The Issue of Paternalism in Nursing - Report Example

The Issue of Paternalism in Nursing Introduction Some of the nurses attending to the paraplegic patient had adopted a paternalistic attitude towards the latter. The paternalistic approach has been seen to interfere with the best interests of the patient. In accordance, with the Code of Ethics and core values of Nursing ,the nurse’s prime duty is to provide the health care that is best suited to the patient’s needs. She has to safeguard the health care interests of the patient in a professional manner. The nurse has to inform the relevant authorities, about colleagues who resort a paternalistic approach that is disadvantageous to the patient’s interests Paternalism Paternalism can be understood as an action, in which one person restricts the liberty of another. Although, these acts are justified as being in the best interests of the person for whom they are done; in most cases, they are performed against the will of the perceived beneficiary. Paternalism can also be defined as a policy that seeks to restrict the freedom of an individual or group, ostensibly in order to safeguard their interests (Breeze, August 1998. pp. 260 – 265). Paternalism involves a conflict of individual autonomy and beneficence. The good that it achieves is in general, not recognized by the beneficiary; and it is sometimes associated with coercion. From times immemorial, healthcare had been dominated by the paternalistic approach. Of late, patient empowerment has gained currency, and has supplanted paternalism. Earlier, it was common to assume that the healthcare staff was best suited to determine what was in the best interests of the patient. Therefore, the healthcare staff had an overriding role to play, in respect of providing treatment to patients (Christensen & Hewitt-Taylor, July 2006, pp. 695 – 696). According to Kennedy, the paternalistic approach of healthcare staff had been viewed as best suited to the interests of patients. At present, this principle has been recognized as being inappropriate. Another, misconception that had previously existed, had conveyed the false impression that the medical staff had to take the decisions, because the patients were incapable of doing so, on account of their affliction (Christensen & Hewitt-Taylor, July 2006, pp. 695 – 696). The historical perception has been rightly discarded, and people have come to realize that such an approach is unreasonable. Informed decision making has come to the fore in health care decisions, because the paternalistic approach in health care has been deemed to be unreasonable. Health care professionals should act in a manner that does not compromise the patient’s interests, at any cost. The paternalistic approach adopted by the health care staff in our scenario is unjustified and unethical. In spite of the patient’s anxiety to overcome the disability and recover speedily, the fact remains that the health care personnel had been treating him in a restrictive manner. Paternalistic approach in health care is unjustified, unless the situation warrants it. In our case, the patient is competent to take a decision on his own. As such, the health care team’s actions are not in the interests of the patient. Core Values Holism Holism states that the nursing profession should respect the patient as a complete person. It is of great value in the nursing profession, and constitutes a fundamental ethic of nursing care that should become a part of universal practice. Such treatment encompasses the family members of the patient, as well as the approach of the care providers. The value of holism in nursing care is assessed through the application of professionalism, the actual provision of nursing care and advocacy (Volp, Re-claiming holism, 2007. pp. 1 – 4). All these factors have to be taken into account, whilst appraising the value of holism in nursing practice. Professional humanistic care is possible, only when the patient is treated holistically. The health care profession has undergone several important changes, which requires nurses to acquire wide knowledge about technical advancement. These advances pose several new ethical challenges to nurses. Furthermore, nurses develop a close relationship with patients and their family members (Berggren & Severinsson, November 2006, pp. 637 – 638). In the present scenario, the healthcare team is not attaching much importance to holistic values. Professionalism Professionalism is inherent in nursing practice, as is evidenced by its diversified response to the needs of the community. Nursing denotes professionalism in action (Volp, 2006). The services of a nurse are generally in the face of unforeseen events and limitations. A proper evaluation of nursing care entails the extent to which nurses accept responsibility for the care provided by them. Such assessment has also to consider the extent to which nurses feel that it is their responsibility to improve nursing care. (Australian Nursing and Midwifery Council, Royal College of Nursing, Australia, Australian Nursing Federation, 2008). Moreover, this exercise requires nurses to take suitable remedial action, in respect of unethical or substandard nursing care. In the present scenario, the unethical behavior of the colleagues should be notified to the competent authority, by