Professional Values Ethics and Law for Child Nursing - Essay Example

Professional Values, Ethics and Law for Child Nursing Introduction The research objective is to outline the distinctive dilemma in upholding ethics when considering professional values and common law by nurses during child care. To assess the dangers and benefits of adhering to professional values and laws. The subordinate objective includes evaluating the key policies that could be amended in the health care system to improve service delivery. The research case study will be in regards to the fictitious case of a surgical liaison nurse by the name Christine Jones caught in the dilemma of undertaking what is ethically right for both her patient and her family against the stringent rules of the operating room. The paper seeks to evaluate the dangers and benefits of ethical theories in relation to the case study. The professional ethical theories include Deontology, Rights, Utilitarianism, Casuist, Virtue, Teleology and Care Ethics. The research further seeks to outline the effects of nursing principles towards professional accountability and responsibility. The principles include Justice, Paternalism, Least Harm and Fidelity. In addition, the research seeks to investigate how the Law affects health care practice through code of conduct relevant to the case study. The case study involve a dying baby who had undergone an unsuccessful heart operation and was placed at the heart lung machine where her parents had pleaded with the liaison nurse to allow them be with their baby in the OR, before she died. According to the rules of the Operating System no visitation was allowed in the area only the authorized practitioners. The nurse went ahead to enforce the hospital’s regulations where she highlighted that the parents could only view the baby after she had died and her chest stitched back up. The baby died the same day without the parent’s presence where they returned the next morning to view the body. The nurse was disturbed from the experience and from the sorrowful mood of the parent’s, where she decided to visit the hospital’s Director of ethics for consultation on the issue. Ethical Theories and Laws Applying To the Case Utilitarianism According to Humber (2013), the medical nurse had the intuition of predicting the outcome of the baby’s condition and the consequence of her action. The theory stipulates that Angela had the choice of making an ethical decision that yielded the greatest beneficial outcome. A dying child greatly affects the parent’s emotions. The nurse practitioner had the ethical duty to empathize with the parent’s who would never had the chance to see their child alive again. Among the benefit of the theory is that it can predict similar solutions and employ a point-system to evaluate the most beneficial outcome for both people (Humber, 2013). The point-system employs rational and logical arguments for the decision which enable people to execute similar contexts. In nursing, patients and guardians usually have different needs whereby the practitioners need different and sometimes overlapping competences and skills to meet their demands. Humber (2013) comments that this can be achieved through partnership or by using the codes of conduct which in return constitute professionalism. Humber (2013) adds any proclaimed competency by the health professionals should be instituted within the acceptable ethical and legal framework. The Nursing and Midwifery Council (NMC) basic responsibility is protection of the public as health consumers. Angela had the moral duty to allow the baby’s parent’s to view the child since it falls under NMC jurisdiction of caring for the public’s interest (Humber, 2013). Humber (2013) adds Utilitarianism has two forms: Rule and Act Utilitarianism. Act Utilitarianism provides that medical practitioners’ acts should have the greatest benefit to the people regardless of the Laws present or their personal feelings. Rule Utilitarianism consolidates Law where it commands fairness. Rule Utilitarianism requires practitioners to offer the fairest decisions with regards to the available Health Care Laws. Deontology Johnstone (2008) contradicts that medical practitioners should stick to their duties and obligations when facing ethical dilemmas. The theory confirms that nurses should uphold their obligations during their practice because it is simply ethically correct to do so. Johnstone (2008) outlines Angela had the duty of restricting baby’s parents to the OR because it was in line with her code of conduct. According to NMC (2010b) nurses have the sole responsibility of acting professionally within the health facility so as to enhance professional responsibility and accountability. The code’s objective is to cultivate self discipline among the nurses so as to initiate professional standards of behavior. Based on NMC codes of practice, Angela’s decision was ethical beyond reasonable doubt in promoting professionalism within its docket (NMC, 2010). Johnstone (2008) explains that through the liaison nurse strict decision the health practitioner will develop consistent decisions throughout her obligations. The theory holds that special people like the nurses have special responsibilities to certain people. Through the prohibition of the parent’s