Thinking Made Easy

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There is much to be concerned with especially when presented with such a case. As a nurse, my first concern will, of course, be the medical one especially since my training has helped strengthen my belief that only when one is healthy and sound both in body and mind will there be advancements in other aspects.

            However, in the case of the Rodriguez family, who have been my friends for some time now, several problems have come at once and, based on their background, their physical health is not the only problem that they are currently facing. From my analysis, one of the biggest problems is the sociological background of our town as well as the limited knowledge of the citizens concerning their rights. It is assumed that the Rodriguez family is not the only family that is facing these problems, but also many of the families and people in our town. Thus, the first step that must be taken should be to educate everyone concerning their rights and benefits and how they will be able to achieve these.

            First of all, one of the problems that should be addressed is the hiring and promotion of people despite having lack of education. Based on an article by Brand (2003), lack of education can be one of the factors for the continuation of lack of promotions. Although the article did not give specific ways on how this problem will be addressed, one of the things that the workers, including Jamaal, can do is to ask their supervisor if their lack of education is the reason for their being held back. If it is, they should request that fair judgment based on their labor be their background. Through this, the workers may possibly be able to gain equal status with their other co-workers despite their education problem.

            Because of the continued problems with their work, one of the community projects that may be done is a seminar for people in the town concerning their rights that are placed under the Department of Labor. The Department of Labor, especially those who are in the Office of Disability Employment Policy and those who belong to the Fair Pay Department be able to give the people in the community some tips and some updates concerning the laws in which they fall under. Joyce may be able to find other work that will enable her to work at home and something that is not stressful for her. She may be able to obtain help from the Department of Labor or even through asking around from her friends. With this, any concerning labor problems and hindrances may be addressed in the seminars, as well as their knowledge concerning their rights will be increased.

            When it comes to the school, there may be some other way for the school to continue. Fundraisers may be organized in order to help the school gain some money. At the same time, the community may recruit the help of the Department of Labor, especially the section concerning Elementary and Secondary Education. Once it is made clear that the community cannot afford to lose the school and that having it will be beneficial to the community children more than if it is closed, then there is the possibility that the school will be granted some time before it will be closed, in time for the community to gather together and organize fundraisers and recruit the help of other divisions of the Department of Education.

 

WHY IS IT NECESSARY TO NOT ONLY ACT ETHICALLY IN THE PRACTICE OF NURSING BUT TO BE SEEN TO BE ACTING ETHICALLY?

Why is it necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically?

 

Introduction

            The application of ethics in the field of medicine has significantly broadened in the past few years. This is brought about by a number of factors like the advancement in medicine which is driven about by technology. Although there is nothing wrong with this, this has posed serious threats to the practice of medicine. This does not mean that in the past the medical and health care communities have been slack in their practice of ethical behavior but rather the changes have made significant ethical implications in the field of medicine and the delivery of health care.

The practice of nursing, being in the front line of medical care, has also been subject to many ethical issues.          In their daily work, nurses deal with intimate and fundamental human events such as birth, death, and suffering. They must decide the morality of their own actions own actions when they face the many ethical issues that surround such sensitive areas.

For this particular paper, the question as to why it is necessary to not only act ethically in the practice of nursing but to be seen to be acting ethically will be answered. This paper will use the author’s own perception on the matter as well as literature derived from other sources. The paper will start off with an explanation of ethics and its application in the field of medicine and health care, with emphasis on the field of nursing. Furthermore, other aspects of ethics will also be discussed so as to help provide a better understanding of the whole concept of doing what is ethically right and the importance of being seen while doing what is ethically right.

 

Overview of Ethics

            Ethics is the study of good conduct, character, and motives. It is concerned with determining what is good or valuable for all people. Ethics is the exploration of what kind of person one "should" be or how one "should" act. A well-recognized premise of such exploration is that "ought implies can." In other words, in saying that someone ought to do X or that X is the ethical thing for him to do, we are assuming that it is actually possible for him to do X. There is no moral obligation to do the impossible. It does not help us in acting ethically to consider whether we have a moral obligation to do something that, quite simply, we cannot do. This is true in health care as it is in other areas of our lives (, 2005).

 

Philosophical Constructions of Ethics

            Discussions about health issues have progressed over time, just as developments in health care and society itself have progressed. The philosophical constructions that shape the discussions also have changed. Ethics began as a standard reference point for the determination of right action. It has now grown into a field of study that is filled with differences in opinion, competing systems of values, and deeply meaningful efforts to understand human interaction with new technologies.

 

Ethics in the Nursing Profession

Medical ethics, a branch of the philosophy of ethics, deals with moral decisions in medicine. The branch of nursing ethics could be considered under the umbrella of medical ethics. The moral foundation of the nursing profession is based on the perspectives of Florence Nightingale, who described nursing as a self-defining moral practice focused on caring. This moral foundation evolves from the nurse-patient relationship. Morality in nursing practice arises from the idea that it is morally good to promote the physical and psychological well-being of patients. Nurses, however, may find it difficult to prioritize these moral nursing values over their personal values (, 2002).

In the nursing profession, acts that are ethical often reflect a commitment to standards which are beyond an individual’s personal preferences – standards on which individuals, professions, and societies agree ( & , 2004). Ethics has become an important way of life in a post-modern society that does not acknowledge any fixed points of reference.

Nursing is essentially a work of intimacy. The tasks of nursing require the nurse to be in close contact with clients, physically and emotionally. This kind of contact is usually not acceptable in public relationships. As a result, the work of nursing involves the negotiation of values whether those values be of the client, the physician, the employer, or other concerned groups.

Maintaining their own moral integrity is central to nurses' moral experience. Studies have documented that nurses sometimes feel they are forced to betray their own values. Their position in organizations, a lack of involvement in the decision-making process, and lack of authority seem to contribute to the experience of powerlessness in situations of moral difficulty (, 2005).

Discussion and resolution of ethical issues requires critical thinking skills. Unlike the resolution of clinical problems, however, the resolution of ethical issues involves the negotiation of closely held personal values and philosophies, not facts or measurable clinical data. Resolution of ethical issues incorporates not only the nurse’s personal values but also the interpretation of the client’s personal values, based on the unique perspective of nurses ( & , 2004). Ethics guided by one’s own moral values is very important since an ability to make good decisions about one's health care promotes healthy behaviors across the lifespan (, 2000).

 

Origins of Ethical Problems in Nursing

            Nurses’ growing awareness of ethical problems has occurred largely because of (a) social and technological changes and (b) nurses’ conflicting loyalties and obligations.

 

A. Social and Technological Changes

            Social changes, such as the women’s movement and a growing consumerism, also expose problems. The large number of people without health insurance, the high cost of health care, and workplace redesign under managed care all raise issues and fairness of allocation of resources.

            Technology creates new issues that did not exist in earlier times. Before monitors, respirators, and parenteral feedings, there was no question as to whether to “allow” an 800-gram infant to die. Before organ transplantation, death did not require a legal definition that might still permit viable tissues to be removed and given to other living persons. Advances in the ability to decode and control the growth of tissues through gene manipulation present new potential ethical dilemmas related to cloning organisms and altering the course of hereditary diseases and biological characteristics. In line with all these, many questions arise.

