As they attend to patients, nursing practitioners are confronted with serious challenges. Left unaddressed, these challenges can frustrate the effective delivery of care. Scenarios requiring the nurses to balance various conflicting needs and obligations are among the most common challenges that they face. For example, a nurse may be confronted with a situation where they have to decide between honoring the wishes of the patient and avoiding causing harm. Fortunately, ethical guidelines and standards have been developed to guide nurses and to ease the decision making process. By following these guidelines, nurses are able to safeguard the wellbeing of their patients while protecting the integrity of the profession. The interview with my colleague confirmed that ethical questions remain a serious challenge for nurses today.
Overall Mood and Appearance
Before posing questions to my colleague, I began with a general assessment of her mood and appearance. She seemed upbeat and excited. Despite the fact that she had been attending to patients the whole day and must have been exhausted, she greeted me with a warm smile. We began by talking about how the day had been and the numerous struggles that we encountered. After the niceties, we proceeded to engage in the interview. Overall, she was receptive and responded to the questions with insightful detail. She seemed excited to share insights on the struggles that nurses endure and the measures that can be instituted to make our job easier. I find that the timing and the setting of the interview also played a critical role in allowing for success to be achieved. We held the interview at the hospital criteria at 3.45pm on March 2, 2019. At this time, all nurses and other practitioners are usually on a break and use this opportunity to talk with their colleagues about personal and professional issues. By holding the interview at the cafeteria, we were able to engage in a casual and friendly fashion that encouraged the nurse to openly share hew perspectives on the place of ethics in nursing. Furthermore, the timing of the interview enhanced convenience since she did not have to abandon any important commitments.
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Response to Questions
The following are the questions that were posed and the corresponding responses that my colleague issued.
Do you think various cultural issues like language, values, and norms play a central role in the delivery of quality care in the nursing profession? Explain?
Yes. In my time at this hospital, I have observed how language, values and norms influence how as nurses, we deliver care. Allow me to offer an example. There are times when my personal values conflict with those of my patients. For example, there is a patient who refused treatment because it violated her religious beliefs. There are other patients who have refused to allow their children to be vaccinated. These examples show that how we deliver care is determined by cultural factors.
What are some of the ethical dilemmas you regularly interact with at the workplace?
I encounter many ethical dilemmas on a daily basis. The most common dilemma involves respecting patient autonomy while protecting them from harm. For example, today, there is a patient who required urgent care but could not issue consent for a procedure to be performed. I had to seek the guidance of my superior to determine the decision to take.
Do you think the four ethical principles of nursing (beneficence, autonomy, justice, and malfeasance) are critical in the delivery of nursing care? Explain?
Absolutely. I have found that these principles are indispensable as they serve as general guidelines that we should follow in our work. For example, the beneficence principle urges us to do good at all times while the principle of autonomy challenges nurses to respect the freedom of their patients and acquire consent when we need to perform procedures. I find that the justice principle is also important as it empowers us to advocate for our patients. The principle of malfeasance is also important because it reminds us to do all that we can to protect patients from harm.
Which of the four ethical principles do you think supersedes the rest? Explain?
I think that all the principles are important. However, I would say that the principle of justice is the most important. This is because this principle elevates our profession from the mere provision of care. We have become advocates for patients and are aggressively involved in initiatives designed to enhance access to healthcare for minority and underserved patient populations.
Why do you think professional ethics is essential in any field?
I would say that ethics is important because it helps to prevent illegalities and violations of practice guidelines.
What are some of the other primary cultural and ethical issues nurses face regularly in their delivery of care apart from language, values, and norms mentioned above? Why do you think they are essential?
Sexual harassment and fatigue are other ethical issues that I think are important. In my unit, we have received reports of sexual harassment perpetrated by and against nurses. I also understand that fatigue among nurses is a serious problem. These issues are important because they influence our ability to deliver care. I think that a nurse who has suffered sexual harassment or is exhausted from the demands of her job is less likely to offer safe and quality care.
Do you think ethical issues cause bias?
Yes. Ethical issues do indeed cause bias. Allow me to illustrate using an example. Cultural differences are among the issues that we face today. I find that when a patient is from a different culture, I tend to rely on stereotypes in my assessment of their situation.
Does bias play a role in nursing?
Indeed. And I think that the role that it plays is negative. When we are biased, our judgment is compromised and we are therefore unable to provide adequate and quality care in a way that ensures equitable distribution of our services. I would strongly urge all nurses to be objective in all their engagements with patients and their peers.
Analysis
The responses that my colleague provided underscore the complex dynamics of nursing and the delivery of medical services. One of the themes that emerged from the interview concerns the role of culture in healthcare. Research has shown that the cultural background of both patients and practitioners influence the healthcare delivery process. For example, Napier, Ancarno, Butler, Calabrese, Chater and Chatterjee (2014) acknowledge the effect of culture on health. They note that culture influences how individuals obtain and process information on medical issues. When the culture restricts access to information, it can be expected that individuals will report poor health outcomes and are less likely to seek nursing services. The impact of culture extends beyond access to medical information. It also influences such other issues as the utilization of healthcare services and the level of trust in the medical profession. As my colleague confirmed, culture does indeed shape healthcare delivery. If they are to effectively navigate the complexities of culture, practitioners must possess cultural competence. This is an essential skill that empowers practitioners to identify and respond appropriately to cultural issues.
Ethical dilemmas and how they affect nursing practice is yet another critical issue that the interview shed light on. Epstein and Turner (2015) are among the scholars who have confirmed the importance of ethics in nursing. In their text, they assert that ethical principles enhance competence and allow nurses to fulfill their obligation with integrity. There is no doubt that to deliver on their mandate, nurses must be guided by the professional code of ethics and conduct. This code outlines the values and principles that nurses should uphold in all their interactions with patients. I am glad that my colleague indicated that she understands the value of ethics. She noted that the principles of benevolence, justice, malfeasance and autonomy are central to nursing practice. Moreover, she added that the principle of justice is the most important as it challenges practitioners to become advocates. She is not isolated in recognizing the importance of patient advocacy. Scholars like Davoodvand, Abbaszadeh and Ahmadi (2016) confirm that the role of the modern nurse has been expanded to include patient advocacy. It is no longer enough for nurses to simply deliver care; nurses must now campaign for patients as well.
Conclusion
The interview with my colleague was informative and insightful. I was able to understand that nursing practice can be exhaustive and demanding. Thanks to the interview, I also gained a fresh and deeper understanding of the value of ethics in nursing practice. Through ethics, nurses are able to maintain their fidelity to patients and the profession. The interview also highlighted the impact that cultural factors have on how nurses perform their duties. For nurses to be effective drivers of care, they need to reject bias and embrace sobriety and objectivity. Furthermore, they should be guided by the four major ethical principles as they execute their mandate of providing quality and safe care.
References
Davoodvand, S., Abbaszadeh, A., & Ahmadi, F. (2016). Patient advocacy from the clinical nurses' viewpoint: a qualitative study. Journal of Medical Ethics and History of Medicine, 9 (5).
Epstein, B., & Turner, M. (2015). The nursing code of ethics: its value, its history. OJIN, 20 (2). DOI: 10.3912/OJIN.Vol20No02Man04
Napier, A. D., Ancarno, C., Butler, B., Calabrese, J., Chater, A., Chatterjee, H. et al. (2014). Culture and health. The Lancet. DOI: https://doi.org/10.1016/S0140-6736(14)61603-2
