This paper deals with a detailed and elaborated description of the moral challenges and problems, and the ethical issues faced by nurses while pursuing their honorable and respectable profession. The paper chiefly highlights the ethical issues faced by nurses related to error on medication. Maintaining and preserving moral values in a health care environment is one of the biggest challenges in the health care industry. Working in a nursing and healthcare environment, a nurse comes across numerable ethical issues and dilemmas throughout her working life. With the developments and advancement in medical and biotechnology, the average lifeline of people has moved up on the lifeline scale, increasing the average life period of people.
Nevertheless, this development has caused brand new dimensions and attributes of ethical issues in nursing. With these advancements, the nursing and healthcare professionals feel it difficult to take hold of the situation, incorporating moral and ethical respects in the environment. Since the premier goal and basic objective of nursing professionals is to render quality attention and great care to the patients, without getting affecting by their health conditions and losing the respect and ultimate dignity for the patients. As the time passes by, the situation of work force or the nurses in the nursing and healthcare environment also alters with respect to the prevailing conditions. A nurse study conducted by a popular nursing centre concludes that there are varieties of ethical issues often faced by professional nurses.
Medication on error is a very serious issue faced by the nursing and healthcare professionals. Medication on error is that error that takes place in the situation where it could be prevented, but causes considerable harm to the client by using an improper medicine even when the medication is under monitoring of healthcare professionals. The possible reasons of these errors are improper knowledge of medication, error in packaging, error in dispensing or injecting, blunders in monitoring of patients pathophysiology and vital signs, misinterpretation of the situation and inappropriate knowledge about condition of the patient.
The results or consequences of this ethical are rather disastrous, both for the nurses and the clients as well. Many firsthand nurses lose their job due to the same reason. The problem includes floating of a nurse in any particular department in which the nurse is unskilled. The healthcare experts have now regarded this practice as illegal as it results in terrible consequences both for the life of the patient and dignity of profession as well. The nurse trained for a specific area should work on that particular area only and not on the others. There is now a check to ensure that the nurse has completed particular training from an authentic organization in order to minimize one of the causes of error on medication in nursing.
The ethical issue that arises in this situation is that when an unskilled nurse works in any particular department, the nurse would not be able to handle the emergency situation well enough as compared to any skilled and trained nurse. Sometimes, the unskilled nurse fails to recognize the actual problem of the patient or client and can cause unpredictable damage to the client by misunderstanding the situation and giving an unsuitable medication.
One of the most significant issues that the nurses frequently experiences is the issue of taking consent. Sometimes situation arises when the patient has to undergo some serious treatments that can risk the life of the patient and not opting for the treatment is sure to have disastrous effects on patient. In these situations, consent is important by the law and by values of ethics. Consent is an agreement to the treatment of the patient using the appropriate techniques in order to make every effort for saving the patient’s life. The patient or the guardian of patients has to sign the consent and they can withdraw from the agreement anytime they want by the law, risking the life of patient by their own will.
The problem arises in taking the consent is to make patient and other related people understand the nature of problem in a timely manner. Obtaining a legal and logical consent means to explain in detail the methods of treatments, the pros and cons involved, risk factors, signs of hope, talking about alternative, extent of uncertainty to the patient and telling every single thing in a very understandable manner. This certainly is very beneficial and helpful in taking the informed consent of the patient as directed by the law and code of ethics for the nursing and healthcare professionals (Hunt, 1994).
Situation arises where the treatment is inevitable in order to save the life of a person who is one the verge of death; in this case, competent adult guardians sign the consent. Nurses find it difficult to prepare the patient for the proposed or suggested treatment in a calculated time as the patient would be in his own grief, depression, fear, and fury, and it would be rather difficult dealing with him on this particular issue. Confidentiality is another major ethical issue that creates ethical challenges for the nurses in action. There are times when the information about the patient’s disease, its severity, personal data, and many other relevant figures should remain confidential within the related professionals in hospital or healthcare industry.
