DNUR135 Contemporary Issues In Nursing

Introduction

Ethics is the study of sensible internalization or realization. Nurses encounter dilemmas in ethics in their daily practices. Ethical habits are based on various issues. An individual’s view of morals may differ from another individuals perspective of the same. Nurses experience these dilemmas notwithstanding of their multiple roles. Ethical decisions may affect nurses and also patients. Generally, there exists no solution to an ethical dilemma. This moral dilemma may be approached to as a stalemate with no agreed-upon solution. The benefits making decisions are based on the perception that even though there are various ethical preferences made associated with certain ethical dilemmas, the ultimate choice may end to neither wrong nor right decision. Ethics involves the doing of what is right without impairment. However different nurses have their definition of ethics. Ethical guidelines lessons equip nurses with the proper tools to underpin ethical decisions. Even though ethical principles are developed by knowledge, beliefs, and values of nurses.  Different choices also may be arrived at based on the same impasse (Tinkler, Smith, Yiannakou, & Robinson, 2018).

There are many ethical issues nurses may encounter in their practice such as; quantity against the quality of life, control versus freedom, between deception and truthfulness, distribution of resources, pro-life versus pro-choice and between personal beliefs and empirical knowledge. Quality looks at the goodness of life although may differ depending on a person’s definition of good. For instance, the position of the nurse in supporting the patient choose the therapy that may elongate life while thinking of a quality life.  The presence of a patient may be lengthened. However, great undesirable impacts may be encountered during therapy. Quantity, on the other hand, looks at the lifespan of an individual, it also concerned with the population of that may be impacted by the decisions. Nurses are encouraged to apply ethical concepts in offering patient care (Lemmenes, Valentine, Gwizdalski, Vincent, & Liao, 2018).

These ethical concepts may include rational, correct and proper care. Patients contribute to their right of choice in the provided prospectus and determine the manner in which they desire to be treated access to services. Nurses who possess ethics appreciate that they are obligated to deliver personalized care that may assist patients to attain their desirable well-being. Nurses with morals offer care dependent on the science of making rational decisions. There exist four significant aspects that are important to better nursing practice such as the duty to operate with generosity, no mischief, respect for patient self-rule and justice. Nurses promote respect for patient self-government by ensuring and appreciating the freedom of the patient’s choices, enhancing privacy and respecting opinions. The National League for Nursing gave out a report stipulating the rights of patients. It is expected of nurses to promote patient’s rights and advocate for the same to those who are ignorant of their rights (King, Harrington, Linedale, & Tanner, 2018).

This paper will focus on the freedom vs. control ethical dilemma that occurs in instances such as nurses having the power to stop patients from their freedom of making choices by themselves which are most likely to injure them? For example, patients may prefer not to eat however the nurse is of the view that it may cause harm to them. The dilemma arises as to whether the nurse has the right to pressure the patient to eat.

Control vs. Freedom Ethical dilemma

Nurses are frequently under pressure because of their duties to ensure the well-being of patients (Jakimowicz, Perry, & Lewis, 2017). Nurses must make an oath to be obliged to professional ethical conduct. Theoretically, what would be the best action if a patient is ruining their health by not eat? There exists two probable approaches, that, is, force the patient or make their wish. For instance two nurses, one who uses values to offer excellent care services to the patients and one who abides by the rules.

From a deontological stand, the nurse who promotes the choices made by patients of refusing to eat is allowed as such a nurse is only abiding their obligations of allowing patients to have their freedom. The theory of deontology contain the duties, rules, and responsibilities that every individual must abide by to be regarded as an ethical person. Ethics is concerned with a self-obligation and towards other people. In this case, the nurse may propose to force the patient to eat as the health of the patient may be endangered if they refuse to eat, although may not be ethical as it is contrary to the will of the patient. Hence it is proper for the nurse to possess virtues to enhance unique and personalized care to various patients particularly in making decisions (Castro & Andrews, 2018).

