Nursing Ethics and Palliative Care - Term Paper Example

Nursing Ethics and Palliative Care Number Introduction In as much as nursing as a career can prove highly fulfilling, it also often comes with a fair share of challenges. In each passing day, nurses, regardless of their accreditation or practice areas, continue to face several ethical dilemmas (Milligan, 2009). Ethics can simply be described as the study of practical reasoning (Milligan, 2009). Demonstrations of ethical behavior can be influenced by a lot of varied factors within a practice setting. In several instances, for example, what one nurse may deem ethical can be in sharp contrast to what another individual tackling the same issue does (Milligan, 2009). Universally, however, nurses are charged with the application of concepts of ethics in their patient care deliveries. These concepts of ethics entail the provision of care that is rational, good and correct (Milligan, 2009). With ethical nursing dependent on sound decision making and rational science, patients are also allowed the right to choice when procuring services and choosing how they wish to be cared for (Milligan, 2009). Even though the definition of ethical behavior concerning different circumstances in nursing can vary from one nurse to another, ethics generally encompass doing good deeds and causing no harm to patients, the institution and the nurse (Austin, 2012). Nurses can obtain basic tools for ethical behavior from lectures, classes, and seminars on nursing ethics principles, but such knowledge is shaped by the nurse’s experiences, values and beliefs (Nzle, 2006). In the end, therefore, contrasting choices can be ethically made regarding the same dilemma. In the current diverse world, it has become increasingly challenging for nurses to work with perceived integrity especially in the wake of the pressures and moral choices that nurses have to deal with (Austin, 2012). This paper briefly looks at one of the main ethical issues common in nursing, called palliative care, with a view of presenting a balanced perspective in the articulation of the issue. Palliative Care Issues surrounding palliative care are perhaps one of the most challenging and controversial kinds in the field of nursing and healthcare (Milligan, 2009). According to the World Health Organization (WHO), palliative care is defined as a multidisciplinary approach used to enhance the life quality of patients (as well as their loved ones/ families and friends) who are plagued with a life threatening condition (Milligan, 2009). This is realized through the prevention and treatment of diseases via prompt identification (diagnosis), assessment and effective treatment of pain and other related physical, spiritual and/ or psychosocial problems (Austin, 2012). Among other things, palliative care aims to relieve one from distressing symptoms such as pain, incorporate the spiritual and psychosocial aspects of patient care in delivery, affirms life and considers death as a normal phenomenon and neither intends to postpone or hasten death (Austin, 2012). Moreover, during palliative care, patients are offered support that allows them to live positively till death while their families are also given support that assists in coping management in sickness of the patient and even when the patient passes away (Austin, 2012). The 1990s saw an increase in the emphasis on the life qualities of patients across the world. In Canada alone, statistics indicate that over 60% of healthcare centers that have over 100 beds have palliative care programs (Davies, 2002). Most hospitals in the world have now caved in to the trend of palliative care teams which are teams of healthcare professionals in medical set-ups that work solely in palliative care regimes. In most cases, apart from those of cancer, palliative care is given for patients with low performance levels and inability to look after one’s self, who have not reaped the benefits of previous evidence based treatments, or those who have not qualified to take part in any suitable clinical trial (Davies, 2002). Palliative care is also administered when the caregiver considers evidence that suggests that no treatment will prove effective (Davies, 2002). Most patients in any part of the culturally diverse globe desire deaths that are dignified and peaceful, and end-of-life situations in which they are still capable of being in control of their healthcare and exercising utmost autonomy therein (Milligan, 2009). Many people thus fear that should they be rendered incapable of decision making from the impacts of a disease/ condition, they could receive treatments that they would not have preferred had they been capable (Austin, 2012). Nurses have therefore been, over the years, placed in conflicting positions especially regarding patients or families that would prefer not to continue treatment regimens after contending with years of chronic disease, especially (Austin, 2012). According to the Code of Ethics for Registered Nurses from the Canadian Nurses Association (CNA), end of life care should focus on nurse accountability, respect for and maintenance of patient confidentiality and privacy, preservation of dignity, respecting and upholding decision making that is informed, well-being and health