the team leader of the health care professionals, so that remedial action can be initiated. Caring Nurses act as a team, and they should ensure that the collective efforts of their colleagues provides quality nursing care. Consequently, a nurse should report to the appropriate authority, the illegal and unethical practices of a colleague, without any qualms. Furthermore, a nurse should prevent a colleague from indulging in unsafe practices (Australian Nursing and Midwifery Council, Royal College of Nursing, Australia, Australian Nursing Federation, 2008).Moreover; a good nurse always supports colleagues in their work. A nurse’s purpose is to ensure a healthy community. Consequently, in the present scenario, the nurse is required to participate in ethical and equitable nursing care practices, which are clinically appropriate and beneficial to the interests of the patient.. Advocacy A nurse, who advocates her patients’ interests, depicts benevolent paternalism. In order to be a patient’s advocate one has to behave in an objective fashion. Such behavior involves neutrality and a purely professional attitude (Tuckett, June 2006, p. 168). Strategies that have as their objective, the reduction, prevention or conquest of the detrimental outcomes of ecological, economic or social factors on the health of communities and their individual members should be given prominence by nurses. Code of Ethics Quality nursing care for all people Nurses who deliver quality nursing care, exhibit responsibility for the decisions they take, while providing nursing care to their patients. They strive hard to develop knowledge and skill, and to acquire experience. Such nurses prove to be competent, and they provide safe nursing care to patients. In addition, they strictly segregate their personal and professional life, by identifying their professional role, in an unambiguous manner (Australian Nursing and Midwifery Council, Royal College of Nursing, Australia, Australian Nursing Federation, 2008). Nurses value a culture of safety in nursing and health care Many a nurse understands that quality nursing care should be delivered to people. This is their fundamental responsibility, since patients are entitled to receive the best possible nursing care. In order to fulfill this duty, nurses are expected to participate in discussions that involve the provision of nursing care to patients (Australian Nursing & Midwifery Council, 2008). If the proposed nursing care is patently unethical or illegal, then the nurses have to oppose it. In the present scenario, the health care team behaved in a way that grossly violated this ethical consideration in nursing. A nurse, who receives adequate support and empowerment, can deliver quality healthcare, while establishing a safe work environment. This necessitates better and more powerful relationships and communication, between patients, their families, physicians and nurses. Furthermore, nurses should be permitted to participate in every decision that has a bearing on the care of the patient (When we value our nurses, we enhance our patients' well being, 11/17/2003, P 5). Moreover, leadership, training and development of professional skills are indispensable for nurses. Respect for one self and others Respect for one self and others, promotes respect for the dignity and self esteem of oneself and others. It is essential for nurses to respect their value and that of others, as well as respecting ethical values in the nursing profession. This includes the ethical values that each individual in healthcare should possess. Acts of gentleness, consideration and care reflect kindness towards patients in healthcare. Such kindness promotes a relationship between nurses and patients that engenders the appropriate power balance between them. (Australian Nursing & Midwifery Council, 2008). Such equilibrium places the nurse at the service of the patient, and this is the relationship that is to be achieved. Nurses value the diversity of people. In the course of their profession, nurses encounter a diversity of people. Valuing such diversity enhances their knowledge of cultural differences and languages. This knowledge could prove to be of great help in not only providing health care, but also its acceptance by the patients (Australian Nursing & Midwifery Council, 2008). Expertise in any field of endeavor, involves skill and knowledge on part of the practitioner. These are also the essential requirements of professional expertise. They are essential for providing quality healthcare (Christensen & Hewitt-Taylor, From expert to tasks, expert nursing practice redefined?, December 2006, p. 1533). Nurses value access to quality nursing and health care for all people The provision of quality health care requires nurses to respect the patient’s right to such services. The provision of such health care services depends upon the availability, accessibility and acceptance by the people. Access to health care denotes the extent to which the patient or the community is provided with healthcare services. This entails knowledge about the appropriateness of seeking healthcare, the capacity to travel and the possession of sufficient means to pay for it. Access does not imply the provision of healthcare services to all the people (Australian Nursing & Midwifery Council, 2008). It