Skär and Söderberg (2018) have the opinion that virtues drive a person in the direction of what is right to achieve a proficient practice. Ethical values instill on the character trait of a person to bring out the best in such a person. They are habits of a person that assists them to achieve the obligations of morals. For instance, when a nurse refuses to eat, an ethical nurse will be understanding and compassionate to find out the cause of refusal to eat and offer a solution to that effect. One of the reasons as to why patients may refrain from eating may be because they find the food is not appealing. This may be accommodated by a nurse through changing of the meals by offering what the patient may prefer. It is essential for nurses to have excellent skills and ethical values that may be helpful in advocating for independence, the well-being, and health of patients.

Ethical values are believed as an important theory when dealing with nurses dilemmas for instance where a patient refuses to eat their meals. It is very vital for the nurse not to jeopardize the welfare of a person and take care of patients. When nurses apply these values, they solve the issues of patients having to consume food for their sake as it is the duty of nurses. However, the theory of deontology may not be applicable in such scenarios because where patients are reluctant to consume their food, it is not the duty of nurses to pressure them to eat. Typically this is like having to watch patients injure themselves and doing nothing about it.

Clinical Story

The nature of nurses is to calm down distraught and anxious parents of infants who are immature. However, when a woman bearing 25-weeks preemie appeared less concerned about her infant, this indifference created a problematic situation for the nurses to understand thus conflicts arose on what to be done.

This woman was a career lady with whom her first pregnancy was attained via vitro fertilization. Surprisingly upon hospitalization for preterm labor, she seldom followed instructions given by the physicians and nurses to remain relaxed and bedrest. She nevertheless continuously worked from her bed and put further trauma on the fetus disregarding the appeals of nurses that the infant may be injured by her actions.

Lam, Kwong, Hung, Pang, and Chiang (2018) appreciated the efforts to prevent delivering prematurely were in vain; she appealed to nurses not to employ extraordinary means for the baby’s safety. The mother didn’t show any interest for the well-being of the infant, but the preemie survived. Nurses undertook every possible means to ignite the maternal instincts of that woman but failed. Her detachment created difficulty for the medical team as she was reluctant to talk to them and the social services.

The mother’s interest worsened, even more, when the infant suffered bleeding leading to permanent damage to the brain. She was very mad at the staff had saved the baby contrary to her wishes. At the end the mother decided to give up the infant for adoption, such a difficult choice it was for the NICU nurses to understand.

Nurses did not have a choice but respect the decision of the mother. Their constant effort to support the mother and try to connect her with the infant did not work and decided to look for the best result.

Literature Review

a) Nonmaleficence

Wilson (2018) contributed to the to the controversy related to physicians having to relieve suffering and pain using a second impact drugs to fasten their patient’s death is because physicians must reduce suffering and pain. Every person including patients has the right not to undergo pain and suffering. Suikkala, Koskinen, and Leino-Kilpi (2018) Suggests that the physician must contain the suffering and pain of an incurable condition. Schmid, Rosland, von Hofacker, Hunskår and Bruvik (2018) Argues along that by any possible means, freedom from depression should be a fundamental human right to be limited only with the consent of such an individual.

Geerligs, Rankin, Shepherd, and Butow (2018) Proposes that relief from suffering should not be morally argued, stating that at least where a physician is not successful in curing the patient, he should be in a position to reduce the suffering. This may be inferred from the position that, regrettably in the effort of reducing suffering and pain a physician may un-deliberate inflict harm on patients. Therefore, physicians should not be morally blamed as their foremost duty is to alleviate suffering and pain. The second effect drugs for that matter not only relieve pain but also allow the sick to die in dignity even though the death was accelerated. Pride is an essential segment of an individual that should be maintained at any time whether alive or at the time of death.

