Professional, Legal and Moral Issues in Nursing - Essay Example

Professional, Legal and Moral Issues in Nursing Introduction The nursing profession is a science and an art, in which the primary aim is to promotequality of life. It include a comprehensive set of activities and duties by which individuals and families are assisted in a range of human life experiences ranging from birth, sickness and end of life. Florence Nightingale is the first person to start modern nursing practices and New Zealand was the first country to regulate nurses nationally. The American Nurses Association defines the practice of nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." Royal College of Nursing, U.K states that nursing is "The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death." The primary goal of Nursing is based on the ideal of servicing humanity to improve dignity and quality of life. The practice of nursing is guided by nursing research. Nursing Research Nursing is guided by the research done, to determine which practices have to be incorporated in nursing. Nursing research fall into two areas: Quantitative research: This research focuses on the outcome of a treatment processes, which are successful and using them as a standard practice. It is characterized by the randomized controlled trial. Qualitative research: This research focuses on understanding how a particular medical experience occurs. It studies the issues of how nursing is received by the patient or delivered to the patient and its impact in the life of the patient. The practice of nursing is governed by professional, legal and moral issues which in totality make up the ethics of nursing. Professional Issues in Nursing The professional issues of nursing basically deal with the situations that nurses will be facing in the line of duty. These issues correspond to the nature of specialization undertaken by the person during their period of training. For example The Royal College of Nursing, Scotland put forth four different categories of the nursing practice such as: Acute and Supportive Care Representative Foundation Nursing Area Representative Primary Care and Public Health Representative Priority Care Areas Representative The professional issues are dealt with in the course of study through this college are according the category chosen by the student and is based on learning the practices involved in that category. They will learn about the norms of practice pertaining to their areas of specialization as well as patient care. Legal and Moral Issues The legal and moral issues of the nursing practice are covered by the code of ethics, which very qualified nurse has to follow, during the course of their professional practice. Nursing code of ethics The ethics of nursing basically deals with the pride of being in the profession murse well as the caution which has to be followed during the practice of this profession. The principles of the nursing code of ethics are similar to the code of ethic followed in other branches of health care, but there are certain codes of conduct dealing with the nature of nursing alone. Following a code of conduct or ethics has been an integral part of the nursing profession. Over the course of years, this has further developed to include new issues, arising in the modern health community. In the early days of nursing, the ethics were mainly focused on the virtues of the nurse, but now it can come around to focusing more on the rights of the patient. The foremost concern in nursing ethics is the respect for human rights of the individual or the patient under a nurse's care. Based on this point, are the five basic moral principles of nursing, which include the following: A nurse must be non-malefic in their duties (do no harm) A nurse must seek to benefit those under treatment (do good) A nurse practice, must create the greatest good for the greatest number with the least harm The practice should incorporate the element of justice (equitable distribution of social benefits and costs) The practice should advocate autonomy (self-determination) These moral principles are intended to basically guide the nurse during the course of giving treatment to the patient. These principles are of high relevance because it states that the patient receiving treatment has the right to decide about their own treatment and be given the necessary information on their condition to make such a decision and dignity of human life. This idea covers the principle of informed consent. This means that the patient or individual under treatment fully understands the implications of having or refusing the treatment required fro their medical condition. The decision of the patient is what the nurse must consider foremost when suggesting treatment options. Informed consent is a very important issue under the ethics of nursing practice. In brief, following is how the New York State Nurses Association states its position in informed consent: Informed consent seeks to establish the rights of the individual through self-determination. The patient must be as involved in planning, implementing and evaluating their personal health care as much they are able to do so. Patients or their designated healthcare proxy, has the right to determine what treatment they can be given. Each patient or designated health care proxy agent has the right to receive information required to make informed judgments. Each patient has