Professional and Ethical Practice within the context of Health and Caring - Essay Example

Profession A profession may be considered as an occupation which requires intensive study, training and mastery of the subjects. It can be defined in the following manner: “an occupation, the practice of which directly influences human well-being and requires mastery of a complex body of knowledge and specialized skills, requiring both formal education and practical experience.” (Glossary) An organisation, whether it is a manufacturing industry or service industry employs the service of various professions in order to achieve some objectives set by the organisation .Especially in the health care industry the professionalism of the workforce determines the quality of service given to the patients. According to Collins Cobuild dictionary a profession is a paid vocation, involving the "practical utilization of advanced education or training.” and specialized skill sets coupled with a combination of individual talents and high standards of work performance (Collins Cobuild English Dictionary 1998). Wide varieties of professions; such as medicine, social work, finance, military, diplomacy, law, teaching and nursing etc are practiced by human beings. Professionalism calls for application of learnt knowledge and techniques in the best possible manner in the discharge of specific responsibilities. Autonomy When a person engages in a profession it becomes necessary for the person to take informed decision about various actions involved in the discharge of his duties and responsibilities. A true professional who receives specialized training becomes able to take independent decision on various matters pertaining to his job even when he applies logic and reasoning with proper adherence to professional ethics. The ability of an individual to take informed, unconstrained decision is called ‘Autonomy’. Autonomy is often regarded as the base for determining moral responsibility for one’s actions. It can be defined as “an autonomous being is one that has the power of self-direction, possessing the ability to act as it decides independent of the will of others and of other internal or external factors’’. (Glosario de Terminos Filosoficos [en ingles]) In other words, it means the ability of people to make “their own decisions rather than being influenced by somebody else.” (Collins Cobuild English Dictionary 1998). According to the western tradition, individual autonomy has been considered as one of the basic moral and political values. It gives the moral weight to the individual’s ability to rule himself or herself. In a sense, to be autonomous means, to be directed by desires considerations and conditions which are not imposed externally but forms part of one’s self. Nurses and autonomy In UK, nurses are trained for either diploma or degree certificates. Post graduate courses are also available for nursing graduates. The nursing profession has a multitude of specializations in various branches of medical care including in mental health, learning disabilities, adult and child care branches. They are classified into two levels. The first level nurses are trained for three to four years. The second category is called state enrolled nurses who are imparted training for two years. The Nursing and Midwifery Council (NMC) register and regulate their services. In order to discuss the autonomy of nurses who are working with patients suffering from learning disabilities, it is paramount that one should understand major responsibilities. Nurses are basically responsible for the care of the patients during their hospitalisation. Some other responsibilities of the nurses envisage making nursing assessment which includes risk assessment and mental state examination, collection of collateral history of the patient by gathering information, etc. The autonomy aspect of nursing professionals in a hospital environment would involve the decision making on their part, regarding matters affecting the degree of care, comfort and convenience of the patients in line with their free will and consent. An understanding of autonomy is required to tackle situations in which the autonomy of the nursing professionals infringes the rights of patients and clients. This aspect of the health care assumes significance because there are areas where the exercise of autonomy on the part of the nursing professionals can sometimes transgress the will and rights of the patients, while working with people suffering from learning disabilities. Occurrences of areas of conflict may arise which are undesirable and not in consonance with the various legislatures and Code of Conduct to be followed by the nursing profession. Various aspects of the autonomy as enunciated in different laws are being examined to see how the autonomy aspect would be invoked. However, in the Mental Health Act, a qualified nurse is empowered to detain a voluntary person up to a period of 6 hours if she is of the opinion that such detention is necessary for his “protection” and it is not feasible to seek the consent of a doctor. (Detention) Again, Article 8 of the Human Rights Act says that “everyone has the right to respect for his private and family life, his home and his correspondence.” (Human Rights Act 1998. 