Nursing ethics

Categories: AutonomyEthicsNursing

For the purpose of this assignment, ethics in relation to nursing will be discussed. “Ethics; A code of principles governing correct behaviour, which in the nursing profession includes behaviour towards patients and their families, visitors and colleagues” (Oxford Dictionary of Nursing 2004).

Autonomy Principles Applied to Patients with Dementia

This assignment will consider autonomy as identified in a practice placement, but will also look briefly at the ethical principle of non-malefience and others that is relevant in this assignment. It will also closely look at this issue and will describe how the principles of ethics apply to practice.

In accordance with the Nursing and Midwifery Council (NMC 2004).

Any names of patients referred to in this assignment have been changed to protect their confidentiality. The NMC states as a registered nurse you must guard against breaches of confidentiality by protecting information from improper disclosure at all times. The first placement referred to in this assignment is an Elderly Mentally Infirm (EMI) home, which is located on Merseyside.

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The United Kingdom Central Midwifery and Health visiting Council (UKCC 2002, clause 6)). Which is now known as The Nursing and Midwifery Council (NMC) Also state that “Health Care Professionals should recognize the respect the uniqueness and dignity of each patient and client, and respond to their need for care irrespective of their ethnic origin, religious beliefs, personal attributes, the nature if their health problems or any other factor”.

Autonomy (“Greek: Auto-Nomos – nomos meaning “law”: one who gives oneself his own law) means freedom from external authority”: Wikipedia, encyclopedia (2004).

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On this placement, there were several examples of how autonomy influenced care delivery; this assignment will address two of these examples. The first incident involved an eighty six year old lady called Betty, who suffered with severe dementia, the Practice nurse from her surgery was coming into the home to administer the flu injection to her and several other clients. It had been recorded in Betty’s case notes that she had had a fear of needles in the past and had refused several injections before her mental health had deteriorated, Does an autonomous decision have to be rational? “In the ideal of autonomy day – to -day decisions should be rational, i.e. consistent with the person’s life plans” Hope, Savulescu and Hendrick, (2003 p 34).

Betty had no living relatives to contact to discuss her treatment. Patients suffering with dementia cannot always exercise autonomy. A client may be mentally incapacitated for various reasons. These may be temporary reasons, such as the effect of sedatory medicines, or longer-term reasons such as mental illness. It is important to remember that capacity may fluctuate, sometimes over short periods, and should therefore be regularly reassessed by the clinical team treating the client. The principles of consent continue to apply to any medication for conditions not related to the mental disorder for which they are being treated. The assessment of their capacity to consent to or refuse such medication therefore remains important.

The NMC (2004) recognises that this is a complex issue that has provoked widespread concern. It involves the fundamental principles of patient and client autonomy and consent to treatment, which are set out in common law and statute and underpinned by the Human Rights Act 1998.

The principle of respect for autonomy entails taking into account and giving consideration to the patient’s views on his or her treatment. Autonomy is not an all or nothing concept, an initial step maintaining Betty’s autonomy may be to clarify all the facts in the case, for example does Betty have any understanding of the risks of not having this treatment?

Her mental illness means that she is unlikely to be competent to consent or refuse the injection, but an attempt should be made to explain to her, in terms that she could understand, what the treatment would involve and what the outcome would be without treatment. Has her autonomy been enhanced as much as is possible? If the conclusion is that she is unable to understand the consequences of non-treatment, or that her fear of needles is stopping her evaluating the risks, then she will not be competent to make a decision. However, this does not mean that her fears and concerns should not be acknowledged.

Mill (1982) states “…..the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others to do so would be wise, or even right” Mill (1982 p 68).

The NMC (2004) Code of Professional Conduct 3.3 states that, “When obtaining valid consent, you must be sure that it is: given by a legally competent person, given voluntarily, and informed”. Crow (1983) suggests that it is the nurse’s responsibility to deliver care within the framework of agreed moral principles, for instance those reflected in the Code itself.

