Ethical Dimensions of Nursing - Case Study Example

Ethical Dimensions of Nursing Name: Course: Tutor: Date: Ethical Dimensions in Nursing Nurses interact with patients more than any other professionals in the medical field. In the course of their work, they are faced by ethical, legal and moral challenges that they have to deal with on a day to day basis. Whereas there is a nursing code of ethics that spells out how the nurses should behave, and a legal framework that has put up the legally acceptable habits that nurses should assume to avoid liability, the moral responsibility is left entirely on the individual nurse to handle. This paper discusses some case studies of ethical dimensions in nursing. Scenario 1 In scenario 1 where Mrs Carotid asks whether she will eventually gain the full use of her limbs despite a dim prognosis from the treating doctor, a nurse would be within the ethical boundaries by answering the patient truthfully. As such, the nurse should consider the patient’s mental health and the effect an honest answer would have on the patient. The nurse should also consider the autonomy of the patient as provided for in the nursing code of ethics (Orr, 2004). In the code of ethics, a patient has the right to determine the course of action that her healing process will take (Davis, Teschudin & De Raeve, 2006). However, the nurse on the other hand has a moral duty to inform Mrs. Carotid that keeping up exercising her limbs would have little effect. Because there is no mention of Mrs. Carotid being mentally challenged, the nurse will give out this information with the assumption that Mrs. Carotid is able to make sound judgements about her next course of action. If not, the nurse should involve the intervention of family members (Davis, Teschudin & De Raeve, 2006). The nurse should however make sure that the autonomy of the patient is upheld. According to Reid (2009) and Thompson, Melia and Boyd (2001), the nurse should give an honest opinion or counsel without trying to manipulate or persuade the patient along a particular line of thinking. Every action that the nurse takes in regard to Mrs. Carotid’s case should be guided by ethics and care. According to Davis, Teschudin and De Raeve(2006), nursing care is not only defined by the responsibility that the nurse has to respond to and serve the patient, but also includes the emotional response that would lead the nurse to portray care, empathy and attention to the patient. Scenario 2 Scenario 2 is a classic case of what nurses undergo each day as they decide the best way to keep patients alive. Such cases not only present the nurses with ethical questions, but moral questions too. According to Hunt (1994), some of the ethical and moral questions facing nurses in a case like Mrs. Smith’s include reaching a decision on how to feed and hydrate the patient, considering the underlying assumptions and values involved in the feeding method to be used, and determining the course of action that is in the best interest of the patient. Hunt (1994) further indicates that oftentimes, the nurses are faced with the ethical question of when and how should a decision to stop feeding or hydrating a patient be made. In the case in question, Mrs. Smith wished to be kept alive by whichever means necessary. However, seeing that the Percutaneous gastric feeding tubes and the nasogastric tubes were causing her much distress, the nurse is caught between respecting her/his patients earlier wish to be kept alive or stick by the ethics that states that the nurse should treat her patient with respect and in a dignified manner (Orr, 2004). According to Thompson, Melia & Boyd (2001), scenarios like this are rarely straightforward. In Mrs. Smith’s case, the artificial nourishing process is being carried out as a technical and biological process to sustain life. This differs from nourishing the patient through the same means, but on a care-giving basis rather than a life-sustenance basis. The fact that Mrs. Smith developed dementia and therefore can no longer talk only complicates issues further. However, judging by the way she pulls out the tubes, the nurses can conclude that the artificial nursing tubes are causing her much distress. By tying her hands to avoid her pulling the tubes out is tantamount to failure to treat the patient with dignity. Hunt (1994) reckons that some patients see the feeding tubes as an invasion or an assault rather than a form of nourishment and by extension treatment. In Mrs. Smith’s case, it clear that she does not like the tubes. Tube feeding on the other hand means that the patient cannot choose food or when to eat them. As such, the nurses know that there is an underlying pathology in Mrs Smith’s case. In addition, the nurses know that this kind of feeding requires regular blood tests to check Mrs. Smith’s haematology and biochemistry. According to Hunt (1994), tube feeding has its own risks, which require the nurses to keep monitoring the patient. In addition, it is doubtful if this kind of feeding poses any significant prolonged gain to the patient. Since Mrs. Smith cannot express herself about the PEG/nasogastric tube feeding, the nurses have a right to feel that the patient’s comfort or acceptance of the tubes are the deciding factors about what is ethical to do in this case. Restraining Mrs. Smith to avoid her pulling the tubes out is ethically unacceptable. It is common knowledge within the medical circles that artificial feeding does not improve or cure a terminal state. All that it does is sustaining biological life to allow the patient to receive other forms of treatment (Orr, 2004; Thompson, Melia & Boyd, 2001). Considering Mrs. Smith’s health status, the nurses do not seem to think that her condition can improve further. As such, it is apparent that the tube feeding combined with her tied hands only prolonged the dying process and in the process caused avoidable suffering to her. Legally, the nurses can omit prolonging Mrs Smith’s life through tube feeding on the basis that the feeding process does not provide useful purposes to the patient. Ethically though, the nurse would have failed to meet Mrs Smith’s wish to be kept alive through any means available. This presents a classic case of the ethical and moral dilemmas that face nurses on a continuous basis. The nurses