An increasing number of situations within the healthcare industry involve the need for ethical decision making nowadays. Thus, it becomes essential for healthcare providers to understand the meaning of ethics and to facilitate the delivery of professional and skilled care. Ethics is becoming increasingly relevant to the day to day practices of nurses, in particular, as they are the frontline in the delivery of patient care. This paper attempts to understand the role of Ethics in the field of nursing. An interview was conducted with a Director of Nursing In a skilled nursing facility specializing in long term care to gain their perspective about the topic. The interviewee was selected because of the wealth of her experience in the field and due to the fact that this position has a significant influence on the development and implementation of policies and procedures within the organization. Furthermore, the interviewee is also involved in resolving complex issues involving patients and health care workers within the organization. Consequently, decisions made will shape the culture of the organization and the patterns of thought and actions of its workers.
Description of Provider’s Experience
The interview I conducted with the Director of Nursing at a long term care facility has proven to be enlightening and insightful in the field of nursing. One of the major topics discussed during the course of the interview include the changes that nursing has undergone throughout the years. According to the interviewee, when she first started out as a nurse, it was common for nurses to take and accept orders only from physicians or a senior staff member. Their work back then was to act based on the physician’s decisions and they were not required to provide any input. As such, their intellectual and reasoning skills were not developed nor valued. Today, however, the field of nursing has changed and nurses are increasingly becoming more involved in patient care and treatment. Nurses are now taking on more responsibilities under their belt and now work with the physician instead of for the physician. Patient care remains at the heart of delivery of services, however, and it is the role of nurses to continue to advocate and contribute to the welfare of those who require care. In asking what she finds most challenging in her role, the interviewee answered that providing essential support to staff in terms of managing ethical dilemmas is a significant challenge for her. The interviewee stated that the facility operates under a code of ethics, which is largely influenced by the medical code of ethics. She stressed that ethical issues must be viewed within a professional context and it must be discussed with the multi-disciplinary team in order to explore and analyze the problem further. Similarly, a team discussion of the issue can facilitate clarity, awareness, and an in-depth examination of the presented issue and would allow members to verbalize their thoughts and professional opinions. In addition to this, the interviewee also stated that there is a need to provide support to healthcare staff, particularly if they remain unaware or unclear of the ethical framework and code of ethics policy that the organization adopts. She states that it is imperative for line managers to lead their units in achieving adequate knowledge and understanding of ethical principles relevant to their roles.
Application of Ethics to the Provider’s Experience
In the field of Nursing, ethical dilemmas can occur on a daily basis irrespective of the setting: be it a nursing home or a critical care unit. Due to their varied roles, nurses can encounter situations where they need to make an ethical decision that has an impact not only for them but for their patients as well (Angelucci & Carefoot, 2007). Ethical dilemmas are particularly hard because there is no “right” solution to the problem. In fact, a variety of decision outcomes can result from a single ethical dilemma, with the choice never deemed to be truly “correct” or “wrong”. The principle of ethics mainly postulates “doing good and causing no harm”. However, defining what is ethical and what it is not can vary from one individual to another. Thus, education on the principles of nursing ethics is critical in order to provide the nurse with the tools to make a wise and ethically sound decision.
A major theme in nursing ethics is the respect for autonomy which means allowing people to make their own decisions about their care and the treatment they receive. Foremost in this theme is the practice of gaining informed consent which must be respected by the nurse at all times (Rumbold, 1999) except in cases where the patient becomes incapacitated or diagnosed with a mental health condition affecting their judgment. Due to the increasing awareness of the importance of autonomy, the Patient Self Determination Act was passed by Congress in the year 1990. This act allows individuals to state their wishes as to medical care and treatment in the future if they become incapacitated. The act also allows the durable power of attorney wherein a competent individual is designated to make medical decisions for the patient (Beauchamp & Childress, 2009). Meanwhile, Beneficence or “doing good”, is at the core of patient advocacy. However, there are occasions when autonomy and beneficence can cause conflict and pose ethical dilemmas. One such example is a patient’s refusal to undergo recommended treatment that can prolong life or alleviate suffering. In this situation, a healthcare provider can be torn between the provision of beneficial care or respecting the autonomy of the patient. Nonmaleficence, on the other hand, relates to the prevention of intentional harm. This principle is closely linked to beneficence and is rooted at patient care. Harm can include physical, emotional, social and economic damage. Justice is another principle in nursing ethics. It refers to equal rights in terms of allocation of resources and treatment, irrespective of wealth, social status, race or gender (Butts & Rich, 2008).
Nursing has truly come a long way since Florence Nightingale started the concept. Today, nurses are not mere handmaidens of physicians. Nurses are taking on more responsibilities and becoming more directly involved with patient care and treatment. However, due to this change in the role of nurses coupled with the increasing complexity of patient care, there is also an associated need to learn and understand ethical principles. Ethics is not merely a theoretical issue that is discussed in classrooms. Rather, it forms a fundamental knowledge base and allows nurses to think critically and examine their actions and decisions in the clinical setting. Since ethical principles are closely linked, there is a need for nurses to consider more than one principle for a single situation. Thus, an understanding of ethical principles and framework prove to be fundamental in guiding an individual to make an ethically sound decision when difficult situations arise.
Angelucci, P. & Carefoot, S. (2007). Working through moral anguish. Nurse Manager. 38(9):10,12.
Beauchamp, T. L. & Childress, J. F. (2009). Principles of biomedical ethics (6th ed., pp. 38-39). New York, NY: Oxford University Press.
Butts, J. B. & Rich, K. L. (2008). Nursing ethics across the curriculum and into practice (2nd ed., p. 48). Sunbury, MA: Jones and Bartlett.
Rumbold, G (1999). Ethics in Nursing Practice. Balliere Tindall.