The Code of Ethics for Nurses in Australia - Case Study Example

Topic: Ethical Dilemma Topic: Ethical Dilemma Introduction: The following pages will lay stress over how Nurses are faced with Ethical dilemmas within their work lives everyday. We would also would be observing a real life case study to actually look into detail of how these kind of situations actually take place and what are the actions reactions and consequences. To begin with globally Nurses are deemed to be responsible for four essential errands: to encourage health, to put a stop to poor health, to reinstate health as well as to lessen the anguish of the patient. The requirement for nursing is worldwide. Natural within the element of nursing is the admiration for human rights, together with civilizing rights, the right to living and preference, to self-respect and to be taken care of with respect. Nursing care is deferential of and unlimited by the contemplations of maturity , color, statement of belief, traditions, disability or ill health, sexual category, sexual direction, nationality, politics, race or else the social standing. Nurses render health services to the individuals, the family units as well as the society as well as integrate their services with those of the associated groups The code of Ethics for nurses in Australia: The explanation of the Terms Code of Ethics Bibliography extrapolated under the patronage of the Australian Nursing and Midwifery Council, the Royal College of Nursing, Australia, the Australian Nursing Federation The rationale of this Code of Ethics is to: • recognize the primary moral obligations of the occupation, • offer the nurses with a foundation for the professional and self indication upon the ethical behavior, • proceed as a guide to the ethical practice, as well as • point out to the society the ethical values which nurses can be anticipated to embrace. The system of Ethics for Nurses within Australia was initially developed during 1993 under the sponsorship of the then Australian Nursing Council Inc., the Royal College of Nursing, Australia along with the Australian Nursing Federation. During the year 2000 these max out corporations arranged to assume a joint development to examine the Code of Ethics. It is identified that the Code of Ethics would not have been rationalized devoid of the contribution of nurses as well as the nursing corporations in Australia, whose countless capitulations and observations are recognized as well as treasured. (ANMC, 2005) The Ethical Dilemma Incident in detail: It was going to be a busy day that day as I had worked overtime yesterday due to severe staff shortages and had already worked out staffing etc to deal with the day’s activities ahead . The Nurse Unit Manager was away moreover I was to look after, acting in her absence. Nevertheless, while all this was going on, what I had forgotten was the worsening condition of one of the patients. I had reached work at around 0615hrs and met the night shift staff in a anxious state due to the speedy decline in Mrs. Jane's (the name has been altered here for confidentiality) condition. She was facing severe respiratory failure and the staff was facing troubles while attaining medical support and proper care for this patient. I was very swiftly caught up in supervising this patient's incident. Sequence of events: • The evaluation of patient signified acute respiratory distress. She had been on BiPAP for 14hrs and only within the previous 2hrs had her BiPAP settings been increased to cope with the altering symptoms, and the present settings pointed toward both a high IPAP and EPAP settings, RR-35bpm, Tidal Volumes-100-200mls, SpO2 88%. There was no main line, so no ABG had been taken, so I ordered an ABG to be achieved through an arterial stab, which the outcomes revealed: PCO2- 104mmHg, PO2-62mmHg, pH- 7.412mmol/L. Patient was semi comatose, conversely was very apprehensive and a bit bewildered when conscious. • I asked the present nursing staff to make suitable arrangements for an emergency intubation, a strict observation of the patient’s hemodynamic status continued, and two morning staff members who just arrived to take over the area of care at the same time as I was busy arranging to get more medical assistance. • The Resident Medical Officer (RMO) contacted and requested for an immediate review as well as bed side attendance until the Intensivist arrived. The RMO stated that she had examined the patient earlier in the night and was aware of her deterioration and had notified the intensivist earlier, and was satisfied with this and so did not review again. I then continued to update the RMO on the situation at present, along with the ABG result, and stated this patient