The Integrity of Nurses - Term Paper Example

Name: University: Instructor: Date: Nursing 1.0 Reason for Choosing Nursing The reason for choosing nursing is because research in this field has a tremendous impact on the present and future practice of professional nursing; therefore, making it an important part of the educational process. Nursing is a professional in the healthcare industry that is concerned with treatment, recovery of chronically or acutely ill patients, maintaining the healthy people as well as treating deadly emergencies in different health care settings. Another reason for choosing nursing is because health care is considered number one priority in Canada, whereby nursing plays a crucial role in health care delivery. Imperatively, nurses educate patients, take part in health promotion, and are involved in injury and illness prevention by offering support, assist and care for patients. 2.0 Historical Background of Nursing In Canada the history of nursing is associated closely with the religious orders as well as Catholic hospitals that were built between 16th and 19th centuries. For nearly three and a half centuries, nurses have profoundly influenced the quality of people’s life in Canada. In 1639, Quebec received the Augustine nuns who were in a medical mission to care for both the physical as well as spiritual needs of the sick people. In the 19th century, Catholic orders like the Grey Nuns in addition to those from the other denominations like the Mennonite and Anglican, realized that the frontier settlers needed health care; therefore, they took their medical missions in different parts of Canada. Nursing in the early English Canada involved midwifery and consultation. Towards the end of 19th century, medical services and hospital care had been improved as well as expanded for the increasing population. Simultaneously, Florence Nightingale, a statistician and social created a system for training middle-class women to become nurses. In 1874, the first recognized nurse training program was established resulting in the proliferation of schools across Canada, particularly in all major hospitals. Individuals’ graduation and teaching in such schools started focusing on nursing professionalization by pushing for creation of professional organizations as well as licensing legislation. Nursing programs in the early 20th century were created for disease prevention and to promote public health. At first public health nursing involved the management of maternal care and epidemics, but later, it expanded into the schools and community. After the World War II, the nature of nursing in was transformed significantly leading to health-care system expansion as well as introduction of medicare. Nursing schools were expanded in attempt to meet the shortage of nurses, and nursing has become specialized and scientific. Progressively, men and visible minorities started joining nursing, and in 1970s, nursing became an organized labor. As of 2013, Canada has 265,000 nurses whose role included offering care to the patients with the hospital settings, providing community and home care. 3.0 How Nursing Relates to the Economy In a hospital context, Aiken (75) argues that nursing is a cost and not revenue; therefore, nursing has become a constant target for reductions of cost. Given that medical institutions are not compensated directly for offering nursing care, there available motivation for offering the correct nursing ‘dose’ so as to meet the varying needs of the patients is very low. 3.1 Government Funding In Canada, nursing homes offer personal and nursing care, and since they are regulated institutions they are subject to co-payments (personal contributions). Basically, the Canada Health Transfer and provincial taxes are the main source of financing for nursing homes’ care. In every jurisdiction, the amount of personal contributions is defined by one’s assets and/or income while the government offers subsidies so as support individuals that need financial help. Health care that is publicly funded is financed by the revenue collected from taxation at territorial, provincial and federal level like the sales taxes, corporate and personal taxes and payroll levies. Besides that, a health premium is charged by some provinces on their residents so as to facilitate the financing of publicly funded health care services. 3.2 Providing Nursing as a Business Nurse entrepreneurs are businesses’ proprietors that offer nursing services in consultation, health promotion, advocacy, education, direct care, administration or research. They offer nursing-related services and they are considered to be private or independent practice. Normally, they are directly responsible to the client. Their clients often include people, communities, families, government departments, educational institutions, private businesses, health care agencies, as well as non-profit organizations. In Canada, private home nursing is a successful industry, with nurses starting businesses in the elderly care sector. Besides that, nurses in Canada are experiencing stressful job change because of restructuring within the healthcare sector, and this has made some nurses to opt for private or independent practice (self-employment) so as to reconnect with nursing values as well as promote the nursing autonomous potential (Wall 30). 3.3 Nursing Contribution to Economy Economic recession and downturns as mentioned by Alameddine, Baumann and Laporte (1) resulted in service reductions and budget cuts in the healthcare sector. In this case, the cost reductions strongly affected the nurse. The nursing labour market was destabilised by the economic downturns leading to negative outcomes, such as shortages. Still, nursing promoted economic development through hiring of graduate nurses. Researchers have established that increased number of registered nurse staffs results in high number of saved lives; thus, shortening the duration of hospital stays and generates economic value in terms of improved patient productivity and medical savings. If nurse staffing is done properly, it helps in achieve both economic as well as clinical improvements, since medication errors are reduced and the patients' stay within the hospital is reduced (Penner 85). 