The Nursing Practice - Report Example

How to Eliminate Paternalism and Misuse of Power from Nursing Practice Name: Course: Tutor: Date: Introduction It is commonplace for people to make decisions in their friends’ or associates’ best interests. This happens in many areas. In medicine and nursing, paternalism implies treating a patient in a manner that disregards the patient’s will while only targeting to promote the patient’s best interest (Tuckett 2006). It implies that a patient may have to take a certain treatment just because the doctor thinks it is good rather than because the patient is comfortable with it. Paternalism is regarded as a bad thing because it ignores a patient’s autonomy (Tuckett 2006). With reference to medicine and nursing, paternalism is a bad practice because doctors and nurses are supposed to value patient autonomy, which is an important aspect of the relationship between a doctor or nurse and the patient (Schattner & Tal 2002; Candib, Quill & Stein 2002). Paternalism can be likened to the opinion that power is linked to poverty. That power arises from the imbalances in the social exchange. Along this line, there is a view that between any two parties, one party gains power because of the inability of the other party to reciprocate. According to Rowley (1970), the party that fails to reciprocate is the subject of dependence in that he or she cannot do without the other, or is basically at the mercy of the seemingly benevolent fellow. Thus satisfaction of the weaker person’s needs becomes a contingent of compliance (Rowley 1970). Power and its misuse In addressing power use and its misuse, Tiffany and Lutjens (1998) regard power as being neutral- that is neither bad nor good. The authors also note that power per se does not corrupt, but its misuse does. In this regarded, they suggest that misuse of power destroys the essence of having the power, and therefore renders it unavailable for constructive purposes. The result of this condition is a state of powerlessness for one party. The state of powerless is commonly linked to poverty, or to the character of a weaker party. Spicker (1993) notes that people who have power are able to control discussions, are able to create environments in which they cannot be faulted, and so forth. On the other hand, powerless people are usually viewed by the powerful ones as poor people of low status and not able to make worthwhile decisions (Spicker 1993). This means that once the person wielding power makes a decision, the decision is final for all the parties involved, or is made in their best interests. Patients commonly find themselves in this position while dealing with nurses According to Rowley (1970), dependence is a result of misuse of power and a characteristic of poverty, and this situation subjects people to many systems that do not value people. True, most patients in their weak states are usually left at the mercy of doctors and nurses, who may choose to do anything that is perceived to be good for them. But this disregards the patients’ autonomy, amounting to a misuse of power. The misuse of power between two parties was exhibited by European settlers when they invaded Australia and settled on the rich lands formerly occupied by Aboriginal people, sending them to marginal lands. But in 1973, the Australian Council of Social Services produced a report that viewed the Aboriginal people in different light (Rowley 1970).The report considered the Aboriginal people to be poor, a condition that was occasioned by the European settlers who took their land and condemned them to living in harsh conditions thereby increasing their dependence (Rowley 1970). The Aborigine society was significantly annihilated and had to live as dependants of the whites, a situation that can be liked to the condition of paternalism in medicine and nursing General overview of paternalism in nursing Without knowing it, medical practitioners and healthcare providers find themselves dealing with patients paternalistically. This involves making decisions for patients in a benevolent manner that disregards their autonomy or will. For instance, Hill, Howlett and Howlett (2004) present a case where a “friendly nurse” may advise a patient to choose a certain type of treatment because it worked for him or her or a family member in the past. In such a case, the patients’ freedom to decide is curtailed by the benevolent character of the nurse, implying that the patient will receive the treatment just because the nurse liked it. In the same way, it is common for nurses particularly those who give advice to patients to deal with them paternalistically, albeit without their knowledge. For instance, it is common for nurses to advise breastfeeding mothers to feed their children, or to give them nutritious food. What the nurses do not know is that the advice they should be open and the decision making process should be left with the party being advised. According to Hill, Howlett and Howlett (2004), it is also common for nurses to make decisions for patients without necessarily implying that they are deciding for the patients. For instance, if a patient asks for a nurse’s opinion about a certain type of treatment or asks for general advice, the nurse is likely to reply: “Well, I were in your position I would do it this way…”, instead of saying something like: “in relation to this condition, these are the options you can choose from”. When the nurse answers in manner that suggests a final opinion, the patient is highly likely to take the perceived decision since patients are usually at the mercy of nurses, who have power over them. Nurses may be acting paternalistically with the belief that they are acting in the patients’ best interests. But this “benevolent” attitude curtails the patients’ freedom to make decisions and has been criticized by many writers such as Mitchell and Lovat, 1991; Johnstone, 2002 and Hunt, 1994. These writers have contented that paternalism limits a patient’s autonomy and may potentially lead to subdued health implications for the patient. Along this line, Tuckett (2006) notes that the ability of a patient to make decisions regarding his or her health is paramount for the patient’s physical and emotional wellbeing. It is therefore imperative that paternalism be eliminated at all costs from the nursing profession in order to enhance autonomy and avoid the perception that nurses have power over patients, or that patients’ decisions depend on what nurses think. This is discussed in the following section. Elimination of paternalism and misuse of power from nursing According to Melia (1994), nurses are more frequently close to patients as compared to any other healthcare experts. They are therefore better placed to know what patients’ views regarding certain issues are. Nevertheless, this