Ethics in Nursing - Case Study Example

Ethics in Nursing: Case Study University Affiliation Name Introduction Johnstone et al (2004, p. 24) asserts that while nursing professionals at all positions and areas of practice are exposed to a myriad of ethical issues in the course of their day to day nursing duties, the impressive growth in international scholarship on nursing ethics that has emerged within the last three decades has provided a comprehensive philosophical critique of the kinds of ethical issues that nurses face and the processes of dealing with such issues. The adherence to ethical standards covers various areas in nursing including patient-nurse relationship, professional boundaries, confidentiality, and duty to care among other areas. Harman (2004, p. 447) posits that management of heath information and especially storage of records is one of the core nursing roles that portend intrinsic potential ethical issues and risks including multiple ethical dilemmas with regard to issues of confidentiality, legal issues and the sensitivity associated with individuals health. In Australia, nurses have at their disposal various tools to aid in decision making when faced with such ethical dilemmas or issues and besides the Australian code of ethics for nurses, they include ethical principles and consequences. These tools when appropriately applied offer a framework that nurses can confidently use to make ethical decisions. Kerridge et al (2009, p. 92) argues that application of knowledge of medical ethics to demands of specific clinical problems requires systematic use of strategies to relate ethical aspects of cases to ones ethical-knowledge base. In addition, moral imagination, which is the capacity to think broadly around a subject and discern various ethical possibilities, is recognized as a major component in ethical decision making. Various models applicable to different ethical issues exist with varying strengths and weaknesses and they include principle based, legal-judicial approach, discursive, care-based approach, and critical decision analysis among others. Most models bear many similarities including reference to principles, emphasis on ethical concepts, care, communication, problem solving approach, patient preference among others. Kerridge et al (2009, p. 93) provides a model that inculcates aspects of various models to provide a framework for ethical decision making and its components include clear statement of the problem, getting facts, consideration of ethical principles, consideration of problem from alternate perspectives, identification of ethical conflicts and consideration of legal issues before making an ethical decision. The essay intends to provide a basis for making ethical decision regarding storage of patient’s health records using the model provided by Kerridge et al (2009, p. 93). Systematic reflection on the ethical issue will provide the best decisions when faced with ethical issues such as one described above (Kerridge et al 2009, p. 92).Such decision making process will utilize the framework for thinking ethically inculcating among other tools, the code of ethics for nurses, consequences and the relevant ethical principle. The decisions that one would make in a similar situation to Ralph would be the key outcome of the analysis. Statement of the problem The case scenario provided demands application of an ethical analysis on the practice of storing patients records (nursing plans, medication charts and observations) at the end of the patients bed and offering suggestions to Ralph, the CNC of a surgical ward on how to review the practice based on literature from nursing. The key issues that need to be resolved in order to come up with ethical decisions include determining how to decide on what to do and deciding what to do in the given situation. Ralph should determine all the facts pertaining to the decision to keep the clients information next to their beds by determining the history of the procedure, and other relevant information. For instance, the decision to place such information next to patient’s bed might have been intended to increase the ease of nursing in providing nursing care by reducing movement in getting the records from the storage thus enhancing timeliness in service delivery. Understanding such issues will provide for ease in determining different solution to the problem while ensuring that ethical concerns are addressed. Systematic reflection involving application of ethical principles Kerridge et al (2009, p. 79) defines principle-based ethics as an approach to ethics that specifies the rules or principles that guide moral actions. The four-principles approach, which was developed by Beauchamp and Childress is the most notable example and its derived from three theses: that morality is concerned with right and wrong, a universal non-relative core also known as common morality exists and appeals can be made suggesting that individuals should behave in particular ways and not in other ways. Beauchamp and Childress therefore provide a complex analytical framework that comprises four basic moral principles applicable to healthcare including autonomy, beneficence, justice and non-maleficence (Kerridge et al, 2009, p. 80). Applying the four principles to Ralph’s case scenario will