was an ALERT criterion for an ICU patient and it was necessary for her to examine and remain with the patient until the specialist had arrived. She also then assessed the patient and gave her consent to my diagnosis of acute respiratory failure thereby intimating the Intensivist again. The After Hours Hospital Co-Coordinator was also informed of the vigilant situation. The patient's relatives, the Next-of-Kin was spoken too and notified of the wife’s fast deterioration and was also asked to come in. The Intensivist had by then arrived; the assessment of Mrs. Jane as done again and very shortly after wards Mrs. Jane was intubated and ventilated. Focus on a case study and relevance to the ethical dilemma faced: It was apparent to me at the very beginning that there were quite a few ethical issues implicated within this situation. A major issue involving the lack of on duty of care by the RMO, where she did not review the patient after calling upon for intubation. I was very disturbed, fuming at times at the lack of respect towards knowledge, practice and experience. The RMO had given the nursing staff a loose end by not listening to them and evaluating the patient when inquired about. Also as a nurse there were two issues that could also be put up in relation to this incident and they included: 1) The nurse's deed in by not attaining the essential medical assistance, even though the RMO did not foresee the need to examine this could, be seen as not upholding the ICN code of ethics: 'The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person.' In review of the situation, it was found that the nurses involved contacted the RMO several times over night for respiratory distress issues. The RMO had evaluated earlier on in the night and recorded her review inside the notes but had not assessed since, despite the fact that the nurses were calling her. By the RMO not reviewing the patient, the patient's health one could say was being dying out as the appropriate treatment and care wasn't being provided. Hence the appropriate action in this situation would have been to call the intensivist directly with their concerns. 2) Another ethical issue relates to the ANMC Code of Ethics for Nurses in Australia, Value statement 5- Nurses fulfill the accountability and responsibility inherent in their roles. As the nurses were unable to obtain what they thought was an appropriate response to the patient's condition, it is the nurses responsibility to report this incidence of what the nurses believe was unsafe practice to the appropriate personnel. The nursing staff on night shift did not notify the Hospital Co-Coordinator of the failure of the RMO to review a patient with hemodynamic deterioration. If this had occurred the Medical Superintendant would have been notified, the RMO would have been contacted and treatment for the patient would have started a lot earlier. How the above incident became the breach of nurse Ethics: The ANMC Code of Ethics for Nurses in Australia, Value statement 5- Nurses fulfill the accountability and responsibility inherent in their roles. As the nurses were unable to obtain what they thought was an appropriate response to the patient's condition, it is the nurses responsibility to report this incidence of what the nurses believe was unsafe practice to the appropriate personnel. The nurses thereby again breached the nurse ethics within the situation where the RMO was not reviewing the patient, the patient's health one could say was being dying out as the appropriate treatment and care wasn't being provided. Hence the appropriate action in this situation would have been to call the intensivist directly with their concerns. Also it should be reserved in mind that the: The underlying principle of this Code of Ethics is to: recognize the most important ethical responsibilities of the occupation, present the nurses with a institution for the skilled and self suggestion upon the ethical behavior, progress as a channel to the ethical practice, as well as point out to the society the ethical values which nurses can be expected to hold. (ANMC, 2005) The conclusions and recommendations: Countless researchers have recognized the destructive effects of ethical/moral anguish. Numerous others such as Kalvermark 2003 identify that the complications of health care make ethical dilemmas as well as moral distress foreseeable. As and when they were winding up their investigations the authors recommended that the associations have got to provide a bigger support, also in the form of finances in order to put off moral distress. This is sustained by Elpern 2005 who considered moral distress amid staff nurses within a medical intensive care unit also established that