Since the formation of nursing as a discipline, patient advocacy has been at the helm of the practice. Florence Nightingale is often accredited for laying the foundation for advocacy by insisting on quality, human rights, and an environment that safety and cleanliness. Part of the nurses' role in advocacy involves the protection of the ethical rights of the people. The American Nursing Association (ANA) provides a code of ethics aimed at ensuring that nurses are at the forefront in advocating for ethical and moral practice in the care facility. Nurses are required not only to comply with the guidelines but also to incorporate them as part of their organizational culture. However, when nurses practice, they meet a host of challenges and dilemmas that can affect their profession. In this regard, nurses are required to apply the bioethical decision-making model. The process of the bioethical decision-making model is composed of ten steps that begin from the definition of the dilemma and ends with the follow-up activity. In a bid to come up with moral decisions, nurses must apply the model to address situations that present an ethical dilemma.
Situation (Hypothetical)
Jane is a 42-year-old single mother with two children. Her husband died two months ago, and she is in severe mental trauma. She is now hospitalized for two days with fever, diarrhea, flu, and general body pain that does not seem to end with common analgesics. She is also exhibiting tuberculosis-like symptoms, and after running a series of tests, she turned positive. One of Jane's late husband's sisters approaches the nurse attending to her and says the following: Nurse, I have some information that I would like to tell you. Jane’s husband died two months ago, and before his demise, he disclosed to us (his siblings) that he had battled HIV/AIDS for years. However, she did not want to disclose it to Jane because of her bipolar condition that might lead her to self-harm and even suicide. Jane has, on numerous occasions, attempted suicide when things did not go her away. So please, in case you diagnose her with AIDS, do not tell her because you will have given her an opportunity to commit suicide. On further examination, the nurse noticed signs of self-harm on her wrist and face. Her medical records show that she had been diagnosed with depression and bipolar disorder. After running an HIV test, Jane turned out positive. More importantly, she now feels better, and due to be discharged in two days. She asks the nurse what disease could have asked her condition.
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Bioethical Decision-Making Model
The first step is to identify the dilemma. The nurse is presented with an ethical dilemma that involves the safety of the patient and their right to know their medical information. If the nurse decides to tell Jane that she has AIDS, she will engage in self-harm or suicide. However, hiding the information also goes against the right of the patient to be informed. The second step is to identify the facts. The medical facts, in this case, include the patient's history of bipolar disorder and depression. Also, based on the vast array of symptoms, she has been diagnosed with AIDS. Non-medical facts include the fact that she has two children and is a single mother. She has been brought to the hospital by members of her husband's family. The primary external influence that applies to the case study is the ANA ethical guidelines. Laws such as the Health Insurance Portability and Accountability Act (HIPAA) apply due to the need for privacy and confidentiality in their information.
Some of the aspects that need clarification include the patient’s background and her source of mental illnesses. It is also crucial to assess the reason behind her past attempts to commit self-harm. The nurses could also consider the hospital’s policy regarding breaking bad news. The next step is to identify the decision-maker in this case. Jane is a 45-year-old person with the power to make ethical decisions. Two ethical principles that come into play in this case study include disclosing medical records and beneficence/non-maleficence. The disclosure of patient information is based on the need for nurses to remain truthful in their endeavors. The importance of truth-telling in the care facility cannot be underestimated. Zolkefli (2018) says, "One of the most pre-disposed values to being truthful is associated with respect for the patient as a person who is able to make a decision." The patient has the right to access nothing less than the right information before deciding on what to do. Truth-telling attribute forms a fundamental aspect of the ethics of justice.
Beneficence and non-maleficence also come to play in this scenario. Beneficence asserts that nurses must always serve the interest that promotes the well-being of the patient. Non-maleficence, on the other hand, prevents the healthcare worker from harming the patient (Stone, 2018). After assessing the ethical principles at play, the next step will involve assessing the alternatives. The first option is to blatantly tell the patient the truth regarding their HIV diagnosis. However, this can lead to immediate suicidal thoughts. Secondly, the nurse can decide to lie and wait for a later date where the actual information can be disclosed to the patient. However, this would be against patient rights to receive accurate information. The third and most plausible option is to structurally break the news to the patient. After completely healing, they should undergo a thorough counseling procedure. Thereafter, they will learn about HIV/AIDS, including the appreciation that it can be managed well. It is after a successful therapy that the patient should receive information regarding their status.
A follow-up process must be conducted to ensure that the patient copes well. A face-to-face interview with the patient regarding their feelings, adherence to medication, and coping skills would help the situation. An alternative strategy would be to conduct a therapy session with the patient to understand how they are faring on with their situation.
Conclusion: Nurse Advocacy
The nurse has a vital role as an advocate of patient rights and needs. Advocacy is about promoting safety and enhancing quality in the healthcare setting. Nsiah, Siakwa and Ninnoni (2019) identify the advocacy roles as providing quality care, being the voice of the patient, protecting patients, and educating the patients. Nurses should remain alive to three fundamental goals when engaging in advocacy on behalf of the patient. First, advocacy should be geared towards enhancing the patient's autonomy. Secondly, the nurse should aim at representing the patient in areas where they could not manage on their own. Thirdly, advocacy should seek to champion for social justice and the provision of care as a human right (Nsiah et al., 2019). Nursing advocacy dates back to the time of Florence Nightingale, who developed the environmental theory. According to this theory, advocacy aims at changing the internal and external care environments to meet the needs of the patient. Davoodvand, Abbaszadeh, & Ahmadi (2016) contribute to this argument by emphasizing that nurses have the most contact with the patient more than anyone else. As such, they are better placed to meet their needs compared to physicians, doctors, and pharmacists. In their advocacy, nurses must strive to act as a link between patients and the healthcare system.
References
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses' viewpoint: a qualitative study. Journal of Medical Ethics and the History of Medicine, 9.
Nsiah, C., Siakwa, M., & Ninnoni, J. P. (2019). Registered Nurses' description of patient advocacy in the clinical setting. Nursing Open, 6(3), 1124-1132.
Stone, E. G. (2018). Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients. The Permanente Journal, 22.
Zolkefli, Y. (2018). The ethics of truth-telling in healthcare settings. The Malaysian Journal of Medical Sciences: MJMS, 25(3), 135.