vantage position should not be exaggerated to mean infringement of patients’ rights by nurses. Being neutral Nurses have to reconsider the kind of assistance they give to patients. They have be aware that by acting so much as patients’ advocates, they deny them the right to make critical decisions. The nurse’s role as an advocate for the patient needs to be viewed from an abstract context in which nurses elaborate on the choices to be made by patients and let them make their own choices rather that choose for them. In essence, nurses have to be neutral It is difficult for nurses to avoid paternalistic attitudes towards patients, but since the phenomenon is not a good practice, nurses just have to get rid of it. If for instance a female client complains about a certain complication in her son’s body, to a nurse who also has a son, the nurse should not take that as an opportunity to advice the client how she also treated a similar condition in her son. Rather, she should use the opportunity to advise the client on the alternative treatments available so that the client chooses from the variety (Hill, Howlett & Howlett 2004). As an example, the nurse can say: the doctor has explained a variety of options to treat your son’s condition and the possible contraindications attached to each. You can choose from the options one kind of treatment you feel suits you”. Such a statement gives the patient or patient’s assistant an ample opportunity to make reliable decisions about his or her health. Use of professional language Hill, Howlett and Howlett (2004) present another good example of a scenario where a nurse used professional language to avoid paternalism. The officer in charge of lactation counselling was presenting a concept in a seminar and used the jargon: “I wish that all women breastfeed their babies. The importance of breastfeeding to both mother and child has been supported by scientific evidence. I will present this evidence and respond to questions arising from the content of my talk. But I leave the final assessment about breastfeeding to mothers and will courteously support their choice” (Hill, Howlett & Howlett 2004). Such a standpoint by a nursing officer leaves those concerned with an open mind and understanding that their decisions will determine their fate. In fact, the open-mindedness makes the audience to ask more questions and request for clarification in various areas before making final decisions. That would not be the case if the officer dictated without giving reasons that mothers have to breastfeed their children since the mothers would follow the instruction without understanding the importance of breastfeeding. According to Shaw and Mahoney (2003), paternalism emphasizes a feeling that the provider of some help understands best, much like the relationship between a parent and a child. If a nurse prepares some medication and expects a patient to take it without questioning, this is an exacerbation of paternalism. Additionally, paternalism is exhibited if a nurse conceals the results of a prognosis from a patient on the pretext that the patient does not fully understand the ramification of the prognosis (Shaw & Mahoney, 2003; Group & Roberts 2001; Brooker & Nicol 2003). This commonly happens in health institutions but is bad practice and a form of misuse of power which should be eliminated. Maintaining openness Apart from the need for nurses to be neutral while handling patients, there is need for need for openness with the patients so that the patients recognize them as their helpers rather than all-powerful decision makers. As earlier discussed, nurses should be willing to disclose all information that relates to their patients as required by the nursing profession and as a courtesy measure to ensure that patients are given a chance to make informed opinions about their treatment or other therapy (Johnstone, 2008). Along this line, nurses should ensure that their role to patients is to help them rather act as their decision makers. It is not possible for a nurse to fully understand what a patient wants. Tuckett (2006) gives an account of a research in which it was found that most nurses overestimate patients’ emotional and physical needs. This implies that the best decision made by a person is that made without influence from another party. The overestimation of patients’ needs is probably a result of coercion of the patients by nurses. The fear by patients to contradict nurses’ decisions makes them to consent (Johnstone, 2008; De Valck, & Van de Woestijne 1996). In order to avoid this, nurses should ensure that any patient’s consent is given voluntarily without any form of influence. Concept of beneficence In order to refrain from misuse of power over patients, nurses should ensure that patients are always in a position to make informed choices. In case a nurse has to make a surrogate decisions on behalf of the patient; it has to be proved that indeed the patient’s situation cannot be improved and decisions have to made for him or her. Such decision making processes are considered under beneficence (Thompson, Melia & Boyd 2000; Buetow & Coster 2001). Beneficence implies a situation that cannot be helped in that decisions just have to be made in other people’s best interest. According to Thompson, Melia and Boyd (2000), beneficence is inevitable in cases where patients are under excruciating pain, are severely disabled or are totally helpless, thereby needing urgent help and making of decisions. Hill, Howlett and Howlett (2004) note that beneficence paternalism may be justified in extremely complex situations such as where a nurse approaches a court to be allowed to sign a document to facilitate a life saving operation on child in case the child’s parents refuse to sign the document. However, this does not mean that paternalism can be justified in nursing. Conclusion This paper has reviewed paternalism in nursing as a phenomenon whereby nurses make decisions in the best interest of patients. In this context, it has been discussed that paternalism curtails the autonomy of patients and should therefore be eliminated. Therefore, it has been argued that nurses should help patients by elaborating the implications of various issues that concern them but leave the final decision-making process to the patients. References Brooker, C & Nicol, M 2003, Nursing adults: the practice of caring, Elsevier Health Sciences, Canberra. Buetow, S & Coster, G 2001, Do general practice patients with heart failure understand its nature and seriousness, and want improved information? Patient Education and Counseling 45 (1): 181–185. Candib, L; Quill, T & Stein H 2002, Truth-telling and advance planning at the end of life: Problems with autonomy in a multicultural world. 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