This paper examines core ethical responsibilities in advanced nursing practice through the lens of a patient case study. It discusses the importance of ethical theory in guiding nursing judgments, the relationship between the principle of confidentiality and the concept of reasonable limits, and the circumstances under which breaching confidentiality may be justified. The paper also explores how cultural values shape the perspectives of both patients' families and healthcare providers, and how conflicts arising from competing ethical principles can be resolved. Finally, it applies a deontological ethical decision-making model to demonstrate how master's-prepared nurses can navigate complex ethical dilemmas in clinical care.
Nurses are required to understand their ethical responsibilities when providing care and when functioning within a diverse healthcare setting. This paper is based on a case study that touches on several areas relevant to nursing and the profession. First, the importance of ethical theory in nursing will be highlighted. The relationship between the principle of confidentiality and the concept of reasonable limits will then be explored, including key elements of each. The rationale for breaking confidentiality will also be addressed. The paper further examines how conflicts between two or more ethical principles can be resolved, and explores the influence of cultural values on nursing practice. Finally, an ethical decision-making model applicable to master's-prepared nurses in the delivery of healthcare will be identified and applied.
Theories are integrated bodies of rules and principles. Ethical theory provides a framework within which nurses assess the acceptability of their actions and the morality of their judgments. There are two major ethical theories — consequentialist and deontological — but there are others, such as ethics of care and virtue-based ethics. Ethical theories are practical and are highly important in nursing practice. First, they can help nurses determine the extent to which a problem is an ethical one. Second, ethical theories enable nurses to develop skills and tools that help them tackle ethical and philosophical questions they encounter in practice. Third, these theories assist nurses in developing the soundness of their ethical beliefs and practices. All ethical reasoning requires that nurses draw on their values and beliefs and attend to them carefully in order to enhance the quality of their reasoning (Allmark, 2005).
An example of the importance of these theories is the fact that nursing professionals regularly face questions that are empirical, formal, or philosophical in nature. In most cases, very practical decisions require nurses to address all three types simultaneously. For instance, when considering a "Do Not Attempt Resuscitation" order, determining whether such an order is appropriate requires a nurse to answer empirical questions — such as the likelihood of a resuscitation attempt being successful — as well as formal questions, such as whether the law permits such an order in the present circumstances. Finally, it requires nurses to address ethical and philosophical questions, such as how they should weigh quality of life against quantity of life (CME Resource, 2011).
The concept of reasonable limits is quite applicable to the confidentiality of patients in nursing practice. This concept is typically used to limit the degree to which nurses and other healthcare professionals disclose patient information. Patient confidentiality means that other people cannot access a patient's medical information without the patient's consent. There are several principles of confidentiality. The first is that medical information may not be disclosed without the patient's consent, meaning that doctors and nurses are only permitted to share a patient's information with family members when the patient has granted permission. Another principle is that healthcare providers must avoid unintentional disclosures. Consent is required before any information is disclosed to a third party. Data relating to patients must always be held securely and stored safely in accordance with data protection legislation. Such information should always be valid, accurate, and retained only as long as it is needed to provide healthcare services to patients.
The concept of reasonable limits is widely recognized in the nursing profession. Reasonable limit refers to the act of moderating or restricting one's actions. This concept has been applied in healthcare to govern the actions of healthcare professionals. It benefits healthcare systems by helping prevent the misuse of patient information and by promoting the confidentiality and privacy of patients. Doctors and nurses are only permitted to disclose information in specific, defined situations (Medical Protection Society, 2013).
Healthcare professionals can breach confidentiality in various ways, some of which are unacceptable and others of which are permitted. One way is by disclosing information to unauthorized individuals — for example, a doctor sharing information with a patient's family members without consent. Confidentiality may also be breached when a relative is informed of something they were not previously aware of. There are circumstances, however, in which healthcare professionals are permitted to breach confidentiality: when there is a risk of harm to a person or to society; when it is suspected that a patient is acting illegally or harming others; when it is believed that the patient may harm themselves in the future; when there is suspected abuse or exploitation of minors; or when the patient holds a role or relationship that affects the public (Gp-Training, 2006).
On the basis of reasonable limits, doctors are not permitted to disclose information to a patient's family members or friends without consent. They must obtain the patient's consent before any disclosure. However, they are not entitled to maintain confidentiality in cases where the patient's life or the lives of others are in danger. This means that doctors retain the right to disclose information when doing so serves a justified purpose.
"Justifications for breaching patient confidentiality"
"How culture shapes provider and family ethics"
"Applying deontological model to the case"
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