This paper will address the principle ethical issues that nurses face in the course of their work. Confidentiality is an aspect of care giving that nurses need to understand so that they can conduct themselves according to societal expectations. However, culture and other factors come into play decision making for ethical issues. The role of a nurse or any other practitioner becomes to balance the professional demands and conduct with the needs of their patients (Beauchamp and Childress, 1994, p. 28). Importance of ethical theory to nursing.
According to Beauchamp and Childress (1994) it is through ethical theories that nurses get an ordered approach to moral reasoning. Through the theories, nurses look at the various methods of moral reasoning. They can therefore make informed judgments on the moral importance of their actions (Beauchamp and Childress, 1994, p. 28). By using ethical theory and using a model to reach an ethical decision, a nurse is helped to have a moral reasoning and backing for choices made. The importance of nursing ethical theories is that they examine the ethics of caring instead of curing (Tschudin, 2003).
This allows the nurses to make choices that enhance the relationship between them and the individuals they care for. Because of the shift in modern nursing towards a nurse’s obligation in regards to patient rights they need assistance with professional codes that can act as guidelines (Tschudin, 2003). There is a distinction between medical ethics as a whole and ethical theory in nursing. According to Tschudin (2003) ethical theories of nursing allow nurses to focus on fostering caring relationships and allow collaboration with patients.
Medical ethics approach is paternal and unsuited to nursing ethics because while in nursing ethics, there is emphasis on dignity and autonomy, in paternalistic performance medical professionals put the interest of the patients (Tschudin, 2003). Thus by using nursing ethical theories, nurses can focus on their caring relationships beyond the ethical principles. One case that underlines this is Estate of Behringer v. Princeton Medical Center, 592A. 2d 1251-N. J. Super. Ct. Law Div. 1991. (enotes. com 2010). Behringer was a surgeon at Princeton Medical Center.
His chart showing information about his AIDS status was left exposed at a nurse’s station (enotes. com 2010). Soon other medical staff and even his patients got to know his status. He sued the hospital for failures to reasonable protect his privacy and Princeton Medical Center was found to have breached confidentiality (enotes. com 2010). In this nurses failed in their role to protect what was in the best interest of the patient. Relationship of confidentiality and reasonable limits Elements of the principle of confidentiality. In nursing, there are two main situations whereby confidentiality becomes an obligation.
When a nurse is entrusted with information and patients understand that it will not be disclosed and when a client expresses desire that the information will not be disclosed (Cain, 1998, 158). Elements of reasonable limits. The limits of reasonable limits are set by the patient or those who have a right to know in the care of the patient. Any disclosure after a patient has made explicit request for the practitioner to keep confidentiality constitutes a breach of confidentiality (Cain, 1998, 160). By Mrs. Z explicitly stating that she does not wish her family to know about her condition, she set the limits for confidentiality.
The doctor can therefore not disclose information to her family. Doing so would be breaking Mrs. Z confidentiality. Rationale for breaking confidentiality. Even though confidentiality should be upheld, it may become necessary in the care of a patient for the confidentiality to be broken since confidentiality is not absolute. There are certain conditions that would compel a medical practitioner to disclose confidential information (Cain 2009, 175). According to Cain (2009) the law can require a practitioner to share patient information. If a practitioner is required to, they have to comply with the law.
In the event that a patient wants to cause harm to self or others, the practitioner can break confidentiality so as to avoid the harm (Cain 2009, 177). Abuse also allows a practitioner to break confidentiality (Cain 2009, 177). When the care of a patient requires sharing of information between practitioners, for example a specialist, then the doctor can consult with others (Cain 2009, 178). For purposes of research practitioners can submit information about their patients although it is usually non-identifying. Practitioners also share information with health insurance companies to various degrees (Cain 2009, 179).
Sometimes practitioners also break confidentiality when the best interests of the patient are threatened and breaking confidentiality appears reasonable (Hunt, 1994, p. 165). Although they leave themselves open to the consequences, the patients sometimes end up appreciating the efforts of the practitioners to ensure their good. Because of fear patients may not be in the best position to disclose important information to those who can assist in their care like family. They may think they are protecting the family. However, it is they who are often in greater need of assistance and protection (Hunt, 1994, p.
169). A practitioner can therefore break confidentiality because it is reasonable to do so, so that the patient can receive care that sometimes borders on life and death situation. In the case presentation, a practitioner could resort to break confidentiality because reasonably speaking, Mrs. Z could benefit from further medical care and this care can not be given without Mr. Z acquiring knowledge of the situation. Failure to disclose the information would lead to non-treatment of Mrs. Z since she can not visit the hospital or incur medical bills without the family knowing.