contribute to an outcome that would be ethically grounded. In applying the principle of autonomy, which asserts that people should be allowed to make their own decisions and self govern to the issue concerning storage of records next to patient’s bed, Ralph would determine whether it would be the wish of the patient to have the records accessible to everyone. These would thus entail ensuring that the patients retain the right to determine who has access to personal information on their health and their continued enjoyment of confidentiality. Only with the permission of the patient should records be accessible. Also, through the principle of non-maleficence that requires that health workers should avoid doing harm would Ralph be in a position to consider whether exposing the records of the patient would pose harm to the patients. For instance, the patient may suffer from an illness that may result to ridicule or stereotype thus causing harm to the patient when information is placed next to the bed and accessed by friends or colleagues. In applying the principle of justice, which refers to standards and expectations that society holds concerning relations between society members, issues that will be addressed include determining whether it’s fair and right to have the patients documents placed next to their bed. Justice involves ensuring that no individual is subjected to subjection or subordination and it captures the essence of free will or choice (Kerridge et al, 2009, p. 81). Finally, using the principle of beneficence, which according to Kerridge et al (2009, p. 87) requires that health practitioners should actively engage in acts that aid in well being of others, Ralph would consider whether its to the patients best interest for the records to be stored next to their beds. Such consideration will determine the benefits of such a decision compared to the risks and in consideration of other principles. Code of ethics and relevant legal concepts as an alternative perspective The crucial importance of ethics in nursing is clearly evidenced in the definition of profession. The Australian Council of professions defines a profession as; “…a disciplined group of individuals who adhere to ethical standards … and are accepted by the public as possessing special knowledge and skills in a widely recognized body of learning derived from research, education and training at a high level, and who are prepared to apply this knowledge and exercise these skills in the interest of others” (Australian Council of Professions, 1997). The code of ethics, which is a core inherent feature of any profession, is recognized as a critical guide in making ethical decisions. The code of ethics for nurses in Australia developed by the Australian Nursing and Midwifery Council (ANMC) is a critical companion in ethical decision making for the nursing professions at all levels and areas of practice in in Australia. The code is based on principles and standard in United Nations universal declaration of human rights, social and cultural rights and international covenant on civil and political rights, World Health Organizations Health and Human Rights publication series, World Health Organizations constitution and United Nations Development Program Human Development Report 2004: Cultural liberty in todays diverse world (ANMC, 2005). The code complements the international council of nurses (ICN) code of ethics for nurses and it provides a framework for responsible and accountable nursing practice, in education, research and clinical management. This is achieved through identification of values and fundamental ethical standards to which nursing profession is committed (ANMC, 2005). Using the Australian code of ethics, as a guide on how to arrive at an ethical decision in regard to Ralph’s decisions in reviewing practice of storing patients records will be guided by value statement seven of the code which asserts that nurses value ethical management of information. A key element in the provision is the requirement that ethical management of information must involve respecting peoples confidentiality and privacy without compromising their health and safety (ANMC, 2005). Storing health information at the patient’s bedside poses risk of exposure of the patient’s health data to patient’s visitors, including friends and relatives breaching the patient’s privacy and confidentiality of data and posing major ethical and legal issues that may necessitate Ralph to review and change the policy. The risk that this portends may also include legal risks since it’s required that a person’s information is only shared with the individuals consent or with lawful authorization (ANMC, 2005). Ensuring confidentiality of records storage will enhance privacy of patient’s information while further augmenting the requirement for nurses not to divulge information about a patient to anyone unauthorized to have the information. Additionally, this will ensure that nurses respect the person’s wishes to determine the individuals whom their health information may be shared with thus preserving their right to confidentiality and privacy and which may not be possible when a patients core health documents are placed next to the patient’s bed. Another aspect that may guide Ralphs review is value statement one