 

B. Conflicting loyalties and obligations

Because of their unique position in the health care system, nurses experience conflicts among their loyalties and obligations to clients, families, physicians, employing institutions, and licensing bodies. Client needs may conflict with institutional policies, physician preferences, needs of the client’s family, or even laws of the state. According to the nursing code of ethics, the nurse’s first loyalty is to the client. However, it is not always easy to determine which action best serves the client’s needs.

 

Nursing Point of View

            Professional nurses play a vital role in the management of health care in both outpatient and inpatient settings. All clients interact with a nurse at some point in the health care system.

            When ethical situations arise, the nurse’s point of view is unique and critical. The nurse usually interacts with clients over longer time intervals than do other health care professionals. Because nurses may be involved in intimate physical acts such as bathing, feeding, and special procedures, clients and families reveal information generally not shared with physicians and others. Details about family life, information about coping styles, personal preferences, and details about fears and insecurities are likely to come out during nursing interventions (, 1997).

            On the other hand, it is important for nurses to remember that care of any one client has become multidisciplinary and often fragmented. The nursing point of view is part of a larger picture that is best built by all members of the health care team, including the client and family. When involved with ethical decisions, the nurse must also seek the opinion of other health care professionals.

            Nurses who face ethical dilemmas in their practice often find their voices and point of views are not heard when it comes to collaborative decision making on the issue. Factors such as conflict within the medical team and the existence of hierarchical structures can mean the nurse at the coal face is not consulted. This is a fact in medical and health care systems and should be given solutions by their respective governing bodies.

 

Nursing Code of Ethics

In professional practices such as nursing, a code of ethics provides guidelines for safe and compassionate care. Nurse’s commitment to a code of ethics guarantees the public that nurses adhere to professional practice standards set for their profession.

 

Nursing Errors, Ethics, and the Law

            The ethical issues associated with nursing practice are closely tied-in to legal issues. Ethics, in a way, dictates what ought to be done and what ought not to be done. As a result of many nursing practices that failed to consider ethical considerations, some nurse and even other health care professionals face malpractice suits. However, it is important to point out that not all malpractice issues are a result of unethical behaviors.

Nursing errors are a part of the nursing profession. Most often these are not deliberately done by the nurse. However, one just cannot expect the client or the family of the client to just let errors pass, especially if this significantly affects the client. When a nurse commits errors, most often this is subject to ethical considerations and the nurse will have to face legal consequences.

One common error made by nurses is medication administration. Such an error will result in the nurse feeling vulnerable and upset. Not only are they concerned about how the mistake will affect the patient, they also worry about the implications on their careers if they are disciplined. By admitting to the mistake, they may be ridiculed by other nurses or even worse, lose the trust of their patients. The outcome of this distress is that often the nurse will hide the truth when the patient seems to be unaffected. Many ethical questions arise in these instances: Should the nurse tell the truth and disclose the error? Will telling the patient, cause more harm than good? If the patient isn't ton and they find out later, will the outcome be an erosion of trust? (, 2005).

            Hidden mistakes also occur in the nursing profession. This means that problems with procedures are not recognized. This eventually has an impact on the quality of care delivered to our patients. Nurses need to be supported and encouraged by management when they disclose an error. They are then in a position to learn from their mistakes and can hopefully help to identify ways in which a similar event can be avoided. This process can help to alleviate feelings of guilt associated with the event.

            Surprisingly, the issue of truth telling in the health care setting is a relatively modern concept. In the past, it was considered preferable to keep unpleasant information concerning diagnosis and the progression of a disease from the patient, under the guise of protecting them from unnecessary distress. It was the health professional's responsibility to decide whether the patient should or should not know the truth. At times, the family would insist that their loved-one should not be told of their prognosis. The patient had no autonomy at all. Modern legislation, however, recognizes the tights of a person to be given true and accurate information about their illness and treatment (, 2005).

            Nurses must accept responsibility for nursing actions to safeguard the privacy rights of patients by carefully protecting confidential information. The patient's confidence that information given to the nurse will remain private is an important element in the nurse-patient relationship. Without this assurance, the patient might be unwilling to divulge information critical to his or her care (, 2002).

            The average nurse still appears to believe that accountability is all about following procedure and making sure that 'one is covered' by having the right kind of note or record or witness to refer to when something goes wrong or when, for whatever reason, an accusation is made (, 1994).

Fighting hospital policy and the fear of lawsuits can influence whether the nurse eventually acts by moral choice. This situation can be frustrating and may lead to considerable distress. A nurse who is not able to find resolution to an ethical dilemma, and then act in a way in which she feels morally comfortable, may experience anxiety, feelings of guilt and possibly burnout. It is therefore very important that our leaders and managers include in their nursing education and hospital in-service sessions, teaching that will prepare today's nurses for the complex ethical issues they will encounter (, 2005).

To defend against a malpractice lawsuit, the nurse must prove that one or more of the required elements is not met ( & , 2004). From this statement alone, one could see that what could practically save a nurse from a malpractice lawsuit is a proof. And what better proof could be provided than a witness that would claim that the nurse did not breach any ethical or moral limits.

 

The Importance of Being Seen Acting Ethically

            To do something ethically in the presence of another person could be a good evidence in case a malpractice suit or ethical complaints are being raised against the nurse. When someone is present while a nurse performs an intervention or procedure, this would minimize and even eliminate questions and doubts as to whether the interventions have been properly performed or not.

            The presence of a non-participant observer does threaten a loss of privacy or dignity for the patient concerned. It may also result in such a loss for any other patients who may not themselves be involved in the study but who can be seen or heard by the observer (, 1994).

           

Application of the Importance of Being Seen Acting Ethically in the Nursing Profession

Let us consider 2 scenarios wherein the aspect of being seen while doing a nursing practice ethically is of paramount importance:

 

Scenario 1:

            In this scenario, a case of autonomy in ethics is the issue. Autonomy refers to a person’s independence, in this case the client’s independence. As a standard in ethics, autonomy represents an agreement to respect another’s right to determine a course of action. Based on this standard in ethics, the health care professionals should respect the client’s decision as to what should be the next course of action. When a client wants to leave the hospital after a health care procedure, the client should be allowed to do so providing the client is capable of making sound decisions for him- or herself. The health care team has no right to detain a client and impose their decisions on him or her since in the first place the client is not found to be mentally incapacitated.

Respect for another’s autonomy is fundamental to the practice of health care. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. The decision to be discharged from the hospital may be at the hands of health care professionals but the client also has the right to voice out his or her opinions which should be respected by the health care professionals.

            The agreement to respect autonomy involves the recognition that clients are in charge of their own destiny in matters of health and illness. Let us take for example the consent process required prior to surgery, this implies that a client may refuse treatment. In most cases the health care team must agree to follow the client’s wishes. Health care professionals agree to abide by a standard of respect for the client’s autonomy.

            In a case where the client manifests autonomy, such as the one where he or she refuses any treatment, someone else should be present in the scenario other than the nurse. The client may refuse treatment but the family of the client may cry foul if anything happens to the client. The family of the client could file a malpractice suit against the nurse or other health care professionals if they have no proof that it is the client’s wish not to be treated and thus would apply to be a client’s exercise of autonomy which is within the bounds of ethical nursing practices.