hazardous care nurses are time and again confronted with circumstances that are connected with elevated levels of moral anguish, which unfavorably affects job contentment, withholding, psychosomatic and corporeal well-being, self reflection and mysticism. (Joanna Briggs Institute, 2008) During another study the effects of moral suffering are recognized as early on as two years post-graduation. Within a research that contrasted the nurse doctor viewpoint of moral pain and moral atmosphere within the concern of dying patients inside intensive care units, Hamric and Blackhall 2007 established that the enrolled nurses experienced more moral pain than did the doctors. In addition, the nurses alleged their ethical setting as being more depressing and were more decisive of the value of care being offered. (Joanna Briggs Institute, 2008) The excess of literature on moral pain would propose that consideration to this occurrence is considered remarkable by the occupation. Gleaning a fused perceptive of how nurses understand the occurrence will facilitate the profession look for intercessions for restraining the noxious effects. The fact of moral distress is well documented in the nursing literature but no orderly evaluation subsists. For the rationale of the evaluating professional nurses are referred to as the approved or recorded nurses. In a position statement on moral distress The American Association of Colleges of Nursing (AACN) 2008 portrayed it as taking place when nurses recognize the suitable action to take, but are incapable of acting upon it, and additionally , proceed in a style opposing to their individual and specialized principles, consequently deflating the reliability and legitimacy( AACN 2008 ). (Joanna Briggs Institute, 2008) The case: The subsequent case study reveals the fact that the disagreement produced by the foundation principles self-sufficiency. It also points out the particular ethical disputes that the nurses within the events face e.g., the patients hand over their concern to local surgeons who may well execute the difficult measures only infrequently and, as a result, lack the understanding of the specialists who carry out surgery within larger institutions. During these kinds of situations, the nurses possibly will experience imposed to contribute without verbal communication out alongside what they recognize as infringement of the very basic ethical principles. CONCLUSION The compound ethical issues as regards the main beliefs along with quality of existence root great dilemmas within health care for the reason that they are conceptual, uncertain, and poignant, along with subject to personal standards. Over and over again, there is not one acceptable resolution to a dilemma but quite a lot of unacceptable substitutes(C Papadakis, 1993-2000). Within the decision-making process, the final influence must be the knowledgeable patient or his or her legal substitute. The nurses in today’s world must educate patients on the subject of the options and possible outcomes of their proposed treatments. It is also essential that the nurses take great care and make decisions themselves if they see some of their seniors ignoring a certain situation. It is also essential that health care professionals become well-informed, convinced, and knowledgeable about the ethical procedure. Situational decision making have got to reinstate total dependency on the extraordinary principles of beneficence. The viewpoint supplied here is based on self-regard, teaching, and organizational responsibility to distribute quality care to all patients in a fair loom to help them preserve their independence and self-esteem while receiving care. Ethical learning is one technique of with regard to others' in addition to one's own autonomy and guiding actions in susceptible situations. (Marianne C Dunn, 1998-2000) The RMO, should have been cautious enough to inform the staff that the patient as detoritaing and constantly needs to be checked. The RMO was at fault here, presuming alls going to settle and then not reviewing the patient again, or following up if all was being done appropriately. What all nurses need to understand and be told is that they have rights and some ethical responsibility towards them when such a situation comes to light with this kind of an outcome. They need to inform someone else who’s in charge of the situation if the present on duty senior does not seem to respond to grave requests of reviewing a quickly detoritaing patient . Blunder free performance is an average anticipated from the health professionals. Though, health systems and employees are not perfect; errors have taken place, with high individual and financial expenses (Runciman WB, Moller J, 