is the ability to provide healthcare services on grounds of reasonableness and equitability. Healthcare services should be provided without any discrimination on the basis of race, age, income, gender, sex, or geographical location. Nurses value informed decision making Another important feature of nursing practice is that nurses attach much importance to the interests of patients, and this is a major consideration, while taking free and informed decisions. Consequently, patients have the opportunity to voice their opinion and to analyze the information supplied to them about their health, whilst deciding upon the course of treatment proposed by the healthcare professionals (Australian Nursing & Midwifery Council, 2008). In the present scenario, the health care staff did not take this aspect into consideration. They ignored the patient’s opinion, while deciding upon the course of treatment. Ethical decision making has assumed great significance in the nursing profession. In conjunction with problem solving techniques, it constitutes one of the fundamental skills required of nurses in their professional practice. A nurse has to deal with different kinds of people, and interact with a large number of people. Clinical nursing supervision (CNS) provides better opportunities to nurses to develop their skills to face ethical dilemmas and ethical decision making (Berggren & Severinsson, November 2006, pp. 637 – 638). All this entails greater support to nurses in their routine work. Nurses value ethical management of information. The maintenance of patients’ records entails the utmost professionalism, integrity and the accurate recording of information pertaining to patients. The medical records of patients should only be updated and never altered. Any remark or notation on the medical record of a patient will have a direct impact on the quality of healthcare provided to that patient (Australian Nursing & Midwifery Council, 2008). Moreover, such remarks play a crucial role in health care decisions. Ensuring safety in health care is a collective responsibility. Therefore, valuing a culture of safety helps nurses to understand shared responsibility. Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing. . Nurses should not assume that quality healthcare will be made available to patients, only if they stay in the hospital. Quality care in a nursing facility necessitates nurses who are skilled and knowledgeable in their profession (Flynn, January 2000, p. 49). Clear communication with the patient resolves many difficult issues, and saves the time and energy of a nurse. The researchers Benjamin and Curtis held the paternalistic approach to be appropriate in three settings. First, it is justifiable if the patient is mentally impaired to the extent that he cannot make decisions. Second, if the medical intervention is indispensable, in the best interests of the patient. Third, if the patient had accepted such intervention on previous occasions (Woodward, November 1998. p. 1049). Since none of these conditions are present in the scenario, the health care staff should not resort to a paternalistic approach, towards the paraplegic patient. Conclusion The nurse, as the leader of the healthcare team, should ensure that the best interests of the patient are not compromised, by the other members of the team. In Australian health care, the emphasis has shifted from paternalism to empowering the patient to take an active part in deciding upon a particular course of treatment. Whenever a paternalistic approach towards a patient is adopted, it is the duty of the team leader of the nurses, to notify the appropriate authority, as per the Code of Ethics. Therefore, the team leader should take all possible measures to deter unethical practices. List of References Australian Nursing & Midwifery Council. (2008). Code of Ethics for Nurses in Australia. Retrieved September 1, 2009, from http://www.anmc.org.au/docs/Research%20and%20Policy/Codes%20Project/New%20Code%20of%20Ethics%20for%20Nurses%20August%202008.pdf Australian Nursing and Midwifery Council, Australia, Australian Nursing Federation. (2008, August). Code of Ethics for Nurses in Australia. Dickson, Australia's Capital Territory, Canberra, Australia: Australian Nursing & Midwifery Council . Berggren, I., & Severinsson, E. (November 2006, pp. 637 – 638). The significance of nurse supervisors’ different ethical decision-making styles. Journal of Nursing Management , Vol. 14, Issue. 8, pp. 637-643. Breeze, J. (August 1998. pp. 260 – 265). Can paternalism be justified in mental health care? Journal of Advanced Nursing , Vol.28, Issue 2, pp. 260 – 265 . Christensen, M., & Hewitt-Taylor, J. (December 2006, p. 1533). From expert to tasks, expert nursing practice redefined? Journal of Clinical Nursing , Vol.15, Issue. 12, p.1533. Christensen, M., & Hewitt-Taylor, J. (July 2006, pp. 695 – 696). Modern nursing. Empowerment in nursing: paternalism or maternalism? British Journal of Nursing , Vol.15, Issue. 13, pp. 695 – 696 . Flynn, L. (January 2000, p. 49). For the patient's sake, communicate! Nursing Management , Vol. 31, Issue.1, p. 49. Tuckett, A. G. (June 2006, p. 168). On paternalism, autonomy and best interests: Telling the (competent) aged-care resident what they want to know. 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