Ethics in Nursing

Today people strive to leave an imprint on the world around them. Towards the beginning of adulthood people choose a path that allows them to take part in one of the integral roles of society. For those of us who choose the role of a nurse, we are expected to provide the best therapeutic care possible for our clients and instil lifelong health values into their everyday lives. In order for nurses to provide a consistent organization of care, I believe the code of ethics was developed. This paper will discuss the code of ethics and why it is important in the nursing profession. It will briefly describe the eight ethical values, and the use of one of the ethical frameworks. Finally this paper will examine the application of ethics and nursing in relation to public safety. Code of Ethics

According to the Canadian Nurses Association (CNA) the code of ethics was created to help clarify rules, regulations, responsibilities and guide practice and decision making while serving as a means of self-reflection (2008). In my opinion, the code of ethics includes much more than this. When used in nursing practice it becomes an essential point of reference when grey areas arise. By reinforcing the code of ethics it becomes a continuous reminder of the acceptable behaviours that we should follow to ensure the best possible nurse client relationship. This code resembles what we stand for as nurses, and why we chose to enter an occupation where advocacy for the client is our number one priority.

Ethical Values
Nurses much like everyone else, have their own set of personal values and beliefs. However nurses are required to adhere to eight specific values as outlined within the nursing profession. The CNA describes these eight ethical values as: the ability to provide safe, compassionate, competent and ethical care, maintain the health and well being of the client, promote and respect the informed decision making of the client, maintain the dignity of the client, respect the privacy and confidentiality of the client, promote justice, be held accountable as a professional nurse and promote a safe environment. Each of these values surrounds an ideology that there is reason and rationale for each and every action we partake in as a nurse.

They define nursing practice as a profession while further instilling confidence and trust for the client receiving care. As stated by Rushton (n.d.), ethics are seen as an obligation within the nursing practice. This paper will explore each of these values in more depth as well as provide examples of how nurses apply each value to everyday practice. Providing Safe, Compassionate, Competent and Ethical care

Providing safe compassionate and competent care in the nursing profession is something every one of us should strive to achieve each day. I believe that most people who adopt nursing as a career of choice do so because they are a kind, compassionate individual at heart. These values can encompass a vast number of actions both physically, and verbally. Some examples of providing safe, compassionate, competent and ethical care can include asking a patient how their day is, reciprocating to a hug when needed and engaging in active listening when the client wants to share with you how he or she is feeling.

This particular section within the code also focuses on doing the right thing. If you feel like any part of the ethical code is being breached, you as a professional are obligated to handle the situation appropriately. A good example of this would be reporting someone who is abusing a patient either verbally, emotionally, or physically. Promoting Health and Well-Being

The health and well being of a patient is a central component of the daily routine in a nursing environment. This value stresses how imperative it is to be an advocate for the client. Many situations arise where a family member may intervene with the client’s wishes. It is our responsibility to stand up for what the client has expressed to us, and try to communicate with the family the client’s decision. I concur with Macdonald (1997), who states that nursing is a means of advocacy for determining personal values which reaffirm who the clients are as individuals. This value will help clarify what the client wants from given situation.

From there, the nurse will be better able to help the client make informed and knowledgeable choices. This would be applicable in a situation where you are treating a client who is an avid smoker and has come to you expressing a difficulty in breathing. While assessing this client it is important to council them about the effects of smoking on their health and provide resources for them if they express a readiness to quit. Informed Decision-Making

Promoting and respecting the informed decision of a patient in my opinion would be one of the hardest values to follow. I feel like there may be times in which a nurse knows a specific treatment could be immensely effective, but the client may choose for whatever reason not to take part in it. The situations outcome may not change regardless of all the information and education they have been provided with. Respecting the client and families decision would be crucial when trying to maintain a positive therapeutic relationship. If a patient wishes to have no further treatments done, or decides on a treatment that is not highly recommended, this value reminds us that the patient is inclined to make that decision and we must respect their wishes despite our personal moral or values.