However, Lamiani, Borghi, and Argentero (2018) stated that on the contrary physicians should always abide by the medical ethical code to avoid causing harm in this case, the duty of nonmaleficence grounded on Kant’s obligation ethics, contends that whatever is right, in itself is good even with no qualification it is still  good. Although if this argument is further interpreted of what good is, then it would mean that it can never cause harm unless the good was not employed then at the start it was never right. It is not right to cause damage notwithstanding it was not intentional but for whichever reason for the initial or main intention. What is good is supposed to be okay with no condition. Therefore, any action arising from duty has its moral importance and not the ultimate it achieves or intends to complete but appears from t the formal philosophy of one performing their duty regardless the kind of commitment.

Grace, Innes, Patton, and Stockhausen (2017) add that physicians owe the society and patients the responsibility and duty to do good not to cause harm. Sarcastically, Kantian ethics may as well be applied to underpin the double effect principle of inflicting damage where one is only concerned with their duty and disregarded the deontological ethics concepts. It is due to the Kant principle that an individual’s deeds contain moral worth then it would appear that only the intended actions of the physicians should be evaluated morally in double effect undertakings while the unintended results, for instance, accelerating death should be disregarded to be without any moral relevance or consequence.

Oman and Brown (2018) contribute that Christian moralists emphasized that physicians should strictly follow the nonmaleficence obligation grounded on their view of freedom. This perception states that human beings have the freedom to choose when meeting his creator because no person even the patient or physician should deceive God. Therefore it is not right morally for an individual to want to welcome death or someone to aid anyone else in welcoming death if God has not determined or occasioned death. They further argued that human life is holy therefore should not be brought to an end, suffering and pain cannot be the justification for anyone to do the role of God. The Christian theology definition could be obtained from the suffering and pain as it offers human the chance to engage in the suffering of Christ. Although eastern theological views such as Hinduism, Buddhism, and Confucianism do not agree with the sentiments exhibited by many of the Christian moralists.

b) Beneficence

Kraft, Kästel, Eriksson, and Hedman (2017) explained beneficence as the worth of right action, from the point that an individual is supposed to advocate for steps that are beneficial to others or take positive initiatives to assist other people. One of the central significant role of nursing staffs in the healthcare unit is to employ positive deeds to boost the welfare and health of patients. Typically, medical staff needs to be considerate about the actions that will favor patients. Using beneficence in instances of ethical dilemmas, a nurse has to contemplate the question that which decision will suit the patient. The unit of Home Care and Ageing Disability stipulated that the principle of beneficence demands that nurses act everything possible maintain the safety and boost the health of the patient. It is understandable that nurses inform other staffs about the patient’s intention to harm themselves hence the involvement of the health care may be engaged to avoid real self-harm to suit the principle of beneficence and be the best preference.

Oliver, Wilson, and Malpas (2017) contemplate all ethical principles, legal opinions and concepts, value statement and utilitarianism in modern literature in that it will not be legal or ethical for a nurse to never tell about the patient’s attempts of harming themselves. The step of determining the information to other staffs is proper consideration of the ethical principle of beneficence. It develops benefits for many people it, therefore, conforming with the utilitarian theory it is a right decision. Apart from these, ethical value statement nursing insists on the obligation of nurses to offer quality services value to acquire quality health care for every person. As a result, nurses gain the support to initiate positive deeds to prevent patients from harming themselves. Additionally, the views in the contemporary literature concurred that nurses should take a constructive action of informing other medical professionals to avoid actions that are harmful thus encourages the decision of informing others. Hence, the preferred ethical choice for patients is for the nurses to give information about patients to other medical professionals.

c) Autonomy

Grace, Innes, Patton, and Stockhausen (2017) states that autonomy is a kind of individual freedom of action whereby people choose their way to act according to the preferred plan. The thing is the principle of autonomy appreciates the patient’s competent freedom of decision making. This principle also demands that nurses respect the confidentiality of patients and make sure that the actions of nurses have acquired their patient’s consent.  The application of autonomy in instances of ethical dilemma consists of the decision keep secrets is honoring the freedom of self-determination of the patient and given approval.