1998 Chapter 42 – Continued. Schedules). From the autonomy point of view, it could be said that the mental health act gives powers to nurses to stop a “voluntary patient” from leaving a ward without the arrival of the doctor. (The liberty guide to Human Rights). In the context of the Health Care Industry, the professional requirements would be to give first priority to the people with health concerns and provide adequate therapeutic care to them in order to ensure alleviation of suffering and permanent recovery. It also entails evolving of a proper state-of-the-art system to ensure that progressive recording of the patients’ welfare is regularly done and, post recovery care is also taken by the patients or their carers. From the perspective of a professional employed in a facility providing health care to people with learning difficulties, the need for professionalism and commitment becomes manifold as he or she is dealing with people who are not completely equipped to respond like normal persons, which requires a certain level of autonomy. The Professional practice relates to the high degree of acumen, judgment and skills displayed by the nursing profession. The aspect of autonomy is also of very great significance, since without autonomy; the nursing staff cannot discharge their duties with high degree of care and skill required for meeting their job expectations. With autonomy comes the use of discretionary powers on the part of the nursing staff and being able to judge what is best for the treatment of the patient and the means of providing the same to him, they must have the freedom to exercise autonomy in order to safeguard the patients’ own interest, in a mental health or learning disability treatment facility Autonomy with relation to NMC Code of Conduct. The Nursing Midwifery Council (NMC) is the authority that awards registration for nurses to practice in the UK. They primarily ensure that the quality of education and training received by a nurse is appropriate to work in the UK as a Registered Nurse. They also have to ensure that there are no impediments in the routine discharge of nurse’s duties in a health care facility. The NMC Code of Conduct has therefore been devised to ensure smooth flow of service to the patients.The aspect of autonomy of the nursing profession with regarding to Code of Conduct could be discussed as follows: Autonomy with regard to Consent of Patients While in the normal course, it is necessary to obtain consent from patient, but, during the case of an emergency, when consent is not possible, the nurses could take up care facilities provided if it is in the best interest of the patient or may be required by law to do so. In the decided case Bolitho Vs City and Hackney Health Authorities, it was ruled that the Doctor’s decision not to administer intubation was in adherence to best medical practice and that was enough, “if he exercised the skill of an ordinary man exercising that particular art.” (Nursing Midwifery Council) Where the consent is forthcoming it should be done accordingly, and where, due to deterioration of the condition, an immediate consent is not possible the nursing staff have to depend on the patients consent prior to the deterioration, if any. If this is not possible, the decisions should be based on the nurses’ autonomy for prudence and best judgment after discussions with concerned persons. Autonomy with regard to disclosure of information The nursing staff is empowered not to disclose confidential information about the patients to outside persons, but are fully empowered to discuss confidential information among the attending doctors and medical team including attending psychiatrists. However, the information so discussed should not jeopardize the condition of the patient or the process of his recovery. Further, in case the nursing staff is not in a position to judge whether to disclose or withhold confidential information regarding the patient, they have the discretion to seek legal help and also seek the advice or counsel from their employers, and should follow the instructions given by legal authorities in the matter. What is important is the motive behind disclosure of confidential information; if it is it being bona fide towards the betterment of the mental condition of the patient, to serve him better, and to place him in a better position in the path to recovery. Autonomy with regard to preservation of health care records Health care records may be needed as evidence for future referrals. It should be accurate and should serve as clear proof of the patient’s case history. It should be regularly updated and should be done along with consultations with the patient/client. The nursing staff has the power to maintain health care records in order to progressively monitor the state of health of the patients and also for future use. The autonomy to delegate work to others The nursing staff has the authority, under its Code of Professional Ethics, to delegate work to non-Registered nurses and midwives. This must be wholly done in order to meet the needs of the patients and to serve them. The delegatees should be capable and they should be supported regarding the execution of the work delegated to them. However, the responsibility of the work vests with the nurses and not with the delegatees. Autonomy regarding advising on any product or service The Nursing staff sometimes advice regarding the use of certain products or services .However, this should not be construed as endorsing the product. In case such an advice is given, they should also mention about the alternate products or services available, so that the patients/clients are in a position to take a decision after exercising deliberate choice by having duly considered the merits and demerits of the products or services offered. The Nursing professions have the autonomy to refuse any gifts, grants or obligations offered which may be in the guise of bribery for getting favored treatment and have to be actively discouraged. The code of conduct for nursing profession debars the autonomy of the members to request for financial favours in the form of money considerations from their patients, clients, friends, relatives etc. The nursing professionals have the autonomy to report immediately to the relevant person or authority, regarding any “conscientious objections” (Nursing Midwifery Council) The nursing professionals are at liberty to accept work within their areas of training and expertise. If they are constrained to accept work outside their area