1.0 Introduction and Background
Ethical challenges In Veteran Mental Health Care management can be diverse. Handling the veterans to help them access the healthcare services at the Department of Veterans Affairs (VA) could come with a number of ethical challenges. This is by the fact that veterans faced with mental health challenges would need tailored approaches to understanding and meeting their needs. There has been limited attention that has been offered to research on the ethical challenges that nurse leaders experience as they attend to mentally ill veterans who need to be assisted. The veterans with mental health challenges need special care considering the experiences that they go through or underwent in their active military service. The active military service comes with a diversity of challenges including exposure to war, noise, and danger, loss of lives of colleagues, weaponry, and injuries just to mention. These experiences normally have the veterans face the mental health challenges that would need to be addressed by nurse practitioners (Ogletree, 2011) . The focus of nurse practitioners in offering treatment to the veterans is to help the veterans recover from mental health challenges.
Unlike other groups of persons who go through mental health challenges, veterans normally, go through an experience that turns their life up and about. As a result, they would get to situations where it could be a challenge for nursing practitioners to understand and help them recover out of their mental health issue. In making the effort to connect, understand, and provide the needed mental health treatment for veterans, nurse practitioners are often subjected with a number of ethical challenges. Effective treatment of veterans going through mental health challenges calls for nurse practitioners to observe key ethical principles and values. Indeed, the nursing practice calls for increased professionalism in the process of offering care to patients. Ethical principles of the nursing profession ought to be observed to allow the process of care giving to work in yielding the desired health outcomes. Nurse practitioners have the duty of confronting the ethical challenges that are presented to them in administering Mental Health Care to Veteran populations (McGuinness, 2017) . On this background, the researcher’s premise is on the need to outline the ethical challenges and principles that should be applied to offer better care to veterans with mental illness.
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Analysis of Primary Ethical Principles
In the healthcare practice, there are four major ethical principles that should be observed by health professionals in offering care to patients. The first principle is that of respect for autonomy. This principle holds that healthcare professionals must demonstrate respect and acknowledge the autonomy of the other persons involved in the care-giving context. Healthcare professionals have the obligation of respecting the autonomy of the other parties including the patients in regards to their own lives. This principle is based on the ideology that everyone needs to be accorded with human dignity by being given the free right to do what he or she choose to do with their lives (Bardes, 2012) . The principle offers healthcare professionals with the negative duty of not interfering with the decisions that competent adults make, while at the same time, take responsibility to empower those that one is responsible for.
The second ethical principle applicable to healthcare management is that of beneficence. This is the principle that everyone has the obligation to bring about good in all the actions that one undertakes. Under this principle, healthcare professionals have the duty of taking on treatment procedures that would prevent harm to their patients. This principle is based on the need to ensure that patients/clients are helped in ways that would prevent harm. The challenge with this ethical principle is that in many clinical setting, it gets to contradict or comes to lead to direct conflict with the principle of autonomy of other persons being attended to in the clinical setting (Adler, 2011).
The third principle is that of nonmaleficence. The principle of nonmaleficence argues that health practitioners have the duty of not harming others. The word "nonmalevolence" a technical legal term, which is used to mean, "First, do no harm." Combining this with the corollary principle, it becomes clear that where harm cannot be avoided, healthcare professionals are obligated to minimize the harm they cause to the patients. The focus of this ethical principle is the need for healthcare professionals to minimize the risks of causing harm to others. In this case, the actions of healthcare professionals are to take on actions that would produce more good than harm (Koffman, et al. 2008) .
The fourth ethical principle that is critical for healthcare professionals is that of justice. The principle of justice makes it an obligation for healthcare professionals to provide others with whatever they are owed or deserve. This is more specifically in public life where healthcare professionals have the obligation to treat all people equally, fairly, and impartially. Health professionals need to avoid imposing unfair burdens on others without necessary cause ( Krinsley, 2008). Deductively, it means that healthcare professionals have the duty of working for the benefit of those who are unfairly treated or disadvantaged in the society.