Since the profession simultaneously expects nurses to ensure autonomy and maintain safety, nursing needs to gather evidence that less restrictive alternatives can maintain safety for their clients and for their own. Rather than encourage changing the procedural laws, nursing needs to ensure that nurses implement involuntary procedures in a manner that protects client safety and clients’ rights.

This is more prominent in situations that concern psychiatric patients. Experienced psychiatric nurses need to articulate more definitive ways to determine risk vs. benefit for ethical decision making in the daily care of psychiatric patients. Nursing education thus must reflect the real situations that psychiatric nurses face and insist that student nurses actually commit to making some choices when faced with a situation (, 2000).

Nurses have little guidance in determining ethical choices in situations such as this where involuntary procedures may be required. Nursing choices are constrained by law and hospital policy, but there are tremendous gray areas where the rules are unclear (, 2000).

The nurse has of course a moral duty to prevent anything bad from happening to the client. However, if the client does not appear to be mentally ill, he or she should be given the freedom and right to decide regarding her treatment. If the client decides to go home, then he or she should be allowed to go home since in the first place he or she does not appear to be mentally ill and could make sound decisions and judgments. Unless the client is proven to be unable to make sound decisions and judgments, then the health care professionals and the family of the client could decide for the health care of the client. Whatever the decision may be, or whoever may decide for the client, a witness should be around in case issues of unethical practice are raised against the nurse.

 

Scenario 2:

            In another scenario, let us consider the case of a nurse who is in charge of the care of a terminally ill man. In the physician’s orders, the man is not to have any liquid taken orally. The nurse is aware of this order yet the nurse did not follow this and instead gave the man a few sips of water to drink.

The nurse in this scenario did not behave ethically. This could be discussed through the aspect of medical ethics which is beneficence. This refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. Commitment to beneficence helps to guide difficult decisions wherein the benefits of a treatment may be challenged by risks to the client’s well-being or dignity.

            In the scenario, the nurse probably went against the doctor’s orders because she felt pity for the client. Given the fact that the client is terminally ill, the nurse could have felt that it was a little selfish and harsh for the doctor not to give the client anything to eat or even drink. Or the nurse could have thought that she owe it to the client to give him something to drink since he is dying anyway and the nurse just wants to grant a dying man’s wish. Thus, the nurse went against the doctor’s orders and gave the terminally ill man small sips of water. Although the nurse did this with good intentions in her mind, it is possible that it could have a bad effect on the client, and thus the nurse still did not behave ethically.

            The nurse should have thought that the doctor’s orders may cause discomfort to the client, but the benefits, both for the individual and the society, outweigh the temporary discomfort. If the nurse has doubts of the doctor’s orders, she could have simply asked the doctor about it and why it should be done. The nurse should not act on her own without asking for advice, especially since this is a case wherein orders from a higher authority is given. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest.

            The nurse must remember that whatever she did on the client, she is accountable and responsible for. If what she did could harm the client, she could be blamed for it, and worse, she could be sued for malpractice. Depriving a client of something to eat and drink could sound harsh, but there are rationales for such actions. In ethics, such is done for the benefit for the client. No matter how terminally ill a client is, health care professionals must abide by what should be done clinically within the bounds of their established code of ethics.

            Suppose the client died just five hours after the nurse gave the man sips of water, the nurse would likely be partly one to be blamed for the incidence if someone else knew what she has done. If there was no one to witness, then it will be in the conscience of the nurse that if perhaps she followed the physician’s orders the client would still have been alive.

            If it was another scenario still where the nurse followed the physician’s orders with witnesses around and still the man died after a few hours, then it is unlikely that the nurse will be blamed for the man’s death. Granting that the nurse only followed the orders of the physician and there were other people around to witness that the nurse indeed behaved ethically, then the nurse does not have to bear any ethical question regarding what she did.

            This situation given here occurs when a nurse disagrees with the treatment decisions made by the attending physician but which she nonetheless is required to follow. In some cases, the nurse may recognize that the orders are mistaken or violate the accepted standard of care. Under the ethical codes of both the nursing and medical professions, a nurse has no duty to carry out such orders (, 2005). However, the nurse cannot act only on her own. She has to talk over with the physician or other concerned health care professional if she deemed the orders unethical or wrong.

 

Conclusion

            In the past, nurses looked on ethical decision making as solely the physician’s responsibility. However, one should consider that no one profession is responsible for ethical decisions, nor does expertise in one discipline such as medicine or nursing necessarily make a person or expert in ethics. The ethical decision thus cannot be left only to the hands of the physicians. And thus it goes also to say that one cannot say that a nurse is an expert in the field of nursing ethics just because he or she is a nurse. Additionally, the advent of technology coupled with numerous other factors has significantly changed ethical concerns and behaviors. This has brought about many issues regarding the conduct of ethical behavior.

The practice of doing what is ethical is not sufficient alone in the contemporary times. There is increasing importance given to the fact that one also needs to be seen when doing what is ethical behavior or practice. This is very important especially with the advent of medical malpractice lawsuits. A witness to a nurse doing what is ethical may save not only a nurse’s profession but also the nurse’s whole life. Perhaps, as the old adage says,  to see is to believe. To be able to see that the nurse does what is right and ethical would perhaps be a lifesaving factor for the nurse from anything that can harm him or her and the nursing profession in general. Being seen doing what is ethically right could not only boost the morale of the nursing profession but also serves to protect nurses against unreasonable complaints from their clients.

 

 

 

 

 

 

 

REFERENCES

Ethics Component

ETHICS COMPONENT

 

1.         Scenario 1:

 

            In this scenario, the case of autonomy is the issue. Autonomy refers to a person’s independence, in this case the client’s independence. As a standard in ethics, autonomy represents an agreement to respect another’s right to determine a course of action. Based on this standard in ethics, the health care professionals should have respected the client’s decision as to what should be the next course of action. The health care team has no right to detain here and impose their decisions on her since in the first place the client is not found to be mentally incapacitated.

Respect for another’s autonomy is fundamental to the practice of health care. It serves to justify the inclusion of clients in all aspects of decision making regarding their health care. The decision to be discharged from the hospital may be at the hands of health care professionals but the client also has the right to voice out his or her opinions which should be respected by the health care professionals.

            The agreement to respect autonomy involves the recognition that clients are in charge of their own destiny in matters of health and illness. Let us take for example the consent process required prior to surgery, this implies that a client may refuse treatment. In most cases the health care team must agree to follow the client’s wishes. Health care professionals agree to abide by a standard of respect for the client’s autonomy.

            The nurse has of course a moral duty to prevent suicide. However, the client does not appear to be mentally ill and should be given her freedom and right to decide. If the client decides to go home, then she should be allowed to go home since in the first place she does not appear to be mentally ill and could make sound decisions and judgments. Unless the client is proven to be unable to make sound decisions and judgments, then the health care professionals and the family of the client could decide for the health care of the client.

 

2. Scenario 2:

 

            The nurse in this scenario did not behave ethically. This could be discussed through the aspect of medical ethics which is beneficence. This refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. Commitment to beneficence helps to guide difficult decisions wherein the benefits of a treatment may be challenged by risks to the client’s well-being or dignity.