should discuss with Mrs Smith’s children on the best course of action. Differences between Legal, Clinical and Ethical Dimensions in Nursing Legal dimensions in nursing refer to the laws that guide the nursing profession (Fry & Johnston, 2002). Should a nurse act outside these legal boundaries, he or she is considered as acting illegally and can therefore be sued for liability. The legal aspect of nursing is based on patient’s right and the need to define the acceptable nursing standards (Mashaba & Brink, 1994). An example of a legal issue that face nurse in the course of their work include handling patients who cannot attend to their most basic needs. Some patients may feel that a nurse crossed the line when helping them dress and can even sue for indecent exposure. Clinical dimensions in nursing on the other hand refer to nursing care, the skills involved (Thompson, Melia & Boyd, 2001; Davis, Teschudin & De Raeve, 2006; Mashaba & Brink, 1994). The clinical aspects in the nursing profession are essential since they determine how fast and effective the nurse will be in delivering care to a patient. In the nursing profession, the clinical dimension is considered vital for the provision of accurate clinical intervention and therapies. Under clinical dimensions the nurse is able to assess the patient’s needs and make a proper decision based on the patient’s needs (Mashaba & Brink, 1994). An example of this dimension is when a nurse notices that the patient is not reacting well to medicines prescribed by a doctor. In such a case there is a dilemma on whether the nurse should discontinue the medication immediately or consult the doctor first. Ethical dimensions in nursing on the other hand are guided by the nursing code of ethics (Masters, 2005). They pertain to issues that define the nurse’s behaviour, with the objective of ensuring that the nurses provide compassionate care to the patients. Ethical dimensions are guided by four principles namely: beneficence, autonomy, justice and nonmaleficence (Masters, 2005). In most cases however, ethics presents a grey area in the nursing profession especially because matters of ethics are closely tied to the nurse’s feelings and reaction towards a patient. In such times, nurses are usually faced with ethical dilemmas where possible ways of handling issues seem neither wrong nor right. In such cases, the nurses usually use their critical abilities to do what looks like the best option. The requirement that all nurses adhere to the code of ethics however sets a professional standard for the nurses. An example of an ethical dimension nature includes when a patient insists on giving the nurse presents as a sign of gratitude for her care. On one hand, the nurse may feel that turning down the presents would disappoint the patient. However, guided by the code of ethics, the nurse should turn down the present and explain to the patient that providing care is what he or she is paid to do. Scenario 4 The nurse in scenario four did not behave ethically. Considering that the doctor has issued a ‘nil-by-mouth’ order, it seems that there was a real risk with the patient’s aspiration. Considering that there are other ways through which the patient could be hydrated, it looks like the nurse put the patient’s health through a considerable risk. Although the nurse may think that he or she was practising beneficence, still there was considerable risk posed to the patient. According to Masters (2005) not everything the nurse does as an act of beneficence is justified. According to Staunton & Chiarella (2003), the nurse has every right to question a doctor depending on observations made when caring for the patient. However, the nurse has no authority to work behind the doctor’s back. The nurse also has the moral duty to discuss how the patient’s suffering can be alleviated with the doctor. However, if the doctor insists against oral feeding, then the nurse has no right to go against that directive. Despite the patient being terminally ill, any proof that the nurse, through disregarding the doctor’s order, may have hastened the death of the patient may lead to the nurse being held accountable (Lyer, 2001). Conclusion Ethical dimensions in nursing are made up of different characteristics that focus on upholding the well-being of patients and the nursing staff. The ethical dimensions are such that the nurse has a professional responsibility, a moral obligation and a necessary moral character in nurse-patient relationship. Overall, this is a discipline that ensures that there are sufficient theoretical approaches to provide a solid base from which the nurses can make ethical decisions and actions. In nursing, it is not simply a matter of nurses and patients relating as happens in ordinary human relationships. Rather, the nurse is supposed to provide care and compassion within the boundaries of nursing ethics. This ensures that he or she maintains the ethical, legal and clinical standards and by extension the professionalism. However, seeing that ethics is not just a matter of right or wrong, nurses are continuously facing ethical dilemmas as shown in the four cases discussed. References Davis, A. Teschudin, V. & De Raeve, L. (2006). Essentials of teaching and learning in nursing ethics: Perspectives and methods. London: Elsevier Health Sciences. Fry, S. & Johnston, M. (2002). Ethics in Nursing Practise: A Guide to Ethical Decision Making. (2nd edition). Malden, MA: Wiley-Blackwell. Hunt, G. (1994). Ethical Issues in Nursing. New York: Routledge. Lyer, P. (2001). Nursing malpractice (2nd edition). London: Lawyers & Judges Publishing Company. Mashaba, T.G. & Brink, H. (1994). Nursing education: An international perspective. Hatfield: Juta and Company Limited. Masters, K. (2005). Role development in professional nursing practice. Sudbury, MA: Jones & Bartlett Publishers. Orr, R. (2004). Ethics & life’s ending: An exchange. First Things Journal. Issue 145 Reid, K. (2009). Respect for patient’s autonomy. (Abst.) American Dental Association. Retrieved October 10, 2009 from http://jada.ada.org/cgi/content/abstract/140/4/470 Stauton, P. & Chiarella, M. (2003). Nursing and the law. Sydney: Elsevier Australia. Thompson, I. E., Melia, K. M. & Boyd, K. M. (2001). Nursing ethics (4th edition). London: Elsevier Health Sciences. Read More