One article I found very informative was written by Scott Woodcock (2011) who speaks about the importance of informed decision-making in the context of abortion counselling. The counselling is provided so the expectant mother can gain information about the procedure, and a better understanding of the strong emotional distress that women often experience when making such a difficult decision. There is also a strong importance placed on health care workers to remain on the side of caution and avoid speaking of any personal feelings, beliefs, or thoughts that may influence the client to lean towards one outcome over another. Factual non biased information must only be presented, while recalling that the client has the right to draw their own conclusions. Dignity

The complex value of dignity is one that I believe is easier to comprehend for some people than others. Chocinov (2007) said “the more the healthcare providers are able to affirm the patient’s values, seeing the person they are or were instead of only the illness, the more likely the patients sense
of dignity will be upheld” (p. 184). In his article he mentions the A, B, C’s of dignity as “attitudes, behaviors, and compassion” (p. 185-186) which encompass critical personal attributes that enhance the ethical dynamic of the nursing profession and strengthen the bond of respect between nurse and client. Privacy and Confidentiality

As a nurse it is well known that a substantial amount of private information is exchanged and recorded when you are a part of a nurse-client relationship. “Confidential patient information refers to individually identifiable health and personal information, and recognizes a patient’s expectation and right to privacy in the maintenance of this information” (Sutherland, 2005, p. 26). As I see it, confidentiality is a means of respect towards the client while appropriately establishing a trusting therapeutic nurse-client relationship.

In order to provide the best possible care, the client needs to feel comfortable in the environment they are in. ‘Ground rules’ are instilled within initial conversation so each party can feel safe and appreciate the openness and availability of the communication that is about to take place. The client needs to understand that the nurse they are sharing their private information with will respect that it is personal and keep it for medical use only. Justice

The CNA (2008) speaks about the promotion of justice as “nurses upholding values by safeguarding human rights, equity and fairness and by promoting the public good” (p. 17). Nursing care should be provided equally to all without discrimination associated with gender, age, racial groups, ethnic groups, sexual orientation, religion, health status, or socio economic standing (CNA, 2008). I initially associated justice with the court systems, until I had the opportunity to read further into my nursing articles. What I came to learn was that justice is a means of understanding; rejecting ignorance for acceptance and allowing people to be seen as individuals opposed to the stereotypical associations that society has the potential to create. Accountability

As a nursing student being accountable for your actions is an extremely important value that can be applied in everyday practice. Being accountable means you must be present physically, emotionally, and cognitively. It is important to self reflect and notice how your actions affect your patient. Student nursing involves seeking further information to benefit the care of your patient when you are unsure. To break this value means you not only put yourself at risk for injury but you also put your patient in a state of harm and that is unacceptable within this scope of practice. Quality Practice Environments

Essential elements that I believe need to be in place for a safe productive working environment are: hygienic facility, no violence tolerated, maintained resources, appropriate technology and properly educated staff. CNA also adds that it is a place, which supports open communication, concerning questions about unethical behavior, and listens to those people who speak out publically in good faith (2008). Circumstances exist where ethics guide the outcomes of personally conflicting situations. One instance that would resemble a situation like this would be when dealing with a young child who happened to be in a car accident and is actively bleeding. The healthcare team may persist that a blood transfusion would save the child’s life, but the religious beliefs of the parents may not allow the implementation of such an intervention.

If the client’s family were to discard the proposed treatment I would be able to implement the ethical values to guide me into accepting the informed alternative of the family. I would be there emotionally and physically for family support while respecting their decision in terms of the known implications and outcome. I would remain non judgmental with my verbal and non verbal behavior, while remaining focused on being kind and compassionate. I would deter from any form of discrimination by being self aware of my feelings, emotions and judgements by separating them from the current situation through therapeutically nursing the family in terms of their expressed wants and needs. Ethical dilemmas

Ethical dilemmas in the nursing profession can arise daily and must be solved. Each client interaction is capable of creating an ethical situation, by applying the code of ethics we can better ensure a positive outcome for all involved. In an occupation that is focused on caring for people, conflicting values or beliefs about what is the most appropriate approach to handle certain situations can arise. As Cohen (2006) says “In such situations, conflict may arise between two or more ethical values, and each possible solution to the conflict may contain undesirable outcomes for one or more parties involved” (p.776).