The principle of non-malefience should also be considered in Betty’s treatment, it would seem to be in her best interests to be treated. If the injection is the proposed treatment, the balance of harms and benefits may be such that treatment would causes distress for a short time not such that her life is intolerable. If the decision is to give the injection, then once again respect for Betty’s wishes and concerns should influence the approach to treatment so that her fears are mitigated as much as possible. All medication given covertly must, be recorded in Betty’s case notes for future reference this shows good nursing practice.

According to Wikipedia, Encyclopedia. (2006). Primum non nocere is a Latin phrase that means “First, do no harm.” The phrase is sometimes recorded as primum nil nocereIt is one of the principal precepts all medical and nursing students are being taught in medical school. It reminds a healthcare professional that he or she must consider the possible harm that any intervention might do. It is most often mentioned when debating use of an intervention with an obvious chance of harm but a less certain chance of benefit.

Another example of how autonomy influenced care delivery on this placement was, the entire patient’s case notes where locked away at the nurses station and the trained nurse had the key, if anybody needed the notes the trained nurse had to either get them or issue the key, which had to be returned straight away. This involved the principle of autonomy but also the principle of non-malefience. In any situation where confidentiality is breached, the nurse or doctor must be prepared to justify his or her decision before the General Medical Council.

Respect for patient autonomy (deontological theory)The principle of respect for patient autonomy acknowledges the right of a patient to have control over his or her own life, and this would include the right to decide who should have access to his or her personal information. Where the basis for the duty of confidentiality is the principle of respect for autonomy any breach of confidentiality means that the patient’s autonomy has not been respected, whether or not the patient is aware of the breach. Now due to The Freedom of information act 2000, which came into force in January 2005, patients and carers now have the right to ask to see confidential records.

There are exceptions to the confidentially clause and the principles addressed in this assignment. The National Health Service (NHS) Confidentiality, Code of Practice. This provides generic guidance where there is a need to disclose information that identifies an individual and that information is held under a legal obligation of confidentiality.

“The issues to be considered and the appropriate steps to take can be ascertained by working through the model and referenced text refers to appendix one, two, three. A range of information disclosure scenarios can be found in NHS Code of Conduct Confidentially (2003). These reference and illustrate the model that can be used to aid decision-making. “They highlight issues relating to particular decisions, e.g. disclosure to NHS managers or to the police. It is hoped that they cover many of the circumstances that staff currently have to deal with” (NHS 2003).

In 1997, the Department of Health published the Caldicott Report (‘On the Review of Patient-Identifiable Information’). It considered the flow of identifiable patient information and recommended that confidentiality should be safeguarded by anonymising health data, where possible. “Each NHS organisation must have a ‘guardian’ (normally a senior health professional) to oversee all procedures affecting access to person-identifiable information” DOH Caldicott report (1997).

The NMC code of professional conduct: A standard for conduct performance and ethics (2004) “requires each registrant to act at all times in such a manner as to justify public trust and confidence. Registrants are personally accountable for their practice and, in the exercise of professional accountability, must work in an open and co-operative manner with patients/clients and their families, foster their independence, and recognise and respect their involvement in the planning and delivery of care.”

According to Beauchamp and Childress (2001) there are four principles, which are the most widely used framework and offers a broad consideration of medical ethics issues generally, not just for use in a clinical setting. Ethics are also applied to every day living, and that everybody has their own opinion of what is ‘right or wrong’, to quote Hinchliff, Norman & Schober (2003) “getting in touch with one’s personal value base is a crucial first step in the study of nursing ethics”.

Midwife Ethics

Midwives are able to be the sole carer of a mother and baby from early pregnancy to around 28 days after the birth and attend over 75% of births in the UK (Baston et al., 2009) and generally view care from a holistic perspective and consider the care they offer from a psychological, emotional, spiritual, social and cultural context (Baston et a., 2009).