of knowledge or skill, they should first seek the help of senior authorities for the work. The work they are undertaking should be executed according to accepted norms, as was decided in the case of Bolam Vs. Friem Management Committee (1957) in which the medical practitioners had acted according to the “existing practices” they could not be said to have been “negligent.” (Bolam Test). The Professional and Ethical issues involved in the scope of autonomy include the following aspects; honouring the patient and his individuality, co-operation with others as team member, having updated professional knowledge and high level of competence, being honest and transparent in dealings, always functioning for betterment of patient and reduction of risk to them, respect for human dignity and non-discriminatory attitude. The ethical issues relating to the care and nursing with regard to the autonomy aspect, should respect and honour the request of the patient. If the patient do not wish medical intervention then, although the medical profession has the autonomy to compel the patient to submit to medical care, it would be best to honour his/her decision, even if it means death for the patient or fetus, or has serious health implications for them. The nursing professionals should always upgrade and update their current knowledge in consonance with the latest technology in the field and also entails utilization of known skills and training and to seek help from more senior qualified and experienced professionals and/or authorities when in doubt. The nursing profession should maintain the highest degree of professional nursing and care when interacting with patients, and for this it is necessary that all dealings with patients/clients should be transparent and forthright. The course of treatment and the medical interventional programmes should be discussed with them, their consent obtained and then only the treatment should progress. Honest appraisals of the state of the patients would go a long way in establishing a good patient-nurse rapport and would lead to better chances of recovery. The matter uppermost in the minds of the nursing staff during the health and caring of the patients with learning disabilities is that the patients would often not be in a position to respond promptly and sometimes, slow yet steady improvement would only be forthcoming. Although the nursing staff has the autonomy of forcible medication and intervention, it may not always bring best results, and voluntary treatment, including non-traditional methods like gentle teaching etc. would prove therapeutically beneficial. The nursing staff always has to keep the best interest of the patients in mind and, when faced with a dilemma, should act in exercise of their autonomy, to prevent a further deterioration in the patients’ condition, or to alleviate their suffering. In a decided case of Wilsher V Essex Area Health Authority (1988), it could not be conclusively proved that negligence on the part of staff led to excess of oxygen inhalation on the part of premature child, turning it blind. Since it could not be proved that the excess inhalation had ‘caused or materially contributed’ to the blindness, the case was dropped. (Bolam Test). The autonomy factor is of strategic importance in the work ethos of nursing professionals in a setting with mentally deficient persons. In such circumstances, the patients may be of unsound mind, of subnormal intelligence and may also be people who are unable to take care of themselves. Therefore, the degree of care and treatment to them has to be more pronounced and intensive, not only taking into account the holistic aspects of their treatment but also its long term effects on the personalities of the patients. Normally patients with mental in-capabilities require long term treatment, sometimes even lifelong, in order to control and alleviate the disease. In certain cases, even after the patients have been declared fit and released from hospital settings, the medication and treatment will have to be continued in order to avoid relapses and also to ensure that the erstwhile patients are capable of becoming self performing according to social standards. It is here that the autonomy factor comes into play since the nursing staff, being in direct, regular and constant vigil over the patients, are in a better position to oversee their progress and monitor their activities. In these circumstances, the use or non use of medication, its dosage, frequency, regularity and other matters directly connected with the patients’ well-being is within the scope of the nursing profession. Autonomy and delivery of care The delivery of care means quick, speedy, and effective and results based caring of the patients with humaneness and consideration without causing undue pain, suffering and misery to the patients. It is common knowledge, that, often, a lot more pain and mental agony is caused to mentally deficient patients by application of the treatment on them rather than the disease. Sometimes the curing aspects are more traumatic than the disease itself, and it is certainly the reason why many people do not wish to become patients or refuse treatment. This is where the professional caliber and skills of the nursing profession comes into play. Given the autonomy within which they have to function, they play a crucial role by making the afflicted patients aware of the state of their illness, impressing upon them the need for medication or other prescribed forms of treatment, ensuring that the patients undergo the medical treatment till such time as their ailment has been brought under control and they are cruising back on the road to normalcy. Constant follow-ups in order to monitor the progress of the patients and avoidance of relapses, ensuring a smooth rehabilitation to normal social life for the patients are also decisive steps to ensure the well being of the