During my nursing practice I have experienced a range of ethical dilemmas, in varying forms. Each instance developed my inner database of ethics, values and responsibilities. In my essay I would like to use an incident that I have experienced as a personal care worker in Australia. Firstly, I will briefly describe events in my first part of the case study and then I will reveal the dilemma this situation posed for me. I will examine related issues including my feelings and thoughts I had at that time and will look at some ethical theories, organisational policies and other aspects that influenced my decision making process. Only then I will reveal the second part of my case study which will show what action I have taken and will reflect upon it.
Before I became an Enrolled nurse in 2012 I worked as a personal care worker in one of the many nursing homes in Australia. I was fairly new to this occupation when I started to have suspicions that one of my colleagues was not treating clients appropriately (for confidential reasons I would like to further call him colleague X). Colleague X would be passing inappropriate comments while helping the residents with activities of daily living. At times colleague X did not respond to the resident’s requests claiming that he was too busy. I witnessed colleague X turning the head of a resident against her will so that she would look at him. Some residents confided to me, their fear of the man. By observing colleague X, I realized he didn’t appear to enjoy working with the residents. I spoke to him about it and asked him why he works in the Aged Care industry, when it is quite clear that he dislikes this caring environment. He admitted his dislike of this occupation but needed the money to look after his family. At this point I realized I was confronted with a dilemma;
Report colleague X to my supervisor with the possible resulting financial hardship for his family? OR
Not report this, and allow the residents suffer further?
The situation evoked in me contrasting emotions, ranging from anger, fear, frustration towards colleague X, to feeling empathy, compassion and even more committed to the residents acknowledging their vulnerability. Undoubtedly the residents were at the mercy of an unsympathetic carer and would inevitably suffer in the care of somebody who treats them with disrespect. I felt obliged to advocate their needs due to the weight of trust they put in me. On the other hand, I was surprised to hear colleague X’s disclosure and did react with compassion with his honesty. My anger was riddled with a pragmatic view of life’s inequities and the necessity to ‘trade off’ one’s personal needs for the greater good of ones family. I saw colleague X as somebody that needed a job to feed his children and felt some sympathy towards him. I thought about the difference between us and realized that I have chosen this occupation because I have always valued the elderly and wanted to positively impact their lives. However, for colleague X, this occupation was only a source of money. Under other circumstances, colleague X could have been a better person and this part of his personality mightn’t be apparent. I also felt guilty and embarrassed that I was planning to report work peer that had not done me any harm personally.
Application of Ethical Theories
The application of ‘Ethical Theories’ was necessary in this situation. As claimed by Warne and McAndrew (2008, p.317) in their article about Values, to be able to act appropriately in a particular situation, we firstly need to know ourselves. I admit that in nursing or personal carers profession we face many difficulties and time constraints that can lead us to hasty decisions. From Warne and McAndrew’s (2008) the self-knowledge can ease facilitate the decision making process and hopefully lead to the right decisions. I would like to highlight a short set of my own most important values.
Cause no harm
My family passed the above values onto me, they were further strengthened by my life experiences of living in a democratic society and travelling and mixing with other cultures. These factors and my natural ‘nurturing personality’ enabled me to make the necessary ethical decision in this difficult situation. These values have shaped me and guided me to the right decision. The study of Ethical Theories further confirms that my compassion was best served with my charges. They assisted in creating an intellectual environment that allows me to react without breaching any of my inner believes. Having those core values listed, it is apparent to me that that the residents were clearly not treated with respect by colleague X who was in my view causing them harm. At the time of the incident I already understood that the Code of Ethics for Nurses plays an essential role in my practice. I have extracted some from the seven points that I find most valid in my case. “Nurses value quality nursing care for all people.”
“Nurses value respect and kindness for self and others.” “Nurses value a culture of safety in nursing and health care.” (Nursing and Midwifery Board of Australia 2008, p.1) These nursing ethics are aligned to my own ethics. I believe that it is not ethical to treat anybody with disrespect or negligence and to steal dignity and autonomy from others. I feel strongly about trying to act in a way that creates positive outcomes under all circumstances. I feel the beliefs I hold and share with the Nurses Code of Ethics were breached by ill treatment of the clients, by colleague X. Creating a positive outcome was essentially a necessity in this situation. However not all three of sections of the equations could be served – our clients, colleague X and myself? Further evidence can be established with the Deontological Principles, which claim that our main obligation is to follow rules and duties set to us by some higher authority (BBC, 2013).
Basing my decision on this ethical theory, I understood that I should not take into consideration colleague X, but should immediately proceed with my compulsory mandatory reporting as it is indicated in Unnamed Organisation (2013) Workplace Bullying, Harassment and Sexual Harassment policy without worrying about the consequences of my action. My inner belief advised me differently, that is to consider other aspects more than just my duties and obligations to the organisation. I definitely feel that the wellbeing of residents is crucial but I also believe that it is only fair to think about all parties involved. Consequently, I feel responsible to consider what good will my actions cause but also what negative consequences could it have on colleague X, other colleagues and myself. I have to further weigh those and evaluate whom shall my actions benefit and why.
This course of thinking would be closer to a consequentialism that claims that we should always question the outcome of our action (BBC, 2013). To further seek the right decision, some answers could be found in Utilitarianism. As Tuggy (2011) lectures in his online presentation, the utilitarian way, is to proceed with actions that benefit the highest number of people affected by it in order to maximise achieved happiness. To explain this in practice by reporting colleague X and assuming that he would lose his job as a consequence of my action, I would negatively impacts on his family (3 children, 1 wife and 2 parents) and possibly on some colleagues (3) that like to work with him. At the same time, by doing so, I would benefit 30 residents sharing the facility who will feel relieved that they won’t be cared for by somebody like colleague X. This simple formula 6+3 = 9; 9
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