Mubassara 2nd Revised Submission: July 19th 2012 Analysis

     Mubassara AhmadWestern Governors UniversitySOT_Task#_1AdvancedNursing Ethics and Values (0310)Initial Submission:     July 5th 2012Revised Submission:  July 12, 2012 2nd Revised Submission:     July 19th 2012  Analysisof Ethical Decisions Facing Nurses            What is ethical?  The question of ethics is a highly debatedsubject in nearly every facet of humanity. However, in the field of medicine, ethics is often a pivotal issue thatbalances life and death.  Nursesespecially face difficult situations on a daily basis that require use ofethical decision-making ability.  Toallow for a panoramic view of ethical decisions facing nurses it is necessaryto explore various components that make up the whole.  Consequently, the analysis will commence witha discussion concerning the relevance of ethical theory to the nursingprofession.

  Following this will be acomparison of the concepts of confidentiality and reasonable limits,specifically reasoning on when confidentiality should be maintained or broken.  Next, is an exploration of conflict that mayoccur when ethical principalities collide and how this can be resolved.  Cultural influences on value systems willfollow and offer two nursing interventions that could be of aid in the casepresentation.  Lastly, an application ofan ethical decision-making model is given to the case scenario.  Ethical Theory            Modern times necessitate anurse’s need to grasp a proper understanding of the ethical responsibilities topatients under their care.  By its very nature,nursing proves to be a virtuous profession. Though material gain can motivate care given to others in need, mostnurses are not inundated with wealth in exchange for their labor.

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  Conversely, many nurses are not materiallypoor.  This fact presents the question ofwhether modern care is provided for ethical reasons; thus, a need for ethicaltheory in the nursing profession (Davis , 1991).   Additionally, variousscenarios present themselves that call for nurses to make decisions that areethical in nature (Knoblauch, Childre & Strasser,1997).  In the case presentation,an ethical situation occurs which forces a nurse to make an ethical decisionthat will affect the patient and her family. What is the “right” decision to make and upon what is the decisionbased?  The answer to such questionsdepends on the ethical theory chosen.            There are an array of ethicaltheories that are used by nurses and healthcare institutions.  Each theory has positive and negativequalities that are exposed in certain circumstances.   Nevertheless, an ethical theory must “beclear, internally consistent and coherent, complete and comprehensive, simple,and generally supportive or ordinary judgment (Sherman,2007).

”  If any of these elements arelacking the theory becomes confusing and unsubstantial.  Conversely, when all of the elements arepresent the theory is not only substantial but also serves as a foundation inwhich important decisions can be solidly based. This is why an ethical theory is essential to nursing; namely, so that medicaldecisions can be made which are born from sound reasonings founded on anestablished mode of thought.              An exampleof such a theory is Utilitarism.  Thistheory, founded by Aristole, holds that whatever brings the greatest amount of goodfor the majority is most important.

  Thoseholding to this theory promote that what is most useful is what is right.  A nurse using this theory may make a decisionthat benefits the majority of patients while negatively impacting the minority.Confidentiality and ReasonableLimits            All healthcare facilities and workersare bound to the laws respecting and guarding patient confidentiality.  In principle patients “should be certainthat, whatever their issues are, they won’t be shared with anybody else unnecessarily (O’Dowd, 2011).”  Especially with advances in technology shouldnurses remain diligent to consent to laws, policies, and standards to maintainprivacy with electronic health records. This openness between the patient and healthcare provider allows for thebest diagnosis and care to be given (Allmark,1972).

              Although confidentiality is afundamental right of all patients, situations do occur where patientconfidentiality interferes with the common good.  In such instances a reasonable limit can beascertained which one can discern whether the right of confidentiality is beingused for a good purpose.  Additionally,it can be determined if ones confidentiality puts the lives of other injeopardy.  Occurrences such as lifethreatening emergencies, government regulations, public health issues, legaland judicial proceedings, and worker’s compensation rules allow for medicalinformation to be disclosed (U.S. Department of Health & Human Services,2003).

  These circumstances and thosesimilar to these present ethical bases for reasonable limits to patientconfidentiality.  When ethical dilemmasto patient confidentiality present themselves to nurses, they must weighdecision carefully and understand the responsibility they have to break suchconfidences when necessary.   Ethical Conflict Resolutions            Conflicts of ethics will arise innursing.