The word ‘midwife’ simply means ‘with women’ (Alberta Association of Midwives 2012). According to the International Confederation of Midwives Council (2005) the midwife is a conscientious and accountable trained specialist in ‘normal’ pregnancy and birth. They work in ’partnership’ with the woman, her partner and family to offer the vital care, support and advice required during the prenatal, interpartum and postpartum period to independently guide the women through the pregnancy and birthing process and provide care for both the new born and infant. The scope of the midwife includes the support and encouragement of normal birth, identifying complications with the pregnancy and performing emergency procedures. Midwives play a significant and critical role in the delivery of health counselling and education which should include antenatal education not only with the women but with the family and network and wider community.

Pregnancy and antenatal care are essential parts of midwifery care. A vital part of this care is carrying out assessments of well being which is not only a process to measure the woman’s and child’s health but is also effective in testing whether the wellbeing of the woman and child is at risk. In order to accurately assess wellbeing the midwife must have relevant practical skills such as, taking and recording blood pressure to screen for hypertension, listening to the foetal heartbeat, taking bloods which can, for example, determine her rubella immunity status, measuring the growth of the foetus, dating the pregnancy and administering medication (Mander, 2009).

The midwife is equipped with extensive knowledge and dexterity of the female anatomy, how the body works and the changes and processes in pregnancy as well as the ability to examine this competently. The midwife is expected to have comprehensive knowledge of the normal progression and different stages of pregnancy, the bodily and psychological changes and common discomforts women experience and has the ability to interpret results of basic screening laboratory tests, for example, urine tests which look for the presence of protein or glucose in the urine which can be an indicator of infection or diabetes (Mander and Fleming, 2009, Medford, 2011).

The midwife works jointly with other health care professionals to provide multidisciplinary care to the woman, these health care professionals include, obstetricians, general practitioners, paediatricians, health visitors and physiotherapists. The midwife is obligated to seek advice or turn to the appropriate professional if there is a complication within the pregnancy that falls outside the midwife’s scope of practice (ICM 2002, 2005). The clear and concise record keeping is an important aspect and legal requirement of midwifery practise and is a vital tool that supplements the care process, which include consultations and sometimes referrals by improving communication between the care providers and the clients, for example information that should be included if this is a full assessment and care plan that should be followed by the woman and child (Nursing and Midwifery Council (NMC), cited Medforth et al., 2011).

Midwives are only able to care for women for are deemed as experiencing a ‘normal’ healthy and physiological pregnancy although a midwife would be aware and have knowledge of abnormal and pathological aspects of pregnancy. If a complication arises that is deem outside a midwife scope of practise the midwife would no longer be able to be the woman’s primary care provider and the care would be transferred over to an obstetrician. An obstetrician is a trained specialist in the foetal abnormalities and complications of pregnancies and childbirth and who are also legally allowed to deliver babies. Although the woman’s care has been transferred to the obstetrician the midwife still participates in her care to act as the woman’s avocate and offer her support (Mander and Fleming (2009).

The midwife can also expect to be in contact with the Health Visitor to discuss newly booked clients and at some point after the birth and to hand over the care of the woman and the child, the midwife will give the Health Visitor an extensive amount of information on the family during the pregnancy and birth experience so that the they can offer direct individual support. Modern midwifery sees midwives also working with social services as some women and their families have additional needs separate to those from the pregnancy.

Midwives may seek advice from a social workers for example, surrounding child protection issues, housing and benefit queries in order to offer the women adequate social support and to signpost them to appropriate services or work in partnership with the social services because the women belongs to a vulnerable group, for instance teenage mothers or disabled mothers or women at risk of domestic violence. It is common for a midwife to also work closely with GP’s, and in the community may be based within the GP surgery, woman may be referred to the GP from an antenatal clinic for minor problems, for example to symptomatic occurrence of urinary infection. (Peate and Hamilton, 2008).