a right to freedom from not being imposed by another's beliefs or judgmental attitudes. It is the nurse's duty to keep confidential all information received from patients regarding their treatment and should disclose this information only to people, directly involved with the patient's care Informed consent is a very important code of ethics to be followed by nurse. If, it has not been adhered to, during the course of a patient's treatment, the situation can lead to a mishap. The New York State Nurses Association recommends that: In the process of informed consent, the nurse should behave as a patient's advocate. This involved teaching and counseling the patient on their health and clarifying issues of concern which the patient rises. The nurse must respect a patient's decision, irrespective of whether the nurse agrees with the decision or not. The nurse however, has the right to choose not to participate in situation where the treatment given to a patient is harmful to others and which is not consistent with the standards of nursing practice or which violates the nurse's conscience. In these situations, the nurse should delegate nursing responsibilities so that patient care still contuse. The nurse should not participate in any test or treatment in which no informed consent has been obtained from the patient or the patient's health care proxy agent. The nurse should take proper action, if informed consent has not been obtained from the patient. There are times when the principle of informed consent is subject to change because the patient is unable to make choices, about their own treatment because there are incapacitated or suffering from a mental illness due to which their normal sense of judgment is impaired. In such a situation, the nurse must judge between the person whom they are giving care and their duties as a nurse before making a decision. Other than informed consent, other important aspects of the ethical code of conduct is telling the truth and confidentially. The nurse must state the truth when informing a patient about their medical condition and at the same time, this concept also has be weighed against the possibility of unnecessary harm caused, by divulging such information. The nurse must maintain patient confidentiality in discussing their condition with others. This means the patient's condition, can be discussed only if they find it acceptable, but this can be reconsidered if the situation calls for information sharing which will help to save another person's life. It is when the code of ethics is not followed or adhered to, that a mishap happens. The cause of such mishaps is due to the inattentiveness of the nurse on duty or failure to realize a potential problem when it first occurs. Treatment is provided to a patient based on nursing diagnosis. Nursing diagnosis is a clinical judgment about individual, family, or community responses to a health problem or life processes. It forms the basis for selecting nursing interventions to achieve outcomes, for which the nurse is accountable. When a nursing diagnosis goes wrong it can lead to critical incidents. Here is a look at some examples of how a particular nursing diagnosis can go wrong: The nurse may have overlooked cues indicating a problem and this can make the already bad situation worse. For example, take a situation in which the patient reports discomfort at the insertion site of an intravenous (IV) catheter. The nurse notices that the area is slightly reddened. but fails to consider the risk for infection. As a result, the client develops sepsis or a blood infection, requiring emergency intervention and longer hospital stay. The nurse makes a diagnosis based on Insufficient Database, which can in turn give way to a wrong direction, wastage of valuable time and resources. For example, a patient may be displaying signs of anxiety. The nurse may administer a tranquilizer, based on this and later when checking the patient the nurse may find the signs of cyanosis, suggesting inadequate oxygenation. Thus, the anxiety probably was not just based on the person's anxiety; it also required other nursing interventions. The nurse may be providing treatment, based on another similar situation. Stereotyping treatment, negates individualization. It is due to the situation of mishaps that the concept of critical incident analysis proves to be useful, as it helps to develop nursing sensibilities which help the nurse align with the nursing code of conduct and at the same time be aware of possible critical issues in which they have to be keenly attentive. Critical Incident Analysis and its relation to nursing Critical incident analysis is the analysis of incidents, which may be close call or disasters, through which significant harm has occurred. The analysis provides a lesson to be learnt about an individual or understanding certain organizational factors that can be remedied to prevent such an incident from happening in the future. According to Cooper, in his book, 'Preventable anesthesia mishaps: a study of human factors. Anesthesiology', critical incidents are "Occurrences that are "significant or pivotal, in either a desirable or an undesirable way," Critical incident analysis serves to make nursing practices safer in the following ways: It serves as a tool that can integrate theory and practice. It helps to promote reflective nursing practice and serves as a medium for developing curriculum content