  As show in our casepresentation, decisions will be placed upon nurses that will have far-reachingaffects.  Therefore, resolving ethicalconflicts is sometimes an essential part of patient care (Fry, 1994).  In the casestudy, Mrs. Z has chosen to keep medical information about her positive biopsyto her family.  Additionally, in order tokeep the information she is refusing medical treatment.  The immediate dilemma suggested by this casestudy is the nurse’s responsibility to help Mrs. Z, while simultaneously respectingher confidentiality.  Two conflictingethical principles occur between nonmaleficence and beneficence (see Table 1).

 In this case, the nurse willcircumvent beneficence is if she decides to alert Mrs. Z’s husband of hermedical condition.  According tothe utilitarian viewpoint, the good of the majority is worth the disaster ofthe minority.  Application of this theorywould support that the good of the majority, represented by Mrs. Z’s family,would be consented to.

  In addition, themedical care given would most likely help all parties involved including Mrs.Z.  A nurse taking this position wouldhave the possibility of prolonging Mrs. Z’s life and saving her family fromgrief.  The nurse presented with such anethical dilemma would certainly be justified in concluding that a reasonablelimit to Mrs. Z’s confidentiality has been reached.

In order torectify multiple conflicts between varying ethical principles nurses need toconsider the holistic values of each theory. After considering the values, they must be weighed against the good thatit will produce for the patient and the patient’s family.  Nurses must remember that their main goal isto give the best possible care to the patient. Therefore, when finding the solution between conflicting values nurseskeep in mind that have the responsibility to use elements of all ethical valuesto reach the common good for the patient’s well-being. Culture’s Influence on Values            Culture often directly affects thevalues that are adopted by the patient.  Thevalues held by Mr. Z conflicts with confidentiality since the husband isaccustomed to being the primary decision maker. However, this culture is not a determining factor to Mrs.

Z who hasopted to make her own decisions regarding her medical health while in theUnited States.              One nursing intervention that can beimplemented is counseling (Varcoe, et al., 2004).  The nurse caring for Mrs. Z can counsel andeducate Mrs. Z about the seriousness and consequences of her decision to refusemedical treatment.

  She may also relatehow Mrs. Z’s decision can negatively affect her family.              Another option is using a patientadvocacy team.  The nurse could alertMrs. Z to take advice from a team of individuals that can give her advice abouther medical and family situation (AmericanMedical Association, 2007).  Thegroup including the nurse may be able to present Mrs. Z with numerousperspectives that may help her to accept the appropriate medicaltreatment.

  Both interventions wouldallow the nurse to maintain confidentiality with Mrs. Z.EthicalDecision-Making Model            Fry formulated a “four-step processthat examines the story and context of the ethical problem; the significance ofthe values pertinent to the problem; the meaning of the conflict to individualsinvolved; and possible solutions to the problem (p.

23).”  In step one, the nurse would review thesituation and solidly fixed in mind the ethical concerns involved.  Next, all background information regardingMrs. Z and the reasons for her decisions must be gathered.

  As a third step, the nurse will analyze howthis specific occurrence affects Mrs. Z and her immediate family.  Lastly, a comprehensive review of resolutionsthat will enable Mrs. Z to receive the best healthcare possible willoccur.  Such systematic approaches toethical dilemmas aid nurses to reduce and relieve tense situations that hindermedical care (Thiroux, 1977). ReferencesAllmark,P. (1992).

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ama-assn.org/ama/pub/category/print/4608.htmlDavis,A. & Aroskar, M. (1991). Ethical dilemmas and nursing practice (3rd ed.

).Norwalk, Conn.: Appleton & Lange.Fry,S. (1994). “Ethics in nursing practice: A Guide to ethical decision making.”Geneva: International Council of Nurses.

Knoblauch,D., Childre, F., & Strasser, P. (1997). Legal and Ethical Issues.

In M.K.Salazar (Ed), AAOHN core curriculum for occupational and environmental healthnursing, (pp. 71-93). Philadelphia; W.

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HCAs and patient confidentiality. Retrieved fromNursing Times.net Web site:http://www.nursingtimes.net/whats-new-in-nursing/unison/hcas-and-patient-confidentiality/5000408.articleSherman,J. (2007). American Society for Bioethics and Humanities.

Retrieved June19, 2012, from American Society for Bioethics and Humanities Web site:http://www.asbh.org/uploads/files/membership/protected/task_force/doukas/pdfs/ethics_course.pdfThiroux,J. (1977). Ethics: Theory and practice.

Philadelphia: Macmillan.U.S.Department of Health and Human Services. (2003).

Summary of the HIPAA PrivacyRules & Frequently Asked Questions & Answers. Retrieved from http://www.hhs/gov/ocr/hipaa.Varcoe,C.

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Journalof Advanced Nursing, 45(3), 316–325. doi:DOI:10.1046/j.1365-2648.2003.02892.x