in the Australian code of ethics for nursing asserting that nurses value quality nursing care for all people (ANMC, 2005). This value entails nurses’ acceptance of accountability for the standards of nursing care besides taking legal and moral responsibilities in ensuring that they have skills, experience and knowledge to provide competent and safe nursing care. It also involves asking questions and reporting and taking action when based on reasonable grounds they find unacceptable policies and unethical behavior and treatment. Based on value statement seven, and supported by value statement one, Ralph should therefore review the policy on storage of patient’s record next to their bedside especially considering the ethical issues regarding patients privacy and confidentiality. Finally, (ANMC, 2005) value statement six requiring that nurses value a culture of safety in using and health care can be essential in Ralphs decision making. This requires that nurses recognize and avoid situations that may injure individuals under health care and support systems that may aid in identification of healthcare settings that may harm the patients. Ralph should thus review the policy on storage of records besides the patient’s bed considering the injury that may be experienced by patient on exposure of confidential health information including stigma, stereotypes among other issues. Systematic reflection on case using ethical standards approach as alternative perspective Various ethical approaches may also be used as alternative perspectives in guiding decision making. These approaches include utilitarianism, right approach, fairness and justice, common good and virtue approach. In using these approaches, Ralph should for instance using the utilitarian approach ask what will provide the least harm and the most good, using the rights approach, Ralph will determine the options that respects the rights of stakeholders while justice approach will determine options that result to proportionate treatment of the patients. The common good approach will determine what best serves the whole community, for instance the patients in this case. Finally, the virtue approach will determine whether the decisions enable the healthcare individuals to be the sort of people they would want to be (Manuel et al, 2009). Using such a framework, Ralph would be in a position to determine the most ethical decision Ethical decision From the foregoing discussion, it is evident that Ralph should review the practice of storing the patient’s documents next to the bedside at the hospital. The decision is supported in using the framework on ethical decision making provided by Kerridge et al (2009, p. 93) which recognizes the role of code of ethics and legal concepts in shaping ethical decisions, and application of relevant ethical principles, code of conduct and various ethical standards approaches and consequences. Ralph should therefore ensure that generation and management of patient’s information including their health records and other documents is done with integrity and professionalism and this entails ensuring that the information is not only accurate but also ensuring that it respects the confidentiality and privacy of the patients without compromising their health or safety. Nurses must also conform to systems of management of patient’s information that take cognizance of the expectations and standards of different communities and determine measures aimed at protecting the confidentiality and privacy rights of all individuals seeking healthcare in Australia (ANMC, 2005). Conclusion While challenges in making ethical decisions amongst nursing professional has been documented (Aitamaa et al, 2010, p. 24-30, Johnstone et al, 2004, p. 469-482), use of ethical decision making model as provided by Kerridge et al (2009, p. 93) can assist nurses in the decision making process by providing nurses with a framework that encourages rigor and reflection while making the internal reasoning process visible. The use of such a model is not only beneficial as evidenced in the analysis of an ethical scenario involving confidentiality of documents but is also applicable in providing a framework for addressing any other ethical issues. References Australian Nursing and Midwifery Council (2005). Code of ethics for nurses in Australia. www.anmc.org.au Australian Council of Professions. 1997. Ethics Resource Center: Definition of a profession. Retrieved from http://www.professions.com.au/definitionprofession.html Aitamaa, Elina., & Helena, Leino-Kilpi., Pauli Puuka., Ritta Suhonen (2010). Ethical problems in nursing management: The role of codes of ethics. Nursing ethics, 17: 469. Sagepub. Harman, Laurinda. 2004. Ethical challenges in the management of health information. Jones & Bartlett. Kerridge, Ian, John McPhee, Cameron Stewart. (2009). Ethics and law for the health Professionals. The Federation Press. Sydney. Johnstone, Megan-Jane, Cliff Da Costa, Turale, Sue. 2004. Registered and enrolled nurses experiences of ethical issues in nursing practice. Australian Journal of Advanced Nursing. Vol 22, No 1. Manuel Velasquez, et al. 2009 .A Framework for Ethical Thinking. Markkula Center for Applied Ethics, Santa Clara University. http://www.scu.edu/ethics/practicing/decision/framework.html Read More