Ethics are described as moral rules which influence how an individual or set of individuals behaves or acts in particular situations. Good ethics are important for nurses, as there are many moral difficulties in the care of patients. In the event that these ethical difficulties emerge, nurses as well as other professionals should recognize and apply the ethics and fundamental principles of the professions in their decision-making and judgement. In view of the privacy proposed for the Council of Nursing and Functionaries of Midwifery (NMC 2018), Mr. Q's pseudonym is highlighted to the patient. The patient's nurse received written consent from Mr. Q in accordance with NMC guidelines all throughout the care period (2018). Legislation to regulate staff is urged to be mindful of health inequalities which might damage treatment results to address sources of health inequality. They can then recommend patients for extra treatment to social services, project managers and some other health care team members. Caregivers should be aware of the social and economic issues that impact patients and health in the communities. Reliability is essential in ensuring that patients can exchange information comfortably with members of the healthcare team regarding their ethnicity and socioeconomic position. This might be particularly difficult if the patient and also the nurse belong to different racial, genders or cultural backgrounds. Ethical principles and standards are all by its definition broad, since they are designed to operate as a framework for weighting the circumstances of an ethical or moral issue. “The Oncology Nursing Society” presents the principles of health care and nursing ethics as guidance on ethical practices in the field of healthcare.
The task will rely upon important social and ethical policy ideas that support judgments taken on the treatment of an individual, regarding the ethical issues presented in the situation. The fundamental principle towards this activity is an understanding of the (nursing) role in promoting decision-making for patients in the care and also in defending the rights and independence of patients. Proper references to the healthcare assessment and collaborative decision-making procedures must be obvious with specialized norms (Al-Abd et al. 2021). In this case Mrs. Q has been admitted in a stroke ward where the student nurse was appointed as a trainee nurse and she was responsible of taking care of Mrs. Q. physical health of Mrs. Q is not very well as she has undergone through a massive store and therefore has been admitted in the stroke ward for treatment and care. Her mental health condition is not stable. As she has suffered with this massive stroke and is admitted in the care ward so mentally, she is disgraced and disappointed as well.
Key ethical challenges and issues
The “Nursing Code of Ethics” of the “American Nurses Association” is used to guide skilled and integral nurses. Ethics and morality of the individuals themselves affect their behaviors and decision - making process and also how they view the effects of their activities. Ethics allows healthcare practitioners and nursing staff to recognize moral problems and to use the judgments in an efficient manner (Suhonen et al. 2018). The ANA Code of Ethics for Nurses also guarantees that nursing staff comply with all rules and laws applicable to their professions and jobs. The 9 principles of the Code lead nursing staff to ethical work in their everyday roles. The requirements are found in the Nursing Ethical Concepts book on four key factors of nursing ethics – non-malignancy, charity, autonomy and integrity.
Overview of ANA ethical code
The code of ethics for nursing is described by ANA as acceptable in any environment. In articulating the ideals, values and duties that define, orient and enlighten the role of the nurse," this code serves as a framework for professional nursing, responsibilities are to ensure.
The integrity, value and individuality of every person, are recognized by nurses. You realize that everyone has the right to healthcare and appreciate their patients, professional colleagues and all others who encounter all of these at several situations.
The major involvement of nurses is with their patients. They are responsible for acknowledging, addressing and compromising possible conflict situations of obligation to the patients (Jae-Woo Oh, 2021). This dedication covers people, family, community and groups.
Patients are promoted and protected by the knowledge, agreement and the necessity for complete transparency and honesty when treating a patient in terms of privacy rules, care quality and security. Corruption or other risks to the well-being of patients should be addressed promptly.
The care provided to their patients is the responsibility of the caregivers. They need to assure that the care is consistent with professional rules, ethical issues and the interests of patients.
Patients should adopt the identical principles of care provided to the patient. Their obligation to encourage safety and health continues to their residences and other environments further than the workplace (Pesut et al. 2020). Professionals are committed to improving and adjusting skills and growing in the profession.
Nursing personnel are obliged to provide a safe working environment which supports quality treatment for all patients. Institutions must define safety regulations and enforce ethical care duties to guarantee the highest outcomes of patients.
