Nurses as one of the healthcare suppliers and members of the healthcare scheme accountable for providing ethical care to customers and patients. They need ethical understanding to perform their proper function in order to handle emergencies and provide secure and correct legal and ethical care in the changing world of today. They always attempt to answer the question of “What can I do?” regarding practical care. While they should attempt to respond to what is crucial in the framework of ethical principles for nurses to do. Ethics seeks the best way to care for patients and the best function of nursing (Shahriari, Mohammadi, Abbaszadeh and Bahrami, 2013)
In settings that are often linked by ethical concerns and dilemmas, acute and critical care nurses provide care that is intellectually challenging and physically demanding. These settings, as complicated adaptive structures, include nurses, doctors, social employees, chaplains, case managers, and administrators who communicate in circumstances of enormous uncertainty and often in the face of professional or social disagreement over patient / family care, procedures, and results. An important retention factor and a hallmark of a good workplace is the capacity of nurses to recognize and address issues in such circumstances as part of a cooperative ethical climate (Robichaux & Parsons, 2009)
Nursing Ethics: Literature Review.
- Human Dignity: The most common value stated in the papers reviewed was respect for human dignity. Respect for people including people, their families, and society has been noted as a significant ethical nursing value. Respect for dignity has been described with definitive characteristics as taking into account human inherent values, respecting the views of patients and preserving their dignity and privacy during clinical processes, and communicating with patients. Pang (2009) claims that nurses should recognize that in practice, individuals deserve respect and dignity. They should cover the body sections of patients when exposed and maintain the secrets of patients private.
- Social Justice: Justice is an ethical value proposed in literature on nursing. Social justice was described by the characteristics that, apart from considering the dignity and regard of people, concentrate on equal access to health services and the right to be treated fairly and cared for free of financial, social and cultural status. In most countries, social justice was the indication and was defined as a fair distribution of resources and equal treatment and care for individuals (Shih et al, 2009).
- Altruism: In different nations, altruism is a prevalent nursing value. It was described as the axis of attention and concentrate in nursing, assisting others and providing the utmost health and welfare for customers, their families, and community, selflessness, and self-devotion with characteristics of human consideration. Altruism is therefore described as concentrating on customers as a human being and struggling to maintain their health and well-being. Pang (2009) discussed that nurses should have a spirit of selflessness and helpfulness towards others based on the concept of altruism.
- Autonomy in Decision Making: Decision-making independence is a value proposed as an ethical nursing value in some research. Nurses have described their characteristics as having the right to be independent in making decisions, the right to accept or dismiss proposed treatments, procedures or care. Moreover, independence in decision-making requires providing customers and their relatives adequate and sufficient data, if needed. Accordingly, autonomy in decision-making happens when nurses allow patients to be informed, free, and autonomous in making decisions about diagnosis, therapy, and prevention by providing suitable data. Konishi (2009) debates that should be decided by conscious adult patients. As far as the nursing profession is concerned, nurses should provide patients with data, clarify suggested interventions and allow them to accept or dismiss ongoing procedures so that they and their relatives can decide on their situation.
- Trust: Trust was stated as an ethical nursing value and is described in words and practice by characteristics of honesty. Nurses should earn the confidence of patients, their relatives and society by understanding the condition and status of patients and by matching them appropriately. Based on this definition, gaining confidence and confidence from customers becomes true when nurses are frank in their words and exercise, and gaining confidence and confidence from people by doing their responsibilities properly (Rchaidia et al, 2009).