Therefore, a practitioner would be acting in the best interest of Mrs. Z by breaking the confidentiality. Resolving conflict between ethical issues Autonomy and confidentiality. One ethical principle that would be in conflict if confidentiality was broken is autonomy. Autonomy gives the patients right to make decisions concerning the medical care they receive (Beauchamp and Childress, 1994, p. 120). They have a right to not have a practitioner try to sway their choices. However, according to Beauchamp and Childress (1994) autonomy does require that practitioners educate their patients so that they can in turn make informed choices.
This principle requires respect for people’s right to make their own choices. If a patient decided on what they want, the practitioner has an obligation to honor that. As long as what the patient desires doe not harm others (Beauchamp and Childress, 1994, p. 120). Thus freedom and consent are hallmarks for this principle. By breaking confidentiality a practitioner would in violation of this principle. This is because the practitioner’s desire would have taken precedence over the autonomy of the patient. Rational theory as support for break of confidentiality
The rational theory of ethics would support the breaking of confidentiality. This is because this theory looks at care and concern shown for the patient to justify morality of an action (Hunt, 1994, p. 181). In this case, a practitioner can break confidentiality for the sake of the greater good of the patient. For a practitioner intent on giving the patient the best care and concerned for the wellbeing, it would be considered the rational or virtuous thing to do (Beauchamp and Childress, 1994, p. 62). Influence of culture on values Relationship of confidentiality and provider/patient cultural values
For the family sharing information is seen as vital. Out of the concern that the family has for each other, they desire to know what is wrong with Mrs. Z. Confidentiality does not seem to take precedence over personal choice to freely give information. When Mrs. Z shares information about the breast lump with the mother-in-law, the mother-in-law shares the information with Mr. Z and Mrs. Z is taken for medical examination. Even though Mrs. Z has assured her husband that nothing is wrong, he still feels that he has a right to know about the wife’s condition.
He is not legally bound to respect or uphold his wife’s desire for confidentiality as spouses do not automatically qualify to get their spouses medical information (Atkinson, 2004,p. 14). The family is also not individualistic but rather employs method of deferring decision making to authority figures in the family. Although Mrs. Z might have told the husband about the lump, she followed the expected norm of entrusting this information to her mother-in-law who is in-charge of the household. It therefore became the prerogative of the mother-in-law to decide what to do with the information.
This is the culture of some communities where it is not the individual but rather those in authority that make decisions on confidentiality and course of action (Madeleine, 2006, p. 352). The doctor and nurse however are ethically and legally bound to fulfill the request of the patient (Kirrane, 2009, p. 95). They can not freely disclose patient privileged information. For disclosure to be justified they would have to follow a process that will examine the best interest of the patient (Bersoff, 1999, p. 7). Mr. Z’s desire to have information about his wife’s condition cannot by itself justify giving that information to him.
Despite his intentions and the fact that he stands to suffer too if his wife is not treated for her illness the disclosure would have to be in Mrs. Z’s interest. Reducing ethical conflict through nursing intervention One of the things that the nurse can do to reduce the ethical conflict is foster communication between patients and practitioners. Communication enables both parties to understand each other especially those coming from different cultures (Kirrane, 2009, p. 110). Nurses should recognize their own cultural beliefs and values and learn to respect those that are not similar to theirs.
They can also learn about the main cultural beliefs of those directly under their care. In communication nurses can understand the whole person and what makes the patients behave the way they do (Kirrane, 2009, p. 112). In this way, they can keep the patient’s confidentiality because they can empathize with patient and understand their unique reasons for what they do. Another intervention is empowering and affirming patient for the care they choose (Madeleine, 2006, p. 354). Sometimes what brings conflict is the fact that patients may not be sufficiently equipped to handle their decisions.
Therefore nurses are conflicted about how to best assist their patients whom they do not wish set up for failure or further harm. According to Madeleine (2006) empowering the patients can assist them to be make informed choices including choosing to disclose information since they feel more in charge. Sometimes patients just need to know more about their situation before they can inform others. Thus a nurse can keep a patient’s confidentiality knowing that the patient is making informed autonomous decisions and will be strong enough to handle disclosing their information when they choose to.