Codes of Conduct for Nurses, Midwifes and Social Workers

Codes of conduct contain a set of rules and guidelines to make sure staff adhere to certain forms of ethical principles and values in turn this promotes a good practice that’s in line with those professional standards and expectations (Gilman, 2005:4). This study will present ethical values of the following two code of conducts, the ethical principles, and theories which define the teachings of the codes of conduct within the Nursing and midwifery council (NMC) and the British Association of Social Workers (BASW). It is also underlying the importance of these two codes for the professional standards that are expected of the workforce that represent them. Will explore the similarities, and differences between these two codes. Ethical values and principles are indeed necessary for any progressive profession either of the healthcare profession or the social work profession. Ethical values and principles are somewhat an aspiration document of the said company that indicates the behavior of a service provider to service-users; it specifies between right and wrong.

Code of Conduct for Nursing and Midwifery

According to the Nursing and Midwifery Council (NMC) the code ‘Y Cod – Cymraeg’ shows professional standards for nurses. It defines a set of rules and guidelines for the nurses and midwives in the United Kingdom. It provides the teachings of performing what’s in line with best practice in these organizations with the most effective outcome for patients and other individuals involved (Council, 2015). The teachings and guidelines of this code are proved to be the most effective way in serving high-quality care with the most effective professional practice in the UK that all healthcare professionals are compelled to adhere to. Under the light of Y Cod – Cymraeg, Nursing and Midwifery promote these principles in the public interest. The Equality Act 2010 also requires nurses and midwives to protect children, young people and adults from discrimination; they are required to perform equal care practices for all individuals from a wide range of diversities and cultures (GOV.UK, 2019). On the other hand, Equality Act 2010 also stipulates for organizations to care for the needs and wants of employees; for example, this act requires the NMC to give training sessions to nurses that implement guidelines about tackling possible mental illness in patients (Chin and Kim, 2016).

The code of ethics also requires that as a nursing associate in England, it is a criminal offense to cause or permit anyone to make a false representation about being on the NMC register.

The code of conduct requires all to adapt to all aspects of maintaining and promoting person-centered care, treating people as individuals and upholding their dignity. It means dealing with people with kindness, respecting them, and making sure that care is delivered effectively to their needs (Chin and Kim, 2016). Also, avoiding assumptions, promoting diversity and the treatment or care being delivered is exceptional and implemented with the best interest of the individual that’s receiving it.

It is vital to listen to individuals with active listening and respond effectively to their concerns. To achieve this, it is vital to recognise, respect, and contribute to the individual’s health and wellbeing in a positive manner (Council, 2015).

The code of conduct for Nurses and Midwives stipulates to pay special attention to fulfill the physical, social and psychological needs of individuals. The nursing and Midwifery Council (NMC) make nurses and midwives accountable to engage in open communication with patients and understand their problems, feelings, sorrows. They are accountable to perform these by adopting a person-centered approach (Council, 2015). They could increase the morale and confidence of patients by promoting the equality-following Equality Act 2010, thereby could reduce discrimination. The nursing profession is not easy because it requires extra efforts to fulfill the needs and wants of a diverse group of patients at any giving time, the above code of ethics, nurses and midwives can perform professionally, while having a positive impact on the well-being of their patients.

A Code of conduct for social work in the United Kingdom

A Code of conduct for social work in the United Kingdom was established by the British Association of Social Workers (BASW). According to the BASW, social work is the practice that is based upon promoting social changes for development, social cohesion, as well as the liberation of people and their empowerment. The Code of ethics provided by this organization promotes ethical awareness which is fundamental in this profession. It improves the practices of social workers that are essential and helps some of the most vulnerable people within society (British Association of Social Workers, 2019). According to the code of conduct of BASW, social work includes challenges to enhance well-being and quality of life. Therefore, it is crucial to perform a high-quality service; it could be performed by respecting human rights and a commitment to promote social justice. Commitment and promoting social justice are at the core of social work practice in the UK (BASW, 2019).

