Advanced Nursing Ethics and Values - Research Paper Example

? Advanced Nursing Ethics and Values A. Introduction Contemporary realities, such as diverse worldviews and technological and scientific progress, make it necessary for nurses to take into consideration the major ethical issues in their personal and professional lives. As delicate and complicated ethical issues keep on challenging healthcare professionals, numerous practitioners have started to adopt an understanding of traditional ethics and principles and the different perspectives of others. This paper discusses the importance of ethical theories to nursing practice; principles of confidentiality and reasonable limits; how to resolve conflict between two or more ethical principles; influence of culture on values; and the application of the integrated ethical decision-making model to the case of confidentiality. These topics are applied to the case of Mrs. Z, who is diagnosed with breast cancer but refuses to take additional treatment and disclose her medical condition to her family. This paper analyzes the ethical dilemma inherent in the case and how can the healthcare team resolve this through the application of ethical theories and principles in nursing. B. Justify the Importance of Ethical Theory to Nursing The key role of theories is to provide individuals with a worldview or perspective which may guide them in identifying, describing, explaining, or predicting phenomenon or formulating measures which will facilitate the phenomenon. The competencies that nurses use in the process of ethical decision making are not enough to make appropriate and coherent ethical decision (Lachman, 2012). There are several theories that are drawn upon to help nurses resolve ethical dilemmas. Ethical theories take into account the purpose or motive of the nurse, the techniques exercised by the nurse to carry out the act, and the outcomes of the act. There are four ethical theories that are widely used in nursing practice, namely utilitarianism, deontology, virtue, and egoist (Fairchild, 2010). Utilitarianism is usually viewed as asserting that the decision-making process is based on the ‘greater good’. Deontology is rooted in the notion of duty. Nurses have a binding obligation to pursue acts that will benefit their patients. Virtue theory states that the motive of the individual making the ethical decision is what establishes whether or not the decision was ethical or good. If the purpose was good, then even though the result was bad, the decision would still be moral. And egoist theory promotes the concept of rational self-interest (Fairchild, 2010; Paganini & Egry, 2011). B.1. Provide one example that shows the importance of ethical theory as it applies to nursing practice Mrs. Z refuses to undergo life-preserving treatment and disclosure of her medical diagnosis to her family after being diagnosed with breast cancer. Dr. F and the nurse confront a typical ethical dilemma: they desire to prevent the perceived ‘harm’ of Mrs. Z’s condition. Nevertheless, they also desire to fulfill the ‘good’ of valuing the informed decision of the patient and prevent the ‘harm’ of violating her autonomy. In this case the process of ethical decision making will require analysis of similarly firm but contradictory ideas—respect for patient autonomy vs. the preservation of life. In this case the healthcare team may look at the deontological side of the situation to determine if their actions are in accordance to the rules and guidelines of their profession. On the other hand, virtue ethics will help determine if their actions are according to moral or good intention. C. Relate the Principle of Confidentiality to the Concept of Reasonable Limits Confidentiality is the obligation to protect and respect private information. The rule of confidentiality states that nurses should give respect to their patients’ privacy needs and use private details about them only to enhance their care (Longhi-Deshefy et al., 2004). Healthcare professionals must observe confidentiality to reduce patient vulnerability. C.1. Explain the elements of principle of confidentiality Generally, the principle of confidentiality requires that information obtained in a nurse-patient relationship should be kept private and protected, even in instances where its disclosure is merited (i.e. for the greater good) (Haggerty & Hawkins, 2000). Confidentiality is at the heart of healthcare providers building trusting relationships with their patients, their families, and other healthcare providers. C.2. Summarize the elements of the concept of reasonable limits Even though the principle of autonomy lies behind the thought that upholding confidentiality is imperative in the healthcare context, it is not a ‘fixed’ virtue. Limits to protecting an individual’s autonomy arise when an individual’s action or decision may inflict harm to self or other people (Haggerty & Hawkins, 2000). When private information that has repercussions for the health or safety of another individual is given to a nurse, that nurse is confronted with the duty of identifying the possibility and level of risk and deciding whether that information should be disclosed and with whom. C.3. Provide a rationale for breaking confidentiality At times the nurse may stumble upon limits on specific moral guidelines associated with nursing practice. One rationale for breaking confidentiality is when the healthcare provider has been ‘released’ from a duty (Longhi-Deshefy et al., 2004). If Dr. F