            In the scenario, the nurse probably went against the doctor’s orders because she felt pity for the client. Given the fact that the client is terminally ill, the nurse could have felt that it was a little selfish and harsh for the doctor not to give the client anything to eat or even drink. Or the nurse could have thought that she owe it to the client to give him something to drink since he is dying anyway and the nurse just wants to grant a dying man’s wish. Thus, the nurse went against the doctor’s orders and gave the terminally ill man small sips of water. Although the nurse did this with good intentions in her mind, it is possible that it could have a bad effect on the client.

            The nurse should have thought that the doctor’s orders may cause discomfort to the client, but the benefits, both for the individual and the society, outweigh the temporary discomfort. If the nurse has doubts of the doctor’s orders, she could have simply asked the doctor about it and why it should be done. The nurse should not act on her own without asking for advice, especially since this is a case wherein orders from a higher authority is given. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest.

            The nurse must remember that whatever she did on the client, she is accountable and responsible for. If what she did could harm the client, she could be blamed for it, and worse, she could be sued for malpractice. Depriving a client of something to eat and drink could sound harsh, but there are rationales for such actions. In ethics, such is done for the benefit for the client. No matter how terminally ill a client is, health care professionals must abide by what should be done clinically within the bounds of their established code of ethics.

 

3. Differentiate between legal, clinical and ethical dimensions of nursing practice. Give example of each to support your response.

 

            Legal dimensions of nursing practice refer to legal boundaries within which nurses must function. There are certain legal guidelines that nurses must follow. An understanding of the implications of the law can protect nurses from liability and also protect their client’s rights. To illustrate, nursing malpractice which results when nursing care falls below the standard of care, is an example of a legal issue.

            Clinical dimensions of nursing practice involve the nursing care itself that the nurse offers to the client. This also pertains to the skills of a nurse which are necessary to deliver a timely and effective care for the client. An example of clinical dimensions of nursing practice those that involve the complete assessment of a client’s condition that enables the nurse to make an accurate clinical decision as to the client’s needs and required nursing therapies.

            Ethical dimensions of nursing practice include the ideals of right and wrong behavior. In professional practices including nursing, a code of ethics provides guideline for safe and compassionate care. A nurse’s commitment to the code of ethics guarantees the public that nurses adhere to professional nursing standards. An example of ethical dimensions of nursing practice includes the following scenario: A young woman is hospitalized in the final stages of cancer. The family of the young woman has expressed their thought for “no resuscitation” since everything has already been done and further treatment would be futile. The health care team caring for the young woman, especially the nurse faces an ethical dilemma.

 

Enhancing Nursing Care

Nursing is the process of caring for, or nurturing, for an individual known as the ‘patient’. More specifically, nursing refers to the functions and duties carried out by persons who have had formal education and training in the art and science of nursing. To promote the restoration and maintenance of health in their clients, nurses became more particular in enhancing their knowledge through integrating with health and biological sciences.

 

            A registered nurse, midwife or health visitor is accountable for what they practice. Furthermore it noted that the following should be followed when caring for patients and clients:

 

o        “respect the patient or client as an individual

o        Obtain consent before you give any treatment or care

o        protect confidential information

o        co-operate with others in the team

o        maintain your professional knowledge and competence

o        be trustworthy

o        act to identify and minimize risk to patients and clients”.

 

            On the other hand, according to the College of Registered Nurses of Nova,  the nursing profession has the following interrelated standards:

 

1)     “ Accountability – the registered nurse is accountable to the public for competent , safe and ethical nursing practice

2)     Continuing Competence – the registered nurse attains and maintains competencies relevant to own scope of nursing practice

3)     Application Knowledge, Skills and Judgment – the registered nurse demonstrates competencies relevant to own scope of nursing practice

4)     Professional Relationships and Advocacy – the registered nurse establishes professional therapeutic relationships with clients and advocates for clients in their relationship with the health system

5)     Professional Leadership – the registered nurse demonstrates professional leadership in the delivery of quality nursing and healthcare services to the public

6)     Self – Regulation – the registered nurse assumes personal accountability to practice nursing competently and ethically.”

 

            According to an interview with a hospital lead nurse (assigned in older people’s acute care) people published in the Evening Chronicle (2004, November 8) good nursing practice is defined as:

 

            “Good nursing practice is all about providing holistic, personalized care that is respectful of the individual and nurses are at their best when caring for older people”

 

The individual healthcare professional's ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring safe clinical care. But professional competence is only part of the picture. Good people, with good skills and good intentions, sometimes make mistakes. As part of this professional issue, to be a nurse is to observe a dynamic process of caring based on a theoretical body of knowledge.

 

The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing practice is on individuals' specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles.

 

            Therefore, a good nursing practice is one that involves the patient in his own care. The patient’s role in his own care must be acknowledged and given importance by the healthcare professional

 

A specific example of a good nursing practice I have witnessed is having an open (and effective) communication between the patient (and / or the patient’s family) and the healthcare professional. First and foremost, the healthcare professional consults the patient about what are his preferences regarding his care and / or treatment. This is of significance in the patient – healthcare professional relationship; because it will prevent any misunderstanding that might arise when a decision regarding the patient’s care and / or treatment must be made. The patient is also given accurate and / or truthful information of his condition. Furthermore, the information regarding the patient’s condition is not relayed on very technical terms but rather using terms and / or language that is easily understood by the patient. This provides a better understanding for the patient on his medical condition. If in case a patient refuses to accept or undergo a treatment, the patient’s wishes are respected and followed by the healthcare professional.

 

Furthermore, a patient’s consent is first obtained before any treatment (and / or operation) is performed on the patient. The patient is informed of the effects and / or benefits of the treatment.  And if the patient refuses the treatment and / or operation, his wishes are respected. And in cases such as that (a patient refuses treatment), the patient is informed of the consequences of the non-treatment and at the same time, possible alternative treatments (in place of the refused treatment) and the possible consequences and / or effects of the alternative treatments. In case, the patient was not able to give his consent an able (and legal) representative of the patient will be informed of the patient’s condition and asked for consent on the proposed treatment.

 

 This is significant so that the healthcare professional will not be made liable on possible unfortunate consequences of the treatment or non-treatment; since it is the patient’s decision that has been respected and obeyed. Aside from that, the patient will have a better understanding of his condition and would feel more responsible about his health. Furthermore, he would be able to think over his refusal of the treatment and might concede to the healthcare professionals’ opinion or decision.

 

Another aspect of patient’s consent is his consent regarding on his medical records. Not only a patient is informed of his medical records but at the same time, he is informed on who has access to it and / or who knows about his medical records and how the information on his medical records are used in relation to his care and / or treatment.  Furthermore, the patient’s consent is obtained regarding on who among his family members or other relations should learn of his medical condition and / or have access on his medical records.

 

Aside from that, the healthcare professional works as a team. Each and every healthcare professional that works in relation to a patient’s care and / or treatment coordinates with one another. Each and every one of them respects each other’s abilities, skills and opinions regarding the patient’s medical condition. A harmonious relationship lessens if not totally avoid misunderstandings, conflicts and tensions within the healthcare institution. Thus, a harmonious relationship in the medical team produces better results in the patient’s medication. Aside from that, a harmonious relationship amongst the healthcare professionals improves their performance which leads to better service and / or care to the patient.

