There are many different thoughts and beliefs surrounding ethics. Ethic codes of conduct are in place. Ethics has always existed but has been more closely looked at over the last 40 years. There is discussion about futile care to patients in intensive care settings and do-not-resuscitate (DNR) orders for surgical patients. Guidelines and regulations need to be followed and set forth.
Patient Rights and Ethical Decisions
Introduction
The purpose of this paper is to discuss nursing ethics. The paper will discuss: the history of ethics, definition, doctor/nurse being education about ethics in college, code of ethics, futile care and the confusion with DNR orders. Ethics needs to be recognized on all levels of healthcare such as doctors, nurses, patients and families. CINAHAL and PubMed search engines were utilized for . Many articles were presented with the initial search, expansion on keywords assisted in generating more specific articles.
Nursing ethics has a vast spectrum of subjects. The history of ethics was around way longer then the declaration of specific ethical issues. According to Fox, Myers and Pearlman (2007), the field of ethics consultation has been developing over the last three decades, (Kosnick 1974; Rosner 1985). Ethics has become an organized and accepted division of healthcare services. Gallagher (2010), discussed the purpose of nursing ethics is to help us think, speak and perform better in our practice. The Nursing Code of Ethics was addressed by Lachman (2009). “Futile care” is discussed by Sibbald, Downar, Hawryluck (2007). Ball (2009) addressed the need for clarification of DNR orders in surgery patients.
Discussion
Ethical issues arise daily in the healthcare world. The manor in which issues are addressed vary. “There are, it might be said, as many histories of nursing ethics as there are individual ethicists and professional or cultural contexts” (Guildford 2010, p.1). “A code of ethics is a fundamental document for any profession. It provides a social contract with the society served, as well as ethical and legal guidance to all members of the profession” (Lachman 2009, p.55). According to Lachman, since the original ANA Code from 1950, the significance of service to others has been consistent. Two changes in the code have occurred since the original. First, not only the patient is being treated, but the family and community where they live are also considered.
One cannot fake being a nurse, one must be extremely genuine in order to perfect being a nurse; therefore, explaining why nurses enforce and value their code of ethics. The purpose of the code of ethics is to ensure patient safety and implement standard of care by following the nine provisions of ethics. The nine provisions explain the nurses’ responsibility while caring for a patient; for example, maintaining the rights and autonomy of a patient. Another point that the provisions highlight is being the patient advocate, nurses are in the front line of patient care and they must protect their patients. An important guideline that the nine provision emphasize is the need and requirement for nurses to continue with their education to promote beneficent and to avoid maleficent. The National Nursing Association (ANA) states that the nursing code of ethics “reiterates the fundamental and the commitment of the nurse” (Lachman, Swanson, & Windland-brown, 2015). The purpose of this paper is to highlight the obligations and duty of a nurse and why it is important when attempting to maintain standard of care.
The first provision of the American Nurses Association’s (ANA) “Code of Ethics” states, “ The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” The second provision states, “The nurse’s primary commitment is the patient, whether the patient is an individual, family, group, or community” (Fowler, 2010). As nurses we need to respect the autonomy and allow for the patient to express their choices and concerns. We also need to provide them with support by giving them knowledge and understanding so they
During week 4, we became familiar with the application of ethics in the nursing practice settings. We learned about ethical theories and principles, which are crucial when practicing in any clinical settings during ethical decision-making and while facing one or multiple ethical dilemmas. Also, we were introduced to the MORAL model used in ethical decision – making progress. The MORAL model is the easiest model to use in the everyday clinical practice, for instance at bedside nursing. This model can be applyed in any clinical settings and its acronyms assist
A code of ethics provides a standard by which nurses conduct themselves and their practice, observing ethical obligations of the profession and providing quality care. To achieve its purpose, a code of ethics must be understood, internalized, and used by nurses in all aspects of their work” (Aliakvari, 2015, p. 494).