4.0 Occupational Closure 4.1 Power Struggles between Nurses and other Professionals Because of the enduring nursing shortage, the relationships between nurses and physicians have always been poor. According to Sirota (53), disruptive physicians’ behaviour contributes significantly to nurse burnout resulting in low job satisfaction as well as decisions to resign. In their study, Sirota (53) noted that a significant number of nurses are leaving their profession because of disruptive physician behaviour. Majority of nurses have continually reported challenges they experience while dealing with impolite, unfriendly, demeaning, dismissive, or unapproachable physicians, and this is more prevalent amongst older physicians. According to Sirota (54), negative behaviours directed to nurses by physicians is normally associated with power gaps, gender issues, hierarchical traditions, or perception that nurses are handmaidens instead of professional collaborators that should be valued. Power issues associated with gender are still creating problems, particularly for female nurses while working with both male as well as female physicians. A number of physicians, particularly the older ones, often consider themselves as having complete control and see nurses as juniors with no power. Many physicians pursue the traditional model where men are considered superior than women. This model is used in the health care setting, and results in a long-simmering struggle between nurses and doctors. 4.2 Equity and Social Class in Nursing In Canada, the health care industry is working hard to ensure it diversifies the health-care workforce. In this case, the nursing profession has been challenged to recruit a workforce that is culturally diverse, and which reflects Canada’s demographics. The inequalities in health outcomes as well as health care between majority populations and underserved as well as minority populations have been studied extensively. For this reason, Phillips and Malone (45) noted the need to urgently eliminate health inequalities. Employment equity can be described as representation of designated groups (women, disabled people, aboriginal peoples, and visible minorities) in every institutional level. The Canadian Nurses Association (CNA) understands that the cultural issues are associated with political and socio-economic issues; therefore, it considers social justice to be integral to the nursing social mandate. CNA seeks to ensure that all nurses are treated equally, irrespective of the person’s culture. Therefore, cultural safety is used so as to promote greater equity in nursing, and it concentrates on causes of inequitable social relationships as well as power imbalances within the healthcare settings. In view of this, cultural safety and cultural competence is considered by Canadian nurses as an essential. Cultural competence in Canada is not shared just by nurses, but also regulatory bodies such as CNA, professional associations, unions, and other organizations. 4.3 Statistics In Canada, nurses form the biggest group of regulated health professionals. In 2011, Canada had over 5,214 RPNs (registered psychiatric nurses), 84,587 LPNs (licensed practical nurses), and 270,724 RNs (registered nurses). The percentage of female RNs is 93.4% with more 58.3 per cent of them working in full-time positions. Besides that, there are approximately 7,945 Aboriginal nurses working in Canada; therefore, aboriginal people account got 2.9 per cent of the RNs labour force, despite the fact that they are 4.3 per cent of the total Canadian population. 5.0 The Regulatory Body for Nursing In Canada there are numerous regulatory bodies for Nursing. The main regulatory body is the Canadian Nurses Association (CMA), whose mission according to its website (www.cna-aiic.ca) is advancing positive health outcomes and nursing excellence in the interest of the public. CNA objectives include promoting profession-led regulation, to serve the interests of Canadian nurses, by offering leadership in health and nursing; and to support not-for-profit health system that is publicly funded. The association has almost 139,000 members and seek to promote the nursing profession as well as assist improve Canadians health. Another regulatory body is the Canadian Council for Practical Nurse Regulators (CCPNR), which according to its website (www.ccpnr.ca) seeks to promote public safety by regulating Licensed/Registered Practical Nurses. CCPNR offers nurses a forum for discussing and working together on initiatives as well as issues pertinent to the practical nurses regulation. Another body is the College of Registered Nurses of British Columbia (CRNBC), which according to its website (www.crnbc.ca) is a regulatory body governing the regulation of registered nurses as well as nurse practitioners in British Columbia. The key roles include establishing standards of practice, requirements/conditions for registration and identifying nursing education courses and programs in British Columbia. The College of Nurses of Ontario (CNO) is another regulatory body for nurses. According to its website (www.cno.org), it is the governing body for nurse practitioners, registered practical nurses in addition to registered nurses in Ontario. Canada. Its roles include establishing entry requirements for nurses, promoting standards for nursing practices and enforcing standards of conduct and practice. 