entry, the nurse was minding the baby’s welfare whereby her parents might be tempted to touch the child or negligently any part of the life support machine leading to drastic effects. Johnstone (2008) adds the effect could have shortened the baby’s lifespan which could also have compromised her career. The theory further terms some people as ‘supererogation’ that is, people who exclude their personal feelings when undertaking sensitive decisions under pressure. Angela acted like a supererogation due to the affirmative stand she took when handling the emotional and sensitive issue in her line of work. She took an oath as a registered nurse to uphold ethical and professional standards when handling her duties, which could have contradicted her principles in case she relented on the parent’s demands (Johnstone, 2008). Human beings are social creatures who portray emotions when confronted with different scenarios, which the practitioner avoided for the best interest of baby, the parent and hospital’s outcome. Rights Theory The rights theory explains that the society’s rights should be considered the first priority during the practitioners practice. The rights are ethically valid and correct because it is largely endorsed by the population’s ruling. The theory holds that Angela had the responsibility of allowing the baby’s parent’s into the OR because majority of the population believe the parents had the right to be with their dying daughter (Kim & Kollak, 2006). Under the Children Act 1989 the nurse has the obligation of helping the child’s family(s) during their most vulnerable moments. From the Act of Parliament the nurse was obligated to assist the desperate parents who only wanted to share the last moments with their dying daughter. The Law recognizes that parents have close affection with their loved ones and can suffer emotionally and physiologically due to their ones conditions. Kim & Kollak (2006) explain Children Act 1989 provides that a health practitioner should undertake every necessary action in ensuring the satisfaction of the guardians needs. Therefore, bearing the emotional distress of the baby’s parents, Angela ought to have given the parents their right to be with their dying child. Angela could not have hesitated in deciding whether to allow the parents or not because under the Children Act of 1989, she had been bestowed the right to undertake crucial decisions at her disposal in times of need (Perry, Hockenberry, Lowdermilk & Wilson, 2014). Angela could have used Evidence Based Practice (ERP) to support her case against her situation. The ERP provides that medical practitioners ought to have undertaken the right decision so as to ensure best practice. Under the NMC code of conduct, the code provides that a health practitioner should act lawfully at any given time irrespective of whether the laws affect their personal or professional practice. The Rights theory holds that for the decision of the health practitioner should marry with another ethical theory in this case Utilitarianism, in order to describe the society’s goals (Carvalho, Reeves & Orford, 2011). Casuist Theory Carvalho, Reeves & Orford (2011) outline that the theory explains that the present ethical dilemma faced by the health provider should be compared with similar scenarios and their subsequent solutions. The theory outlines that the practitioners should analyze the situation’s severity and present the best solution based on the experiences of others. According to a case of an aggressive end stage prostate cancer patient in Brisbane, QLD, Australia, the patient had revealed to a certain nurse the possibilities of committing suicide and further told her to keep it a secret(Carvalho, Reeves & Orford, 2011). After evaluation of their country’s code of conduct, moral decision, ethical theories and principles; the nurse decided to revel the situation to the other health providers where they later intervened by providing self-harm and suicide protocol to cease the issue. Based on the illustrated intervention, Angela should have overstepped her professional ethical standards and allowed the parents to the OR since it was best solution in the case. Based on the EBP 2008 Angela could have defended her decision by basing on the aforementioned case to support the move. NMS codes of conduct 2008 allow for lawful decisions to be undertaken by practitioners at all times. At this particular situation, Angela could have done the rightful decision in order to avoid self guiltiness in future. After the experience, Angela approached the hospital’s Director for Ethics for consultations on the matter (Carvalho, Reeves & Orford, 2011). Based on the Nursing and Midwifery Order 2001, the NMC was mandated to ensure education of all nurses against ethical and professional issues. The hospital’s management failed to institute the program timely, which could have resolved the issue at its convenient moment. However, according to ERP Angela is also to blame since she could initially have taken an incentive to familiarize herself with the current research or information pertaining ethical issues. Virtue Theory The theory holds that health providers should be judged by their character rather than by their action. The nurse having not rendered the parents their moral right of viewing