 

Hand Washing as an Infection Control

In the healthcare surroundings, hand washing is frequently referred to as the main weapon in the disease control arsenal. The principle of hand washing in the healthcare setting is microbial diminution in an attempt to diminish the risk of nosocomial infections.

Hand sanitation can also be a dilemma in demanding health centers and clinics where patients are seen both in growing numbers and taken care of in rapid series.  Deterrence and control of communicable actions are intended to limit the increase of contamination and give protected surroundings for all patients, in spite of the locale. In light of the materialization of antibiotic defiant organisms, useful infection control measures, such as hand washing, are necessary to avoidance.

Hand sanitation is commonly recognized to be the only most essential activity for reducing the spread of illness, however facts imply that many health care professionals do not disinfect their hands as frequently as they require to or utilize the right method which means that spots of the hands can be missed. Hands should be disinfected before direct contact with patients and after any activity or contact that infects the hands, as well as following the removal of gloves. While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly. Hand preparation increases the effectiveness of decontamination. Adequate hand washing facilities must be available and easily accessible in all patient areas, treatment rooms, sluices and kitchens. Basins in clinical areas should have elbow or wrist lever operated mixer taps or automated controls and be provided with liquid soap dispensers, paper hand towels and foot-operated waste bins. .Alcohol hand gel must also be available at ‘point of care’ in all primary and secondary care settings (National Patient Safety Agency (2004). All health care workers should bring any lack of, or inappropriately placed facilities to the notice of their managers (or matron). They also have a duty of care to patients and themselves and must use facilities provided to prevent cross infection.

Infection control is significantly significant to the successful condition and organization of healthcare services. On the other hand, it is a locale of nursing theory and practice that has been inadequately studied and has gone nearly uncontested. Contamination control needs a vital understanding of the epidemiology of diseases caused by frequently encountered micro-organisms, of the danger that augment patients' vulnerability to infection by these micro-organisms, and the exercises, measures and cures that encourage infections (Hargiss et al 1981). In the study of) a small number of nurses inquire about principles, clinical practices or educational programs in infection control. Paradoxically, this took place at a time when disease control teams are progressively more moving away from the everyday gathering of hospital infection rates towards target observation programs.

Nurses have the opportunity to practice infection control as an integral part of patient care on a day-to-day basis (Simmons 1983). However, the results of several studies suggest an overall lack of understanding of the components that make up informed infection control care. Hospital-acquired infections are often related to inappropriate patient care practices. This may be due largely to non-compliance with infection control policies, which in turn is attributed to poor knowledge, a lack of motivation and low awareness of the need for infection control. It is important, therefore, that infection control personnel understand what factors influence compliance and how compliance can best be achieved (Larson et al 1988). A review of nosocomial infection control indicated that the incidence and subsequent cost of hospital infections can be reduced significantly by implementing an active infection control program.

One solution that could encourage change in infection control practice is the development of an infection control audit program. The aim of clinical audit is to improve the delivery of care to patients as well as promote multidisciplinary working in clinical teams. It involves simply taking note of what nurses do, learning from it and changing practices if necessary. Clinically-based audits ensure that the infection control nurse can examine practices where care is actually being delivered. A standardized infection control audit tool could be used by all care providers. This would furnish purchasers with a measurable standard in relation to quality in infection control.

The risk to patients of infection is much higher than for the general population, partly due to under- lying intrinsic risk factors and the need for invasive therapy. The spread of infection is also increased when patients with existing infections are in close proximity to other susceptible patients. Assessment of infection status can be divided into two distinct categories, the patient who has an infection which could spread to another patient, and the patient who is at risk of acquiring infection. These findings reveal that the majority of hospitals included in the study assessed the risk of infection through the nursing process. However, the nursing process does not necessarily offer a framework for risk assessment for infection control. Only one hospital had an infection control risk assessment tool applied by the clinical nurses and evaluated by the infection control nurses. Suggested that the rate of infection can be altered significantly by staff awareness and the risk of infection reduced by a number of recognized healthcare practices, including risk assessment.

Often guidelines for infection control precautions are standardized and based on a medical model of care. Infection control is also perceived as 'rules and routines' that are grafted onto care plans. In reality, infection prevention and control is the basis of all care. Findings from this study demonstrate that the nurses' approach to applying infection control precautions in the clinical setting was inconsistent. Infection control nurses in each of the six hospitals viewed the hand washing technique of nursing staff as poor, with insufficient time allowed for the procedure. The seriousness of this finding was reinforced by a study on compliance with treatment by patients undergoing isolation nursing. The researcher found, among other things, that a failure by nurses to wash their hands after contact with patients known to be potentially infectious meant that the acquisition of pathogens was highly likely.

While no harm is likely to befall a patient as a result of hand washing, one potential adverse effect of hand washing for healthcare workers is skin irritation. Indeed, skin irritation constitutes an important barrier to appropriate compliance with hand washing guidelines (Larson:1985). Soaps and detergents can damage the skin when applied on a regular basis. Alcohol-based preparations are less irritating to the skin, and with the addition of emollients, may be tolerated better..

Another potential harm of increasing compliance with hand washing is the amount of time required to do it adequately. Current recommendations for standard hand washing suggest 15-30 seconds of hand washing is necessary for adequate hand hygiene. Given the many times during a nursing shift that hand washing should occur, this is a significant time commitment that could potentially impede the performance of other patient care duties. In fact, lack of time is one of the most common reasons cited for failure to wash hands.¹¹ Since alcohol-based hand rubs require much less time, it has been suggested that they might resolve this concern. In fact, a recent study which modeled compliance time for hand washing as compared with alcoholic rubs, suggested that, given 100% compliance, hand washing would consume 16 hours of nursing time per standard day shift, while alcohol rub would consume only 3 hours.

Conclusion

            Nursing a profession that has been around since the middle ages, that began from health restoration of ill and wounded persons in wars, is now an institutionalized profession that faces a lot of issues, but is never the less stable in enhancing their skills through training and studies.       Based on the analysis, we can conclude that nursing is a sacred profession for it aims to help patients/ clients gain insight and access to their subjective experience.

             Indeed it is no argument in saying that in time, the nurses have increased their roles in the society. This is proven by the numerous specializations that were made in the past years that were employed in the field. Through periods of rapid changes in industrialization, and in the present day information technology, nursing institutions have designed nursing care appropriate to expectations of the patients and clients. Theoretical and practical management has evolved in this institution from the time it was formed).

            Even in the event of modern thinking and high technology, the latest gadgets that enhance medical practices and the theories taught in the universities cannot replace the effectiveness of actual and personal involvement of the nurses to their patients. The nurse-patient involvement is crucial for wellness of the patient for it is one of the few interactions of the patient to other people while recuperating. Human interaction avoids the patient from being depressed. Furthermore, nurse-patient interaction provides the nurse with additional experience and promotes professional growth.

Practical knowledge supports praxis for it is indispensable, in the nursing field. A nurse needs to integrate his skills, experience and technical knowledge to result into a better and effective performance. Praxis has many implications in the field of nurturing and caring. Despite criticisms and complex issues, the theory Clinical Effectiveness should be present in a nurse’s profile for him to handle situations with patients in distress. Technical knowledge supports evidence based practice, practical knowledge endorses practical knowledge and emancipatory knowledge gives both nurses and patients interaction and ease.

