Ethics in Nursing
Introduction
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 apply ethical theory and principles on a certain case in nursing practice, which would help a particular nurse to arrive at an important decision. This essay also presents all the relevant principles and theories that would provide guidance to the practice of nursing ethics. 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 ethics and theories in nursing.
Case in Question: Application of Ethical Theories and Principles
The case in question presents a dilemma in terms of nursing practice, and is relevant to discuss, as it happens in real life situations. In this dilemma, the nursing student caring for a particular patient is torn between the dilemma of allowing the patient to be discharged and knowing the cause of her vomiting, which may cause the extension of her stay in the hospital. From this dilemma, it can be seen that the ethical theory that applies to the situation is the applied ethics theory, which discusses and provides solutions on moral dilemmas, involving ordinary situations of individuals that conflict demands (1996). Specifically, the bioethics theory or the clinical ethics theory also explains the dilemma or situation in question, as is provides an approach to guide medical practitioners in determining, analyzing, and providing solutions in terms of ethical issues in the applied medicine field. This ethics theory involves the working knowledge on issues, including informed consent, telling the truth, confidentiality, pain relief, and patient rights, thus, exhibiting important moral values, such as respect, trustworthiness, commitment, honesty, and compassion towards the patients in order to resolve and face choices, which may provide conflict to their values (1998). The bioethics theory or the clinical ethics theory is the theory to be used for this situation because it provides the guidance for medical practitioners on how to identify and assess a particular situation, presenting a moral issue that may conflict or challenge their profession and own ethical principles. This ethical theory also emphasizes the importance and significance of the use of moral values, which may serve to provide a medical practitioner, which in this situation is the second year nursing student, the basis for good and effective decisions that would benefit the patient. In relation to the nursing practice, the ethical theory that can be used to explain the dilemma is the Situational Ethics or the situational perspective, which takes into consideration the unique context of the situation, and in this regard, it acknowledges that each situation or perspective offers a different point of view (1996). Each point of view brings different aspects to the ethical situation in focus (1996), thus, the use of such ethical theory emphasizes that the decision the nursing student would make actually depends on the situation and not on the consequences that it presents.
This emphasizes the use of ethics in the medical practice, where ethics is defined as the science or study of morals, and refers to how individuals determine what is good for the flourishing of people in society, and what rules individuals need to prevent people from being harmed (2000). This aspect is important in the nursing practice as it enables nursing practitioners to practice morality in their profession, thus, further serving and meeting the needs of their patients based on a humane and moral way. In order to arrive at an important decision in relation to the dilemma facing the nursing student, it is important to take note of the different relevant ethical principles in nursing that would provide the basis for making such an important decision. It has been reported that there are six ethical principles that support moral philosophy, namely, autonomy, beneficence, non-maleficence, justice, veracity, and confidentiality. In discussion, autonomy is the principle that addresses independence, and allows the individual the freedom of choice and action. It also encourages the nurses to encourage clients to make their own decisions and act on their own values, if necessary. Beneficence is the principle that emphasizes the nurses’ responsibility to contribute to the welfare of the patient, thus, one has to do good, be proactive, and prevent harm to the patient. Non-maleficence is the concept of not causing any harm or danger to others, and means not inflicting intentional harm, and not engaging in actions that risk harming other individuals. Justice, contrary to its common definition, is treating equals equally and treating unequals unequally in proportion to their relevant differences, which is based on the necessity and appropriateness of the situation (1996). Veracity is exhibiting truthfulness and honesty, and fundamental to the development of trust in building the relationship between the nurse and the patient. Confidentiality 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 (2001). Based on these six ethical principles, it can be perceived in the situation of the nursing student that the principles of confidentiality, beneficence, autonomy, and non-maleficence. This is because the patient wanted the nursing student to keep the information regarding her vomiting from the parents of the patient, and in this regard, the nursing student must observe the ethical principle of confidentiality. Autonomy is also another ethical principle that serves to guide the decision of the nursing student because the nursing student must allow the patient to decide on her own welfare, if the patient knows that her vomiting would not do her any harm after her discharge from the hospital. The third ethical principle that may concern the situation is non-maleficence, as the nursing student must remember that he or she can cause harm to the patient if he or she would inform the parents or the doctor of the patient of her vomiting. This supports the principle of confidentiality, which would prevent the nurse from telling anyone of the situation of the patient. Lastly, the ethical principle of beneficence is also relevant to the situation and further present dilemma on the part of the nursing student, as it emphasizes the responsibility of the nursing student to contribute to the welfare of the patient. With this, doing well to the welfare of the patient may involve either telling her parents of her condition or keeping the information. These ethical principles are helpful in support of ethical decision-making, which involves the balancing of ethical principles, as it exists within the context of human experience (1996). In making an ethical decision based on the situation, the nursing student must pay particular attention to the eight central values in the nursing practice, namely, 1) safe, competent and ethical care; 2) health and well-being; 3) choice; 4) dignitiy; 5) confidentiality; 6) justice; 7) accountability; and 8) quality practice environments, and these values provide