promotions, and provision of care that is ethical, competent, compassionate and safe (Davies, 2004). The code continues to outline that nurses are expected to alleviate suffering, provide and advocate for a peaceful and dignified death to the patient while also ensuring support is provided for the patient’s family during the period of palliative care and following death (Davies, 2002). However, most nurses joined the profession of nursing with the sole purpose of saving lives and not watching helplessly as a life is lost (Davies, 2004). According to a majority of nurses worldwide, nursing is supposed to defy death, and thus the end of life care issue only leaves them in despair and lowered morale especially after the death of a patient (Davies, 2004). Nurses are taught to run as fast as possible immediately their bleeps signaled a distressed patient, for instance, but with the advent of palliative care, as soon as a patient makes a decision without any duress or coercion, nurses can now be allowed to assist in the death of their patients – a fact that is quite unpalatable amongst a majority of the modern nursing workforce (Davies, 2004). Consequently, moral and ethical distress can result in feelings of anger and helplessness amongst nurses (Davies, 2002). This distress stems from when nurses are told to do their work in a way that goes against what they have always believed nursing to be (Davies, 2002). The nurses feel that their integrity has been undermined through a blatant disregard for their professional and personal values through palliative care/ end of life obligations (Davies, 2002). The nurses therefore struggle between following the orders of the physician and their responsibility of ensuring a comfortable death (Austin, 2012). Barriers are bound to occur when nurses and other healthcare professionals are prohibited from performing their duties as per professional standards and personal values (as stated by Davies, 2002). According to surveys from various institutions across the world, nurses begin to show increased levels of helplessness, sadness and ambivalence when they are informed that they can no longer be allowed to assist those who are terminally ill to recover (Davies, 2004). According to Austin (2012), nurses find it extremely difficult to impossible to coping with the dilemma of providing curative care and palliative care. A good instance to illustrate this is case management and pain management issues. A bedside nurse who tends a patient for 12 hours, for example, is arguably the best candidate to assess the effectiveness of presently used pain relief medication technique and other needs for end of life. Such a nurse may report the need for a patient care conference or poor pain control, but such may not be regarded leaving the nurse with strong feelings of frustration, resentment and anger concerning the care provided to the patient (Davies, 2004). It is common knowledge that patients and their families want to live lives of purpose and meaning, and nurses are thus left contending with a myriad of various challenges when attempting to meet the holistic needs of dying patients (Guido, 2006). Moreover, the nurses at palliative care settings say they face recurrent personal pain to various extremes in this constantly evolving profession (Austin, 2012). For example, nurses feel extreme pain when they deal with the death of a patient who was allowed to die especially if the deceased was a patient of the same age as a loved one, relative, friend or child (Guido, 2006). Nurses also feel pain when they consider the cold stare of the bereaved family, coupled with overwhelming grief, devastation and feelings of disappointment at the current health care abilities of medical centers which were unable to treat their loved one (Austin, 2012). It is not uncommon that the bereaved family should blame the healthcare providers for giving up too soon, even if it is they themselves who helped sanction the end of life care (Guido, 2006). Many palliative care nurses have also reported sad moments when a physician tells a patient that they have no chance of surviving and the patient pleads to the medical team that they are not ready to die yet (Davies, 2004). Several clinical conversations from palliative care nurses strongly indicate that nurses suffer emotional pain when established connections with patients and their families are terminated through death (Guido, 2006). It is therefore common that such nurses should consequently attempt to keep themselves concerned only with physical care in order to avoid establishing relationships with patients and their families so as to protect themselves from distress in the wake of death in the palliative care setting (Guido, 2006). Needless to add, this inevitably retards the positive holistic approach of patient care (Guido, 2006). Apart from this ethical distress and personal pain, nurses who provide palliative care are often left unsupported following the demise of a patient (Nzle, 2006). In the end, there is need for services that assist the nurses in such settings to cope well with the most-often unfavorable outcomes of palliative care (Nzle, 2006). Added to the fact that there are few nurses that are qualified for palliative care work, such nurses are