bad from happening to the client. However, if the client does not appear to be mentally ill, he or she should be given the freedom and right to decide regarding her treatment. If the client decides to go home, then he or she should be allowed to go home since in the first place he or she does not appear to be mentally ill and could make sound decisions and judgments. Unless the client is proven to be unable to make sound decisions and judgments, then the health care professionals and the family of the client could decide for the health care of the client. Whatever the decision may be, or whoever may decide for the client, a witness should be around in case issues of unethical practice are raised against the nurse.   Scenario 2:             In another scenario, let us consider the case of a nurse who is in charge of the care of a terminally ill man. In the physician’s orders, the man is not to have any liquid taken orally. The nurse is aware of this order yet the nurse did not follow this and instead gave the man a few sips of water to drink. The nurse in this scenario did not behave ethically. This could be discussed through the aspect of medical ethics which is beneficence. This refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. Commitment to beneficence helps to guide difficult decisions wherein the benefits of a treatment may be challenged by risks to the client’s well-being or dignity.             In the scenario, the nurse probably went against the doctor’s orders because she felt pity for the client. Given the fact that the client is terminally ill, the nurse could have felt that it was a little selfish and harsh for the doctor not to give the client anything to eat or even drink. Or the nurse could have thought that she owe it to the client to give him something to drink since he is dying anyway and the nurse just wants to grant a dying man’s wish. Thus, the nurse went against the doctor’s orders and gave the terminally ill man small sips of water. Although the nurse did this with good intentions in her mind, it is possible that it could have a bad effect on the client, and thus the nurse still did not behave ethically.             The nurse should have thought that the doctor’s orders may cause discomfort to the client, but the benefits, both for the individual and the society, outweigh the temporary discomfort. If the nurse has doubts of the doctor’s orders, she could have simply asked the doctor about it and why it should be done. The nurse should not act on her own without asking for advice, especially since this is a case wherein orders from a higher authority is given. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest.             The nurse must remember that whatever she did on the client, she is accountable and responsible for. If what she did could harm the client, she could be blamed for it, and worse, she could be sued for malpractice. Depriving a client of something to eat and drink could sound harsh, but there are rationales for such actions. In ethics, such is done for the benefit for the client. No matter how terminally ill a client is, health care professionals must abide by what should be done clinically within the bounds of their established code of ethics.             Suppose the client died just five hours after the nurse gave the man sips of water, the nurse would likely be partly one to be blamed for the incidence if someone else knew what she has done. If there was no one to witness, then it will be in the conscience of the nurse that if perhaps she followed the physician’s orders the client would still have been alive.             If it was another scenario still where the nurse followed the physician’s orders with witnesses around and still the man died after a few hours, then it is unlikely that the nurse will be blamed for the man’s death. Granting that the nurse only followed the orders of the physician and there were other people around to witness that the nurse indeed behaved ethically, then the nurse does not have to bear any ethical question regarding what she did.             This situation given here occurs when a nurse disagrees with the treatment decisions made by the attending physician but which she nonetheless is required to follow. In some cases, the nurse may recognize that the orders are mistaken or violate the accepted standard of care. Under the ethical codes of both the nursing and medical professions, a nurse has no duty to carry out such orders (2005). However, the nurse cannot act only on her own. She has to talk over with the physician or other concerned health care professional if she deemed the orders unethical or wrong.   Conclusion             In the past, nurses looked on ethical decision making as solely the physician’s responsibility. However, one should consider that no one profession is responsible for ethical decisions, nor does expertise in one discipline such as medicine or nursing necessarily make a person or expert in ethics. The ethical decision thus cannot be left only to the hands of the physicians. And thus it goes also to say that one cannot say that a nurse is an expert in the field of nursing ethics just because he or she is a nurse. Additionally, the advent of technology coupled with numerous other factors has significantly changed ethical concerns and behaviors. This has brought about many issues regarding the conduct of ethical behavior. The practice of doing what is ethical is not sufficient alone in the contemporary times. There is increasing importance given to the fact that one also needs to be seen when doing what is ethical behavior or practice. This is very important especially with the advent of medical malpractice lawsuits. A witness to a nurse doing what is ethical may save not only a nurse’s profession but also the nurse’s whole life. Perhaps, as the old adage says,  to see is to believe. To be able to see that the nurse does what is right and ethical would perhaps be a lifesaving factor for the nurse from anything that can harm him or her and the nursing profession in general. Being seen doing what is ethically right could not only boost the morale of the nursing profession but also serves to protect nurses against unreasonable complaints from their clients.           Credit:ivythesis.typepad.com

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically?

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically? Introduction ...