in nursing colleges. Enables a professional nurse to become more analytical, thereby, identifying the problem quickly. Critical incident analysis can be made more effective, when it is taught to nursing students as part of their course curriculum. The teaching can be done using the following simple steps: Describe a critical incident and the social context in which it occurred. Explain the meaning of the incident within that social context and the lessons to be learnt from the incident Provide a more general meaning, in the situation Identify your position, in the situation The teaching steps can be implemented through a small training project. For example, students can be invited to compile a critical incident file, by analyzing events which happen during their clinical experience. These events may be positive or negative in nature, but by analyzing the critical incident, the student is forced to go beyond their personal response and consider the "bigger picture". This lesson will increase the student's their ability to withhold judgment, until all aspects of a situation have been considered. Solution for safer nursing practice Though critical analysis is a key factor in bringing about safer medical practice, it alone will not suffice. There have been reports that Nurses increasingly are facing deteriorating working conditions at the facilities in which they work. Nurses also are reporting increasing burnout and widespread job dissatisfaction. Though these are not directly related to the treatment process, these reasons cause a shortage in nursing staff which may affect the treatment process. In order to solve such problems and to inculcate safer nursing practices, what is most importantly required is to reinforce the true value of nursing in modern times and focus on the values of nursing, which state that: Nursing is based on giving holistic care, and is intended to focus on the person as a whole person and not a particular aspect or pathological condition. It is based on Ethical values which respect the dignity, autonomy and uniqueness of human beings. In the nursing profession, there exits a privileged nurse - patient relationship, which forms the basis of trust and confidentiality that must be maintained at all times. These values have been put forth by the two most important organizations concerning the ethical code of conduct to be followed in the nursing profession and ensuring public safety. These organizations are the Nursing and Midwifery Council, (UK) and the American Nurses Association. Nursing and Midwifery Council The Nursing and Midwifery Council is an organization which was established by British Parliament to ensure that nurses and midwives provide high standards of care to their patients and clients. It carries out it aim in protecting the public through the following activities: It records details of qualified nurses, midwives and specialist community public health nurses. It had laid down the standards for conduct, performance and ethics. It offers advice for nurses and midwives. It looks into allegations of misconduct, lack of competenceor unfitness for practice, arising out of ill-health. American Nursing Association The American nursing association and the United States Congress initiated the Code of Ethics project on nursing practice in 1995. In 1996, the Code of Ethics Project Task Force, appointed established a comprehensive process of review, analysis and revision of the Code for Nurses (1985), providing initial substantive critique and suggested modifications, creating open review process, and developing final recommendations. Following is a brief summary of the code of ethics as pt forth by this task force: The primary commitment of a nurse is to treat the patient The nurse should promote, advocate and strive to protect the health, safety and rights of the patient . The nurse is responsible and accountable for the nursing practices they follow. The nurse is responsible for maintain their integrity, safety, competence during .the course of their professional career. The nurse is responsible for improving the health care environment and conditions in the place of employment in order to provide quality care to the patient. The nurse should participate in contributing towards advancement of the profession. The nurse should collaborate with other health care professionals to meet health needs. The nurse should practice with compassion, with respect to he inherent dignity and worth and uniqueness of every individual and should no be biased by social or economic issues, nature of a person's health and their personal attributes. Case Study In order to further understand the professional, legal and moral issues which apply when a nurse is on duty, let's take a critical incident as an example and analyze this incident from these standpoints. Critical incident: A 55yr old gentleman was admitted to hospital, due to his emergency condition at 5 pm. The next day, he was transferred to the High Dependency Unit (HDU) because of his deteriorating condition, which was caused by Acute Pancreatitis. The Consultant Surgeon requested for a naso gastric tube (Ryle's tube) to be passed via the left nostril for feeding. The nurse looking in the patient had inserted a fine bore naso tube so that the patient could receive internal feeding. However, the nurse passed the tune through the lung instead of the stomach, in spite of having many years of