The Philosophy of Ethics as a Fundamental Requirement to Nursing Practitioners - Essay Example

Case Study for ODP On the 25th March a 15 year old patient, Mary, walked into the hospital where I was attached, as a nursing practitioner, to seek medication on her rapidly deteriorating health. She underwent the regular examinations to determine the nature of her sickness and immediately the doctors arrived at a conclusion that Mary should be taken to the theater for a minor operation on her left hand besides further medical attention. Upon closer observations, I noticed that Mary was a very anxious young girl. Although she had been accompanied by her Mother, Mrs. Silvestre, to theatre for a minor operation under local and is being checked into the department, she remained restless throughout the entire period of admission process. My mentor, Dr. Hughes, supervised me as I took Mary and Mrs. Silvestre through the theater admission procedures. After sometime, Mrs. Hughes decides to quickly nip to the toilet during the process in order to get back ready to transfer the patient into theatre. He leaves me behind to complete the remaining procedures and prepare the patient for admission. It is during this time that I observed that the consent form has been signed by Mary and a comment added to the notes that Mary thinks she may be pregnant. I proceed to confirm this comment setting Mary free for theater admission after completing all required procedures. After transferring Mary into theatre my mentor attempted to insert a cannula into the dorsum of Mary’s hand. To my utter amazement, Mary is startled by the sharp pain inflicted upon her by the inserted cannula. She immediately withdraws her hand resulting in the cannula becoming dislodged with some blood spillage. I privately ask Dr. Hughes, my mentor, why such a unique occurrence is taking place and she quickly confesses that she has not really attempted a cannulation procedure unsupervised before. I concluded that she must have forgotten to follow certain necessary procedures resulting into the pain experienced by the patient and consequently, the blood spillage upon withdrawal. Despite all these, however, Dr. Hughes decided to have another go on the patient in order to save time. Introduction Nursing practitioners have a huge role to play in seeing forth the liberation of patients from the anguish of various diseases. The situations to which nursing practitioners are often exposed as health care professionals are sometimes so complex and demanding including serious issues of health and well being of various patients. It is for this reason that nursing practitioners have to be well informed of their duties and mandates to enable them execute their duties in an ethical and acceptable manner while maintaining their professional understanding in different areas of specialization. The philosophy of ethics is a fundamental requirement to all nursing practitioners. The term ‘ethics’ implies an illustration of how NPs should behave themselves or determine what they are required to do while interacting with and giving care assistance to patients. Perhaps Beauchamp & Childress, (2009) contributions into this matter can shade more light in informing decision making process in line with a close observance of the ethical issues underlying the practitioners’ behaviour during care giving process. Edwards, (2009) asserts that due to the different settings upon which NPs are subjected and the necessary philosophical assumptions that have to be made in order to arrive at an appropriate procedure in every circumstance, nurses are often involved in various circumstances of patients’ lives. It is, therefore, very important for all NPs to be sound aware of the available ethical concerns surrounding their work before embarking on their varied array of roles. The case study illustrated above shows a general breach of the necessary requirements that the nurses in question needed to comply with before handing the pertinent issues relating to the patient’s health and care giving affair. All nurses are required to strictly adhere to all theoretical and regulatory measures set to inform their decision making procedures. Total compliance to these set rules and regulatory frameworks have been advocated for by several writers and regulatory bodies (Gastmans, 2006; Hendren, 2010 and Kohlen, 2011) A breach of these rules often results into serious problems that can cost the lives of the respective patients hence violating the intent by the practitioner. This article is an illustration of the ethical issues to be considered by nursing practitioners in order to ensure that their missions are successful in every aspect. In this regard, I have provided an illustration of the ethical concerns from the legal, professional and theoretical points of view with a view of highlighting the salient features expected of nursing practitioners. The guiding principles under the HCPC have been used to inform the various arguments illustrated in this paper in order to enhance the NPs understanding of their roles and requirements based on the case study illustrated above. The study has also drawn from various ethical theories used to inform decision making by nursing practitioners. These theories have been related to the case study described in this paper in order to illustrate a full understanding of the underlying contexts in the field of nursing and medicine in