often overloaded with stressful and emotionally draining responsibilities of ensuring patients die in comfort and dignity, even as their families are equally looked after (Guido, 2006). This often leaves a nurse with a bad inability to sufficiently care for all their patients, thereby leaving the nurse with stress and overwhelming feelings (Nzle, 2006). In addition, there is currently very little professional collaboration and relevant education to ensure that the best management of palliative care and end-of-life situations are achieved (Guido, 2006). A majority of nurses in palliative care centers feel inexperienced in talking with patients and their loved ones regarding end of life situations, pain management issues, and choice not to resuscitate, and transition into palliative care or hospice care (Davies, 2004). This can lead to enormous stress in the nurses and result in poor healthcare. Even so, most nurses lack sufficient skills, knowledge and expertise to comfort parents/ families that are grieving. Most of these nurses say they feel uncomfortable when loved ones cry fro their lost ones and do not know how to go about theses situations, especially when they fear they might say something offensive or inappropriate to the grieved person(s). Palliative care is therefore an important issue in healthcare that could impact negatively on the quality of care provided to patients if not properly managed (Keatings & Smith, 2010). Many have argued for palliative/ end of life care as a contravention of the basic principles of a nurse which is to save lives at any cost (Nzle, 2006). However, according to the CNA’s position that apart from preventing illnesses and promotion sound health, nurses are also tasked with easing suffering, respecting human rights to subscribe to any belief (culture), life, choice, dignity and respectful treatment, palliative care regimes can indeed be a suitable option especially in extreme cases of illnesses such as cancer that are beyond redemption (Keatings & Smith, 2010). My nursing position is that there should be no discrimination in service for persons of any belief or desire and that they have the right to make well balanced and non-coerced decisions. To minimize the obstacles to quality healthcare listed above, however, staff allocation to palliative care units have to be improved even as more nurses are appropriately educated concerning matters palliative care (Keatings & Smith, 2010). Personally, while working at palliative care, my position is to improve on bedside time with patients and their families (to help them cope well), enhance communication skills (to adopt methods that are open and sensitive), better understand euthanasia, terminal sedation, cultural and religious matters that may impact on dying patients and their families, power issues, symptoms and pain management, maintenance of a healthy balance of family needs/ choices and those of the patient, truth telling, nutrition issues, antibiotics use, place of care and confidentiality (as Mckenna & Clark, 2015, postulate). Conclusion While providing quality health care, nurses are plagued with day-to-day ethical dilemmas. To address these difficulties and ensure nurse retention which is important in the contemporary medical institutions, it is vital that interventions and regulations that target ethics in order to enhance satisfactory management of an increasingly complex population of the patients are instituted in attempts to erase certain conflicting grey areas in the general practice of nurses (Nzle, 2006). Palliative care plays a crucial role in the advanced stages of cancer and other terminal chronic diseases. Therefore, there should be an ethical approach to the various aspects of palliative care which include end of life care, pain and symptom management, and psychosocial care (Mckenna & Clark, 2015). Palliative care must be conducted in a manner that is consistent with the cardinal principles of ethics of autonomy, justice, non-maleficence, and beneficence (Mckenna & Clark, 2015). The palliative care team ought to conduct their duties with utmost dignity, respect and honesty (Keatings & Smith, 2010). To improve on current palliative care regimens there is need for good, legal and ethical researches, trials and studies (Milligan, 2009). Provision of palliative care and medical ethics complement each other to maximize the quality of healthcare given to the vulnerable patient and members of the family (Keatings & Smith, 2010). References Austin, W. (2012). Ethical issues in qualitative nursing research. Routledge International Handbook of Qualitative Nursing Research. Davies, E. (2004). Palliative care. Copenhagen, Denmark: World Health Organization. Davies, P. (2002). Nursing. Oxford: Oxford University Press. Guido, G. (2006). Legal and ethical issues in nursing (4th ed.). Upper Saddle River, N.J.: Pearson/Prentice Hall. Keatings, M., & Smith, O. (2010). Ethical & legal issues in Canadian nursing (3rd ed.). Toronto, ON, Canada: Moseby Elsevier. Mckenna, M., & Clark, S. (2015). Palliative care in cardiopulmonary transplantation. BMJ Supportive & Palliative Care. Milligan, S. (2009). Palliative Care Research. Palliative Nursing, 312-324. Nzle, S. (2006). Palliative care. Heidelberg: Springer Medizin. Read More