 All health care professionals who have a clinical responsibility for patients must include infection prevention and control as part of their every day practice. The RCN believes all health care staff should receive mandatory infection control training as part of their induction and on an ongoing annual basis. It is particularly important that knowledge and skills are continually updated. The training should cover all the general principles of infection prevention and control, to emphasize the key role that health care professionals play in minimizing the spread of infection; to highlight what can happen as a result of bad practice and underline the importance of good communication.

Team Work

Introduction

            My name is Betty Annie Mathew, 25 years old, and has a BSC in nursing from the PSG College of Nursing in India. I am currently doing my adaptation programme in order to become a registered nurse in the United Kingdom according to the rules and regulations set by the Nursing and Midwifery Council. Prior to this, I had three years work experience in the field of nursing pediatrics back in India.

I am doing my adaptation programme at Fulwood Lodge Nursing Home in Sheffield. This is a 42 bedded nursing home with 24 hours nursing care. There are 2 nurses and 6 care assistants on the morning shift where team work plays an important role for the proper and smooth running of shift. At night, there is 1 nurse and 3 carers on duty. The nursing home has a matron who is fully incharge of the nursing home and a deputy matron who will be assisting her.

As I have noticed that team work has significantly affected the level and quality of client care in my place of work, I have decided to do a paper on this particular issue of team work and its relationship to the level of patient care and satisfaction.

 

Body

            Health care teams have been described as multidisciplinary, interdisciplinary, cross-disciplinary, polydisciplinary, pandisciplinary, transdisciplinary, and virtual. This is also applied to nursing care teams. An advantage of this is the collaborative style that encourages each member of the team to help the other members.

            Effective team work requires good communication in order for nurses to be able to provide to their patients the best quality of care. Frustrated team members often express concerns about its quality and extent. As in any relationship between people, the ability to "keep the lines of communication open" in a team is an important indicator of effective team work skills.

            As the old saying goes, “two heads is better than one.” How much more a team? Each member of a team can contribute ideas for the care of the client. This could definitely give the team options and chose what is best for the client and his situation. The members of the team also can each help each other and at the same time divide their tasks in order to be able to provide the best quality of care for the client.

 

Conclusion

            Working outside teams still can provide quality of care to the patient. But having a team to take care of a patient can significantly increase the quality of care offered to the patients. Aside from that, team work can enhance relationships between nurses and also provide many options for the care of the patient.

            It is thus important that there is cooperation within the team in order for hospital shifts to run smoothly and for nurses to be able to provide high levels of quality of care for the patients.

References

Clark, P.G. & Drinka, T.J.K. 2000, Interdisciplinary Practice and Teaching,

Auburn House.

Potter, P. and Perry, A. 2004. Fundamentals of Nursing. Mosby.

Drug Abuse

Drug misuse may immediately merit the suggestion whether a person should be rehabilitated, corrected, punished, or indeed, treated (Alterman et. Al.: 1993). Furthermore, the notion of chemical dependency as "disease" warrants examination. Just as there are an assortment of drugs and those who use them, there exists a rather diverse population for which treatments should also vary. Cunningham (2000) implies that where a doctor's criteria of what constitutes abuse or dependency of alcohol or (other) drugs are generally restricted to medical and psychological aspects. More specifically, noted that rarely are the consequences of harmful use actually restricted to one or two spheres of a person's life. (Cunningham:2000) The restricted aspects have set the premise for narrow minded thinking. Furthermore, it widens the gap of unsuccessful treatment.

Although causal use of drugs has slightly declined, there has been no apparent progress or change in the numbers of heavy users of heroin and cocaine (Chaney et. Al:1998). Hard-core drug abusers, those who use at least weekly and exhibit drug related behaviour problems, typically are at the bottom of the social ladder where drug treatment programs have had the poorest track record.  Currently, one of the nationwide initiatives and interventions within the U.K. include slapping Anti-social Behaviour orders to curb unacceptable behaviour, which may quite often be the result of misusing substances.

Within the UK the Drug and Alcohol Action Teams (DAAT) programmes continue to address national and local government objectives in the provision of treatment across all tiers of the profession.  I attended the recent launch of the DAAT Programme for 2004/05 (6^th May 2004) in the borough of Hounslow, Middlesex.  Key themes and objectives of the DAAT’s work programme were presented and the local DAAT Treatment Plan had been agreed by the National Treatment Agency.  There were many themes, however the DAAT’s top priorities for 2004/05 for the borough of Hounslow are as follows:

·        Development of a Young people’s Substance Misuse Service

·        Reducing waiting times and improving GP prescribing levels.

·        Developing clearer responses to crack cocaine.

·        Developing provision to reflect more sophisticated understanding of needs of Hounslow’s diverse communities.

·        Improving data collection, including joint working with CDRP

(DAAT Programme 2004)

Advocates for expanded drug treatment argue that new programs will more than pay themselves in reduced crime, improved health and fewer broken families. It's not clear which, if any, government and / or approaches really work, however counsellors working together in partnership with other service providers continue their endeavour in seeking appropriate therapeutic interventions with clients who misuse substances.

Drummond (1995) declares that, traditionally, we may oscillate between perceiving addiction as a medical hindrance and a social amiss. Similarly, the therapy of addiction has conceded in the course of sequences of medical attention ensued by disciplinary crackdowns.

Unfortunately, addiction models and consequent treatment approaches have been rigidly constructed. It is this generic programming and lack of flexibility that results in high recidivism and poor success rates. The completion of treatment, the "treated" individual is usually returned to the same environment that s/he struggled with prior to entering that program.

 

“The expectation is that the client is better equipped in dealing with the problems s/he entered treatment with. The degree to which many clients are able to cope is usually not sufficient to ensure long-term stabilization. Success ultimately boils down to an individual's personal decisions.” (Drummond, 1995).

 

The individual's capacity to decide would be less inhibited if s/he had a broader range in which to choose from. The current disease model short-circuits treatment potential. In fact, it holds an element of damage in itself, in that there seems to be a mentality of labelling accordingly (Drummond:1995).

Frequently, upon failing in treatment, a client is offered another chance by the same agency ("to get it right (Drummond:1995)"). Programs are more often than not geared toward delivering curricula that suits the protocol of the agency. Many programs tend to facilitate the same basic treatment to all clients, and fail to distinguish first time clients from "recycled" clients (Hay:2001). If the person in relapse enters another agency, s/he is likely to be re-assessed, and there's a good chance that the client will be subjected to the same treatment regimen as previously prescribed, only the new program will have a different name.

The 12 steps of Alcoholics/Narcotics Anonymous are the foundation of many treatment centres. A.A. originated in the 1930s (Hay:2001). There is no cost, and it was designed as an outlet for chronic alcoholics who choose to attend. To administer treatment from a 12 step orientation is a question of ethics. It is important to note, if a program mandates attendance, let alone operates solely on the principles of the 12 steps and charges for such "services," it conflicts with the notion of anonymity and the intrinsic features of AA. They may be a good supplement for many in recovery, but the 12 steps should not be the main component for any agency (Harwin and Forrester:2002).