Additionally, Jakimowicz, Perry, and Lewis (2017) choosing not to tell secrets may disregard the capability of the patient to harm themselves and might cause the behavior of self-harm in patients. Patients with cancer are in most cases likely to pursue precipitated death. One example of the facilitated dying habit of medical staff is withholding from interceptions to discourage or stop patients from harming themselves. Ethical dilemma instances of withholding secrets may be categorized as promoting death. It is argued that moral point of autonomy is not validated in law associated with helping self- harm, and euthanasia because no one has the right to be aided in dying at any moment they desire. Although the autonomy should be honored, it cannot precede the common law which stipulates that the habit of professionals facilitating death is strictly forbidden.

Austin, Saylor, and Finley (2017) suggested that in case a patient in a critical condition makes such reckless choice that may lead to severe results to themselves medical professionals have right take advantage of their desires to prevent and reduce such consequences. In cases of self-harm, the deeds may be determined as choices that lead to severe self-harm outcomes. Hence the autonomy of the patient may be taken advantage to prevent attempts of self-harm. Evaluating the present condition of the patient at the time when they have self-harm thoughts is required as some study indicated that patients suffering from unstable emotional or mental disorder conditions might not be regarded as persons capable of making decisions on their own.

A study indicated that attitudes and feelings of nurses when encountering same situations to the clinical story. More than half nurses in their research showed that personal and professional ethics hinder nurses from facilitating self-harm and enables nurses to undertake constructive actions in preventing such. In this study, almost 40 percent of nurses in their research emphasized that it is the nurse’s professional obligation to avoid patients from dying. It, therefore, means that many nurses would in such cases choose a constructive act to prevent the death of patients under professional and ethical considerations. Another study insisted that patients with bad attempts on health care in most cases seeking sympathy from people. In short, they are requesting assistance from the care providers. Therefore, it is upon the nurses to offer support in various ways like proper communication to solve the patient’s thoughts of self-harm. Moreover, some nurses stipulated that other health professionals like physicians performed a significant role in preventing self-harm. Therefore, they need to be informed first where nurses discover the intentions of patients to harm themselves. It is understandable that views from contemporary literature conceded with nurses.

Moreover, Squires, Jylhä, Jun, Ensio, and Kinnunen (2017) argued that it is the responsibility of nurses to respect ethical of handling information. Nurses have to respect the desires of patients in regards to their privacy, confidentiality and any information shared. In ethical dilemmas situations, nurses are expected to value their choice of not sharing secrets with other medical staffs. However such secrets have a tremendous negative impact on the safety and health of patients hence nurses should judge professionally to decide whether they may give such information to other staffs. Even though nurses are to maintain the privacy and confidentiality of patients, this may result in harmful impacts on the safety and health of patients.

Jakimowicz, Perry, and Lewis (2017) take from the National Code of Ethics for Nurses and Midwives established in 2008 that contains professional and ethical behaviors of midwives and nurses. It has value statements concerned with nurses helping patients to make decisions. ANMC argues that nurses need to value the right of patient engagement in giving decisions affecting their treatment and care. Nurses should also consider the choices of incompetent individuals such as mental disorder.

Conclusion

Instances of patients speaking out their thoughts of harming themselves are very common in nursing practice. Hence information concerning issues of ethics like the clinical story should be regarded as of importance. Nurses possess a professional duty as know ethical and moral complexities that link with attempts of patients harming themselves can be rationally and efficiently solved.

To be able to solve these ethical dilemmas, the present condition of the patient must be evaluated before arriving at a decision is essential. It enables nurses to decide as to whether the patient is capable of decidinthe g health and go ahead to contemplate on taking the right action to handle the ethical dilemma. Additionally, to efficiently solve such situations and arrive at the preferred ethical and moral decisions the following factors must be comprehensively analyzed before nurses arrive at ethical decisions they include; the code of ethics values statement in nursing, ethical decision and ethical concepts.

