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Ethical Problems in Nursing

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    Nursing is a field where an individual's sense of ethics and morality can be deeply impacted. Nurses do far more than merely assist other medical staff and provide patient care; indeed, nurses are often required to resolve significant moral conundrums and must oftentimes make difficult ethical decisions. This sample nursing paper explores ethics in the nursing industry.

    Ethics in the nursing industry

    Modern nurses are essential members of the healthcare team. Nurses are obliged to understand and follow the principles of biomedical ethics as well as professional ethics particular to the art of nursing practice. The ultimate aim of healthcare is the health of the patient, that is each provider’s primary concern the telos of the activity (Delap, 2008).

    Toward that end, nurses are challenged in resolving moral conundrums as they arise in clinical practice. Therefore, nurses should have understanding and training in the theoretical foundation of the principles of healthcare as well as a practical theory to apply these principles to nursing practice (Callahan, 1998, ANA, 2001, Butts, 2005, Gastmans, 2002).

    Principles of health care ethics

    There are eight principles for healthcare:

    1. Autonomy
    2. Nonmaleficence
    3. Beneficence
    4. Justice
    5. Privacy
    6. Confidentiality
    7. Veracity
    8. Fidelity

    Autonomy, justice, privacy, and confidentiality

    Autonomy is the idea that the patient is the ultimate decider of their own benefit. The patient’s right to make their own healthcare decisions is paramount. Justice is equity in the healthcare system. Privacy and confidentiality are essential to the sanctity of the helping and healing relationship.

    Veracity, fidelity, and beneficence

    Veracity is honesty and the courage to advocate for what is right for the patient and the profession in the face of opposition. Fidelity is loyalty to the community, the profession, and the patient. Challenges that nurses will face include concerns of valid informed consent based on understanding patient comprehension (Callahan, 1988, Delap, 2008).

    It is the nurse's responsibility to ensure patient care is beneficial. Beneficence is a measure of ensuring that patients understand their medical conditions and that treatment provided is to help the patient. This is required to obtain informed consent and incorporates fidelity and veracity (Beauchamp, 2001, Delap, 2008). Fidelity and veracity are demands from society on the practitioner.

    Nonmaleficence and trust

    As trusted professionals nurses have a public trust with skills most individuals do not have. Nurses are therefore obligated to be thorough and honest (veracious) with the primary goal of healthcare as the motivation for the nurse (fidelity) (Beauchamp, 2001, Barbison, 1997, ANA, 2001). Nonmaleficence is not necessarily the opposite of beneficence.

    Although to do no harm is a healthcare mantra, nonmaleficence includes consideration of when not to intervene is the best course of action, distinguishing the difference between killing and letting die, and respecting DNR orders.

    For example, a nurse could also violate fidelity and veracity by failing to commit to the duty-based ethical theory (deontology) or reflective moral practice of clinical decision making (teleology). (Beauchamp, 2001, Delap, 2008). Cases of nurses not following the principles of the profession and the healing activity erode the public trust in the profession.

    Ethical decisions in medicine

    A sound process for patient advocacy helps nurses to make ethical decisions in clinical practice is necessary. However, understanding what ethical issues are and what principles apply to the art of nursing is preconditional to evaluating a system for resolving ethical issues. The ethical precepts for the profession should be delineated. The American Nursing Association has promulgated a code of ethics that tells the profession and the public what is expected of the profession (ANA, 2001).

    Codes of ethics are critical for any profession as the legitimize the profession in the public’s eyes (Callahan, 1988). However, the code of ethics is only one part of the puzzle and leads to a duty based or deontological moral method whereby the nurse would consider which rule applies to the morally ambiguous situation.

    This can lead to a form of Kantian utilitarianism whereby following the rule is more important than the patient (Beauchamp, 2001, Delap, 2008). This practice marry’s well with Evidence Based Practice, however, it must always be considered that the aim of nursing practice is always the health of the patient. In cases of moral ambiguity, the nurse as part of the healthcare team must have the cognitive skills to decide what is best for the patient.

