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Defined as the philosophical study of right and wrong action, Ethics is a predominant subject of concern in nursing (Michael Dahnke, 2006). Being presented with various situations, the ethical and cultural problems are a serious concern faced by the nursing and healthcare staff which needs to be catered to day in and out. There is no time tested methodology that can be applied here, since the every patient is different, with a different background history, therefore the ethical and cultural implications of each decision would also vary.
Importance of Ethical Theory to Nursing
Defining what is right and wrong is a very subjective approach and even that can change from scenario to scenario. Therefore it is important to have some form of umbrella under which the functioning of nurses takes place. It is under this rationale that the importance of ethical theory emerges in front of us.
In the absence of an ethical theory to guide the nursing staff, it will then only result in everyone finding their own anchor point for reasoning their decisions, and some of these anchor points, for example religion, can be a sincere cause of conflict in the decision making process.
Therefore, it becomes important to have some sort of theory which would act as the guiding factor. Some of the most popular theories that have guided the nursing professionals, each with its own point of emphasis, include Deontological and Utilitarian approach.
The Deontological approach or the duty-based theories focus more on the obligation aspect, so that it is in the welfare of the patient but regardless of this. A Deontological course of action usually emerges from a pre-determined conclusion of what is right and wrong, and where the individual is treated as a rational, free being (Wilson, 2008). Whereas the Utilitarian approach takes the result of the outcome into consideration to judge the course of action as right or wrong, it is also thus called the outcome based theories (Samar Noureddine RN, 2001).
Virtue Ethics is a school of thought established by Aristotle, in which the basic thought was that reason is the main driving force for any human life, and it is reason that would ultimately lead to a good life. Therefore, nursing decisions based on this school of thought would focus on presenting the reasons in front of the patient and letting him know the pros and cons. After which the patient can decide the final course of action to be taken (Slowther A, 2004).
B1. Supporting Examples
Consider the case of a patient who wishes Euthanasia, which is still considered illegal in the United States. In such a case, the deontological decision, would be to consider the autonomy and the free-will of the patient, however, while the nurse may be sympathetic to the wish, they are still binded by their law. Any action they take would still be viewed as illegal.
The Utilitarian approach would not take this course of action since this would impact the whole of the society as the ultimate outcome. As for the Virtue Ethics Approach, it is the reason behind this decision that would matter, and since the reason is that there is no need to go through this much pain and suffering, therefore this course of action maybe justified by this school of thought as well.
Considered as one of the trickest elements of the healthcare and the nursing profession element, Confidentiality has been a much debated discourses. Confidentiality is basically protecting the private information of the patient safe and protected from any third party. There are however some exception to this rule, for example if the non-disclosure of the information would result in harming a third party.
C2. Reasonable Limits
Reasonable limits can be applied when the confidentiality needs to be breached in certain cases, like sharing the information for the welfare of the patient or in some cases a third party. This may include when there is a significant threat to the health and lives of other in which case, it becomes important that the information be disclosed (Wynia, 2007).
C3. Rationale for breaking the Confidentiality
The only rationale that exists for breaking this confidentiality can be found in the conclusive outcome that may emerge from this decision. This breach of action can only take place when there is a serious risk to the people who are related to the patient and there is a chance that even they may be affected by the disease, for example, in the case of a HIV positive patient, it becomes necessary to tell the partner or spouse of the patient about this.
C4. Justification of Confidentiality Decision
Confidentiality has always been considered as the backbone of a good relationship between the healthcare staff and the patient and the breach of this can result in upsetting this very relationship. It can even, in a worst case scenario, result in the patient refusing to seek treatment from the concerned physician or simply lose faith in the entire healthcare system.
D. Resolving Conflicting Ethical Principles
When faced with an Ethical Dilemma, it is always best to see the options that are available at hand, or to consult the client. It is always possible that a team of healthcare professionals may be contacted to come up with a cohesive plan of action to counter the situation.
D1. Ethical Principle in Conflict With Broken Confidentiality
In the given scenario if the confidentiality were to be broken, then the individual, Mrs. Z as an autonomous, rational being is denied the right to make their own decision. Since, it is the duty of the nurse to protect the information, from a Deontological point-of-view and it is the patient who is the autonomous being, and therefore there would be a serious ethical conflict in this regard.
D2. Ethical Theory to Support Confidentiality Decision
If the case was to be approached from a Utilitarian point-of-view, then it is the outcome that would be judged, no matter what the course of action was. Therefore, if there is a breach of confidentiality, then the result of this decision would be that Mr. Z would get to know about her wife condition, and may persuade her for a treatment, which there is a probable chance that she is denying out of fear.
E1. Influence of Culture on Confidentiality Values
The understanding of Cultural Differences is an art in itself, which requires us to acknowledge firstly that every culture has intrinsically different values, under the influence of which an individual makes decision for himself.
The understanding of this factor and some basic knowledge regarding these cultural differences therefore is essential to the healthcare system, in which the nurses need to know that the person in front of them comes from an entirely different background, with completely different set of values, beliefs, family structure and decision making techniques. Hence, the method and the way to deal with their problems would be very different as well, and will require Culturally Sensitive Care.
E2. Nursing Interventions
There are only a few situations in which the breaking of confidentiality can be considered a lesser crime and may even be accepted. However, even then caution needs to be applied to the path that is taken to gain this end.
It is always best to apply an approach that does the minimum damage to the confidentiality agreement, since the repercussion of such a step is quite severe. It is always therefore advised, that through any mean the nursing staff convince the patient himself to allow for the information to be disclosed. However, in this situation it is the nurse that needs to play the most pivotal role to present to the patient the impact of the decision with regards to the confidentiality.
The other condition in which it would be acceptable to break the confidentiality agreement is when the patient is the victim of abuse and is not disclosing the information in fear of a social stigma or some other reasons. In this situation, if the nurse decides to intervene and breach the confidentiality agreement, then the impact of this would ethical argument that can be presented for taking such a step (Green, 2001)
F. Ethical Decision- Making Model
One Ethical model that is immensely used by advanced nurses today is the Synergy Model, which focuses on enhancing the relationship between the nurse and the patient. This is done by creating a synergy between the nurse that would be providing care to the patient and dealing with the family and the nurse's competencies. The competencies of the nurses are evaluated on a scale ranging from Level one to level five and are then assigned to the patient as per the level of complexity of the patient's condition (The AACN Synergy model for Patient Care, n.d.).
F1. Steps in Model
1. Get familiar with the patients history and his clinical charts, and then categorize their characteristics as per the "Patient Characteristics" table, which have been prepared with the understanding that they are…[continue]
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