Challenges in Developing Ethical Practice in Healthare - Essay Example

?Challenges in the Developing Ethical Practice in Health Care I. Introduction It is true that it is an innate ability for human beings to care. People look out for each other; otherwise, humanity would have ceased to exist today. As the health care society evolves, a set of governing rules has been implemented today to aid nurses and individuals alike in order to make judgment regarding ethical issues. Furthermore, the mastery of these rules ascertains that success is more likely to happen by incorporating the safety of the patients without losing the human element of caring. After all, in the nursing field, focus is as much about the nurturing act, as much as it is about administering different treatments, including but not limited to drugs, for the improvement of a person’s health and well-being. The ethical practice in health care industry faces different challenges each day. Given are some common scenarios that nurses encounter, and how it is being handled. II. The Foundation of the Code of Ethics The set of rules is widely known as the “code of ethics.” The word “ethics” is derived from Greek terminology ethos, which implies conduct and character, among many others, such as practices and habitual operation. It is a universal code practiced by many nurses all over the world with a common goal in line with the “Nightingale Pledge,” which was first used in 1893. The pledge is the physician’s counterpart of the “Hippocratic Oath.” An ethical practice in the nursing field includes basic ethical obligations, which nurses are presumed to follow. Nurses are responsible for how they interact in terms of offering comfort and respecting their patient’s requests, their patients’ family members and/or friends, community, and colleagues, in a professional manner (Canadian Nurses Association, 2008, p. 2). A responsible nurse is a good nurse; being responsible is an indispensable trait since an ethical practice is merely a guiding principle to help nurses in decision-making, and therefore, it is the nurse’s decision to whether or not follow and practice the ethical code. The Canadian Nurses Association (2008) believed that in order for the ethical practice to be considered as such, these factors have to be weighed: the nurses’ word to do good; views on ethical topics; and his or her interrelationship communication skills, to deal either in an individual or a group of people who requires medical attention (p. 4). Moral integrity is one’s ability to keep their ethics intact under any circumstances. III. Moral Identity in Ethical Practice Nurses give qualified and ethical treatment filled with compassion. A lot of professions, especially the ones in the non-medical field, often do not have guiding principles to the extent of the ethical code being practiced in the nursing field. Whereas the same level of compassion is not really needed in other professions, as mentioned in the Canadian Nurses Association (2008), one of the nurses’ roles is to deliver compassionate service by talking in a sensible manner that communicates care and act in a way that shows empathy (p. 8). Empathy and compassion allow nurses to even feel the patient’s pain to some degree, which is a valuable trait, because it shows the human element in communicating caring is evident. A. Moral Identity Moral identity is an intellectual depiction of a person’s ethical character, which is innate by nature and projected externally (McFerran, Aquino, & Duffy, 2010). Its blueprint is characterized by the actions and the corresponding people involved in it, such as colleagues, the organization, or even the society in general. As an example, based on the code of ethics, a critical care nurse, according to the American Association of Critical-Care Nurses (2012) may intervene when the patient’s interest is in question, as in the case of patients in Intensive Care Unit (ICU). Similarly, they can speak on a patient’s behalf according to the patient’s beliefs and values. The importance of getting compassion from someone has been given less credit than for what it is worth; in fact, a case study by Chambers and Ryder (2009) supports that there is a fine line between life and death for people in institutions when there is an absence of compassion (p. 9). B. Influences and the Reasons Why Conflicts Happen In the nursing literature, Corley ascertained that the following are considered to be reasons leading to moral distress: seeing the suffering of patients under their care; insufficiency in terms of workforce (which may force nurses to do more than what they should be doing); policy constraints (as cited in CNA, 2003). Based on a study made on 406 medical staff involved in the treatment of 102 patients, the primary source of conflict arises when making a decision for a patient in the intensive care unit. Decision on whether or not to sustain the patient’s life support system is the primary reason. This constitutes around 63% of the cases, and 45% involves conflict over pain management and communication. Social issues are said to have played a role, which contribute to 19% of the cases. The studies reveal that at least 1 in 78 health care professionals in this type of medical case had gotten involved in this type of conflict. It also shows that in 48% of the cases, there was conflict among the medical professional and the family members. The same percentage was noted among health care providers in terms of conflict while percentage was lowered to half when it came to conflicts among family members (24%). C. Another Powerful Influence: Fear The dilemma occurs when a patient’s choice to refuse treatment interferes with a nurse’s beneficent obligation to ensure the best interest of the client. The dilemma, however, is considered resolved in the event that the patient is not making a decision based on unrealistic ideas and has been made aware of the consequences of his decision (Pantilat, 2008). Faden and Beaucamp had an example wherein a patient refuses nursing care and or chooses euthanasia. Contrary to nurses respecting their patient’s decision to refuse lifesaving medical treatment, which could directly affect a patient’s autonomy when violated, nurses would often go the extra mile in trying to persuade the patient to see the benefits of accepting treatment. Persuasion can be a powerful influence on a patient’s autonomy and may end up changing their decisions, which in effect, might benefit them in the long haul (as cited in Aveyard, 2012). Nurses, for the sake of beneficence, could at least give an overview by discussing the pros and cons of the procedure to be done to the patients to lessen their fear of the unknown, which is sometimes the primary cause of the refusal as per the case studies made by UKCEN Clinical Ethics Network (n.d.). The study was based on a thirty-five year old woman who turned down the possibility of dialysis because she had viewed it as an “invasive” procedure. Despite this, health care providers, nurses and doctors alike, try with all