patients. Knowledge of disease Perhaps one of the most daunting and difficult tasks of the nursing profession is to create the awareness of the disease in the afflicted persons. While some may flatly refuse to accept their condition and display aggressive symptoms, others may have emotional outbursts. Still others would have withdrawals symptoms, which may last for some time. Through the use of autonomy, which the nursing profession has, it is possible to share medical history and pathology of the disease with the other professionals responsible for the treatment, and also initiate a plan of medication and treatment for the patients. Impress upon them the need for treatment With the utilization of the autonomy and freedom available, the nursing staff should be able to convince the patients regarding the need and importance of treatment. In this case, it has also to be considered that patient‘s consent is of prime importance unless under circumstances, it is not possible to attain such consents. In case the patient does not seek medical intervention, it need not be done. Social rehabilitation Perhaps the most undermined but most important aspect of mental disabilities is the social acceptance upon total cure. Earlier, most societies view people with mental disabilities as outcasts not having social importance. However, now, with the progressive developments in medical science and healthcare technology, mental disabilities are no longer taboo, and there is greater acceptance and non-discriminatory attitude towards it. The nursing profession with the necessary autonomy has a big role to play in the social rehabilitation of people who were once mentally disabled. The autonomy of the nurses entails educating the new entrants to the profession and also informing them about the current trends in it. It is also imbibing in them the highest standards of commitment and devotion for the profession. Accountability in nursing profession Professional accountability in nursing has recently become an issue because of expansion in nursing roles and increasing autonomy for nurses. In a sense, it means nurses should think more carefully about their professional course with relation to patients (Code for nurses: ethical concepts applied to nursing. Geneva, International Council of Nurses, 1973.) According to the medical profession, accountability means that the health care professionals who have been empowered to take decisions with regard to patients are responsible for those decisions. In healthcare profession, accountability is a part of ethical behaviour and nurses carry individual liabilities for their health care functions. Conclusion The autonomy enjoyed by the nursing profession in the hospital setting of patients with learning disabilities needs to be seen in the wider context of how well it could serve the society and make life for the patients easier, more purposeful and fulfilling. Although the persons confined to settings have restricted access to education and development, the nursing profession should ensure that, along with the cure and alleviation of their present condition, the regenerative power of their mind also takes improvement by sympathetic care. The aim of the nursing profession should be higher than mere eradication of diseases, but should lie in the fact of allowing people to take their rightful place in society, even though it may take some time to do so. The nursing profession through the exercise of autonomy and other rights should create an environment in which patients are treated with the highest standards of professional care and are given ample scope to express themselves creatively, to live with dignity and self- respect despite their condition and also contribute towards the total harmony and equanimity of the settings. It could then be rightly said that the nursing profession has served its purpose with distinction for the cause of the patients and their families. Work Cited Glossary. Retrieved March 7, 2007, from www.unmc.edu/ethics/words.html Glosario de Terminos Filosoficos (en ingles). Retrieved March 7, 2007, from www.filosofia.net/materiales/rec/glosaen.htm Collins Cobuild Dictionary: 1995: Great Britain: HarperCollins Publishers Ltd. Netlink. The UK’s Largest Internet Site Provider. Document Not Found (Error 404). Retrieved March 7, 2007, from www.hyperguide.co.UK/http://www.hyperguide.co.uk/mha/s1 Human Rights Act 1998. 1998 Chapter 42 – Continued. Schedules. Retrieved March 7, 2007, from http://www.opsi.gov.UK/acts/acts1998/80042--d.htm The liberty guide to Human Rights. Retrieved March 7, 2007, from http://www.your.right.org.UK Nursing Midwifery Council. Retrieved March 7, 2007, from http://www.mne.uk.org/aDisplayaspx?DocumentID=201 Bolam Test. Retrieved March 7, 2007, from http://en.wikipedia.org/wiki/Bolam_test Code for nurses: Ethical Concepts Applied to Nursing. Geneva, International Council of Nurses, 1973. Works cited Definitions of profession: Available From: www.unmc.edu/ethics/words.html [Accessed on 7th Mar 2007] Definition of autonomy: Available From: www.filosofia.net/materiales/rec/glosaen.htm [Accessed on 7th Mar 2007] Collins Cobuild Dictionary: 1995: Great Britain: HarperCollins Publishers Ltd. Turner, Nigel, Hyper guide to Mental Health Act 2004: Available From: www.hyperguide.co.UK/http://www.hyperguide.co.uk/mha/s1 [Accessed on 08.03.2007] The Human Rights Act 1998: Available From: http:// www.opsi.gov.UK/acts/acts1998/80042--d.htm [Accessed on 08.03.2007] The liberty guide to Human Rights 2005: Available From: http://www.your.right.org.UK [Accessed on 08.03.2007] Nursing Midwifery Council: 2004 Available From: http://www.mne.uk.org/aDisplayaspx?Document ID=201 [Accessed on 08.03.2007] Bolam Test, 2007: Available From: http://en.wikipedia.org/wiki/Bolam_test [Accessed on 08.03.2007] Code for nurses: Ethical Concepts Applied to Nursing. Geneva, International Council of Nurses, 1973. Read More