 

 

 

 

 

 

 

 

References

 

 

Cherry, A., Dillon, M., & Rugh, D. (2002). Substance Abuse: A Global View. Westport, CT: Greenwood Press.

Drug and Alcohol Action Team. Drug misuse statistics United Kingdom 2004 . Edinburgh: ISD Publications.

 

Harwin, J and Forrester, D. (2002). Parental substance misuse and child welfare: A study of social work with families in which parents misuse drugs or alcohol. London: Interim Report for Nuffield Foundation.

 

Hay, G, McKeganey, N and Hutchinson, S.( 2001). Estimating the national and local prevalence of problem drug misuse in Scotland. Glasgow: University of Glasgow.

 

Schwartzberg, A. (1998). The Adolescent in Turmoil. Westport, CT: Praeger Publishers.

 

Paper in Nursing

Introduction

A hospital has initiated a program which utilizes computer system called Meditec in replace of the traditional paper charting. The ER department of the said hospital has started using the program and has been successful with its implementation. However, a certain department at the 4^th floor of the hospital receives resistance to the system from some staffs especially the older nurses who are afraid to use the computer. The focus of the paper is the steps and strategies that the hospital management need to undertake to be able for all the employees of the hospital accept the changes brought about by the new system and for the system to be utilized affectively.

 

Assessment

The use of the computer system in a hospital is a strategy not only implemented by hospitals but by almost all business firms and institutions and has brought a lot of changes as well as advantages. The use of technology such as the computer and the internet makes the process in an organization, may it be paper works or production process, easier, more accurate and more reliable than the traditional way of doing things.

In a hospital, creating a change involves many stakeholders including the patients who receive the services provided by the hospital. Once the computer system is implemented there will be improved and enhanced services that are definitely advantageous in the part of the patients. Another stakeholder who will benefit from the Meditec is the nurses. The nurses are the one who have direct access to the computer system. The nurses’ task which is to provide health care involves the sorting of patients’ records, laboratory and pathology test results and integrating these record to other departments that are involved in decision making.    

The system is basically a network of computers within the hospitals interconnected with each other to be able to implement sharing of information across departments. The information shared in the network has to be patient records and some confidential records have to be accessed by authorized persons only with the use of password. This centralized and distributed databases and linkages between computer systems significantly enhance access to patient information, saving time and resources.

Though investing in the development and installation of computer systems costs a substantial amount and resources, many medical institutions still invest into it due to its many benefits it can provide including the storage of medical records and electronic links among departments and sophisticated support in the form of diagnostic tools, error detection, and automated reminders. The implementation of Meditec needs resources not only the physical equipment as well as the human resource and skills necessary to run such system.

In implementing computer-based system, the hospital will need technical support, from the installation to its maintenance. Also, a hospital is an institution where not all employees are adept with the use of computers. Most hospitals have older nurses and staffs that are afraid to use computer because of lack of knowledge in computer. This results to resistance and objection of some employees with the system. Some who resist the system may insist that the hospital need not waste money because the hospital can run in a traditional way while some employees, although they support the computer-based system can not admit that they do not know how to use the system.

Planning

The goal of the system is to make the work of nurses less time consuming, less paper works, more accurate shared data and easy to access information system within the hospital so that the nurses can focus on the core of their job which is providing health care services and not managing of the paper works in the hospital.

A strategy or change, a social psychologist has three phases: unfreezing or getting the need to change to be accepted; moving or putting the changes into effect; and refreezing or consolidating the changes so that there is no reversion.

Unfreezing or preparing is the initiation of change and involves preparation for what is to happen. The implementation of computer-based information system in the hospital is actually a change program. According to the force field analysis, a management technique developed, there are two variables involved in planning and preparing a change program: the driving forces that seek to promote change and the restraining forces that attempt to maintain status quo or to resist change. It is important that the plan is informed and shared with the employees because they are the one who will be using and implementing the system.

 In the hospital, the driving force is the technology. The management saw the advantages and benefits that this kind of technology can give the hospitals such as information available more quickly; accuracy and consistency of information; and free up people’s time to do other tasks. Also, pressure from the management to implement the system is another driving force. Competition from other hospitals can also be considered as a driving force to this situation.

The restraining forces in this situation are the fear of the use of computer and lack of technological knowledge about the computer. Concerns about competence, personal uncertainty and preference for the way things are done now are just some of the reasons why people resist change.  The cost of the technology used can also be considered restraining force but in this situation, the hospital seems to be willing to invest in such system. When the driving force is just as strong as the restraining force, then no change will happen which only mean that the implementation of the system is not successful thus, it is important to overcome resistance.

 

Implementation

Moving, the 2^nd phase of change as noted above is putting changes into effect. This is now the phase where the restraining forces will be overcome. Basically, there are five possible approaches or strategies to overcome resistance. These are the directive strategies; expert strategies; negotiating strategies; educative strategies; and participative strategies.

Looking at the restraining forces, the better approach could be the educative strategies. The system is not new to the hospital since it has been implemented in the ER so educating the nurses and other employees involved in the change will not be that difficult in the part of the management. The system is expected to be functional and operating in three months time. As long as there are available resources and equipments, installation and testing will not take long. By the time the network has been installed, the training of nurses and staff can be started. Training schedules should not be conflict with work schedules so the staffs and nurses at the 4^th floor should be divided into groups. One group can attend the training in the morning and the other group in the afternoon training session. Moreover, younger nurses and employees usually have the knowledge in computers and are not easy to educate whatever system the hospital is using.

Educative strategies should involved orientation, lectures on basic knowledge and operation of computer, knowledge on how to access confidential data for authorized employees only, and educating them on how to maximize the usefulness of having a system such as Meditec. A two-months training is enough to train and educate employees of the basics of computers. The trainers should not only have the technical knowledge but also have the ability to convince all employees that the system is not only advantage on the part of the hospital but more importantly on the part of them, the employees, making their works easier and less-time consuming. Management may opt to hire trainers and educators outside the hospital and one staff of ER may demonstrate the use of the system. Consequently, the hospital should organize a technical department that will be responsible for the maintenance and technical aspects of the system. This department should also be responsible in educating and promoting technological developments that will help enhance services provided by the hospital.   

During the training, it should also be emphasized that the world is driven by technologies and every organization including hospitals are adapting to the changes brought about by technologies. The hospital should take advantage of the benefits technology brings especially when it is related to customer service and quality health care. Proper motivations are needed to embed the new system within the culture of the hospital.

 

Evaluation

The change strategy will be constrained with the time available. With the hospital’s case, the basic knowledge is only what the employees needed and as the system is implemented, employees will get used to it especially when the employees are starting to get the benefits brought about by the system. At this stage, refreezing phase is now taking place.

After the seminar/training, it is expected that all employees will now embrace the new system and will be happier with their work. The system may be modified as new technology emerge and as the requirement of the hospital arise. However, the hospital should be aware that a system may experience lockdown due to external uncontrollable factors. In case like this, there should be back up file so that the hospital operation can still continue.