Ethical decision-making model used by advanced practice nurses in health care To arrive at sound judgment concerning ethical issues practitioners must have principles or values they want to uphold (Hunt, 1994, p. 149). The decision making process becomes a tool for assisting the practitioners uphold the most values that they can in the best interest of the patient. According to Forrester-Miller and Davis (1996) the decision making model encompasses seven steps. The first step is identifying the problem. In order to make a good decision, the key points and issues at and needs to be thoroughly understood.
Thus a nurse should gather the most information possible about the situation and look at it from as many viewpoints as possible. All parties and their roles in the problem should be examined. Depending on the problem help from the outside may be required, for example, legal advice for legal problems. The next step is to apply the code of ethics to the problem (Forrester-Miller and Davis 1996, p. 2). If the problem and solution are outlined in the code of ethics, then the nurse can follow the directives given to resolve the problem.
However if the problem is not addressed there a nurse should progress further to reach a decision (Forrester-Miller and Davis 1996, p. 2). According to Forrester-Miller and Davis (1996) the next step is for the nurse to examine all the dimensions of the problem. This can be achieved by looking at the problem through the principles of ethics, reviewing related literature, consulting with other professionals and professional associations. This can help the nurse to be aware of current thoughts and experiences that can enlighten the problem.
Next would be to come up with all options for resolving the problem (Forrester-Miller and Davis, 1996, p. 2). The nurse should examine all potential options so that their potential to resolve the problem can be viewed. Next would be to consider consequential outcome of each option (Forrester-Miller and Davis, 1996 p. 3). Some options may have undesirable and grave consequences for which the nurse should be aware of. According to Forrester-Miller and Davis (1996) only after a nurse has looked at all possible consequences should she then make a decision.
The next step is to assess the possible solution arrived at (Forrester-Miller and Davis, 1996, p. 4). If the solution resolves the ethical problem then the nurse can move to the final step. If however it does not, the nurse has to restart the process. A possible solution is said to resolve the problem if it does not present its own ethical issue, the nurse would advice the course of action to other nurses, would be comfortable with other knowing of their decision and would apply this solution to other patients (Forrester-Miller and Davis, 1996, p. 5).
The final step is implementation whereby the nurse carries out the planned course of action. In implementation, the nurse will be responsible for the action whether the expected outcome is reached or not (Forrester-Miller and Davis, 1996, p. 5). Application of model to case presentation In the first step the problem would be stated as whether to tell Mrs. Z’s husband of her medical problem or not. Information about Mr. Z and his intentions, values, and the relationship between Mrs. Z and him would be gathered to determine if his knowing about the situation would benefit Mrs. Z or harm her. Next would be to consult the Code of ethics.
According to the American Counseling Association in the ACA 2005 code of ethics guide, there are provisions for breach of confidentiality for the benefit of the patient. In section B. 2. a a provider can break confidence incase the patient will encounter serious and foreseen harm by maintaining confidentiality. Since this is the case in Mrs. Z’s situation the providers can break her confidentiality. The next step would be looking for ways in which this can be done in a beneficial providing Mrs. Z with preparation if possible and the best ways to deal with the situation. It would be best if Mrs.
Z is made aware that her husband needs to know, his concerns and the fact that in due time, her situation will be obvious that something is wrong and by then it might be too late. In that context Mrs. Z can share her fears or reasons for her request and she can be given assistance accordingly. The providers would look at consequences of Mrs. Z refusing them to share the information. Conclusion Ethical issues have always been and still are a concern in the practice of medicine. Nurses need ample preparation for the making of ethically sound judgments that will auger well with their profession and their patients.
Failure to honor patient expectation to confidentiality can seriously damage the patient/practitioner relationship. It is only by exercising professional conduct that is mindful of the best good for patients that nurses and all medical practitioners can bring about good relationships with their patients and protect themselves from undesirable consequences like being sued for violation of patient rights. References American Counseling Association. (2005). ACA code of ethics 2005. Confidentiality, privileged communication and privacy.
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Nurse Education Today, Vol. 19, 3, 175-181. Enotes. com (2010). Patient Confidentiality. RTetrieved on 16 August 2010, from http://www. enotes. com/nursing-encyclopedia/patient-confidentiality Forester-Miller, H. and Davis, T. (1996). A practitioner’s guide to ethical decision making. Pennsylvania: American Counseling Association. Hunt, G. (1994). Ethical Issues in Nursing (Professional Ethics). New York: Routledge. Kirrane, M. B. (2009). Medical confidentiality versus disclosure: Ethical and legal dilemmas. Journal of Forensic and Legal Medicine, Vol. 16, Issue 2, 93-96.