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Principles of ethics in nursing
Cultural competence at the forefront of care
Chapter 2 the basics of ethics in nursing
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In 1893, Mrs. Lystra E. Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan created an adaptation to the Hippocratic Oath. She titled it the Florence Nightingale pledge. It was used for nursing students to be sworn in on upon graduation (American Nursing Association). It is named after Florence Nightingale, who was classified as the "founder of modern nursing", after she spent time in the Crimean war caring for sick and injured soldiers. Up until this point in time nurses and hospitals were there only to care for individuals that were dying, but not to prevent death (Bassendowski, 2014). If it were not for Nightingale’s advocacy for “improvements in sanitation, crowding, and nutrition for the soldiers…, the
It focuses on the relative position of one social group in relation to others in society as well as on the root causes of disparities and what can be done to eliminate them (p. 28).
In the code of ethics advocacy is defined as “actively supporting a right and good cause, supporting others in speaking for themselves, or speaking on behalf of those who cannot speak for themselves” (p. 22).
As healthcare providers, it is necessary that we treat all patients with the respect and dignity that they deserve. Karen Roush a doctoral candidate at New York University College of Nursing wrote in her paper Speaking Out on Justice that, “Ignorance is no excuse”. She explained that it is a nurse’s responsibility to remain informed not only on new drugs and evidence-based treatments. Also it is essential for nurses to be educated on the topics of human rights, hunger, abuse, oppression and privilege that occur in our own backyards. (p. 11). This is a powerful message as providing safe, competent care to a patient requires more than just understanding drug interactions and which drug works best for which illness. It requires understanding those individuals that we as nurses are working for. It requires, knowing their background, their history, their culture and their traditions. As a nurse you can have all the knowledge in the world when it comes to how to properly treat a wound, care for a cardiac
The principles include providing care that is patient centered, equitable, and sustainable. Providing quality of care, health promotion and illness prevention. Most of all remaining accountable for the care that is provided (Canadian Nurses Association). A major fragment in providing patient centered care is realizing that not all patients are the same. A treatment that works for one patient may not work for another patient. Also, that not all patients were born and raised in Canada. Statistics shows “approximately 19.8% (one per five) of Canada 's total population were born outside of the country" (Potter & Perry, 2009, p. 115). Thereby, meaning that a nurse needs to take into consideration that these individuals originate from another culture and therefore could maintain different beliefs and perceptions in regards to their health care. This is classified as providing culturally safe care. A concept that was not recognized until 1988. When a nursing student in New Zealand stood up during an education meeting and asked "you people talk about legal safety, ethical safety, safety in clinical practice and a safe knowledge base, but what about cultural safety? (Richardson & Williams, 2007, p. 701) Also when a group of Maori nurses felt they as insiders were incapable of providing appropriate
Over the years, I have developed a stable cultural sensitivity aptitude. I find it is most important to take cues from the patient and their families on how to care for them. As well as to ask the patient what is most important to them and how I can best serve them. In his article, Collins (2015), states that “improved health outcomes are achieved when culturally competent nurses acknowledge the patient’s culture care values and preferred care practices, and incorporate into the professional plan of care the patient’s generic care wishes” (p. 11). I have encountered a few situations which make me most uncomfortable, families not wanting the patient to know the severity of their illness, and obvious servitude behaviors toward the females to name a couple. When these occur, I have found the inclusion of the charge nurse, the physician and social services can lessen the negative outcomes in these situations. My goal is to assure the patient is cared for in a manner that is most comfortable to them and satisfies their needs to ensure a speedy and comprehensive recovery. Another practice in my own career has been to share the cultural information gathered with oncoming shifts of care givers, the charge nurse and
Environmental justice can influence the population’s health. This environmental justice is relevant to nursing, because awareness brings changes and can save and improve many lives. When a person in a hospital or in a community setting is affected by a health problem, the entire community is at risk, knowing the population is lack of knowledge and have limited access to understand health care system. Therefore, a solution to eliminating cultural disparities is optimal for immigrant communities. In conformity with the Journal of Transcultural Nursing journal, nurses need to follow 12 steps to have a successful result when integrating cultural competence in the health care environment: social justice, critical reflection, knowledge of cultures, culturally competent practice, cultural competence in the health care systems and organizations, patient advocacy and empowerment, multicultural workforce, education and training in culturally competent care, cross-cultural communication, cross-cultural leadership, policy development, a...
...ir personal encounters with Aboriginal classmates that they might have had in high school. Life experiences, parental upbringing, ethnic roots, social status and education all shape nursing practices. Nurses and other health care professionals are trained in institutions that fail to recognise the socio-political injustices that occur in health care settings. In addition to this, their experiences in their work and in their personal lives and communities, they already have opinions about certain groups of people. “Cultural safety would encourage nurses to question popular notions of culture and cultural differences, to be more aware of the dominant social assumptions that misrepresent certain people and groups, and to reflect critically on the wider social discourses that inevitably influence nurses’ interpretive perspectives and practices” (Browne, 2009, p. 21).
Providing culturally competent care is a vital responsibility of a nurse’s role in healthcare. “Culturally competent care means conveying acceptance of the patient’s health beliefs while sharing information, encouraging self-efficiency, and strengthening the patients coping resources” (Giddens, 2013). Competence is achieved through and ongoing process of understanding another culture and learning to accept and respect the differences.