 

Conclusion

            It can be concluded that changes in work situation is not easy to implement because there are always those who are against or what are called restraining forces. However, these forces can be approached using different strategies. The strategy used above is educative. It is an effective strategy because it gives the employees better understanding of the change, making them adapt to the change less resistive. The study has provided important knowledge on how to implement changes especially in today’s technology driven world and when people always seek on ways on how to improve ones life.

 

Code of Nursing Ethics

"Let whoever is in charge keep this simple question in her head - not, how can I always do this right thing myself, but how can I provide for the right thing to be always done?"

 

                                                                                            -- Florence Nightingale

 

            Like the founder of modern nursing Florence Nightingale, nurses nowadays are compounded with the same question: What can I do for my patient? This question may seem trivial and easy but when has to consider the many factors that are involved in the context of caring, one might realize that this is a tough question after all. Thus, the Code of Nursing Ethics serves its purpose in defining the scope of nursing practice including the merits, risks and other relevant ethical issues involving the nursing profession.

 

            Furthermore, one of the most common issues in the health care setting is the importance of the doctrine of informed consent. Maxwell J. Mehlman, an expert in health law and bioethics, put it simply as the presence of a physician giving patient an explanation of his health condition, different alternatives and other health choices. Robertson (1981) further stressed that it is a legal doctrine that recognizes the patient’s right to decide for himself and the doctor’s obligation to provide him/ her necessary information so that the patient can choose whether to submit himself to the proposed treatment.

 Meanwhile, there are five important points in an informed consent that should be taken into consideration. The first concern is patients signing consent forms without having any comprehension of what it is they are consenting to. After an explanation is given by the doctor, it is the duty of the nurse to assess the patient’s knowledge and if further teachings are required. Another concern is that there are nurses who directly assume incorrectly that complete explanations are already given thus fail to re assess the patient before obtaining the patient’s consent. Obtaining of consent from people who cannot understand or speak the English language without the presence of a qualified interpreter is the third concern. It is important that the patient fully understands the treatment he will go through and this would be impossible if the patient has no comprehension of the language thus an interpreter is needed.

 

 

Meanwhile, there are cases when the patient has knowledge of the procedure of the treatment however they don not have any idea of the associated risks involved and this is the fourth concern. As a nurse, assessment is very necessary and patients should be informed not just with the procedure itself but also the risks that could possibly occur and lastly, there are procedures being done to the patient that the patient has no knowledge at all. As the doctrine states it, every patient has the right to self determination and the patient should always be involved in the plan of care.

 

            Moreover, the concerns mentioned fall under the four important principles covered by the doctrine. These are autonomy, non-maleficence, beneficence and justice. The principle of autonomy connotes that patients have the right to choose for themselves so they can choose what treatment to subject themselves into or they have the right to refuse whatever is not favorable for them. On the other hand, non-maleficence lives by “above all, do no harm” and patients should be protected from anything that will cause harm such as assault and battery, false imprisonment, exploitation and others including those that resulted from inadequacy of information that resulted to harm while beneficence lives by “above all, do good” which emphasizes that maximum care should be given to patients and lastly is justice wherein patients should be treated fairly and without bias.

 

 

            On the other hand, the presented scenario dwells on the moral stand of the nurse on suicide. As already mentioned, the patient has the right to autonomy thus he only has the right to choose what’s best for him but as a nurse, we are faced with the dilemma of  upholding the patient’s freedom to protect him or allowing him to be free and commit suicide. According to Beauchamp (1980), “if people are autonomous, then they have the right to be left alone and to do with their lives as they wish, so long as they are sufficiently free of responsibilities to others. From this perspective, the intervention in the life of a suicide is simply an unjust deprivation of liberty”. Glover (1977) added that it is a person’s free choice if suicide will be committed and other people’s say would not matter at all.

 

 

            Since the patient is not mentally ill, the patient has the right to decide and then best thing that the nurse can do is to provide necessary health teachings to the client conveying the feelings of empathy and using therapeutic communication. Any nurse or health care professional for that matter is drawn to feel obliged to help a suicidal patient to feel better by giving him/ her words of encouragement and encouraging patient to voice out fears or any concern. By doing this, the nurse might believe that the patient may change his or her mind. On the other hand, nurses also counsel patient to bring back feelings of hope, worthiness and sense of belongingness and this will help patient gain a positive outlook in life. Lastly, is to help individuals who committed attempted suicide to feel good again and treat the injuries that they have- it may be physical or emotional.

 

 

            The second scenario presents a case of a terminally ill client. What the nurse did is ethical since she practiced the principle of beneficence. It is the duty of the nurse to make the terminally ill client feel comfortable as much as possible and if the sips of water will make him feel better then the nurse will provide it even if she has to go against the doctor’s order. However, the nurse also has to take into consideration the possible consequences and in this case the ‘sips of water’ is not that detrimental to the patient. Beauchamp and Childress (1994) states that  beneficence literally means ‘act for the benefit of others’.

 

Compassion, care, altruism, love, friendship, empathy, sympathy, kindness, mercy, and charity are examples of acts of beneficence however, doing such acts will not guarantee that no consequence will occur thus certain limits should be employed and should be dealt with accordingly or according to other moral implications.  Thus, it is important that when the nurse acts beneficently towards a patient, he or she should put this on her mind that she is not obliged to act that way and in doing  such action, certain responsibilities should be carried especially if the act committed has moral interests and in one way or another comprised or harmed the patient’s safety seriously.

 

The last situation entails that although knows the patient’s condition and prognosis, he or she has no right to disclose the information to the patient. What she must do is to continuously provide the patient with high quality care and to make the patient comfortable as much as possible. Since the Doctor has the right to inform the patient, it is best that the nurse will let the patient understand the situation and inform him that the Doctor will come right in to tell him with the progress of his condition and what would be expected. Moreover, the nurse should make the patient feel that he is not alone and to do this it is helpful if the patient and his/ her support system are involved in his care.

 

 

Meanwhile, the legal dimension of nursing takes into consideration the legalities of the nursing profession. Such considerations include the laws that govern the profession including the crimes, torts and others that might occur while practicing nursing care. An example of this is when a patient died while under the direct care of the nurse. Before the nurse is questioned in the court, many things will be accounted for first like if the act was an act of negligence on the part of the nurse or the health team in general or an act of malpractice. Since laws are part in the legal dimension of nursing, it is important that the nurses know, understand and follow conscientiously the legal implications  of the practice including the state’s nurse practice act, board of nursing as well as the standards of nursing care. 

 

 

On the other hand, the ethical dimension of nursing is more or less related to its legal dimension. The ethical dimension of nursing believes that each individual deserves an optimal nursing care and this could be achieved through the nurses understanding of life in general. As nurses continue to face different ethical dilemmas, it is empirical that the nurses know their stand in these issues to be able to deal with these ethical issues appropriately.  An example of an ethical situation is the patient who wanted to abort his child. In this situation the nurse is faced with a dilemma whether to participate in the process or not to participate and stick to his or her values even if this is the patient’s choice.

 

 

Lastly, is the clinical dimension of nursing. This dimension entails the diagnosis, treatment and the implementation of evidence-based nursing interventions may it be in the clinical or the community setting. In this dimension,  the focuses of nursing care are the individual, the family and the community as a whole and like the legal and ethical dimensions, the clinical dimension is also guided with standards of quality nursing care. Moreover, the three dimensions could exist in one setting.