The Equality Act 2010

In addition to this, all the above-defined practices of social workers have also dined in the Equality Act 2010, this act implies that every social worker who provides services to the public whether a charge was incurred or not for the service is liable to be treated with dignity and respect (Webb, 2016). This act also comprehends that social workers should prohibit discrimination on all grounds. Every individual social worker is accountable for considering the aspects of disability, race, religion, sexual orientation etc. Social work practices are to develop potential in human beings, and the Equality Act 2010 promotes human rights and social justice to reduce poverty (Collins, 2018).

There are some ethical values of the code of conduct for social work which are provided by the British Association of Social Workers (BASW). These values are described below.

The code of conduct that represents ethical values for social workers requires all to promote self-determination and respect for the rights that they are entitled to (Clapham, 2017). They are accountable to perform and promote the Equality Act 2010 which stipulates giving equal rights to all service users.

The right to It indicates involvement in the participation of people by implementing more efforts in services and empowerment in all aspects and situations (British Association of Social Workers, 2019). Treating every individual and family with dignity and respect and reporting any concerns, respecting their social and natural environment, and identifying all the aspects of personal life through discussing it with the individual and helping them to manage his or her lifestyle.

Social workers are responsible to determine their strengths and weaknesses to improve professional practices and increasing their motivation level (British Association of Social Workers, 2019).  Social work Promotes ethical principles and theories The theory relates to the code of conduct and guidelines provided by the BASW for social workers. Virtue Theory stipulates that a person not be selfish and should be free from pain and displeasure (Clapham, 2017). All social workers should perform his or her duty to bring positive reinforcements to the wellbeing of others.  The Care theory also relates to the code of conduct of social workers, it requires them to maintain an interpersonal relationship with care and good quality (Collins, 2018). According to the care theory of ethics, it is vital to focus on relationships to maintain positive well-being which is also defined as natural caring.

The ethical principles according to the code of conduct for social work are based on the value of the service that is provided. The Ethical principle’s primary goal is to help people in need and addressing their social problems. Social workers are responsible to use their knowledge and skills to maintain good well-being. The other value is social justice where the ethical principle is to ensure social change, they are focused primarily on issues like poverty, abuse, neglect, discrimination, unemployment, and various other types of social injustice (Webb, 2016).

They are liable, therefore, to promote diversity and equality through applying meaningful decision-making for everyone. The next value would be dignity and worth where the ethical principle is to ensure Social workers are responsible for caring and respectfulness for individuals from various cultures and ethnic diversities (Clapham, 2017). They are accountable to increase the capacity of people to resolve conflicts in society and implementing the guidelines of the above code of conduct by BASW.

The nursing and midwifery profession also has a broad category of ethical theories which include deontology, utilitarianism, rights, and virtues which highlight the importance of ethics in the field of medical and nursing practices. These theories are defined by the moral laws of deontology and utilitarianism. The deontological theory indicates that nurses should engage in effective decision-making for individuals. They must provide the best health care to individuals through fulfilling their promises. Deontology is an ethics system that stipulates if an action is right or wrong based on the moral code of the institution it represents. The potential consequences of those actions are not taking into consideration. Ethical actions follow the moral laws of don’t lie, cheat, or steal (Tanner, Medin, & Iliev, 2008). Deontology is a principle that forces us to obey the ethical code of the institution we follow regardless of the consequences. For example I had a Client who had Parkinson’s disease took him a long time to trust me as he had witnessed poor care and abuse before. One day the client stood up without support and fell under my work policies and procedures which is based on my companies’ ethical values I am supposed to let him fall, under my own ethical values I went against my work policies I judged it on a more consequentialist theory and caught him. This resulted in me taking time off work but on the contrary, the client still trusted and felt safe with me.