Since you examined the number of moral issues you will face in this profession, look through the code of ethics that you chose for this assignment and explain
Nurses everywhere face problems and challenges in practice. Most of the challenges occur due to a struggle with the use of ethical principles in patient care. Ethical principles are “basic and obvious moral truths that guide deliberation and action,” (Burkhardt, Nathaniel, 2014). Ethical principles that are used in nursing practice include autonomy, beneficence, non-maleficence, veracity, confidentiality, justice, and fidelity. These challenges not only affect them, but the quality of care they provide as well. According to the article, some of the most frequently occurring and most stressful ethical issues were protecting patient rights, autonomy and informed consent to treatment, staffing problems, advanced care planning, and surrogate decision making (Ulrich et. al, 2013). The ethical issue of inadequate staffing conflicts with the principle of non-maleficence.
Thompson, I. E., Melia, K. M., & Boyd, K. M. (2006). Nursing Ethics: Churchill Livingstone Elsevier.
The nursing profession is formed upon the Hippocratic practice of "do no harm" and an ethic of moral opposition to ending another human’s life. The Code of Ethics for nurses prohibits intentionally terminating any human life. Nurses are compelled to provide ease of suffering, comfort and ideally a death that is coherent with the values and wishes of the dying patient, however; it is essential that nurses uphold the ethical obligations of the profession and not partake in assisted suicide. (King, 2003)
Providing the steps to ethically sound excellent care, healthcare providers must acknowledge first the legal and ethical matters involved with proper investigation and then devise a plan for best possible action recognizing the rights of the patient and its benefits followed by the application of the chosen intervention with positive outcome in mind (Wells, 2007). Delivery of excellent and quality of care at a constant level (NMC, 2008) must be marked in any responsibilities and duties of the care provider to promote exceptional nursing practice. Codes of nursing ethics and legal legislation have addressed almost all the necessary actions in making decisions in consideration to the best interest of the patient. Nurses must make sure that they are all guided by the set standard to lead their action and produce desirable and ethically sound outcomes.
The word ethics is derived from the Greek word ethos, which means character (1). Being moral always fills a nurse with morals respects, guidelines of good judgment and expert lead. There are three essential obligations for nurses, among many other which are the duty of autonomy, confidentiality, and obligation of care to all patients (2). There are professional duties with becoming distinctly legitimate obligations if any law and policies are ruptured in between professional practice. In 2001, a review found that there was an apparent requirement for more guidance on moral predicaments inside the medical professionals, subsequent to expanding legal cases and open request (3). Medical attendants ought to withstand to regulatory law and statutory law while managing the nursing practice.
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 American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.
The nursing code of ethics has a very standard definition. It is the base on how nurses should guide themselves in conduct by making the right decision regarding ethical issues. According to the National Student Nurses Association “students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide nursing care” (2003). In the clinical setting nurses have a lot of responsibilities while caring for an ill patient, they have the obligation to practice their profession with compassion, love, and respect the uniqueness of each patient, as nurses we are not supposed to deny care to a patient because of their economic status, their skin color, race, or the nature of health problems, we are here to help the people in need in particular those of susceptible populations. The NSNA states that the code of conduct is based on an understanding that to practice nursing as a student is an agreement that trust and honesty is depended on us by society. The announcement of the code provided direction for the nursing student in the personal development of an ethical foundation and not limited to the academic or clinical environment but can assist in the holistic development of a person. (National Student Nurses Association, 2003)
Integrity, respect for persons, justice, non-maleficence, and responsibility are all identified within the code, however compassion is not directly stated but is implied. To show compassion for others during suffering is an almost automatic response in nursing. When nurses decide to act either beneficently or non-maleficently they are doing a service to those being cared for. When dealing with human lives moral value becomes especially important, and is not situationally dependent. Ethical neutrality does not have a place in professional ethics, and an obligation to respect the moral values is necessary. The code deals with specific issues related to the nursing profession, and ensures standards are upheld. Creation of code of ethics within a profession limits misconduct, create safeguards, promote trust for the profession within society, and preserves the integrity of the profession (Soskolne, 1984) It is important for me to emphasize the difference between the nurse’s code of ethics and the Hippocratic Oath. The nurses ethical code is tailored toward the care provided to the patient, and not the involved science and diagnostic aspect of the