Concept of Ethical Framework in Nursing - Essay Example

Most people tend to think of nurses as individuals who are primarily expected to assist doctors with medical procedures and help patients follow the doctor’s orders. But nurses are much more than just assistants to doctors and patients. While discharging their duty, toward patients nurses are expected to follow high standards of professional conduct. Central to the practise of the profession is the concept of ethical framework based on a number of guiding principles of bioethics. But situations in which nurses may have to knowingly or unknowingly breach these basic principles are not uncommon. Under such conditions they may have to face moral and/or legal dilemmas that may be difficult to resolve. Such dilemmas can be resolved and correct action consistent with the best interests of all concerned parties can be taken with the help of ethical frameworks for decision making developed by medical associations, authorities etc. Ethical frameworks for decision making are based on sound principles that serve to define a moral approach to addressing issues related to health care ethics. The ethical principles most commonly used in ethical issues are autonomy principle, non-maleficence principle, beneficence principle and justice principle (Johnstone 2004, p. 37). Autonomy as a moral concept means ‘a person's ability to make or to exercise self-determining choice’ (Johnstone 2004, p. 38). Non-maleficence refers to doing no harm. Johnstone (2004, p. 39) explains non-maleficence as an obligation not to injure or harm others. The principle of justice is not amenable to definition due to its nature and content but, in general it means fairness and equal distribution of benefits and burdens (Johnstone 2004, p. 42). Beneficence refers to actions performed that contribute to the welfare of others. There are two principles of beneficence: positive beneficence requires provision of benefits, utility requires that benefits and drawbacks be balanced. (Beauchamp and Childress, 1994, p. 121). It may not always be possible for nurses to perform their duties strictly as required by the above principles. Situations may arise, for instance, in which there is a conflict between what is required of them as per one of the above principles vis-à-vis what is required of them in the context of another. For instance there are cases when the principles of veracity and non-malficence place conflicting demands on them. Such a situation arose in the pediatric ward of the RKH Hospital , Saudi Arabia when 3 year old Rashid was admitted to the Pediatric Intensive Care Unit (PICU) after a fall in the backyard pool at his home. Rashid was playing near the pool under the supervision of his babysitter, when the telephone rang in the house. The babysitter rushed in to answer the telephone and on returning she found Rashid face down in the pool. The boy was rushed to the RKH hospital where the doctors found the child’s vital signs absent. He was resuscitated with intubation, ventilation and intravenous epinephrine injection. The boy remained comatose and unresponsive. His breathing was spontaneous with reactive pupils and he had intermittent generalized seizures. The condition of the boy deteriorated over the next six hours. A CT scan was done which showed severe cerebral edema. Two independent specialists were called in who confirmed the diagnosis of brain death. During the time the boy was in the hospital the nursing staff on duty was told not to tell the truth about the boy’s condition. To the family’s persistent queries about their son’s condition the doctors maintained that the boy was doing well and was showing signs of improvement. For reasons better known to them, the doctors kept the truth from the boy’s family. Registered nurses are often faced with such dilemmas when they have to disclose to patients. It is the right of the patient to receive accurate information that is presented to him in such a way that it is comprehensible to him as a lay person. Based on his understanding of the situation that he finds himself or his loved one in he can take further decisions. Taking the patient into confidence is therefore vital as they have to fully understand not only the treatment that they are getting but also the options and alternatives if any. In the case of Rashid, not taking the family into confidence regarding his condition and probability of recovery did more harm than good to the family. The family suffered more distress and anxiety because of the reluctance of the doctors and nurses to tell them the truth. Even if the doctors and nurses had the best of intentions in withholding the correct information for the boy’s family what they did amounted to a grave breach of the family’s trust as well as the ethics of the profession. To compound the situation the doctors gave false hope by maintaining that the boy was improving and would be fine. By wilfully giving a completely false impression the doctors breached the basic principle of veracity. All patients irrespective of their status, literacy etc. have a right to know the truth from the doctors. It was once believed that patients should not be given the full details as this may cause more harm than good to the patient. It has been shown from several studies however, that patients are more likely to respond positively to