Nurse-Patient Relationship Ethical Frameworks
A framework needs to be followed to maintain such code of ethics among do towards the patients. As stated above, several moral theories can be used to navigate medical ethics problems. On the other side, clinical environments of true life may not immediately lend themselves as a theater of philosophical moral discourse. However, there are some ethical frameworks based on moral philosophy that can resist the pressure of time-limited clinical encounters for instant implementation and use in clinical environments. One such well-known framework among health care professionals (HCP), particularly doctors and students of medicine, is “the four principles” (Luna, 1995). Autonomy, charity, non-malfeascence and fairness are the four principles. In most (particularly Anglo-American) advanced nations, patient autonomy is at the heart of ethical medical practice. This recognizes the patient’s rights and gives the patient certain undeniable privileges owing to a patient in his or her ability as an individual and patient. Autonomy recognizes, and as a rational being, the individual and his / her characteristics of person hood. Benefit is only the responsibility to do good in the person / patient’s interest. Non-malfeascence or the obligation not to damage the person / patient, otherwise the physician’s obligation not to abuse his / her professional position in the partnership within the patient doctor relationship (Philosophical Medical Ethics, 2000). Finally, justice focuses mainly on awarding conflicting interests between individuals ; or distributive justice in allocating scarce resources to groups. The four boxes strategy is another framework that is increasingly being used in clinical environments. In this situation, ethical dilemmas resulting from the patient’s point of perspective, medical necessity, quality of life and contextual or other variables are considered (Fantacci, 2007). A third framework job underlines the health care professional (HCP) and patient dyadic connection under the guise of care ethics, combining aspects of feminine ethics, Levinasian ethics and virtue ethics. Care ethics aims at ensuring that the patient “does not fall through the vulnerability internet” (Ethics in Community Based Elder Care, 2001, pp 60-68) In this case, the importance of a “virtuous” character, combined with a caring nature, and the ability to perceive the suffering of the patient in the light of the Levinian concept of “thou and l,” is key to ensuring that the patient does not slip through the vulnerability web and get lost. These frameworks are intended to rapidly prime and orient physicians and act as ethical path maps to guide their daily nurse-patient interaction in a clinical environment that is otherwise hectic and time-limited (Diedrich, Burggraeve & Gastmans, 2003).
Nursing Ethical Framework Case Scenerio
1) Identify issue and collect information: The issue in this case is of Maddie wanting to maintain contact after discharge. Is it ethically wrong to do that? No. Will it affect any future interactions with the patient as a nurse? Yes, it will. Therefore, this is an ethical dilemma. For a nurse it is very important that the step he/she takes doesn’t affect the patient’s mental health. This can be avoided if the patient does not develop strong emotional relations with the nurse. In this case, the nurse should keep herself within the professional boundaries of her work.
2) Evaluating the Issues: This part of the framework involves both the ethical and legal framework. In the given case scenario, the nurse is expected to follow the eight code of ethics of the Nurse and Midwifery Board Practice. The nurse should follow the ethic code 7 which states that nurses should value ethical management and development. The ethical value of the statement 7 is very fitting as Anh the nurse, has all the right to refuse sharing her personal information with the patient. Her job position requires her to deal with the patient in a therapeutic manner. Nurses are required to not just maintain good communication with the hospital staff but also the patients involved. This means that good communication is the key to identify and improve a patient’s health therapeutically (Kornhaber et al, 2016). However, this should be done by staying within the professional grounds. Going beyond this is a violation of ethics and misuse of power. Anh’s carefree attitude probably helped Maddie feel very relaxed and open to discuss any issues but it opened a Pandora box which could potentially harm the former’s career. Sharing personal information can be both a good and a bad thing for Anh. In a case where Maddie needs a friend, Anh can be there for her. However, if Maddie requires nurse care in an emergency situation, Anh has become emotionally compromised. She would have to bring this to the notice of the head nurse to keep her in check or to take her off the case.
3) Action and Implement: In practice Anh should refuse providing any personal information, which she should do in a very polite and compassionate manner. Anh can extend this friendship by letting Maddie know that she is always welcome for any help at the hospital. She should set the stance very clearly but politely, that she is under oath and cannot give her details without harming the values she has promised to uphold as a nurse. A patient of sound thought would immediately understand. Otherwise, if the patient persists to the point of being pushed into giving information, it should set of an alarm, and the authorities informed to take care of the situation.
4) Assess: Anh should self-evaluate her actions and think about how such a situation can be avoided. She should re-evaluate her position as a nurse and what is expected of her within the legal boundaries of the profession. Self-reflection and a discussion with a head nurse would be extremely helpful at this point as Anh can feel down by her own lack of professionalism. Ethical dilemmas are a common problem in the medicine world. Anh will have to be realize that one mistake is not an end to her career. A counselling session with the head nurse/nursing manager will calm herself and think about possible steps she can take in the future to avoid such a scenario.
Traditional health systems, with patients being passive care recipients, proved unsuccessful in stemming the most irresistible and exponential growth of the epidemic we are facing now. In a healthy nurse-patient relationship, there is significant healing power. Patient empowerment has been recognized as an option to compliance in the field of healthcare in order to guide the connection between provider and patient. It will assist patients to slowly turn their confusion, fear, and doubt into clarity, relief, and certainty. Patients will definitely be relieved of hopelessness with the beneficial role of nurses, have greater satisfaction, better adherence, and better health.
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