Stakeholder's Perspectives
When it comes to offering primary care to patients, the key stakeholders who are involved in the process include the government/policy makers, the primary care giver, and the patient/client. Each of these stakeholders holds key perspectives with regard to the execution of the above ethical principles. The enforcement of the said ethical principles in care giving requires the healthcare professional to have knowledge of the perspectives that are of interest to each of the mentioned stakeholders (Engel et al.2016).
A deeper understanding of the perspectives of each of these stakeholders in the process of facilitating better delivery of care is critical in the process of promoting better health outcomes of treatment/therapy. It is on this account that the stakeholder’s perspectives cannot be ignored but must be taken into account to facilitate better health outcomes.
In order to handle the Ethical Challenges of Mental Health Care provision to veterans effectively, the perspective of the said stakeholders must be observed. The first stakeholder is the policy makers/government. Veterans work for the government and the government through the policies made by the ministry of health on ways to handle the veterans faced with mental health issues become binding. Healthcare policy has a major role it plays towards the observance of ethical principles that have been outlined (Rosenheck et al. 2009) . The government through the ministry of health holds on the need for healthcare professionals to uphold the four ethical principles for the good of the client and sanctity of the health profession.
The second major stakeholder in offering mental care to veterans is the primary care givers including doctors, nurses, and clinicians. Veterans in need for treatment of mental health illness would require the help of their primary care givers who would offer the treatment and therapy on the illness. In context of this stakeholder group, the ethical perspective of the caregivers is making effort to offer treatment for the good of their clients (Engel et al.2016). The primary caregivers have the duty to observe key ethical principles in delivering care to the mentally ill veterans. Upholding ethical principles such as respect to autonomy and offering care that does not harm the patient are highly expected when it comes to serving the veterans.
Thirdly, there is the client/patient where in this context; it is the veterans suffering from mental illness and in need of treatment. The patients hold on the perspective that caregivers and care giving process should address their needs as opposed to being mechanical. The focus of the client is that they need to be assisted to overcome the mental illness. However, in the process of treatment, they have the expectation that caregivers would demonstrate the needed competence and professionalism in giving care to them (Reyes, 2014) . The focus of the client is to be assisted through being provided with the right care to overcome mental problem at hand. While veterans have issues, they expect to be understood and helped by the mental health primary care providers.
4.0 Implications for Health Care Provider Groups
The said ethical principles for healthcare providers have key implications on caregivers attending to veterans with mental health illness. There are three major implications of the ethical principles that would need to be understood and practiced by primary care givers attending to veterans with mental health issues. The first implication is that primary care givers would need to understand the cultural differences in military and civilian populations. This understanding is critical in the process of facilitating improved mental health care. Probably, this would call for increased investment in running new psychologists training in the health care centers under Department of Veterans Affairs (Seal et al, 2014) . Through this approach, it would be possible to provide the best care for veteran populations suffering from mental health issues.
The second implication is there is need to ensure that healthcare professionals attending to veterans have increased military-specific cultural competence. This would be done through developing specially tailored programs that would increase military-specific cultural competence in new psychologists who are posted to the VA health centers, which attend to military personnel. At the same time, the administrators working at the VA health centers would also have the duty helping primary care givers to become sensitive to their personal values and protect themselves from developing biases toward veteran populations. Through continued training on the military culture as well as history, it becomes easier for the healthcare personnel to understand their patients (Ignacio, et al., 2007).
The third implication is that primary care givers attending to veterans with mental health issues would need to learn on ways to engage with their clients to understand the needs clients have. It can be a challenge to observe the said ethical principles without understanding the needs, expectation, and context by which the veteran has come to seek help. Indeed, it is important for caregivers to get familiar to the needs of VA patients before patient contact, or during orientation to help trainees identify areas where they may need continued education or reading. Such an approach would ensure that the caregiver continues to offer help that causes less harm and has the good of the veteran at hand.
5.0 Conclusion
Ethical challenges with regard to offering care to veterans with mental health problems can be diverse. However, it is possible to address the ethical gaps through observing the four major ethical principles in care giving. Additionally, there is need to increase their level of knowledge of military culture among healthcare professionals. This approach works well in ensuring that there is effective delivery of service to the veteran populations with mental health issues. The focus of healthcare practitioners attending to veterans would be to add knowledge on the military history and cultural patterns. Such knowledge would help in facilitating better mental healthcare delivery to veterans.
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