treatment when the doctor/patient relationship is based on trust born of the knowledge on the part of the patient that the doctor is not keeping anything from him. Thus by being truthful with the patient the doctors, nurses etc. are actually helping the patient recover (beneficence), while when they suppress information from the patient they are actually causing harm i.e. violating the principle of nonmalficence. Thus meeting with patients and their families, specially, when there are serious concerns that the patient and his family feels should be addressed helps establish trust and avoid suspicions and misgivings. Nurses in their role as primary care givers to patients should take the lead in arranging such meetings. As it has been discussed earlier, autonomy refers to “a person’s ability to make or to exercise self-determining choice” (Johnstone 2004, p. 380). The autonomy principle is applicable to mature adults and children until they are sixteen years of age are not considered competent to decide on issues relating to their treatment without the guidance/consent of their parents. Health care professionals therefore need to be especially supportive when parents have to decide regarding treatment of their children. Consent for treatment can be either verbal or written but whichever type it is, it must be informed consent. When consent is informed consent it means that the patient is aware of the implications of the treatment i.e. he has been properly apprised as to what to expect what not to expect, how the treatment will help him, what are the like side-effects and so on. In short the patient is aware of the likely positive as well as negative consequences of the treatment that he is consenting to undergo. Written consent usually involves prior explanation of the procedure and any complications and risks involved in the course of the treatment or at a later stage. Verbal consent happens when a verbal agreement between the patient and the doctor is reached to perform medical treatment. Even when there is a written consent there may be situations in which the written consent is not valid as for instance when the patient signs under sedation. The written consent is not valid under such conditions. It is clear that Rashid’s family was not explained about the CT scan procedure, nor was any consent form given to them to sign. This is a breach of the principle of autonomy. In effect the decision to conduct a CT scan was that of the doctors and Rashid’s family was not a party to the decision. Nurses can use several strategies to deal with such situations and resolve the moral/legal dilemmas that are a part and parcel of their profession. The use of ethical models embodying the underlying principles of can be implemented especially in the larger hospitals. As trusted care givers, they can help the patients by ensuring that the patient gets the right information generally and especially when they need to sign documents like consent forms. As patient advocate, nurses can play an important role in determining whether the patient has made a freely informed decision. The education of nurses can help by making nurses more aware of the dilemmas of the profession. With the internet it has now become possible to impart instruction and education to working adults at times that they find most convenient. The internet is especially suited as a medium to impart skills and education to further develop the skills of nurses. Confidentiality of the information that patients may furnish or nurses may obtain from patients has to be maintained. It is the duty of the nurse to ensure that the information is given only to concerned persons who are directly involved with the patient. At the professional level professional organizations of nurses can start programs to spread awareness and adoption of the ethical approach to decision making. Using these strategies nurses can adopt the right approach to successfully resolve and deal with situations arising from cases such as Rashid’s. It is important for registered nurses to have adequate understanding and knowledge of ethical principles. The ethical decision making framework has proved to be a versatile tool that enables nursing professionals to apply proven approaches to resolving difficult issues dealing with patients. With an increasing number of nurses pursuing higher education in the field, more nurses will be called upon to perform medical procedures that were previously performed only by qualified doctors. In such a scenario ethics based frameworks for taking decisions will play an important role in guiding actions that are based on sound ethical principles. List of References: Alderson P1993, Children's consent to surgery, Open University Press, Buckingham. Beauchamp T & Childress J 2001, Principles of biomedical ethics, 5th edn, Oxford University Press, Oxford. Brody, H 1981, Ethical decision in medicine, 2nd edn, Little Brown & Co., Boston. Forrester, K & Griffiths, D 2005, Essentials of law for health professionals, 2nd edn, Mosby, Sydney. Johnstone, MJ 2004, Bioethics: a nursing perspective, 4th edn, Churchill Livingstone, Sydney. Taylor DC 1999, ‘Treating children and adults: whose body is it anyway?’, European Child & Adolescent Psychiatry, vol. 8, issue 4, p315, viewed 12 August 2006, EBSCOhost database Academic Search Premier, item: AN 4689647. Read More