general. Legislation, case laws & legal issues Various legislative laws and other regulatory frameworks have been laid down by various nations and health related bodies to help NPs execute their mandates efficiently without infringing on the patients’ rights. Lachman, (2009) has provided an illustrative investigation about the whole aspect of care giving. However, Mead, Bursell, & Ketelsen, (2006) arguments are concurrent with that provided by other scholars stating that the ultimate need of all patients is recovery from their respective illnesses. He however asserts that, in the process of ensuring the provision of such care to the needy patients, they need to be respected and their held with utter conscience. The ethical provisions illustrated herein are in support of this idea highlighting that the patients, as customers in the health sector must have the overall say and, therefore, care givers must seek and adhered to their conscience. According to Vanlaere & Gastmans, (2011) only the patients’ own words should be used to make relevant judgments concerning their sicknesses. It is for this reason that clear conscience is often sort for before care givers embark the provision of care to patients. The Oregon board of nursing has provided an acute definition on the scope of nursing practice taking into consideration the responsibilities of the individual nurses (Watson, 2001) Among the key considerations in their definitions include the assessment of clients, synthesis and analysis of data, and the application of nursing principles and the related therapeutic procedures required at ever y stage. In cases where the NPs are not certain of the necessary steps to be taken in order to ensure successful implementation of nursing requirements, the board provides room for consultation and/ or collaboration with other care givers as well as community resources in order to make conclusive decisions. These regulations provide room for all NPs to engage in a consultative exercise before making decisions (American Nurses Association (ANA), 2001). Besides, every NP is entitled to making sure that all data and other clinical information are in line with all the requirements of all existing laws, legislations and set regulations by the nursing bodies as well as other regional bodies. According to the case study described above, the regulations set for safe practice puts all NPs in charge of the patients’ data and ensuring that the information provided therein is right and reflects the patients’ feelings and true status. Failure to closely scrutinize the content of the information provided in order to make safe decision was a dire mistake that certainly recapitulated in the later stages. Debates have arisen on the person that should be authorized to sign the consent form before any theatrical operation is conducted. Some experts have argued that both the patient and the accompanying persons should append their signatures on the form as a form of legality. However, a great deal of literatures has pegged their argument on the basis of the patients’ conditions (Casals, 2000). A good portion of the existing regulations in various nations such as USA, Britain, India, have maintained that, owing to the critical conditions in which some patients may be, they may not be in a position to sign the consent forms. According to Pojman, (2010) would bring discord in ensuring uniformity in the legal procedures during care giving process. In many countries as Butts & Rich, (2008) observe have left the signing of the consent form entirely to the accompanying persons. The international regulations on nursing practice are aligned with the view that all consent forms should be signed by the accompanying persons. The ODP has gone ahead to give details on the accompanying persons authorized to sign the consent forms. These include close associates to the patients such as: relatives, spouses, siblings, parents, guardians, well wishers and children that are in charge of the patients admitted at the theaters. It is the sole mandate of the accompanying persons to give their consents guaranteeing the physicians the authority to operate on the patient. Contrary to this normalcy, in line with the set regulations, the consent form in this case was signed by the patient without the involvement of the person in charge. Besides, the irregularity noticed on the consent form, the ODP guidelines advices all NPs to seek clarifications on the sections that are not clear to them from other experts, especially their mentors. According to Beauchamp & Childress, (2009), every practitioner is allocated a mentor that is often in charge of all the activities undertaken by them. NPs are not authorized to make decisions not approved by their mentors (Kass, 2001). During the period when student nurses are attached to any health providing unit, they are suppose to execute every activity under strict supervision of the mentors. Questions have been raised on the legalities behind NPs acting in the absence of their mentors. For instance, Oberle & Tenora, (2000) has argued that the NPs should be allowed by laws to act in the absence of their mentors in case of emergencies. For instance, in some cases, the mentors may be committed with other affairs and the NP is the only person available, especially in care centers where the number of nurses is low compared to that of patients streaming in for medication. In such cases, the Oregon