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Ethics in patient care
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With unparalleled technological advancement, nursing and bio-medical research, and the present healthcare environment, nurses must be cognisant of their professional and personal views of ethics. Ethics are standards of behaviour, developed as a result of ones concept of right and wrong (Judson & Harrison, 2010), and are intended to influence the actions of healthcare professionals. Ethical principles help guide the decision-making process among healthcare workers in complicated situations. [Therefore] we cannot understand nursing unless we also understand ethics (Gallagher & Wainwright, 2005)
There are many different ethical theories which can mainly be divided into three groups. These are Duty based, Goal based and Rights based theories.
Deontology is a duty based ethical theory. This means that a moral person must always do their duty and must perform them “without exception, whatever the consequences” (Seedhouse, 2001). However, this theory has limitations and objections because it does not allow for conflict between duties, flexibility or compromises and these are all essential for health work. (Seedhouse, 2001)
Goal based theories such as Utilitarianism, believe that what is morally right is determined by the good that is produced as the consequence of the action. The acts that achieved this were defined as “good” and those that produce “pain” were bad. (Rumbold, 2000) An objection with Utilitarianism is that because it is only concerned with the consequences, then even if an action was taken that was intentionally bad, it would still be ethically right if the eventual consequences were favourable. (Seedhouse, 2001)
Dunbar (2003) states that there are four main ethical principles, these are beneficence, non-maleficence, justice and autonomy. The principle of beneficence is to do good for patients and to put their needs before your own (Rumbold, 1999 p217) and with beneficence comes the principle of non-maleficence meaning to do no harm. Rumbold (1999, p222) describes how in many nursing duties nurses have to “do harm” to our patients but only when it is alongside beneficence and the long-term goal is to do good by the patient. In not giving a patient assistance to eat their meals we are acting in a manner that these principles don’t support as there is no good that could arise from this. Beneficence is considered to be the caring ethic, as it guides us to work in the best interests of the patient but at the same time for the benefit of other patients, considering their rights to justice and fairness with their care (Kennedy, 2004).
Ethical principles are judgments that serve as a basic justification for the ethical evaluation of one’s action. They are the viewpoints from which guidance can be obtained along the pathway to a decision. According to the Journal of the American Nurse Association, ethical principles are the general goals that each theory tries to achieve in order to be successful. The widely accepted prima facie ethical principles are; Autonomy, duty to respect one’s right. Beneficence, the desire to do good. Non-maleficence refers to avoidance of harm or hurt. Justice, duty to treat one fairly. (Beauchamp, 2004). While some of the ethical dilemmas includes: ensuring informed consent, determining decision-making capacity, promoting advance care planning, surrogate decision-making, withdrawing and withholdi...
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.
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).
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
Ethics has been a popular topic in nursing for a long time. Nurses are expected to demonstrate ethical decision-making as well as professionalism. I believe that in order to accomplish this, they need to use the ANA Code of Ethics as framework for their decision-making. It is also imperative for nurses to have a strong understanding of ethics, because they will be faced with many difficult ethical decisions that do not always have a straightforward solution.
This paper will focus on two BNUR leaner outcomes (University of Calgary, 2013) relevant to my learned understanding of nurses as ethical decision makers. I will outline the ways that I have seen ethics used and not used in practice, what I learned about ethics and its use in my theory courses and throughout my practicums, and I will reflect on how this understanding will translate into my professional practice moving forward.
The Code of Ethics for Nurses was created to be a guide for nurses to perform their duties in a way that is abiding with the ethical responsibilities of the nursing profession and quality in nursing care. The Code of Ethics has excellent guidelines for how nurses should behave, however; these parameters are not specific. They do not identify what is right and wrong, leaving nurses having to ultimately make that decision. Ethics in nursing involves individual interpretation based on personal morals and values. Nursing professionals have the ethical accountability to be altruistic, meaning a nurse who cares for patients without self-interest. This results in a nurse functioning as a patient advocate, making decisions that are in the best interest of the patient and practicing sound nursing ethics.
In order for nurses to practice ethically they must understand the meaning behind each professional value. The first value is human dignity. With each patient we encounter we must show them respect as individuals. It does not matter what the medical condition is, race, ethnicity, culture, religion or gender of the individual. The dignity of a person must be protected. As nurses we must respect the uniqueness of each individual we care for, as this is a fundamental right of all humans. A person with dignity feels a sense of self-worth and as nurses we must do our best to help our patients maintain that feeling of worthiness.
Thompson, I. E., Melia, K. M., & Boyd, K. M. (2006). Nursing Ethics: Churchill Livingstone Elsevier.
6). Good intention is the main moral principle considered and consequences are irrelevant (Joel, 2013, p. 526). Seemingly, the deontological ideology focuses on the actions of the agent and would disregard patient focus and individuality. It is difficult to apply contemporary ethical theories to the nurse because of the values of the nursing profession. “Contemporary ethical theories do not lend themselves to the health-care professions or to ethically defensible decisions in health-care practice. None of the dominant ethical theories could be discovered in, or derived from, the profession of nursing” (Joel, 2013, p. 526). Casuistry, while not an ethical theory, is a case-based approach to practical decision-making. Cases that have set precedence are identified and comparisons are made using similarities, differences, and previous experiences. This concept is used to complement ethical theories in patient decision making by clinical ethics committees (Slowther, Johnston, Goodall, & Hope, 2004, § C4). Personally and professionally balancing ethical perspectives to be able to consider all details on a case by case basis seems like a more appropriate
Ethics is defined as moral principles that govern a persons or a group’s behavior, ethical principles apply to both personal and professional relationships (Webster, 2015). The field of nursing is a profession that has been highly regarded and respected in society. Most nurses enter the profession in order to utilize their clinical skills to help others in their time of need. Those in failing health rely on nurses to care for them in their most vulnerable states, and expect a level of compassion and humanity while receiving care. Nurses have an ethical responsibility to their patients, clients, and their community. Compassion, empathy, and integrity are staple characteristics that nurses possess that allow them to successfully perform their
The four fundamental nursing responsibilities of promoting health, preventing illness, optimizing health and alleviating the ill are represented in the code of ethics. (Arnold & Boggs, 2016) One can say that the code of ethics are rules that a nurse needs to follow in order to effectively communicate and protect the patients. The American Nurse Association provided the code of ethics to guide nurses to ensure that patient’s care, safety, rights and health are well cared for and well managed. Models like Utilitarian, deontological, and the human rights-based all contribute in answering dilemmas that can arise with a patient. Thus, explaining what some of the code of ethics are, and how the code of ethics influence our responsibilities as a nurse will impact the overall care of the
In conclusion, there are numerous legal and ethical issues apparent in the nursing practice. Nurses should study and be as informed as they can with ethics and legality within their field in order to ensure no mistakes occur. Ethical issues vary based on patient’s views, religion, and environment. Nurses are influenced by these same views, but most of the time they are not the same as the patients. As a nurse we must learn to put the care of our patients and their beliefs, rights, and wishes before our own personal
Utilitarianism can be described as an ethical theory that states if the consequences of an action
A deontologist asserts that you should do your duty even if you or others suffer as a consequence. Deontology is seen as an obligation to protect regardless of the impact it has on others, whether it be people, animals, and/or the environment and so on. “Deontology focuses on the duties and obligations one has in carrying out actions rather than on the consequences of those actions” (Mosser, 2013). According to deontologist Immanuel Kant, when doing your duty as a deontologist there are “categorical imperatives” that should be followed. In other words there are exceptions for why one is not taking action. “All imperatives command either hypothetically or categorically” (Kant,