Meanwhile, after nurses arriving at the best decision, a constructive reaction should immediately be employed to deal with the ethical dilemmas related to patients. The self-harm protocol in hospitals is among the practical tools for nurses to handle in instances found in the clinical story. Contracts offer guidance to nurses on how to deal with the attempts of patients harming themselves. Moreover, working together with other health care givers is a significant thing, other professionalisms like social workers, physicians and psychologists will ensure that nurses come up with better solutions (Hem, Gjerberg, Husum, & Pedersen, 2017).

References

Austin, C. L., Saylor, R., & Finley, P. J. (2017). Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychological Trauma: Theory, Research, Practice, and Policy, 25(1), 399-399.

Castro, A., & Andrews, G. (2018). Nursing lives in the blogosphere: A thematic analysis of anonymous online nursing narratives. Journal of advanced nursing, 25(5), 329-338.

Geerligs, L., Rankin, N. M., Shepherd, H. L., & Butow, P. (2018). Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes. Implementation Science, 36-36.

Grace, S., Innes, E., Patton, N., & Stockhausen, L. (2017). Ethical experiential learning in medical, nursing and allied health education: A narrative review. Nurse education today, 23-33.

Hem, M. H., Gjerberg, E., Husum, T. L., & Pedersen, R. (2017). Ethical challenges when using coercion in mental health care: a systematic literature review. Nursing Ethics, 25(1), 92-110.

Jakimowicz, S., Perry, L., & Lewis, J. (2017). An integrative review of supports, facilitators, and barriers to patient-centered nursing in the intensive care unit. Journal of clinical nursing, 25(2), 4153-4171.

King, L., Harrington, A., Linedale, E., & Tanner, E. (2018). A mixed methods thematic review: Health?related decision?making by the older person. Journal of clinical nursing, 57(5), 1327-1343.

Kraft, M., Kästel, A., Eriksson, H., & Hedman, A. M. (2017). Global Nursing—a literature review in the field of education and practice. Nursing open, 122-133.

Lam, S. K., Kwong, E. W., Hung, M. S., Pang, S. M., & Chiang, V. C. (2018). Nurses’ preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence. Journal of clinical nursing, 1244-1255.

Lamiani, G., Borghi, L., & Argentero, P. (2018). When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. Journal of Health Psychology, 51-67.

Lemmenes, D., Valentine, P., Gwizdalski, P., Vincent, C., & Liao, C. (2018). Nurses’ perception of ethical climate at a large academic medical center. Nursing Ethics, 28(5), 724-733.

Oliver, P., Wilson, M., & Malpas, P. (2017). New Zealand doctors’ and nurses’ views on legalizing assisted dying in New Zealand. The New Zealand medical journal, 10-10.

Oman, D., & Brown, T. T. (2018). Health Policy and Management, Religion, and Spirituality. In Why Religion and Spirituality Matter for Public Health, 191-210.

Schmid, W., Rosland, J. H., von Hofacker, S., Hunskår, I., & Bruvik, F. (2018). Patient’s and health care provider’s perspectives on music therapy in palliative care–an integrative review. BMC palliative care, 32-32.

Skär, L., & Söderberg, S. (2018). The importance of ethical aspects when implementing eHealth services in healthcare: A discussion paper. Journal of advanced nursing, 1043-1050.

Squires, A., Jylhä, V., Jun, J., Ensio, A., & Kinnunen, J. (2017). A scoping review of nursing workforce planning and forecasting research. Journal of nursing management, 25(6), 587-596.

Suikkala, A., Koskinen, S., & Leino-Kilpi, H. (2018). Patients’ involvement in nursing students’ clinical education: A scoping review. International journal of nursing studies, 40-51.

Tinkler, L., Smith, V., Yiannakou, Y., & Robinson, L. (2018). Professional identity and the Clinical Research Nurse: A qualitative study exploring issues having an impact on participant recruitment in research. Journal of advanced nursing, 25(6), 318-328.

Wilson, M. A. (2018). Analysis and evaluation of the moral distress theory. In Nursing forum, 259-266.