board, Alabama laws on nursing and medical practice among other regulations allows NPs to seek clarification from other quarters before making radical decisions. Schlesinger, (2002) on the other hand prohibits NPs from acting on any emergency arguing that they are prone to making serious mistakes in the course of exercising their duties. Slowther, Johnston, Goodall, & Hope, (2004) has drawn his arguments from a wide array of cases where NPs have been allowed to carry out the legalities involved during patients’ admission to theaters. He sites several cases where grievous mistakes have been committed that are against the laws and ethical requirements. Based on these practical observations, Crigger, (2002) also recommends barring of NPs from acting on emergencies. Moreover, the Oklahoma Statute on nurse practitioners bars NPs from acting on any emergency owing to the possible mistakes that can be committed by them in the process of executing their mandates. According to Crigger, Brannigan, & Baird, (2006) theatrical enrolments are considered emergency issues and therefore calls for fast action by the persons involved. Some scholars give leverage for NPs to act on emergencies only under strict supervision of their mentors. For instance, the Pennsylvania laws on health practitioners spells it out that the nurse practitioner is the only person available in the absence of their mentors, the case should be dealt with as a referral case rather than being executed. This argument owes to the possible mistakes, ethical, legal and professional, that the practitioners are liable to cause. A number of regulatory frameworks, laws and legislations on the mandates in Australia, USA, Britain, India etc calls for a mandatory presence of a mentor in cases where the NPs have to deal directly with cases of emergency (Daly, 2002). In fact, the HCPC hold mentors responsible for any mistake committed by NPs in their absence. Relating these laws and regulations to the case described above. It is the sole responsibility of the mentor to ensure that the NPs under their control do the right things at any given moment. The fact that the mentor left in the process of carrying out an emergency admission shows his neglect of the mandated duties. The mentor is therefore to be held responsible for any mistake committed by the mentor while attending to the emergency case described above. A lot of the laws and regulations are in agreement that the NPs are to act on referral cases only in the presence of their mentors. According to the case in question, the mentor left alone the student practitioner to act on the patient and make own decisions by completing the admission process. This negligence resulted into overlooking of serious offences under the nursing and practitioners laws. Treating the case as an emergency, the student practitioner did not wait to confirm the actions with the mentor. Allowing the patient to sign the consent form was the initial mistake committed and which required correction at the admission stage. This did not happen and is, therefore, a serious breach of the existing laws and regulatory frameworks mandating only the accompanying persons, described in the ODP document for NPs. All medical practitioners act in collaboration and constant consultation with their colleagues in order to ensure that the patients are cared for adequately (Dossey, 2000). The general rule of the health sector (Esterhuizen, 2006) implies that in cases where the health practitioners charged with the responsibility of taking care of the patients at any stage, they are only required to act on the basis of their surety. In cases where the practitioners are not sure of the procedures and the intended outcomes, they are directed to refer the cases to other practitioners that are confident with the situation under examination. The ethical concerns in the medical field require medical practitioners to act only on cases for which they are certain. Fowler & Benner, (2001) has investigated the aspect of medical care offered by the medical practitioners all over the world. He asserts that the aspect of care should be strictly based four fundamental basics. These include good attitudes on the side of the practitioner, the inclusion of certain activities relevant to the patients’ condition and the professional requirements. Moreover, In the Mix, (2007) adds the two additional aspects including a good knowledge of the patients and accurate assessment of the patient’s and clinical situations. An adequate and effective assessment of the prevailing condition stated above should be enough to inform the medical practitioners of the required course of action. The legal requirements set for all NPs in North Dakota states the responsibilities of the practitioners highlighting the limits and the course of operations expected of all practitioners. In this regard, the North Dakota NPs regulations assert that all practicing nurses are expected to provide supportive and restorative care and nursing treatment, medical administration, health counseling and teaching to patients with chronic illnesses, case findings as well as referral of persons with acute illnesses, injuries or those experiencing changes in their normal health processes. In line with these requirements, the medical practitioners are required not only to provide health services to their patients but also to uphold their professionalism in alleviating the patients’ pains. Inflicting pains on the patients attended to is an indication of the level of unpreparedness on the side of the medical practitioner. Section 2836.1.C of the nurse practitioners laws and regulations provided by the Board of registered Nurses of the state of California states: The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure (Rushton, 2007: 153). NPs are required to strictly adhere to the set standards for the maintenance of their professional abilities and avoid erroneous performances. In this regard, the levels of qualification of the nurse are supposed to be closely scrutinized by the recruiting bodies before registration. Professional qualifications determine the purported success in executing the roles of any nursing practitioner. The mentor accepted his failure to successfully insert the cannula resulting into the pain inflicted on the patient and the consequent bleeding experienced. He says that he has never attempted the insertion in the absence of an instructor, which was the prime cause of the wrong insertion. International Council of Nurses, (2006) has maintained that honesty is as important in the medical field as the observance of the underlying ethical requirements. Internet Healthcare Coalition, (2002) pegs her argument based on Aristotle’s statement to more applicable in the medical field maintaining that even a right action is not ethical by itself, unless the action comes from the ethical motivation. About this fact, we can conclude that even though the action by the mentor to carry out the insertion on the patient without the supervision of an expert could be justified, the motive cannot be justified since it was deliberate. Deliberate mistakes are prohibited under the HCPC regulations and call for severe punishment of the persons involved, including prosecution of the respective persons. Breaching of the rules of absolute knowledge in carrying out medical mandates was a sure mistake committed by the mentor and was liable to punishment by prosecution under the set laws and legislations. Ethical theories The philosophy of ethics has attracted the attention of many people, including researchers and experts in various fields of knowledge. In medicine, just as in sociology and other related disciplines, the term has been widely used to define appropriate behaviour of nurses and other medical practitioners while executing their mandates (Johnson, 2003). Owing to its wide application in different fields of knowledge, the term ethics has been defined differently by different people depending on their areas of specialization and contexts in question. A lot of medical literatures are in agreement with the definition provided by (Kuhse & Singer, 2001). He defines ethics as the philosophical discipline that studies how nurses and other medical practitioners are expected to behave, or how to determine between right and wrong while interacting with others, especially with patients (Beauchamp & Childress, 2009). Medical practitioners are expected to uphold their ethical standards to ensure that their actions are in line with the ethical standards specified in the guiding laws and regulations set by various medical bodies. Different theories have been designed by different people to help illustrate situations under which medical practitioners are mandated to observe ethics while providing care to patients. In this section, I have discussed some of these theories in relation to the case study described above. Among these important theories include the Utilitarian theories and the deontological theories (Edwards, 2009). I have related the propositions of the theories above with the case context described in this paper. Utilitarian theories The utilitarian theories also referred to as the consequentialists theories advocate for the satisfaction of a majority of the population involved in an affair. Utilitarianism holds to the fact that before one carries out an act on the basis of their responsibilities or courtesy, they should weigh all possible outcomes on different people. Beauchamp & Childress, (2009) have investigated the relevance of the utilitarian theory to unveil the underlying consequences associated with it. He asserts that determining the course of action to be taken while dealing with various situations calls for a close analysis of all possible actions to be undertaken. The possible outcomes of each action should then be examined on every individual or group of individuals that may be involved in the affair. In this sense, the actions that lead to the best outcome for most people is to be selected among the other actions (Crigger, 2002). There were a number of options to be considered in the absence of the mentor and which were not put into consideration. A lot of laws have addressed various options to be considered in such situations. Consultation is of prime importance in situations where one is not sure of the possible action to be considered. The rule for health practitioners dictates that where one is not sure of the possible course of action, the expert is required to consult with other experts and other senior members in the same field of specialization (Kohlen, 2011). Room for consultation has never been closed to NPs at any given moment. Lack of proper consultation with the other senior members with similar specialization certainly led to ignorance on important issues that such as signing of the consent form by the patient. Besides, the