their end stage child should have been evaluated by her personality rather than by her action. The child’s parents were evidently shocked and agitated by the nurse decision which they obviously left with a bad perception about her. The nurse could naturally have been strict or scared about bending her principles which could have contributed to her action. The National Health Service Act 1997 permits the health practitioner to make life saving interventions according to situation’s best interest. In case the practitioner upholds kindness, honesty and integrity during her routine practice, her characteristics form the basis of her actions. In case Angela is of good character, her virtues will highly be considered as part of her action. Angela could have used her virtues to prohibit the baby’s parents into the OR due to her natural personality. She could have felt for the parent’s, but her natural instincts could not have allowed her. Angela could further have enforced her stand in order to prevent mistakes that could occurred in case something went astray. Teleology Theory Teleogical theory states that the moral actions of the health providers are based on the consequences or outcome of the medical situation. The theory elaborates that any rightful decision of the practitioners is premeditated on the outcome of the result. Angela’s decision can be marked as morally wrong due to lack of premeditated consequence of her action. Her strict decision led to the solemn state of the parents due to lack of last respects to their child. The parents also treasured the last moments of their child which never materialized. According to the Nursing code of ethics, the health providers are required to use their personal judgment while following the professional values, in order to realize moral consequences. The General Medical Council (GMC) usually has the responsibility to protect the public’s interest as well as monitoring of the health providers conduct. In this case, Angela could have avoided giving the permission due to fear of disciplinary action or deregistration. The consequence of Angela’s action was unfavorable which indicates that the decision was morally wrong. The decision could have been morally right if the consequence of her action had positive impact on the parents. Based on Human Rights Act (1998) every person is subjected to family and private life. Based on the case study, the parents were denied their right to view their dying child at most crucial time. From Angela’s decision the hospital was to minimal consequence as compared to actual consequence faced by baby’s parents. Ethics of Care (Eoc) The theory holds that medical practitioners should make decisions in response to what is importance. The theory supports Teleology theory which holds that health providers’ actions or decisions can either be morally wrong or right based on their response value. The theory provides that people have varying measures in terms of dependence of interdependence towards one another. The baby’s parents had a high interdependence value towards their daughter whom they dearly wanted to spend their last moments with. Under the Nursing code of conduct, the nurse had the right to seek guidance in dealing with the dilemma (Evans & Tippins, 2008). Consultation could have yielded better decision based on the situation’s sensitivity. The hospital could also have been sued under Vicarious Liability Act, in case the parents pressed charges due to the actions of its staff. The Vicarious Liability Act provides that the health providers should act diligently and responsibly in every situation. The liaison nurse should have effectively assessed the intensity of the situation before provision of her decision (Evans & Tippins, 2008). Ethical Principles and Laws Relating To the Case Study Fidelity Principle Based on the NMC principles, the virtue should be a symbol of care among the health providers which encompasses fairness, advocacy, loyalty and dedication. Based on the case study, the care giver employed loyalty towards her codes of conduct. Angela avoided personal feelings towards her situation in order to provide accountability and professionalism towards her superiors. Reading & Webster (2014) adds the principle stipulates that all health care providers should encompass integrity in all their duties so as to promote NMC codes of practice. Angela was able to keep one of the NMC themes which stipulated professionalism and trust. Under the theme, Angela is required to undertake duties in reference to the desired NMC values. According to Reading & Webster (2014) the nurse also instituted NMC’s safety preservation theme which defines nursing regulations in reference to their work. Angelina maintained the codes of practice which prevented other unforeseeable issues that could have occurred were it not for perseverance. Based on the NMC code structure, quality of practice is uncompromised by any care giver. However, the NMC code themes the nurse relatively failed to prioritize. The child was on the verge of dying but yet her parents were alive. The nurse prioritized the child too much excluding the welfare of her parents. The parents wanted to have a fresh memory of the child while alive which they got (Dogra & Leighton, 2009). Despite Angela being a professional