External Influences on Nursing Ethics - Essay Example

It allows the patient to decide, after considering all the consequences of such treatment protocol. The patient is given unconditional worth and utmost respect (Morrison, 2011, p. 28).

Truth-telling is an ethical imperative; however, there are situations where absolutely telling the truth can be harmful, creating an adverse reaction from the patient and his family. Truth can be told in stages, or in installments. Morrison mentions that Kant requires truth-telling as a categorical imperative but utilitarianism, on the other hand, requires the health care provider to weigh the benefits of truth-telling against possible harm if the truth is told all at once. Fidelity can be done in installments if the situation warrants it (ibid. p. 34), and out of compassion.

A similar situation which I had encountered concerned patients who are diagnosed with Alzheimer's disease. It presents an ethical predicament for a need to communicate honestly and a need to keep it secret at first due to the reluctance of family members to disclose to the patient that he is suffering from an irreversible, incurable, and eventually hopeless, diagnosis. Silence may be conflicted with patient autonomy as at its early stages, an Alzheimer's patient can still decide.

Staff within a health care system are hired based on their initial competence and then must undergo regular evaluations based on demonstrated continuing competence (JCAHO, 2002, p. 12) to create an ethos of continuous learning. A good competence assessment program must be systematic, objective, and measurable, done by a series review of performance data (Smith & Pelletier, 2009, p. 21) and attendance in continuing medical education (CME) programs.

NON-MALFEASANCE AND WORKPLACE BULLYING

There are definitely a number of situations where the nurse is exposed to certain acts of bullying, from the head nurse, the supervisor nurse, the nurse manager, or even worse, the attending physician who acts in a menacing manner to see if instructions are followed. This situation puts the nurse in a compromising situation where the nurse can be torn between a tendency to uphold nursing ethics or comply with a directive. One of the foremost principles in the nursing profession is to do no harm (non-malfeasance) but there are certain times when the nurse has to choose between complying with orders or following his or her conscience with regards to patient treatment. Bullying cases arise from work-related pressures and are against medical ethics.

Workplace bullying where the nurse is threatened with suspension or termination if she does not follow orders can have a demoralizing effect. This can cause the resignations of those who are well-qualified nurses, who may not take it lightly to do things against their conscience. It is the entire community that will eventually suffer as it loses its good and competent nurses. It is the job of health care executives to see this situation does not develop or is even tolerated.

Executives must be vigilant and investigate complaints of bullying by a supervisor that compromise patient safety and overall quality of health care. It is imperative that a culture of ethical conduct pervades throughout the institution or organization. American College of Healthcare Executives (ACHE) regularly conducts its continuing education programs through its foundation (ACHE, 2012, p. 1) and has an institute of leadership to instill the importance of acting ethically (Owen, 1990, p. 155).  Staff who were proven incompetent, even physicians, will lose their privileges and credentials, even cause their removal from the list of accredited practitioners authorized on behalf of and by the health care organization (JCAHO, 2003, p. 2).

INCREASED FEDERAL FUNDING OF HEALTH CARE

An immediate impact on increased federal government funding for health care is making health care services more affordable and equitable. Previously, only people of financial means can afford to buy private health insurance, leaving out those in the lower economic classes from availing of needed health care services. These people usually avail of health care as a last resort, resulting in higher medical expenses because their entry point is the emergency room.

However, the recently-enacted health care reform laws now make it mandatory to obtain health insurance coverage, mostly from private insurance providers who are operating under the market forces of competition, efficiency, and profitability. In this aspect, health care quality may suffer if profits are considered more important than quality and affordability. A health institution can still render quality health care services and at the same time, remain a profitable venture or undertaking; administrators act as the guardians of public health using a paradigm shift.

Cost containment is a concern, and so all those involved in the health care and another ancillary medical profession must find new ways of reducing the now escalating costs and this can be accomplished with a new paradigm shift (Wheatley, 2006, p. 101) to view the delivery of the health services as a social responsibility. New technology can be harnessed that will reduce cost, improve efficiency, and enhance accuracy to improve patient safety (The Hastings Center, 2012, p. 1). Increased federal funding can result in lower local community fundraising markedly.