Before Nightingale, nurses were lower class citizens that were alcoholics or prostitutes with no to a little education. Florence Nightingale realized that nurses ought to have some education in caring for others and be of a higher class. In 1860, she opened the first nursing school in London that did not accept prostitutes and alcoholics. To signify Nightingale’s view of nursing, Lystra Gretter composed a Hippocratic Oath for nurses called the Nightingale pledge.
The term nursing ethics means that the nurse has an obligation judge what is right and wrong in her or his duties as guided by the profession or the moral principles that govern the profession and as prescribed by the professional body. Nursing ethics initially encompassed virtues that were desired in a nurse. At the time, these virtues included physician loyalty, commitment to high moral character and obedience. Evolvement of nursing profession gradually made nurses embrace patients’ advocacy. As patient advocates, nurses work as part of an interdisciplinary team to provide patient care. Nursing ethics have kept pace with the advancement of the nursing profession to include a patient-centered focus, rather than a physician-centered focus.
The Code of Ethics for Nurses with Interpretative Statements (American Nurses Association [ANA], 2015) serves as a guide for nurses in making ethical decisions in their daily practice. While all nurses are called to put this code into action, the use of leadership skills in nursing is what sets apart superior leaders from the average. For example, all nurses have an ethical obligation to care for a patient; however, a nurse utilizing ethical principles and leadership skills jointly, investigates further into what the underlying structures are that impact patient care and safety (Grande, 2015). Ethical principles that apply to my practice on the mission field and in parish nursing are similar to those in any practice. Autonomy, beneficence,
Nursing code of ethics was developed as a guide in carrying out nursing responsibilities in a matter consistent with quality in nursing care and the ethical obligations of the profession (ANA, 2010). The term ethics refers to the study of philosophical ideals of right and wrong behavior (Olin, 2012). There is a total of nine provisions however, throughout this paper I will discuss provisions one through four. These provisions would include, personal relationships, primary care, nurse commitment, safety, patient rights, responsibility and accountability of the patient.
Similar to other organizations, NAHO has also released the fact sheets and position statements regarding aboriginal health issues. In 2008, NAHO published a guide "Cultural Competency and Safety: A Guide for Health Care Administrators, Providers, Educators". The focus of this guide is on the need for cultural safety in education programs and health care. In order to improve cultural safety, education, recognizing diversity of population, historical context, and understanding health care provider and patient relationship is essential. NAHO further focuses on how the cultural safety improve the health care quality of the aboriginal by integrating client 's health beliefs into medical treatment, determining communication techniques and decision making process.(Baba,L.2013, p 11). In addition, NAHO focuses on providing culturally safety education to student nurses which emphasizes on teaching students about history of colonization and its impact on health of indigenous people rather than on increasing the knowledge of values and beliefs about aboriginal in terms of
I feel as a nurse that I need more education to become more culturally competent. There are many routes that I can take to increase my knowledge and cultural awareness. If I had more worldly knowledge it would improve my awareness, strengthen my nursing skills, give me a more positive attitude. This, in turn, could change my behaviors and will improve my direct patient care in an acute setting. I remind myself each day to work as a non-judgmental nurse, free of biases and prejudices and to integrate research, knowledge, skill, flexibility, and creativity into my practice in order to deliver culturally appropriate and sensitive health care.
doi: 10.1093/intqhc/8.5.491 Polaschek. (1998). Cultural safety: a new concept in nursing people of different ethnicities. [Article]. Journal of Advanced Nursing, 27(3), 452-457.
“Nursing is an art, and if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work...” (Nightingale, 1868)
Florence Nightingale is a very prominent person in the medical field. She had a strong desire to devote her life to helping others. She is known as the founder of modern medicine. The Nightingale Pledge is taken by new nurses and was named in her honor. The annual International Nurses Day is celebrated on her birthday. Without her contributions healthcare would not be what it is today.
233). She studied anthropology and applied the research findings in nursing. Later, she developed the theory of “culture care diversity and universality” from her personal experience as a nurse and other factors that influenced such as ethnic conflicts, commuting, and technology changes. It is illustrated and described by the Sunrise four-level model, and it is labeled as “an enabler” (Masters, 2014, p. 69). The first level represents a “worldview”, the second level presents “knowledge concerning individuals and groups”, the third level includes “specific features of care in the system”, and the fourth level is “specific nursing care” (Masters, 2014, p. 69; Jarošová, 2014, p. 47). The main purpose of this theory is “to generate knowledge related to the nursing care of people who value their cultural heritage” (McEwen & Wills, 2014, p. 233). The major concepts in this theory include: culture, culture care, and diversities and similarities and sub-concepts include care and caring, emic view (language expression, perceptions, beliefs, and practice), and etic view (universal language expressions beliefs and practices in regard to certain phenomena) (McEwen & Wills, 2014, p. 233). The base knowledge
Before the modernization and reform of their profession in the mid-1800s, nurses were believed to perform “women’s work”, which implied menial duties, unskilled service, and an overall lack of skill (Garey, "Sentimental women need not apply"). This mentality was substantiated by the “untrained attendants, [including] past patients, vagrants, and prostitutes,” that performed a variety of nursing tasks (Garey). Florence Nightingale’s nursing experiences during the Crimean War, her subsequent publication of Notes on Nursing, and her work to build up professionalism within the field transformed the way that the world and society viewed nursing. She introduced invigorating ideas of patient care, nursing roles and responsibilities, and was a strong proponent of nursing education. Nightingale’s overall work inspired and changed the profession of nursing, laying the foundation for its