6.0 People Served by Nurses Nurses’ clients include patients and old people: Normally, older people are affected with disabilities and chronic diseases and need nurses to care for them. Basically, aged individuals are important to the society and need advanced care when they get sick. Even though some older people’s mental health is good, the majority of them are at risk of developing neurological or mental disorders and other health problems like osteoarthritis, hearing loss and diabetes. Besides that, as people get older, they start experiencing numerous conditions simultaneously. Nurses are needed to care for older people because of high probability of them having more than one disorder at a time. Patients are key clients of nurses because they need care and to be helped to overcome their illness. 6.1 Nursing Vulnerabilities Vulnerability is considered by nurses as an important and central concept in nursing. A number of studies such as Tomm-Bonde (1) have recognized vulnerability concept as an important factor in establishing health status of communities, groups and individuals. Still, staff vulnerability is considered a key issue in nursing because of its enduring implications on the psychological and physical health which may result in staff burnout. Until now, vulnerability has remained a silent issue in the nursing literature. Comprehending why and how nurses feel vulnerable is crucial in determining strategies that can support them not to switch their emotions off, but instead to focus on how they can build their relationship with patients. In acute setting, nurses are left vulnerable while working with unpredictable clients because of their physical health needs. In view of this, employers need to support nurses by developing strategies that can help manage their vulnerability feelings, which is beneficial to the nurses themselves as well as patients. 6.2 Responsibilities of Nurses Canadian nurses have a number of responsibilities, but the main responsibility is caregiving. Nurses as caregiver offer hands-on care to patients in different environments and make sure that the patient's dignity is maintained while offering care that is skilled and knowledgeable. While offering care to the patients, nurses also address spiritual, developmental, psychosocial as well as cultural needs. Another responsibility is decision making, whereby they are expected to employ critical thinking skills so as to set goals, make decisions and promote patient’s outcomes. Such critical thinking skills involve examining the patient, problem identification, putting interventions into practice, and assessing the outcomes. Imperatively, the nurse is expected to utilize clinical judgment in determining the best course of action. Understanding communication techniques is another responsibility of the nurse with the goal of improving the healthcare setting. Imperatively, nurses have to communicate efficiently with the patient and other healthcare team members and are responsible for patient charting, which is a crucial component of care continuity. A fiduciary relationship according to Penfold (19) is whereby an individual with a specific knowledge and ability accepts the confidence and trust of another to act in the best interest of that person. In this regard, it can be argued that there is fiduciary relationship between nurses and patients because the nurses expect patient to communicate about an injury or illness. The nurse is expected to keep the information confidential. 6.3 Code of Ethics In their practice, nurses are increasingly challenged by complex concern; therefore, codes of ethics are considered a crucial guidance for nursing. The code of ethics offer nurses a culturally-adapted guidance that facilitates them to make ethical decisions. Nurses in Canada are expected to understand the ethical codes of conduct as well as the fundamentals of ethical decision making. The codes of ethics summarise how the nurses must ethically behave as professions, and what to do when they come across barriers that can prevent them to conduct their professional obligations. 7.0 Ethical Issues There are numerous ethical issues facing Canadian nurses; first issue is the patient freedom versus nurse control. Nurses normally understand the best clinical strategy, but it becomes challenging when their medical advice is rejected by the patient; thus, leading to decision that can bring about less optimal outcomes. The second ethical issue is the reproductive rights; the pro-life verses pro-choice argument is extremely personal that is rooted in a person’s core set of beliefs as well as values. In this case, if a nurse is a pro-life, he/she can support the right of the patient to abort while if the nurse is a pro-choice he/she can respect the choice made by the patient to keep the pregnancy even if it puts her life in danger. The third ethical issue is honesty verses information, whereby families often prefer withholding truthful information in attempt to protect the patient from emotional suffering. This poses ethical dilemma to the nurses because deciding what information they can share is a challenging part of the nurse’s responsibilities. The fourth ethical issue is the minor dilemma considering that working with children results in some ethical challenges. In this case, the nurse is expected to take the patient’s best interests into account and at the same time balance this against the family’s values, beliefs and wishes. Ethical issues associated with privacy may come about when working with minors. The law requires disclosure of particular information about the minor illness or injury to the parents, despite the fact that the minors have some basic rights to privacy. In such a situation, the nurses are expected to understand the hospital policy and law. The fifth ethical issue facing Canadian nurses is the battle of beliefs considering that medical procedures such as blood transfusions are not allowed by some religions. In this case, nurses always find themselves in a compromising situation trying to explain the benefits of the procedure given that it is their responsibility to support the patient’s right to the decision. 