In all their positions, nurses are responsible for the promotion of the profession including research, professional growth and health and care policy (Van Hoof et al. 2018). They must guarantee that norms of professional practice adapt with the development of new medical methods.
Nurses safeguard human rights, promote health negotiations and resolve health inequalities in conjunction with some other healthcare professionals. In this procedure, nurses must undertake continuous learning and preparedness to adequately react to new and unique circumstances.
In nursing practice and activism for equal health care policy, social justice concepts must be included (Brodtkorb et al. 2017). Thus, the nursing community is strengthening its voices to demand social justice via participating in groups and panels that recognize and address ethical concerns.
Ethical decision-making models
Ethical decision-making models give a proposed framework for the confronted with ethical issues through critical foresight and planning. An ethical decision-making system is a model that caregivers may use to build the capacity to reflect and decide ethics in an ethical issue. A variety of models, which are mostly identical in form and substance, are offered in ethical literature. The objective of every model is to give a framework for determining the optimal choice in a specific circumstance that is faced by the health care practitioner.
The model provided by this topic is a basic six-step method drawn by Atchison and Beemsterboer's decision-making research, which has been utilized in a combined ethics curriculum with dentistry and dental hygiene students since the 1990s. It is a theoretical and principle-based approach. The concept is designed as a cycle that emphasizes the utilization of previous experiences and knowledge in decision-making both present and future.
Figure 1: Decision making model in nursing ethics
(Source: https://www.dentalcare.com, 2021)
Identification of the ethical problem
Phase 1, as knowledge of the issue needs to pass through the processes, is the most essential step. Many circumstances are just never seen as ethical difficulties or challenges. Once the issue is detected, the decision maker has to establish the ethical dilemma simply and succinctly, taking all relevant elements of the situation into consideration (Beykmirza et al. 2019). If the ethical dilemma does not clash with principles, this is a simply good and bad problem and no ethical decision-making procedure is necessary. Step 2 is not required if a definite decision has been reached of correct or incorrect.
Collection of information
In order to develop an accurate choice, the decision-maker should acquire information. This can be fact-factual knowledge and may originate from several sources regarding the issue as it develops. Information is required on the objectives of the interested parties, especially the healthcare providers.
Statements of options
Upon collecting any essential information, the next stage is to discover as many choices or options as feasible via brainstorming. Frequently, the best choice is not the only one. There is also a propensity to believe that there is only a single expected response (Tajabadi et al. 2020). This phase requires us to pause and observe from every perspective what other individuals may perceive as alternate solutions to the challenge. In order to often know and over one solution to an issue, you need an illumined and inquisitive mind.
Ethical principal operations
Concentrates on ethical ideals (autonomy, charity, non-maliciousness, fairness, truthfulness) and ethics. In general, any ethical judgement will include several principles. This approach allows professionals to choose which ethical standards in this circumstance clash. For assistance, everyone sees the relevant code of ethics. Addressing the question sometimes with a trustworthy colleague will help to obtain a better overview and settlement of the scenario.
If each possibility has been properly defined in advantages and drawbacks, a logical decision-making framework is evident. In turn, every choice should be evaluated with an eye on how many advantages and disadvantages every decision would take (Sperling, 2021). The right answer to an ethical problem is often evident simply by studying the choices carefully. Before executing the choice, the healthcare professional must evaluate all principles against the decision to see if the approach bears up to this analysis.
The final stage is to act on the choice taken. If no changes are made, the decision - making would be worthless. Many relevant choices are never taken because this step is not taken. Recall that the implicit approbation of a situation is not an activity.
This decision-making model framework would help the student nurse to evaluate each of the problems of Mrs. and those problems can be evaluated and sorted out with this ethical decision-making model implementation.
Ethical framework and discussion of case
Ethical decision-making framework
In their daily practices, nurses are obliged to undertake ethical choices, some being more complicated than the others. In a pandemic there are many and complicated issues to examine for ethical decision-making. In order to identify the best possible course of action, professionals can use this ethical decision-making model, including the Code of Ethics for Professional Seniors, to cooperate with patients, family or other health care team members (Al-Banna, 2017). This framework comprises five phases, each of which contains thoughts and motivating issues to assist in making ethical decisions.