their might to help these people battle their own demons, before finally giving in to that person’s request for non-treatment. IV. A Nurse’s Biggest Challenge: In the Throes of an Ethically Distressing Situation An ethically distressing situation is unlikely to occur when a person’s capability to react on his or her ethical choices was hindered, in cases where there is some form of hindrance that prevents that person from doing what he or she believes to be moral or right (Canadian Nurses Association, 2003). This includes events happening beyond a nurse’s control to the extent that they are unable to do anything, under certain circumstances, to stop harm. CNA stressed out that the term can be used interchangeably with “morally distressing.” In the event that nurses are unable to follow through with their ethical obligations and responsibilities, it could already be considered a deviation from the moral agency in Nursing (CNA, 2003). Fenton stated that shocking life and death situations, multiple role obligations, commitment and high expectations, together with having to maintain a secure and efficient treatment with little to no resources may produce moral conflicts for the nurse dedicated to professional excellence (as cited in CNA, 2003). Hence, as much as it is a human’s innate ability to care, some may feel pressured to live up to the expectations day by day to perform their duties and do what is expected of the nurses. The impact that this makes in the ethical practice is not to be taken lightly. After all, studies conducted by Sverinsson showed that unsolved moral distress is closely linked to a “burnout” feeling (as cited in CNA, 2003). Corley et al. argued that it is one of the leading causes of nurses resigning from their nursing positions, if not totally giving up on the idea of doing what they vowed to do (as cited in CNA, 2003). In which case, nurses would have to look for another career, unless they want to spend the rest of their lives unemployed. In addition, doing so would contradict the Nightingale pledge: “endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care” (American Nurses Association, 2012). Many people would agree that awareness is the first step to solving a problem. It is like a key that opens a door to a new path. Sundin-Huard and Fahy (1999) stated that putting a name to how nurses feel when in moral distress may help a lot because (as cited in CNA, 2003) these health care providers will be using positive strategies to cope with the situation, as opposed to maladaptive coping such as self-blame, or indulgence to drugs and/or alcohol to somewhat “escape” from the situation. For this reason, listed are other common moral experiences (CNA, 2003): A. Ethical Uncertainty. It is where a nurse feels undecided or confused with a feeling of uneasiness and anxiety about the situation. In addition, he or she does not even know what exactly the moral problem is. B. Moral Questions. When there are two plausible speculations for and at the same time many other courses of action to take and preferring one action over the other means letting the option go. In short, it is deciding what the best course of action to take is. C. Moral Residue. It is when a particular action has been done, and that the “residue” is merely a reflection of the medical intervention. It is a live and learned experience where nurses can think of ways, as a result of the reflection, to do it better in the future. D. Moral Disengagement. This occurs when, for some reason, a nurse is starting to lose the “human touch” and ends up being hostile to their patients and other health care professionals. E. Moral Violations. This directly goes against the moral agency of providing care to the people who needed it most (i.e. negligence of duty or failure to give the prescribed drug at the right time). F. Moral Courage. In this situation, a nurse holds his or her ground about his stand concerning the ethical practice, and at the same time, faced with fear to himself or herself (CNA, 2003). As shown above, different scenarios have different names, and once identified, awareness can easily follow naturally; however, it is not enough to simply acknowledge that a nurse is in the throes of ethical distress. As part of the ethical practice, a nurse should look out for another nurse’s best interest and should bring it up to their attention if a distress seems likely. Storch et al. emphasized that “Talking with other nurses about ethical practice concerns can be a powerful strategy” (as cited in CNA, 2003). The next rational thing to do after being aware is to ask for support from colleagues or create a support group where open discussion is encouraged without biased opinions. The support group can also be the health care team. Last but not the least, one may bring whatever burden they have during the ethical practice to the ethics committee because this would, in turn, help one to develop a clear perception about his or her obligations as a nurse, especially if there is an ethical problem, and he or she is in conflict with himself or herself (CNA, 2003). Conclusion Nursing is a vocation which needs not only dedication and commitment, but also a willingness to do good based on ethical practice. The examples or scenarios aforementioned entail that awareness is the key to ensure that the ethical practice will remain unthreatened in the long run. There will always be conflicts arising from time to time, but for as long as the people involved are aware and specific actions are taken (i.e., getting help from a support group), then the impact will be lesser, and the moral integrity would likely to remain intact than otherwise and will ensure a harmonious interaction with oneself as a nurse and the people around him or her. References American Association of Critical-Care Nurses. (2012). About critical care nursing. Retrieved from http://www.aacn.org/wd/pressroom/content/aboutcriticalcarenursing.pcms?menu= American Nurses Association. (2012). Florence nightingale pledge. Retrieved from http://nursingworld.org/FunctionalMenuCategories/AboutANA/ WhereWeComeFrom/FlorenceNightingalePledge.aspx Aveyard, H. (2004). The patient who refuses nursing care. Journal of Medical Ethics, 30(4), 346-350. Canadian Nurses Association. (2003). Ethics in practice for registered nurses (1480-9990). Ottawa, ON: Regulatory Policy Division of CNA. Canadian Nurses Association. (2008). Code of ethics. Ottawa, ON: CNA. Chambers, C., & Ryder, E. (2009). Compassion and caring in nursing. Oxon, UK: Radcliffe Publishing Ltd. McFerran, B., Aquino, K., & Duffy, M. (2010). How personality and moral identity relate to individual’s ethical ideology. Business ethics quarterly, 20(1), 35-56. Pantilat, S. (2008). Ethics fast fact: Autonomy vs. beneficence. Retrieved from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_auton_bene.htm UKCEN Clinical Ethics Network. (n.d.). Case study 2: A competent patient refuses treatment. Retrieved from http://www.ukcen.net/index.php/main/case_studies/ a_competent_patient_refuses_treatment Read More