2001). These unfavorable events are visible symptoms of mistakes, and most symbolize accidental errors of lapse typically or costs (Siddins M, 2002). Gaining experience from both unfavorable events and near loss is necessary for civilizing the quality of care (Reason J, 2000). Yet lesser reporting has become a major problem, (Lawton R, Parker D, 2002). The Incident reporting behaviour varies between the medical and nursing professional sets (Lawton R, Parker D , 2002) with nurses reporting considerably more frequently than the doctors. Outside the restraint of anesthesiology, the nurses kicked off an 88% and the medical staff only a 2% of the reports that were offered in the course of the Australian Incident Monitoring System (AIMS) between 1998 and 2002 ( AIMA , 2002 ).The Junior and senior nurses’ anxieties were principally over the concerns of responsibility and reprimand e.g., black script on the employment records, job uncertainty with pressures to the future service. This was most apparent amongst the junior staff, some of whom dreaded discrimination and nuisance. The Nurses require a more proficient, democratic system that does not involve additional input from the doctors. They promoted education and point of reference for mutually the nurses and the doctors. Whilst most of the nurses braced unspecified reporting systems as a constructive means of dealing with the concerns and not the self, in most of the cases the senior nurses express apprehension that this would bound their capability to sufficiently follow up episodes. (Marilyn J Kingston, Sue M Evans, Brian J Smith and Jesia G Berry, 2004) References American Association of Colleges of Nursing (AACN) 2008 . Moral distress. Retrieved January 23, 2008, from http://www.aacn.org/aacn/pubpolcy.nsf/vwdoc/pmp Codes of Ethics for nurses in Australia, ANMC July 1993, revised in 2002 reprinted February 2005. The Australian Nursing Council has officially changed its name to the Australian Nursing and Midwifery Council. Australian Nurse Registering Authorities Conference. (ANRAC), (now ceased), 1990, Report to the Australian Nurse Registering Authorities Conference Vol 1 pp 91-94, Australian Nursing Council Inc. (ANCI). C Papdakis, "Ethical issues involved in euthanasia," Paper presented at the Eight Annual World Conference of Operating Room Nurses, Adelaide, Australia, 1993-2000 , 282. Elpern E, Covert B, Kleinpell R. 2005 , Moral distress of staff nurses in a medical intensive care unit. American Journal of Critical Care. ; 14: 523-530. Hamric A, Blackhall L. 2007 , Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral Distress and ethical climate. Critical Care Medicine. ; 35: 422-429. Leslie Rittenmeyer , Lisa Hopp , April 16th 2008 , How Professional Nurses Working in Hospital Environments Experience Ethical Moral Distress: A Systematic Review The Joanna Briggs institute , Indiana centre of Evidenced based Nursing practice Lawton R, Parker D, 2002 Barriers to incident reporting in a healthcare system. Qual Saf Health Care ; 11: 15-18 Marilyn J Kingston, Sue M Evans, Brian J Smith and Jesia G Berry, 2004 , Attitudes of doctors and nurses towards incident reporting: a qualitative analysis, The Medical Journal of Australia (MJA ) 181 (1): 36-39. Avialble at: http://www.mja.com.au/public/issues/181_01_050704/kin10795_fm.html#elementId-1088301. Accessed on the 14th of October 2008. Marianne C Dunn, Knowledge helps health care professionals deal with ethical dilemmas Association of Operating Room Nurses. AORN Journal; Mar 1998-2000 ; 67, 3; Health Module pg. 6589 (MARIANNE C. DUNN, RN, DIP ADM NURSING (UNE), MCN (NSW), is a staff nurse in the OR at the Geelong Hospital. Geelong, Victoria, Australia. She was OR manager, Latrobe Regional Hospital. Traralgon Campus, Victoria, Australia. At the time this article was written.) M Evans, 1991 – 2000 "Professional ethics and reflective practice: A moral analysis," in Towards a Discipline of Nursing, Ed G Gray, R Pratt (Melbourne: Churchill Livingstone) 310, 313. Runciman WB, Moller J. 2001 Iatrogenic Injury in Australia. A report prepared by the Australian Patient Safety Foundation for the National Health Priorities and Quality Branch of the Department of Health and Aged Care of the Commonwealth Government of Australia. Adelaide, South Australia: Australian Patient Safety Foundation. Reason J, 2000, Human error: models and management. BMJ , 320: 768-770 Siddins M, 2002, Audits, errors and the misplace of clinical indicators: revisiting the Quality in Australian Health Care Study. ANZ J Surg 72: 832-834 The Concise Macquarie dictionary Second Edition sv, “ethics” 417 The ICN Code of Ethics for Nurses Copyright © 2006 by ICN - International Council of Nurses. Read More