Figure 2: Steps in ethical decision-making framework
(Source: https://nurses.ab.ca, 2021)
This decision-making framework will help in the treatment of Mrs. Q and also will give a clear idea to the student nurse about how to proceed with the care and when to take necessary decisions without any hesitation.
Relevant legislation and law of nursing ethics
This is because it gives nursing practitioners a responsibility for developing understanding about the law of clinical situations and the ethnic frameworks that are the cause of decision making and determinations. This is because the NMC (2008) offers strict advice concerning the code and responsibility of practitioners with regard to patients in the hospital.
The “Act on Mental Health (DOH, 2008)” is meant to safeguard the rights of persons living with a mental illness in England & Wales and offers several parts that give guidance and advice on how people are handled. In accordance with Section 3 of the Law on psychological health, a prescription may be administered to people secretly, especially if medical professionals have confirmed a certain kind of mental disease that makes medicinal diagnosis suitable for the particular patient (Dowie, 2017). Section 3 of the “Mental Health Act” is characterized as a therapeutic sequence. It is essential to note that such “Act on the mental capacity (2005)” of the individual and the “Mental Health Act 1983 (DOH, 2008)” are 2 laws and regulations which safeguard health care workers and patients only in cases where there is proof of mental illness or of an inability to act.
This act of mental capacity is very relatable with the condition of Mrs. Q. as she has been diagnosed with a stroke so her mental capability and strengths have been affected for this reason and psychologically, she becomes weak to respond to the treatment. Also, the “health and social care act (2012)” has a relation with the case scenario.
Role of nurses
Ethical norms show professional ideals. Ethical rules, in reality, define care methods, the standards of healthcare and professional standards. Technological advances and the increase of the work of nurses created serious ethical issues for healthcare personnel (Myller, 2020). Such problems impact the capacity of rookie nurses to take clinical judgments if they are not adequately handled. With the growing numbers and complexities of ethical problems in care environments, promotion of ethical identity in nursing curriculum grew increasingly important. Accountability is accountable for oneself and others in its own activities, as per the “American Nurses Association (ANA)”. The nurses operate under an ethics code based on the moral values of faithfulness, loyalty, truthfulness, benevolence and respect for the dignity, value and consciousness of patients, in order that they are responsible (Schiller et al. 2019). Clinical practice supporting systems and technology supplement the skills and know-how of nurses, rather than replacing them. Therefore, even in case of system or technological failure, nurses are responsible for their practice.
Paternalism poses a series of moral problems about the basis of a free and open society, its duties towards individual people, and individual responsibilities towards each other's culture. One major question is how the limitations on personal rights or independence may be termed paternalistic correctly.
Many elements affect and shape nursing decision making skills and limitations. Which include professional nursing associations' legislative and legal borders, professionally related standards and the expectations of societies, professionals and institutions (Heinen et al. 2019). In certain nations, when based on facts and supported up by strong reasoning and explanation, it may be regarded as appropriate that nurses choose independent and autonomous judgments, which might be connected to job requirements and additional learning, like the registry of nurses. Other nations may have less demands of their function as nurses and are restricted to moving beyond established medical hierarchies. In other instances, the anxiety is related to the effects of inability to act as possible; that they need to provide all care available in restricted circumstances and those limited resources will lead in the health-care profession operating outside their own reach, or that they have to do so in a few cases.
These conflicts and issues can be resolved and also these will be controlled if the nursing ethics can be more composed of proper decision taking scopes and also separate nursing empowerment where nurses will be free to take decisions and actions as and when required.
It can be concluded that ethical nursing practices are more complicated than it is thought of. Nurses in the ethical and legal issues often set back due to lack of assurance from the governing authority and also from the patient side. In this case, Mrs. Q as a stroke patient has been admitted with the written consideration of Mr. Q so that no legislative issue can be occurred. Also, the decision making model and legislative laws regarding the nursing practices are being related with the condition of Mrs. Q and also several points and proposed models have been highlighted in this context.
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