she failed to balance the interests of everyone. Dogra & Leighton (2009) the NMC code theme also outlines that health providers need to undertake their services effectively. The nurse only implemented the hospitals regulations without consideration of the moral concerns issues. The outcome could have been effective if the nurse considered the society’s interests too. Human Rights Act allows the citizens to undertake public authorities accountable in case they failed to uphold their private rights. Least Harm Brykczynnska & Simons (2011) confirms under the principle the practitioner needs undertake actions that have limited harm to the people. Under the concept the health practitioner should perform actions that have limited benefits. Angela decided to protect the baby by ensuring limited disturbance and interference at her life support machine. Due to her parent’s emotions, the parents knowingly or unknowingly could have done a mistake which could have turned regrettable. The health provider’s career was also on the line in case she could have granted the permission. The National Health Service Act 1946 outlines that all health care providers should undertake absolute measure to prevent cases of negligence based under the Vicarious Liability Act. Paternalism The principle involve where the nurse makes or performs decisions based on their personal opinion. The nurse can also infer herself some authority in order to regulate or self regulate decisions. According to the case study the nurse acted on behalf of the patient in restricting the family’s visitation. The nurse had the duty to consult with relevant authority so as to enhance effective decisions and moral practice. Based on the Mental Health Act 1983 the health provider can only undertake such decisions if the child is underage, has parents of unsound mind or both guardians are not present (Brykczynnska & Simons, 2011). Justice The principle highlights that practitioners should employ ethical theories that have fair outcomes to these concerned. The practitioners decisions be in line with the ethical theories unless under different circumstances. Angela had the moral obligation of using past or similar situations in order to evaluate on the best decision concerning the issue. Cases which had inconsistent unfolding could have been avoided so as to use relevant and reliable solutions. Angela’s dependence on her own decisions yielded biased outcomes which affected the baby’s parent’s emotions. Justice was absent due to lack of logical basis to support her decision (Perry, Hockenberry, Lowdermilk & Wilson, 2014). The baby was dying and little effort could be done to save the situation. The nurse avoided the child parent’s contact due to dangers of negligence. Analysis The Nursing and Midwifery Council needs to enforce strict rules on the education of nurses regarding ethical issues in order to prevent future cases of unfavorable decisions. The ethical dilemmas could produce wrongful decisions leading to healthcare deterioration. The service delivery provides a fundamental role in healthcare provision which could affect the sector’s reputation (Perry, Hockenberry, Lowdermilk & Wilson, 2014). The safety rules regarding visitation of children in the OR pertaining to critical conditions need to be evaluated to avoid traumazation among the loved ones. The visitation will be essential as it provides psychological development among the involved people and comfort. The family presence during the end stage period also promotes bondage among the members which is highly effective during psychological and physiological healing (GOSHSC, 2006). Conclusion The study included evaluation of ethical theories including Deontology, Virtue, Rights, Casuist, Care ethics and Teleology which illustrates the benefits and dangers of implementing ethical dilemma issues. The study further instituted nursing principles in relation to the case study and how they affect practitioners’ implementation. Reference list Humber, J. M., & Almeder, R. F. (1979). Biomedical Ethics And The Law. New York: Plenum Press. Johnstone, M. J. (2009). Bioethics A Nursing Perspective. Sydney, N.S.W., Churchill Livingstone/Elsevier Kim, H. S., & Kollak, I. (2006). Nursing Theories Conceptual & Philosophical Foundations. New York, Ny, Springer Pub. Co Carvalho, S., Reeves, M., & Orford, J. (2011). Fundamental Aspects Of Legal, Ethical And Professional Issues In Nursing. London, Quay Books Evans, C. D., & Tippins, E. (2008). Foundations Of Nursing An Integrated Approach. London, Mcgraw-Hill Higher Education Dogra, N., & Leighton, S. (2009). Nursing In Child And Adolescent Mental Health. Maidenhead, England, Mcgraw Hill/Open University Press. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal Child Nursing Care. Great Ormond Street Hospital For Sick Children (London). (2006). Great Ormond Street Manual Of Clinical Nursing Practices. Oxford, Blackwell. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal Child Nursing Care. Brykczynnska, G. M., & Simons, J. (2011). Ethical And Philosophical Aspects Of Nursing Children And Young People. Chichester, West Sussex, Uk, John Wiley & Sons. Reading, S., & Webster, B. (2014). Achieving Competencies For Nursing Practice A Handbook For Student Nurses. England, Open University Press. Read More