the nursing student with the belief or attitude about the importance of a goal, object or behavior in the nursing practice ( 2002). These values and principles must interact effectively and properly, in order to make sound and effective decisions in the nursing practice, based on the presented dilemma. Such principles and values would be further applied, using the Potter Box Model in decision-making, which was expanded by Jay Black. In this model, the primary step in making the decision is to define the ethical situation or dilemma, through looking at it in detail and from different points of view. After analyzing the ethical situation, the next thing to do is to identify the values involved in making the decision, where values define what the nursing student stands for. In this regard, the values being pointed out in this stage refers to the eight central values in the nursing practice mentioned earlier. The third step in this model is to identify the principles involved in the decision-making process, and involves the ethical principles previously discussed. The use of such principles involves the use of moral philosophy, based on the ethical situation or dilemma. After the analysis and realization using the values and ethical principles, the nursing student is now ready to choose his or her loyalties, depending on competing loyalties, including his or herself, family and friends, professional colleagues, or the patient (2003). Using this ethical decision-making model, the nursing student would be able to use the values and ethical principles as a basis for making a sound decision in relation to the dilemma. In addition, the use of such principles and values would enable the nursing student to evaluate the values needed and his or her own personal values. The nursing student would also be able to assess the use of communication tools, which may be utilized in order to make sound decisions. Using such values and principles, the nursing student would be able to assess his or herself regarding loyalties, which may gear towards his or her profession or towards the patient. From this, the nursing student would be able to make a decision to further enhance his or her nursing practice and profession.
Conclusion
The discussion above emphasizes the use of the Potter Box Model of decision-making, which features four steps or phases, namely, identifying the ethical situation or the dilemma, determining the values that would help the nursing student to rationalize or defend his or her behavior, using ethical principles in decision-making that uses the processes and theories of moral philosophy to the real situation ( 2001), choosing one’s loyalty, and then coming up with the sound decision based on the analysis of the situation. Based on this decision-making model, the resolution for the dilemma of the nursing student is to first obtain information from the patient based on her current condition. The nursing student must first ensure that the patient is feeling well, and be able to determine the cause/s of her vomiting. Second, based on the symptoms and physical manifestations of the patient, the nursing student would be able to assess if the patient is perfectly well. From this, the nursing student can inform and educate the patient regarding her condition, thus, helping her to assess herself, which would be in time for her discharge. In simple terms, before promising the patient of not divulging any information to the parents of the patient, the nursing student would be able to obtain relevant information on the condition of the patient, thus, knowing if the patient needs more time for hospitalization and medication.
In this regard, the dilemma faced by the nursing student allows him or her to determine the related and appropriate values, which include choice, accountability, and confidentiality. The value of choice must be given importance because the nursing student has to observe autonomy and respect the decisions and the wants of the patient. In addition, the value of choice is also related to the value of accountability, which enforces the nursing student to educate the patient regarding her condition. Along with this, the value of confidentiality must then be enforced in order to build a good and effective relationship between the nursing student and the patient. In relation to such values are the ethical principles discussed earlier. From the values and principles, the loyalty of the nursing student must first be exhibited in his or her patient, before expressing loyalty to the profession. The loyalty of the nursing student must be first expressed before he or she would be able to perform his or her profession better.
Based on the ethical situation or dilemma, the key note in providing a solution for this is effective communication, in making clear to the patient that certain information must be kept and obtained in order to make effective decisions. Primarily, the nursing student must be able to obtain substantial information regarding the condition of the patient, and secondly, the patient must be able to divulge information regarding her condition. From this, the nursing student must be well-informed in order to make effective decisions, based on the information obtained, his or her personal values, the ethical principles involved in the profession, and the nursing student’s loyalty. From this, the decision would be effectively and efficiently executed, thus, providing a good training for the nursing student and his or her nursing practice.
Many influences on ethical decision-making and behavior can add to ethical dilemmas. These factors can be loosely grouped into four broad categories, namely, personality-based, organizational-based, issue-related, and society-related factors. The personality-based category includes cognitive development, personal experiences as well as an innate biological tendency or personal orientation to react more intensely to lower levels of stress than others and to take longer to recover. Such factors are shaped through family, education, religious upbringing or training, gender, work position and role, locus of control, and culture. Organizational-based factors highlight the effect of significant others within the organizational setting, exemplified by top management’s actions, corporate policies, behavior of peers, reward systems, organizational climate and professional codes of ethics. Issue-based factors that influence ethical decisions and behavior include rewards associated with unethical action, the magnitude of consequence, temporal immediacy, proximity, probability of effect, concentration of effect, social consensus and the nature of relationships. A variety of societal factors have been identified as influential on ethical decision-making and behavior, such as society’s political ethics and climate, moral climate, legislation and governmental regulations, as well as media coverage and disclosure.
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