“Let whoever is in charge keep this simple question in her head – not, how can I always do this right thing myself, but how can I provide for the right thing to be always done?”


 


                                                                                            – Florence Nightingale


 


            Like the founder of modern nursing Florence Nightingale, nurses nowadays are compounded with the same question: What can I do for my patient? This question may seem trivial and easy but when has to consider the many factors that are involved in the context of caring, one might realize that this is a tough question after all. Thus, the Code of Nursing Ethics serves its purpose in defining the scope of nursing practice including the merits, risks and other relevant ethical issues involving the nursing profession.


 


            Furthermore, one of the most common issues in the health care setting is the importance of the doctrine of informed consent. Maxwell J. Mehlman, an expert in health law and bioethics, put it simply as the presence of a physician giving patient an explanation of his health condition, different alternatives and other health choices. Robertson (1981) further stressed that it is a legal doctrine that recognizes the patient’s right to decide for himself and the doctor’s obligation to provide him/ her necessary information so that the patient can choose whether to submit himself to the proposed treatment.


 Meanwhile, there are five important points in an informed consent that should be taken into consideration. The first concern is patients signing consent forms without having any comprehension of what it is they are consenting to. After an explanation is given by the doctor, it is the duty of the nurse to assess the patient’s knowledge and if further teachings are required. Another concern is that there are nurses who directly assume incorrectly that complete explanations are already given thus fail to re assess the patient before obtaining the patient’s consent. Obtaining of consent from people who cannot understand or speak the English language without the presence of a qualified interpreter is the third concern. It is important that the patient fully understands the treatment he will go through and this would be impossible if the patient has no comprehension of the language thus an interpreter is needed.


 


 


Meanwhile, there are cases when the patient has knowledge of the procedure of the treatment however they don not have any idea of the associated risks involved and this is the fourth concern. As a nurse, assessment is very necessary and patients should be informed not just with the procedure itself but also the risks that could possibly occur and lastly, there are procedures being done to the patient that the patient has no knowledge at all. As the doctrine states it, every patient has the right to self determination and the patient should always be involved in the plan of care.


 


            Moreover, the concerns mentioned fall under the four important principles covered by the doctrine. These are autonomy, non-maleficence, beneficence and justice. The principle of autonomy connotes that patients have the right to choose for themselves so they can choose what treatment to subject themselves into or they have the right to refuse whatever is not favorable for them. On the other hand, non-maleficence lives by “above all, do no harm” and patients should be protected from anything that will cause harm such as assault and battery, false imprisonment, exploitation and others including those that resulted from inadequacy of information that resulted to harm while beneficence lives by “above all, do good” which emphasizes that maximum care should be given to patients and lastly is justice wherein patients should be treated fairly and without bias.


 


 


            On the other hand, the presented scenario dwells on the moral stand of the nurse on suicide. As already mentioned, the patient has the right to autonomy thus he only has the right to choose what’s best for him but as a nurse, we are faced with the dilemma of  upholding the patient’s freedom to protect him or allowing him to be free and commit suicide. According to Beauchamp (1980), “if people are autonomous, then they have the right to be left alone and to do with their lives as they wish, so long as they are sufficiently free of responsibilities to others. From this perspective, the intervention in the life of a suicide is simply an unjust deprivation of liberty”. Glover (1977) added that it is a person’s free choice if suicide will be committed and other people’s say would not matter at all.


 


 


            Since the patient is not mentally ill, the patient has the right to decide and then best thing that the nurse can do is to provide necessary health teachings to the client conveying the feelings of empathy and using therapeutic communication. Any nurse or health care professional for that matter is drawn to feel obliged to help a suicidal patient to feel better by giving him/ her words of encouragement and encouraging patient to voice out fears or any concern. By doing this, the nurse might believe that the patient may change his or her mind. On the other hand, nurses also counsel patient to bring back feelings of hope, worthiness and sense of belongingness and this will help patient gain a positive outlook in life. Lastly, is to help individuals who committed attempted suicide to feel good again and treat the injuries that they have- it may be physical or emotional.


 


 


            The second scenario presents a case of a terminally ill client. What the nurse did is ethical since she practiced the principle of beneficence. It is the duty of the nurse to make the terminally ill client feel comfortable as much as possible and if the sips of water will make him feel better then the nurse will provide it even if she has to go against the doctor’s order. However, the nurse also has to take into consideration the possible consequences and in this case the ‘sips of water’ is not that detrimental to the patient. Beauchamp and Childress (1994) states that  beneficence literally means ‘act for the benefit of others’.


 


Compassion, care, altruism, love, friendship, empathy, sympathy, kindness, mercy, and charity are examples of acts of beneficence however, doing such acts will not guarantee that no consequence will occur thus certain limits should be employed and should be dealt with accordingly or according to other moral implications.  Thus, it is important that when the nurse acts beneficently towards a patient, he or she should put this on her mind that she is not obliged to act that way and in doing  such action, certain responsibilities should be carried especially if the act committed has moral interests and in one way or another comprised or harmed the patient’s safety seriously.


 


The last situation entails that although knows the patient’s condition and prognosis, he or she has no right to disclose the information to the patient. What she must do is to continuously provide the patient with high quality care and to make the patient comfortable as much as possible. Since the Doctor has the right to inform the patient, it is best that the nurse will let the patient understand the situation and inform him that the Doctor will come right in to tell him with the progress of his condition and what would be expected. Moreover, the nurse should make the patient feel that he is not alone and to do this it is helpful if the patient and his/ her support system are involved in his care.


 


 


Meanwhile, the legal dimension of nursing takes into consideration the legalities of the nursing profession. Such considerations include the laws that govern the profession including the crimes, torts and others that might occur while practicing nursing care. An example of this is when a patient died while under the direct care of the nurse. Before the nurse is questioned in the court, many things will be accounted for first like if the act was an act of negligence on the part of the nurse or the health team in general or an act of malpractice. Since laws are part in the legal dimension of nursing, it is important that the nurses know, understand and follow conscientiously the legal implications  of the practice including the state’s nurse practice act, board of nursing as well as the standards of nursing care. 


 


 


On the other hand, the ethical dimension of nursing is more or less related to its legal dimension. The ethical dimension of nursing believes that each individual deserves an optimal nursing care and this could be achieved through the nurses understanding of life in general. As nurses continue to face different ethical dilemmas, it is empirical that the nurses know their stand in these issues to be able to deal with these ethical issues appropriately.  An example of an ethical situation is the patient who wanted to abort his child. In this situation the nurse is faced with a dilemma whether to participate in the process or not to participate and stick to his or her values even if this is the patient’s choice.


 


 


Lastly, is the clinical dimension of nursing. This dimension entails the diagnosis, treatment and the implementation of evidence-based nursing interventions may it be in the clinical or the community setting. In this dimension,  the focuses of nursing care are the individual, the family and the community as a whole and like the legal and ethical dimensions, the clinical dimension is also guided with standards of quality nursing care. Moreover, the three dimensions could exist in one setting.



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