makes a promise to Mrs. Z to keep her medical information confidential the physician would, as a rule, be forced to conform to the moral law requiring confidentiality. But if Dr. F asks Mrs. Z for consent to disclose and she consents, it may perhaps be assumed that Dr. F has been ‘released’ from the confidentiality law. C.4. Based on reasonable limits justify keeping or breaking confidentiality The tenet that nurses should perform care that will promote the wellbeing and health of the patient perhaps involves several unstated limits. In the case of Mrs. Z, the healthcare team should decide what limits are incorporated into the obligation to provide the best possible patient care. Hence, the nurse of Mrs. Z was right in deliberating first the nature of confidentiality required by the patient about her health situation. However, in the interest of preserving her life and to afford her necessary medication for her life, her husband, being her able partner in life, should be accorded necessary information, albeit the prescribed limitations, so that the family can also support her medical, emotional and psychological needs. D. Identify how to resolve conflict between two or more ethical principles The healthcare providers of Mrs. Z are confronted with two conflicting ethical principles, namely, patient autonomy and preservation of life. D.1. Summarize one ethical principle that would be in conflict if confidentiality were broken An ethical principle that would be violated in case of breach of confidentiality is patient autonomy. This principle focuses on the right of patients to have control over their own lives. Patient autonomy stresses that an individual has the right to make a decision to whom private information about him/her should be given to (Milton, 2007). Hence, Dr. F and the nurse will violate Mrs. Z’s right to autonomy if ever they decide to disclose her medical information to her family. D.2. Explain an appropriate ethical theory that could support the decision to keep or break the confidentiality. In contrast to patient autonomy, virtue ethics places emphasis on the standpoint of the healthcare provider instead of that of the patient. This perspective focuses on the issue of what determines whether an individual is virtuous or not instead of what is the right response to certain situations (Quinlan-Colwell, 2010). One of the attributes of a virtuous nurse, it may be claimed, is that s/he values human life more than anything else (Parker, 2007). Hence, based on virtue ethics, it is ethical for the healthcare team to disclose private information about Mrs. Z to her family. She may be persuaded by her family to undergo additional treatment to prolong her life. E. Discuss the influence of Culture on Values Knowledge of a patient’s cultural mindset is fundamental to understanding of the individual. Taken for granted cultural differences between the patient and the nurse can lead to problems with the relationship or disappointment when the nurse or the patient does not fulfill the unspoken, culturally based expectations and preferences of the other (Carnevale et al., 2009). Just like in the case of Dr. F and Mrs. Z, patients may disclose symptoms or other private information to a healthcare provider with the same gender as that of the patient but of different culture because they might think that confidentiality will be upheld. E.1. Compare and Contrast the cultural values related to confidentiality for the Z family and for the providers. Apparently, the culture of the Z family highly values confidentiality and privacy, even in the face of perceived harm. In contrast, the healthcare team seems to be willing to forgo their duty to confidentiality in favor of life preservation. It appears that the cultural belief system of the Z family hinders the delivery of modern medical treatment. E.2. Propose two nursing interventions that could help reduce or resolve the ethical conflict of keeping or breaking confidentiality. First is to consult other professionals, within or outside the organization, and try to involve the patient to the process. Allow the patient to look for other professionals so that s/he can regulate the disclosure of confidential information. And second, take appropriate measures to determine the competence of Mrs. Z to make a decision. A psychiatric assessment must be carried out, if needed, before making a final decision regarding confidentiality. F. Identify one ethical-decision making model used by masters-prepared nurses in the delivery of healthcare The ethical decision-making model that is most appropriate in the case of Mrs. Z is the integrated or holistic model. In the integrated ethical decision-making model components of virtue ethics and principle ethics are combined to establish a holistic evaluation of the condition of the patient so that the ethical and needed plan of care could be made (Garcia et al., 2003). F.1. Describe the steps in your selected ethical decision-making model The healthcare team can use the integrated model to decide whether to maintain or break confidentiality. The integrated model requires completion of four steps of data collection, planning, implementation, and evaluation. Tarvydas (1998 as cited in Garcia et al., 2003) identifies these four steps as (1) interpreting the situation through awareness and fact finding, (2) formulating an ethical decision, (3) selecting an action by weighing competing non-moral values, and (4) planning and executing the selected course of action. F.2. Apply