mentor, just as other medical experts would have consulted on the appropriate ways of inserting the cannula. Wrong insertion as evidenced in the case study, could have possibly been avoided. According to the utilitarian theory, lack of consultation with the other experts was the core cause of harm experienced by the patient. As Kass, (2001) notes, psychological pains inflicted on the patients due to practitioners’ negligence and unprofessionalism can have much impact on the patients’ lives compared to the physical pains resulting from their illnesses. The choice to ignore information from other medical practitioners and each of the practitioners in question acting on their own understanding did not only affect the patient negatively but also her close associates. As a result, both psychological and physical effects were registered contrary to the assertions of the utilitarian theory. The action chosen in each of the cases analysed above were not fairly evaluated and therefore did not cater for the interest of most of the parties. Actions related to the lives of human beings should be closely evaluated to be in favour of a majority of the persons in question. The lesser the number of people negatively affected by such actions, the better is the action, hence its recommendation. The utilitarian theory has been widely applied in medical research and patients care strategies. Beauchamp & Childress, (2009) has presented a rather absolute assertion on the need to uphold the utilitarian theory. He records that any action geared towards a person’s life must be well evaluated and no negative impacts be tolerated. He specifically mentions the increment of pain on patients as the initial point of argument in the nullification of an action as ineffective and inappropriate, an idea that is commensurate with the assertions of the utilitarian theory. Non- compliance with the utilitarian theory in conducting the whole process was a great breach of the laws and makes both parties involved liable for prosecution and other forms of punishment. Deontological theories Deontological theories are among the ethical theories that hold to the fact that the ethical consideration of an action depends on the motivational basis informing the particular action. The term ‘deontological’ was developed to distinguish duty- bound ethics from more utilitarian ethical consequences. The term has however been considerably expanded to include emphasis laid on other consequences other than the utilitarian ones alone. The term was coined by Immanuel Kant, a philosopher by profession, who lived between 1724 and 1804 (American Nurses Association (ANA), 2001). The sole intention for the development of the term, and consequently, the theory was to elaborate the rationale for ethical behaviours that were based on pure reasons as opposed to those that were developed on the basis of traditions and other authoritative pronouncements. Both the utilitarian and deontological theories have been widely applied in determining the ethical behaviours for medical practitioners. Deontological theories have for instance been extensively utilized in informing rational decision making in various circumstances. Two foundational principles have been used to inform decision making under deontological theories. These principles or rules included: categorical imperatives and unconditional ethical laws (Butts & Rich, 2008). Law, according to this theory was defined as the reason for an action that is universal and must be followed by everyone (Mead, Bursell, & Ketelsen, 2006). The deontological theories use the existing rules and regulatory frameworks in justifying an action as opposed to the other theories that base their arguments on consequences. According to the theory, the rules, laws and other regulatory frameworks must be adhered to by the global communities that subscribe to the same laws. Despite every country developing their own laws and regulations to control the operations of their medical practitioners, these laws are commensurate to the international legal frameworks put in place by the international community and thus hold universally. Breaches of deontological laws are consequential and lead to severe punishment all over the globe. Nursing ethics are laws that bound internationally. Carrying out the cannulation process while not sure was a clear breach of both the utilitarian as well as deontological laws and was subject to prosecution in a court of law. The professional HCPC codes The HCPC codes are a group of regulatory frameworks that have been designed by the Health and Care Professions Council to guide student practitioners on the right behavioural mannerisms. The codes realign the students’ behaviour with that of the international health care community. Moreover, it is vital to note that the HCPC codes are a combination of all international care rules that guide the actions of all practicing nurses across the globe. These rules are applicable both at the local and international levels hence their observance is guided by the international laws. Among the key regulations stipulated in the HCPC codes is the ability to meet the required principles of the nursing profession including academic standards set by the council of nurses. All student practitioners, according to the HCPC codes regulations are required to execute their mandates only under the regulatory frameworks of the nursing council and ethical