I exemplified an ethical act to my client where my consequentialist intentions determined the morality of my actions and our future working relationship. The Consequentialist theory falls more in line with the utilitarianism theory. This theory provides an ability to predict the reasons of actions for example if anyone is behaving with a negative attitude or is seen to be responsible for an accident; it impacts the feelings of others as well. There are two types of Utilitarianism, one is act utilitarianism and the other one is rule utilitarianism (Barrett et al., 2016). A person when performing acts which impact the personal feelings of individuals is regarded to be as under the act utilitarianism. On the other hand, a person when follow the rules of ethics such as treating fairly and equally, it indicates the type- rule act utilitarianism. The codes of conducts and ethics are a great force for a basic structure but situational problems can arise due to multiple ethical considerations that contradict one another (Kitchener,1984) for example, the code of ethics for health and social work fails to specify what standards, values or principles are more important. What one has more worth when they conflict with one another (NASW, 1999:3)

The ethical theory based on the rights indicates the rights of individuals who are protected by the official bodies to a larger population. Nurses are liable to follow this theory as; they are responsible in maintaining and promoting people’s rights.

The ethical principles must include providing confidence, promoting autonomy, and sense of well-being among individuals. Justice and fairness are the two most important principles which should be performed by the nurses and midwives among the different group of patients. In addition to this, a nurse must remain faithful with all the patients to perform practical and safe care in a competitive manner (World Health Organization, 2018).

Both of the following code of conducts has great importance, the code of conduct of Nursing and Midwifery Council the code ‘Y Cod – Cymraeg’ shows professional standards for nurses and midwives. This code implies the safety, security, and well-being of individuals. Likewise, the code of conduct of the British Association of Social Workers (BASW) implies the social work practices to promote social change (Council, 2015).

It is necessary to follow these aspects for effective and appropriate care of individuals, social workers should respect, defend every individual’s psychological, emotional, and spiritual integrity. According to the ethical code of conduct by BASW, social workers are accountable for the best interest of people in society by avoiding harm and risks (British Association of Social Workers, 2019).
The similarities between these two codes include maintaining the trust and impartial relationships with all individuals, for example, the codes of conduct guidelines of both professions including nurses and midwives as well as a social worker are compelled to adopt these aspects, treating people as individuals and upholding their dignity (Clapham, 2017). The guidelines and teachings of both codes are required to maintain people’s independence and to make sure they are treating with kindness, respecting them as well as making sure that care is delivered effectively with the most appropriate outcome for each individual. The differences between these two codes are; to some extent, fluctuating in responsibilities. Nurses and midwives are accountable to provide care and treatment and performing with a person-centered approach whereas, the responsibilities of the social care worker do not include giving treatments to the individuals. Likewise, nurses cannot perform the work of social care workers as highlighted also from the two codes of conduct (Barrett et al., 2016).

Ethical Treatment of Patients with Cancer

This assignment would discuss how the medical decisions for A B who has undergone radical mastectomy are made using the model for ethical decision-making.

A B’s husband suspects that there might be a spread of the tumors and informed the nurse in the out patient clinic not to mention to her if she had a spread of the tumor. A has the right to refuse to speak to the counselor and not to know in depth of her disease process. The ethical dilemma is in this case study is, whether the nurse should refrain herself from reveBng A’s progress on her condition. The second ethical dilemma is should A continue to restrain herself from speaking to her counselor.

Yarbro, Frogge and Goodman (2005) states that the prognoses of patients with non invasive tumors will benefit from the mastectomy, however for patients who have invasive tumors are at probability for relapse. After the mastectomy operation the patients are at risk of wound infection, flap necrosis and seroma formation. Yabro et al. (2005) also mentioned that although breast cancer in young women is a rare condition, the disease is more aggressive biologically and has unfavorable prognosis as compared to older women. In most of the conditions, radiation therapy or chemotherapy is given to reduce the chances of relapses and to increase the chance of survival.

This shows that there is high chance for A to have a relapse and that she is also highly at risk for depression due to her medial condition, and the altered body image. Mastectomy causes emotional distress and that is advisable to seek a counselor or a social worker to express the feelings which aids in recovery (Mills, 2006, p.561). In a research done on emotions of patients after mastectomy found that patients who have undergone mastectomy experienced is similar feelings to those of bereavement. Anxiety, denial and tension leading to stress are commonly found after post operation of mastectomy patients .The research further elaborates that the role of the patient in social, sexual and interpersonal is altered thus affecting the individual physically and mentally (Farooqi, 2005, p.270).