your selected decision-making model to the given case to determine a decision for resolving the confidentiality conflict The first step is to look at the condition and identify the kinds of situations that form an ethical dilemma. The healthcare team should consider the situation as an ethical dilemma and identify the people directly involved in these situations. This part is data collection. The healthcare team should gather all the relevant information such as the psychological condition of Mrs. Z, the financial status and cultural beliefs of the family, etc. It is the responsibility of the medical practitioner to gather all the relevant details and evidences related to the ethical issue. For example, the entire medical details, background, principles and laws. This information will help the healthcare team determine the possible reasons why Mrs. Z refuses to disclose her true health condition to her family. The second step is making the ethical decision based on the data collected. Primarily, the healthcare team assesses the issue particularly to identify what ethical principles are relevant to the situation. Practitioner should review the certified standards, for example, ACA (Affordable Care Act), ASCA (American School Counselor Association) and NBCC (National Board for certified Counselors). And then, after a thorough assessment of these principles, they list all the possible measures alongside the favourable and unfavourable outcomes for implementing these measures. The healthcare team should ask the opinion of other professionals. Finally, the most appropriate ethical step is chosen based on a systematic, rational assessment of the relevant principles. In the case of Mrs. Z the ethical principles involved are confidentiality, patient autonomy, and preservation of life. Based on these principles, any or all of these following courses of action may be taken: (1) inform Mrs. Z about the nature of her illness, the possible consequences of not taking additional treatment, and the possible impact of the disease on her and her family if left untreated; (2) persuade Mrs. Z to take the additional treatment by explaining to her the ethical codes of the profession and the possible problems that may arise due to her refusal to divulge her medical condition to her family; and (3) involve Mrs. Z in the entire ethical decision-making process. However, based on the case given, the most appropriate step to be taken for the moment is disclose the medical condition of Mrs. Z to her family because they have the right to know and because the patient refuses to take the additional treatment which could lessen the severity of the illness. The third step requires an analysis of the course of action from the point of view contextual principles (e.g. cultural, institutional) and personal conflicting principles. The healthcare team should first accurately determine the forces influencing Mrs. Z’s decision not to inform her family about her illness before choosing the best course of action to take. If, for instance, her reason overweighs the importance of being treated then the healthcare team should consider the option of maintaining confidentiality. If Mrs. Z cannot give such reason, then the healthcare team should break confidentiality. The healthcare team should be certain that there decision is not value-laden. The last step is planning and implementing the chosen course of action. In this stage the healthcare team identifies the actual steps that have to be taken, as well as the possible hindrances to the implementation of the chosen course of action. For instance, since the healthcare team decides to inform the family of Mrs. Z about her illness, they should consider the possible responses of the family members, especially the husband; the possible impact of the bad news on the family members, especially the children; and the possible response of Mrs. Z to the disclosure of her health condition. If, for instance, the disclosure of the confidential information will stigmatize Mrs. Z and her family then the healthcare team should re-evaluate the situation. There are other relevant factors, besides the importance of preserving life, that must be taken into consideration. Conclusions In conclusion, the healthcare team has to give authentic explanations to Mrs. Z and tell her the advantages of informing the relatives about the disease. In this way, Dr. F and the nurse can solve the ethical dilemma inherent in the case of Mrs. Z. Due to its consideration of stakeholders, conflicting personal principles, and contextual factors, the integrated ethical-decision making model seems the most appropriate model for the case of Mrs. Z. This model is multicultural and applies virtue ethics, which justifies limits to confidentiality. References Carnevale, F. et al. (2009). Ethical Considerations in Cross-Linguistic Nursing. Nursing Ethics, 16(6), 813-826. Carney, M. (2011). Influence of organizational culture on quality healthcare delivery. Journal of Health Care Quality Assurance, 24(7), 523-39. Fairchild, R.M. (2010). Practical ethical theory for nurses responding to complexity in care. Nursing Ethics, 17(3), 353-362. Garcia, J. et al. (2003). Transcultural Integrative Model for Ethical Decision Making in Counseling. Journal of Counseling & Development, 81(3), 268+ Haggerty, L. & Hawkins, J. (2000). Informed Consent and the Limits of Confidentiality. Western Journal of Nursing Research, 22(4), 508-514. Lachman, V. 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