stipulations. The body expects all student practitioners to maintain a high standard of conduct and ethics during the period when they are attached at any institution or conducting an action on behalf of an approved medical practitioner. The codes advocate for equal treatment of all persons seeking medical care at all levels by desisting from doing anything that can put one in danger. The HCPC codes addresses the course of action in situations of uncertainty, especially, when one is not sure of or worried about a situation at hand and suspects that such situations can lead one to risk. Under such conditions, the codes accord that the persons in charge seek guidance from the senior members of the placement team or their education providers for further guidance on the right course of action. Making unsure decision that can pose risks to the health of the persons seeking medical assistance from the care centres around the globe is therefore reciprocate to going against the set laws by the HCPC codes. All student practitioners are expected to comply with the situations mentioned above and give their best to the unsuspecting patients all over the globe. Under these laws, it is certain that both the student and the mentor all committed similar offences by not adhering to the rules of consultation in cases where they were unsure of the appropriate course of action. Moreover, the codes also direct every practitioner, including the student practitioners to only act within the limits of their knowledge. This ensues that where the practitioners are not certain of the way forward, as Casals, (2000) records, such cases should be referred to the persons that are able to handle them appropriately. All the above mentioned codes of conduct were entirely breeched by both the student and his mentor hence totally in collision with the regulatory measures put forth by the HCPC codes. The ethical laws and theories advocate for actions that favour the majority while trying to alleviate the ill conditions of the patients seeking medication at all levels. It is, therefore, very necessary for the student practitioners as well as the practicing nurses registered by the nursing council to comply fully with the set regulations and maintain a high standard of ethics and conduct while handling patients. Non compliance with the set ethical rules is not tolerated by the nursing council and all regulatory frameworks guiding the conducts of all practitioners around the globe. Both student & qualified roles in maintaining safe practice Both the student and the qualified medical practitioners have a critical role to play in ensuring that the lives of patients are kept in check while at the same time maintaining the required ethical standards. The roles played by each partner are well spelt out in the various laws, rules and regulations developed by various health care councils around the globe. Both the student practitioners and the qualified members of the heath sector are expected to adhere to all set rules and regulations guiding their operations at all levels. For instance, the rules of operations direct every student practitioner to act only under the directives of their mentors. Making sole decisions by unsure students can lead to the commission of grievous mistakes that can lead patients to critical conditions. The ultimate desire of every care provider is to ensure that the health conditions of their patients are alleviated to better than they came. Inflicting injuries on unsuspecting patients as seen in the case described above, as a result of ignorance and negligence due to lack of adequate consultation with other members of the council for a better course must not be condoned (Daly, 2002) under the rules and regulations set for the sector. The student in the case study was suppose to adhere with all set rules in the nursing sector and consult with any senior practitioner around before making any decision on the course of action for the patient. Qualified practitioners on the other hand are expected to provide assistance to all student practitioners attached under their directives. The students are only allowed to carry out instructions under the keen watch of their mentors. It is therefore the sole responsibility of the mentors to ensure that their student practitioners are kept updated with the latest occurrences and avoid commission of simple mistakes that can lead to grievous mistakes later in the course of their practice. It was therefore unnecessary for the mentor in the case above to leave the student alone leading to the stated mistakes. Besides, he was supposed to consult with the senior members before carrying out the cannulation process. Conclusion In conclusion, it is good mentioning at this stage that the nursing profession is a very critical and risky area of speciality that requires very keen attention by all practitioners. All rules, laws and regulations governing the conduct of all medical practitioners are therefore to be strictly adhered to in order to ensure the success of the whole operations. Overlooking any of the simple ethical rules and codes of conduct often result into grievous mistakes as has been described in the past sections of this paper and, therefore, should be avoided at all costs. Bibliography American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Beauchamp, T. L., & Childress, J. F. (2009). 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