7.1 Case Study Ewashen, McInnis-Perry and Murphy study examines how nurses as well as other healthcare professionals ensure ethical inter-professional collaboration-in-practice as day-to-day practice. According to Ewashen, McInnis-Perry and Murphy (325), ethical interprofessional collaboration is crucial socially when decisions in interprofessional practice are contested. In their study, they analysed two healthcare scenarios using virtue ethics, relational ethics and biomedical ethics. In the other study, Dawe, Verhoef and Page examined experiences and beliefs of Alberta nurses with regard to withdrawal and withholding of treatments from terminally or incurably ill patients. According to Dawe, Verhoef and Page (71), nurses occasionally acted devoid of physicians’ knowledge. Dawe, Verhoef and Page (71) assert that consensus amongst consumers as well as health care practitioners are important in end-of-life decision-making. The issues discussed in both studies are ethical issues. According to Ewashen, McInnis-Perry and Murphy (326), the professional nurses have an ethical responsibility to collaborate with other stakeholders in healthcare industry to maximize health benefits to patients. According to their ethical analysis, McInnis-Perry and Murphy (332) illuminate certain challenges in negotiating tensions in the interprofessional practice, which includes conflict that practically affected interprofessional collaboration-in-practice all together. According to McInnis-Perry and Murphy (332), conflict and disengagement dominate the nurses’ working setting. According to nurses studied by McInnis-Perry and Murphy, embodiment was a professional, ethical, and moral source of distress. Dawe, Verhoef and Page (71) argue that nurses normally create close relationships with their patients, but occasionally they face situations where physicians, patients or families ask them to withdraw or withhold life-sustaining treatments. Such actions according to Dawe, Verhoef and Page (71) normally results to patient’s death given that the condition or illness is expected to take its natural course. In their study, Dawe, Verhoef and Page (77) noted that ethical conflicts surface when people are not certain of, or fail to agree onwhat to do when the patient’s health or life is under threat. The survey results in Dawe, Verhoef and Page (77) study proved that this was a weighty issue that scores of nurses practicing in Alberta are facing. 8.0 Character of Nursing 8.1 Strengths and Sensitivities Without a doubt, nursing as a profession is very challenging because it needs a wide of abilities as well as skills. Besides that emotional qualities required for patients’ caring, nurses are expected to operate complicated medical equipment, adapt to an environments that is constantly changing, and work in a multidisciplinary team. They are expected to remain calm even while under intense stress and also make important decisions when required. Some of the strengths of nurses include emotional health that is crucial for full exploitation of their capabilities. Other strengths include ability to exercise virtuous judgment and ability to develop sensitive, mature as well as therapeutic relationships. Nurses are expected to sensitively interact with patients, families, as well as other healthcare providers from different intellectual, emotional, social and cultural backgrounds. They should also have emotional intelligence, which according to Brackett and Salovey (34) is the ability to monitor the patient’s emotions and be able to use information in guiding one’s thinking as well as actions. 8.1 Threats to the Integrity The integrity of nurses is normally challenged by economic constraints in the healthcare system. Some of the threats to integrity include the requests to withhold information, lie to the patients, to fabricate records or to verbally abuse co-workers or the patients. Another threat to integrity is when a nurse behaves in a manner that violates the values of nursing or the code of ethics. It is the responsibility of the nurse to maintain integrity and preserve the safety of the patients, not abandoning the patient or withdrawing involvement after the alternative care for the patient has been made (Irurita and Williams 579). Works Cited Aiken, Linda H. "Economics of Nursing." Policy, Politics, & Nursing Practice 9.2 (2008): 73–79. Alameddine, Mohamad, et al. "A narrative review on the effect of economic downturns on the nursing labour market: implications for policy and planning." Human Resources for Health 10.7 (2012): 1-7. Brackett, Marc A. and Peter Salovey. "Measuring emotional intelligence with the Mayer-Salovery-Caruso Emotional Intelligence Test (MSCEIT)." Psicothema 18 (2006): 34-41. Dawe, Ursula, Marja J. Verhoef and Stacey A. Page. "Treatment refusal: the beliefs and experiences of Alberta nurses." International Journal of Nursing Studies 39 (2012): 71–77. Ewashen, Carol, Gloria McInnis-Perry and Norma Murphy. "Interprofessional collaboration-in-practice: The contested place of ethics." Nursing Ethics 20.3 (2013): 325–335. Irurita, Vera F. and Anne M. Williams. "Balancing and compromising: nurses and patients preserving integrity of self and each other." International Journal of Nursing Studies 38 (2001): 579–589. Penfold, P. Susan. Sexual Abuse by Health Professionals: A Personal Search for Meaning and Healing. Toronto: University of Toronto Press, 1998. Penner, Susan J. Economics and Financial Management for Nurses and Nurse Leaders. 2nd. New York: Springer Publishing Company, 2013. Phillips, Janice M. and Beverly Malone. "Increasing Racial/Ethnic Diversity in Nursing to Reduce Health Disparities and Achieve Health Equity." Public Health Reports 129.2 (2014): 45–50. Sirota, T. "Nurse/physician relationships: Improving or not?" Nursing 37.1 (2007): 52- 55. Tomm-Bonde, Laura. "The Naïve nurse: revisiting vulnerability for nursing." BMC Nursing 11.5 (2012): 1-7. Wall, Sarah. "Nursing Entrepreneurship: Motivators, Strategies and Possibilities for Professional Advancement and Health System Change." Nursing Leadership 26.2 (2013): 29-40. Read More