When a decision that needs to be made becomes difficult and strenuous nurses can enforce an ethical framework to offer insight and formulate a decision that will uphold the code by instigating an appropriate process. A framework that is commonly used by CARNA is known as the Bergum model. This model demonstrates the relationships between all aspects of the ethical dilemma while maintaining a centralized focus (2010). This particular framework was created in the shape of a flower, with the ethical dilemma in the middle, and each individual petal being an issue that needs to be considered before arriving at a conclusion.

The Bergum model can be applied to a variety of circumstances, catching a co worker stealing pain medications from her patient would be a prime example. In this case I would follow the petals that are laid out by this model to help guide my thought process in dealing with the situation. The goal as this patients nurse is to provide therapeutic pain management as ordered. Without the optimal level of medication the patient would be in some form of discomfort. Moral considerations with an issue such as stealing are: the care of your patient has been compromised, it breaches professional and ethical standards of practice, and it breaks the law.

External considerations would be to acknowledge that the stealing is taking place, get the patients pain under control, and aim to get the patient a new nurse to avoid further neglect and potential abuse. The final outcome and consequences that would result include an investigation to the nurse in question, potential loss of her job, enhanced care to the patient, intrinsic moral satisfaction, and an active demonstration of the implication of the ethical code while advocating what’s best for the patient. While looking at the relationships that occur in a situation such as this it becomes easier to do what’s right and resolve the dilemma accordingly. Ethics and Public Safety

The code of ethics is in general a united code; it is understood amongst all professional nurses in Canada and provides a criterion that everyone must adhere to (CNA, 2008). It holds every individual accountable for implementing each of the ethical values every day in practice. The basic concepts of the code are also known by the public which provides a mutual understanding of the degree of care for which they are entitled too. In my opinion, this also minimizes ignorance and misunderstandings between professionals and clients in reference to the level of care being provided. One fundamental aspect of ethics is the relationship between safety and the knowledge we as professionals pass on to our clients.

The public entrusts us to provide them with health information which addresses their health questions and concerns. By following the ethical code we are a resource to our clients, and we must make certain that the education we supply is recent, credible, and relevant to their concerns. The action we recommend will affect the most important aspect of their life and that is their physical, mental, or emotional wellbeing. To me ethics is a guiding principle that supports nurses with decision-making and practice actions; it is an underlying rationale for why we do what we do as professional care givers. Conclusion

Nursing is a profession that revolves around caring for the client, and despite ethical issues we may encounter we will always provide the best care we are capable of. Nursing today must balance the many demands made on it by society. Having a better understanding of the code of ethics and the values it entails I feel like I have gained a more comprehensive appreciation for nursing as a profession and will be better prepared to provide care in my future career.

References

Canadian Nurses Association. (2008).Code of ethics for registered nurses. Ottawa, ON: Author. Chochinov, H. M. (2007). Dignity and the essence of medicine: the A,B,C and D of dignity conserving care. BMJ Group, p.184-187. Cohen, J. S., & Erickson, J. M. (2006). Ethical Dilemmas and Moral Distress in Oncology Nursing Practice. Clinical Journal of Oncology Nursing, 10(6),
775-782. doi:10.1188/06.CJON.775-780 College & Association of Registered Nurses in Alberta (2010) Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and Recommendations. Edmonton: Author. MacDonald, H. (2007). Relational ethics and advocacy in nursing: literature review. Journal of Advanced Nursing, 57(2), 119-126. doi:10.1111/j.1365-2648.2006.04063.x Rushton, C. (2004). Nursing Code of Ethics an important practice tool. AACN News, 21(11), 6. Sutherland, B. (2005). Practice corner. Role of nurses in maintaining confidentiality of patient information — advisory opinion statement [AOS] #34. KBN Connection, (5), 26-27. Woodcock, S. (2011). Abortion counselling and the informed consent dilemma. Bioethics, 25(9), 495-504. doi:10.1111/j.1467-8519.2009.01798.x