Practice Ethically and Challenge Equality - Case Study Example

Jane Schulz (2007) argues that ethics is “a set of moral principles or values”. Discussions regarding the origins of ethics and values have stirred debates in more than one way. It is especially hard to conclude whether they are inherited, learned by experience or both. As a nurse who performs direct patient care in community, I have witnessed the best and worst of ethical behaviours in both my clients and other health staffs at different settings. On more than one occasion, I have had to acknowledge my own ethical value system, challenge it, and develop it throughout my life but never so much as I have since I began my nursing career. This reflective account will discuss a clinical interaction involving a service user and myself and his key worker and my mentor in terms of the principles of ethical practice. I will explore this incident and give my understanding of the event in relation to professional, legal and ethical considerations. The reflection will highlight NMC, NOS and produce evidence within the practice evidence criteria, using Gibbs (1988) to help me present my reflection in a natural sequence of events. The framework is iterative and enables me to ask myself a series of questions at stopping points, to help me put the experience into an organised manner. In order to respect the service user’s confidentiality in concordance with the Nursing & Midwifery Council (2004; 2008) code of professional conduct – point 5.1. The author shall refer to the service user as ‘Kendal’ throughout this essay. Description: I first met Kendal in his house in sequence to an internal reference from our team to support him with dental hygiene / health check to follow up with his anxiety medication. He is one of my direct allocated cases; he is from the Caribbean, aged 23 and non verbal. Kendal uses limited speech and can be very challenging at times. Staffs are unsure of what to do and how to support him as he was found to be harming himself most of the time. Staff thought that he could be expressing dental pain and hence, he was refereed to our team. I responded to his needs appropriately by reading out more information to him that were uploaded from previous professionals on FRAMEWORK I. I phoned his key worker and introduced myself and later planned visits with him. I used the Community TRIAGE assessment form to gather information. Also, I sought permission before carrying any activities and made sure that Kendal was present at the scene. Feeling: When I had talks with Kendal and his key worker, the latter informed me that they find it difficult to work with Kendal as he often displays challenging behaviours. I usually try not to judge anyone for their choices or actions. I believe in attempting to understand and accept rather than obliterating the possibility of developing any type of relationship. I do have a keen sense of what is right and wrong. However, I know how it feels to be condemned for simply having different morals. So I was quite careful for what I was discussing with the key worker. I informed and sought approval from Kendal and his key worker that information discussed there would be subject to confidentiality and was needed to be shared in the team (Julie Clark, 2006). There were other ethical issues as the key worker decided what was best for Kendal. I asked for his advocates and I was told that it was his mum. I discussed with the key worker that he would need to discuss his decision with mum. According to Carolyn Ann Laabs (2007) decision-making factors in ethical dilemmas that we use are tested by our personal lives. As a nurse, I must remain empathic and objective, yet maintain a close connection to the patient. This is a very fine line on which a nurse must balance in the workplace. A good seasoned nurse must constantly struggle to maintain his or her values with constant ethical conflicts that make many cynical in their practices. Kendal’s key worker was not upset. He said that he is in a better position to know the type of intervention that would be suitable for Kendal. I reminded him that he can act in his best interest but would need to discuss the decision or approaches with his advocates, for, they too needed to be made aware of the ongoing activities. I feel that I promoted his independence and addressed some of the risks that he causes for himself such as bruising and injuries. I discussed different interventions such as health action plan, bowel monitoring charts, and ABC charts. The key worker told me that some of these things were already in place and were not working. I understood my need to be there for my patient when he needed me and I made sure the care and support was present. Confronting my beliefs changed my opinion on society’s norms. I used my values and morals to guide my actions. I completed a task that I thought I would not be able to cope. I was in fact enamoured with the types of support and ideas that I could share with my mentor. I decided to help in the experience after evaluating the patient’s level of discomfort and need of assistance. Evaluation: These situations make me feel that our job is a very difficult and challenging at times. I was very concerned with Kendal considering the risks he posed to himself as well as other people around him. Still, I had to respect his right to autonomy (Carolyn Ann Laabs 2007). I usually try not to sound patronising. In addition, the referral that came into our team was not what the staff was concerned about. Until I completed the assessment TRAIGE, I realised that Kendal would need further intervention. I searched through his care plan to find out the type of care he was given till than. I came across in his care book that mentioned his recent visit to the Dentists and I understood that he wouldn’t need any dentist intervention. I clarified with the key worker and he confirmed that Kendal did not need dentist any more. He was rather in need of a psychiatrist. Analysis: I took the information with me back to the office and discussed the same with my mentor. My mentor seemed to be pleased with the different approaches I had in place. My mentor suggested that I should put in health action plan. I informed my mentor that it was already in place and that it was updated, checked and monitored by staff. Later, I and my mentor came to an agreement to refer him to see the psychiatrist. I wrote out the referral form and put it through internal to the psychiatrist’s doctor. Before that, I had already raised the issues with the psychiatrist and she was planning for our joint visit. Conclusion: To my knowledge I believe that I have justified and addressed the criteria quite well. I know that I have the skills and ability to do it. I showed positive attitudes and did not allow the conflicts to get at me. Also, I concluded that moral conflict is common within any group (e.g. staff, team, co-workers) and keeping ones moral integrity makes them feel great about their actions in a fundamental way while keeping those morals on a professional level. This connects to my experience as I was in a situation where I had to make a decision involving my moral integrity and do what I believe I could do based on my values. I had to decide, for instance, whether to step in as an advocate for Kendal or allow the key worker to do it. This experience has helped me to challenge my ethical beliefs and make decisions based on what I believed was right and in the best care for Kendal. I discovered that our education can only guide us, but it is our experience that allows us to develop our feelings and beliefs and we should always update our knowledge and use the NMC code of ethics as our main bible to guide us ethically. With knowledge gained from this experience,e and those to be gained from similar future situations, I believe I can develop a comfort in my skill level. Having to adapt to a variety of situations and conditions is a part of a nurse’s career and with experience and further education, I may come to terms with it and develop as a nurse. Having reflected on my actions, I am confident in my ability to follow my values and ethical beliefs while giving my patients my full attention and providing them with the holistic care they are entitled to receive. Actions: If the same situation arises in the future, I will give the key worker an opportunity to step in as advocate since he knows the patient better and has been working with him for six years and have known him more than what I do. I would listen to him and value his experience more. Read More