Having so many mental and physical conflicts, A should seek help from the counselors and allow herself to express her thoughts so that she is able to cope with the situation. By doing so, she will be able to see things positively and have the courage to move on. Keeping in mind that she has two children, A will also need to make the necessary arrangements for the children in terms of financial, social and physical needs. National University Hospital (n.d) states that patients have the right to know information about their treatment and care plan and to participate in decision-making about their treatment care and their discharge. A has the right to know her treatment plan. She will not be able to see the broader picture of her condition and will remain in depression thinking that it is the end of the world if she remains unaware. When help is provided, she will be highly motivated to move on.

Respect for autonomy is the fundamental rule of clinical ethics. It is defined as an individual right to make a decision without having interferences by others and personal limitations. Healthcare providers should educate and guide the patients so that they can understand the medical condition and will be able to make decisions. Patients have the right to seek consent for their medical treatment and to disclose information about their medical condition to them (Pantilat, 2008).

Therefore, the nurse should inform A regarding the spread of the cancer, if there is, so that she will be able to make a rightful decision on her treatment. This is supported by AustrBan Nursing and Midwifery Council (AMNC) (2006), Code of Professional Conduct, Conduct Statement 7; nurses are required to inform the patient of the nature and purpose of recommended nursing care to assist the patient to make informed decisions. However, the husband had mentioned not to inform A about the spread to prevent their marriage from getting worst. By listening to the husband’s point of views, there are chances of saving their marriage and it benefits A and her family. Beneficence

Beneficence is explained has an action done to promote good for others. An obligatory act to assist patients based on their importance and legitimate interests (Beauchamp & Childress, as cited in Parker & Dickenson, 2010, p.195). In the case study, it is said that A is very stressful and that she does not want to talk about her disease to the counselors. If the nurse listens to the husbands instruction, A’s stress level will not be added on and thus doing good for her. On the other hand, if A is not told about the disease and how much the counselors wanted to help her. The more she will pull herself back and may decide not to have any further treatment. These will deteriorate her condition. SNB Code of Ethics and Professional Conduct Value Statement 7 states that clients’ best interests must be taken care of (SNB, 2006 p. 8). Non-maleficence is a principal that requires not inflicting harm to the patients.

Before being ethically reasonable in trying to help the genuine interest, the nurse must be very certain of doing no harm. Aiken (2004), non-maleficence demands that health care providers defend from harm to those who cannot protect themselves. SNB Code of Ethics and Professional Conduct Value Statement 5.1 and AustrBan Nursing & Midwifery Council (ANMC) Code of Ethics for Nurses in AustrBa Value Statement 1 both supports that nurses should safeguard the health and safety of their clients against incompetent, unethical or illegal practices. In A’s case, there is no evident that she is in a state of unsound mind or there that she wants her husband to decide for her.

Therefore A should be informed of a disease process and allow herself to speak to the counselors. If A is not told the truth, the nurse is indirectly inflicting harm for the patient as she owes a duty of care. Yeo, Moorhouse, Khan and Rodney (2010, p.293) mentioned that justice is the wider sense of fairness, whereby everyone should be treated fairly and equally based on the individual or groups entitlements. Every patient would want know how much their condition has improved or deteriorated. In A case, she deserves to be treated and to know her prognosis as this allows her to have time to make arrangements in her social life. She may not want to talk about her disease to the counselor but there might be someone whom she feels comfortable in opening up. As her care providers, the team of healthcare professionals should find out the details and provide her with the best care possible.