experience. Though chest x-rays were taken, the patient continued to receive feeding though the tube passed into the lung. After a week of such feeding, the ICU Anaesthetist informs the patient's wife and sister, that the patient had multiple organ failure in addition to Acute Pancreatitis. Following is an analysis of what the staff failed to do on duty: The Nurses on duty do not recall being specifically asked to insert a fine bore tube. However it is standard practice that naso gastric feeding is administered via a fine bore tube. Therefore a fine bore tube was inserted. This meant the patient had two naso gastric tubes inserted. According to the National Patient Safety Agency's (NPSA) advice, radiography is the most accurate method for confirming naso gastric tube positioning. A chest x-ray taken, to determine this and the x-ray was misinterpreted. It is the responsibility of the nurse who initiated the naso gastric feed to confirm that the tube is correctly positioned, when doing this, but failed to do so. When the patient showed signs of respiratory problems on the second day of treatment, the cause of this deterioration was thought to be related to the patient's first condition and not the problem of a misplaced tube and internal feeding going into the lungs. There were three chest X-rays taken. Chest x-ray (No 1) stated that there is a naso gastric tube with its tip below the diaphragm. Chest x-ray (No 2) states that two naso gastric tubes are inserted; one just to the right of the midline appears to pass into the lower lobe medial segmental bronchus'. Chest x-ray (No 3) also states that two naso gastric tubes are inserted. The first tube is positioned to the right of the midline and appears to end abruptly before the diaphragmatic hiatus. A second tube, although poorly seen is noted within the stomach. All these x-rays were not reported and the reports were not available until after the critical incident. The Nursing and Medical documentation does not give a detailed account of the exact naso gastric tube to be used, the recording of the fine bore tube insertion and confirming its position. In their internal document, they mention that internal feeding was stopped at 01.00hrs and then restarted at 02.00hrs, but no reasons were stated for these actions. The Nursing and Medical Staff involved in the incident failed to identify the misplaced tube as the unusual cause of respiratory deterioration in a patient with severe pancreatitis. The professional issue not met was, that the standard procedure of checking the position of the tube was not done, when it was inserted it into the patient. Furthermore, chest x-rays were neither reported nor examined properly. All this is part of the routine medical duty. The legal issue is that staff negligence had cost a man his life and they can be sued for this. The moral issue is that, the very nurse responsible for saving life has but it into a threat, which goes very much against the nursing code of ethics. What is to be understood from this critical incident is that, procedures that should be followed must be strictly adhered to, so as to avoid mishaps. In this case, if the nurse on duty had checked the position of the tube inserted, it could have saved the person his life. They should realize their accountability in the issue of patient care. Their utilitarian thought of presuming what they think is correct had lead to negligence. Some recommendations Following is a list of comprehensive recommendations for safer nursing practice: At all times the nurse must follow their nursing code of ethics They must develop a client database and analyze this data during treatment Identify the need for treatment in a step-wise manner Create a plan of action and implement it Note if the desired outcome have been met Documenting the Nursing Process for further knowledge and learning Bring in the concept of critical incident analysis, during practice to prevent mishaps and induce better nursing sensibilities References ANA, The code of ethics, Avialable://http://www.nursingworld.org/ethics/ecode.htm Patient Safety Network, Available: //http://psnet.ahrq.gov/glossary.aspx ANA, Nursing Shortage Indicators, Available: http://www.nursingworld.org/readroom/fsshortage.htm NCBI, Reflection and critical incident analysis: ethical and moral implications of their use within nursing and midwifery education, Available:. http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=PubMed&list_uids=8675857&dopt=Abstract International Nursing Group, Available:http://www.ingid.org/news-eu-consensus-conference.html NCBI, Developing reflective practice in mental health nursing through critical incident analysis, Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=PubMed&list_uids=7714277&dopt=Abstract Curtin University of Technology, Using critical incidents in professional education to develop skills of reflection and critical thinking, Available: http://lsn.curtin.edu.au/tlf/tlf1997/burgum.html Nursing and Midwifery Council, Nursing, Available: http://www.nmc-uk.org/aSection.aspxSectionID=32 New York State Nurses Association, Informed Consent, Available: http://www.nysna.org/programs/nai/practice/positions/position18_04.htm Wikipedia, Nursing, Available: http://en.wikipedia.org/wiki/Nursing Wikipedia, Nursing Theory, Available: http://en.wikipedia.org/wiki/Nursing_theory Wikipedia, Nursing Ethics, Available:http://en.wikipedia.org/wiki/Nursing_ethics Read More