    Creating a code of nursing ethics

    Sometimes EBP and the code of ethics fails to make sense for the benefit of the patient. Also, there may be disagreement among the health care team providing care. Ultimately, the nurse is singularly responsible for their own emotional health as a caregiver and personal actions regardless of pressure for other sources. Cognitively resolving moral problems in nursing requires an understanding of the ethical principles of health care and nursing generally.

    Also, research on the type of ethical conflicts nurses faces in clinical practice (Fry & Redman, 2000). Considerations of methods for resolving moral conflict in nursing is desired by Fry and includes suggestions for modeling clinical decision-making around various caring models already inherent in nursing practice (Fry, 1989). Integrating moral decision making using current knowledge makes moral decision-making more accessible.

    Approaches to ethical guidelines

    Some ethicists have expanded on the notion of using programmatic approaches to resolving moral conundrums in clinical practice. Jonsen et al. outlines a four box method for ethical evaluations of patients and scoring the various influences of certain cultural aspects affecting the patient’s understanding of their health condition (Jonsen et al. 2002).

    Like mentioned before, incorporating a formula to address ethical conundrums in clinical practice is a noble endeavor, but its usefulness ends with the assembly of information. Knowing what effect religious identity will have on a patient’s decision making is valuable as part of the nursing assessment.

    Of note, an ethical monograph could be integrated into the nursing practice of assessment allowing the nurse to gather more information. There is a point in the nursing assessment where there is no more information to gather, in these instances, a healthcare decision becomes ethical rather than ethical (Delap, 2008).

    Respecting nurse's autonomy

    Nurses must resist the temptation to hide behind physicians or the current nursing legislation and focus on the best practices to the advancement of the nursing profession and, more importantly, the best outcome for this patient. The best course of action is to respect the autonomy of a patient like Mrs. Z in the case presented. There is no evidence to support Dr. F or the nurse to intervene in any other way.

    Mrs. Z has decided that the best course of action for her health is to not treat her cancer. It is her right and it is the obligation of nursing and medicine to respect that expression of rights. This is rooted in the ethical principles of veracity (honesty) and fidelity (loyalty) to the ethical principles themselves as well as the profession itself.

    Nurses continue to face ethical issues in their clinical practice. Understanding those issues is critical to advancing the nursing profession and the art of nursing care for the sake of individual nurses as well as the teleological aim of nursing care for the patient.

    References

    Barbison, J. (1997). Nursing Ethics: a principle-based approach. Journal of Medical Ethics, 23(1), 59.

    Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). Oxford: Oxford University Press.

    Butts, J. B., & Rich, K. (2005). Nursing ethics: across the curriculum and into practice. Sudbury, Mass.: Jones and Bartlett.

    Callahan, J. C. (1988). Ethical issues in professional life. New York: Oxford University Press.

    Code of ethics for nurses with interpretive statements. (2001). Washington, D.C.: American Nurses Association.

    Delap, T. (2008). A Doctor's Conscience Conventional and Reflective Morality in Clinical Decision Making. Saarbrucken: VDM Verlag Dr. Muller.

    Fry, S. (1989). Toward a theory of nursing ethics. Advances In Nursing Science, 11(4), 9-22.

    Gastmans, C. (2002). A fundamental ethical approach to nursing: some proposals for ethics education. Nursing Ethics, 9(5), 494-507. Retrieved April 5, 2013, from http://nej.sagepub.com/content/9/5/494.short

    Jonsen, A. R., Siegler, M., & Winslade, W. J. (2002). Clinical ethics: a practical approach to ethical decisions in clinical medicine (5th ed.). New York: McGraw-Hill, Medical Pub. Division.

    Redman, B., & Fry, S. (2000). Nurses' ethical conflicts: what is really known about them?. Nursing Ethics, 7(4), 360-386. Retrieved April 4, 2013, from http://nej.sagepub.com/content/7/4/360.short

     
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