There is no evidence that A is in a state of unsound mind and that she has given her rights to her husband to make decisions on behalf of her. Therefore it is Madam Aminiah’s right to know her condition and to discuss her treatment plan. Although by breaking the news A would be distressed but it is the responsibility of the practitioners to give her an opportunity to participate in the decision making even if it has to involve a third party with A’s approval. After making discussions with A, she decides that her husband will be the only decision maker, he will be the surrogate decision maker (University of Illinois at Chicago College of Medicine, n.d) and we should respect her decision. Butts and Rich (2013) mentioned that a better ethical approach to patient care is by providing truthful information at the same time keeping the patient composed and educating her successful ways to manage her condition. Although by not telling A the truth may save her marriage life and benefit her family.

The rights of the patients should not be violated. When patient right are being violated, the nurse is at risk of causing harm. SNB Code of Ethics and Professional Conduct Value Statement 2 emphasize the mandate of respect and support clients’ autonomy. Value Statement 7 requires nurses to defend those clients who may be vulnerable and incapable of protecting their own interests and to be an advocate in the best interest of their clients. Everyone is considered innocent until proven guilty. The approved investigators must collect enough evidences to visibly convince Nursing commission members that a violation had occurred. Under the Patients’ Right (Scotland) Act 2011, section 3, states that patient has the right to know about their condition and to make decision relating to the patient’s health and well being. As nurses, we should not refrain ourselves from telling the patient the truth unless stated.

This is vastly supported by SNB Code of Ethics and Professional Conduct, value statement 2 Respect and promotes client’s autonomy. Therefore the nurse could be liable for professional misconduct under the Nurses and Midwives Act 2012, Chapter 209. Although A is in a stressful situation, there is no evident that her stress is allowing her to loose her rights in making decision for her disease. A is still in a state of sound mind and therefore her rights should not be violated unless she has agreed for her husband to decide for her or she showed signs and symptoms of unsound mind. This case is indeed an ethical challenge faced by the health care professionals. The author’s decision is to inform the patient on her current condition. If A is to have a spread, it’s her right to know so that she could make the right decision. This decision is supported by AustrBan Nursing and Midwifery Council, (AMNC, 2008) conduct statement 7; Nurses support the health, wellbeing and informed decision making of people requiring or receiving care.

However, the physician will be the best person to break the news. Sullivan (2011) mentioned that health information is compulsory for the patient and it is the ethical and legal obligation of the physician to communicate that information so that patients can make decisions. The patient has the right to a diagnosis and, if consented to, the physician has a duty to treat. Therefore the author will update the team doctors. When A had decided to allow her husband to be her decision maker, than her rights will be respected. In A’s case, a family conference would help to resolve not only her medical issue but also her social issue.

The team doctors will have to document the decision in the treatment and progress notes Medical records are legal documentations that are extremely essential and serve as a means of communication in the health care industry. When there is systemic documentation of patient’s medical history and the treatment provided are recorded, it may benefit when used as an evident in the court (Judson & Harrison, 2013, p. 196).


After considering these four Principles, which are general guides that, leave considerable room for judgement in specific cases. “Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices. Beneficence: this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient. Non-maleficence: avoiding the causation of harm, the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment. Justice: distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner” (Beauchamp and Childress 2001).

This assignment claims that ethics are an important part influence in the delivery of care, but are also a very complex subject, and often leads the Healthcare Professional to examine their own ethical values, it is recommended that a wide range of reading is required to clarify the subject further.

After examining the subject further, it is clear that that in the work place a majority of the delivery of care is, planned with the patients before it is put into practice, which try ‘s to ensure that ethical principles are followed. Professional practice and ethics are changing every day, and it is a complex subject it is also debatable how different people interpret ethics. Ethics is also about questioning our own and others practice “challenging our own and others practice requires courage and vigilance” Kenworthy, Snowy, & Gilling (2006).

Reflection on ones own and other people’s ethical values is a very useful part of continuing learning throughout both career and life, and as a health care professional we must have a good knowledge of nursing ethics and use this in practice rather than personal opinion. In addition, with such issues as euthanasia and cloning, in the news almost every day the ethical pressures on the nursing and medical profession grows stronger. Nurses are seeking to develop further their knowledge of ethics and are increasing their ability to recognise ethical issues in practice.


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Nursing ethics

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