Many a times healthcare professionals ignore the sensitivity of the situation and their careless attitudes make them leak even the most confidential and secret information. Had the patient get to know about it, it would have been an emotional shock and moral dilemma for the patient to cope up with the immoral situation. The situation would then be more painful and more traumatic for the patient who was already fighting with his deadly disease. Now, nurses share a very critical responsibility to make the patient feel better and to neutralize the effect of mistake which was never their own.
Nurses that work in epidemiological departments in a hospital find themselves in a great trouble. Though the there are number of nurses working in an epidemiological departments as data collectors, record keepers and other such aspects, the regard, value and quality of their job gets ignored and unrecognized most of the times in a nursing and healthcare environment. Nurses experiences problems when the doctors do not give complete information about the disease to the patients, especially to that of HIV /AIDS disease patients. At that particular point, they feel a breach of patient’s trust, negation of the moral values, and insincerity towards their sacred profession.
Error on medication is a very severe and critical issue and nationwide training programs are in progress in order to minimize it. These programs include effective training and learning of the nursing and health care professional to mitigate and minimize the medication errors. Moreover, there are various tools available in order to develop easing understanding of the situation that can cause medication errors. These programs have helped the nurses to minimize the ethical issues faced by them due to error on medication.
The two major types of ethical issues that the health care problems come across are the moral conflicts and the moral distress. Moral conflict occurs when the nursing care professional gets stuck in a situation that has dead ends or two equally beneficial and disastrous ends, and the confusion arises in nurse’s mind to follow which of the ethical and moral theory. It occurs when the responsibilities and duties are not clear to the nursing and healthcare professionals (Marquis & Huston, 2008). On the other hand, moral distress is the phenomenon when the nurse knows and acknowledges the right thing to do in a particular ethical issue or moral situation but the organizational administration stops or restrain the professional from doing the right thing. In moral distress, the administration makes impossible to carry out the moral obligations properly as we have seen in consent and confidentiality issues.
The other critical issue that come across in the cases of patient, where there is no hope of survival. These are the cases where patient’s body stops showing any sign or indication of life, moreover there is no hope or chance of the patient to get back to the life, or when the disease is fatal and no treatment on earth can save the patient. In such cases, sometimes the doctors prolong the death of patient by utilizing inappropriate or useless measures to get the patient back to life. The professionals have the responsibility to render only the treatments that are helpful and beneficial for the patients and should never use the techniques that cannot help them in any possible way.
At some point of time during their professional practices, nurses run into the clients that are patients or subject of Do Not Resuscitate Directive or DNR directive. This directive states that if the patient come across any cardiac or respiratory problem or arrest, alternative measure are not permissible for the patient. These alternative measures include cardiopulmonary resuscitation to catch up patient’s respiration back. This is a very critical and vital nursing issue, as no aid or emergency care and attention would be there for the patient in extreme need; this is contrary to the nursing teachings. However, doctors discuss this issue openly with the patients but it still this issue exists as a moral challenge for the nursing professionals (Crisp, Potter, Taylor, & Perry, 2005).
Another important moral issue arises when the organization keeps the workforce on low budgets, as an advantage to itself. In this situation, the workforce or the health care professionals would suffer from the low budget and the greater workloads as low budgets gives rise to lower number of workforce to practice in this organization. Moreover, the client would suffer on their side as well as they would have to longer for their turns in order see doctors and communicate with other healthcare professionals during emergency or normal checkups. Stress takes over nurses and the health care professionals that result in efficiency of the organization and a threat to patient’s precious life as well (Huber, 2006).
However, there are different issues faced by the nurses and health care professionals that care for patient subjected to chronic diseases or terminal illness. These issues mostly arise in the last days of the patient or the client. For examples, nurses take care of the client and attend them more during the last period of such illness. Most of the times, it is mandatory for the nurses to take special care and attention during the middle and last days of life of the patients suffering from chronic illness and even from the terminal illness. In doing this patients undergo several painful treatments and handling that causes severe problems for the patients that are already close to death. At these times and in such cases, nurses ponders and healthcare professionals wonder if the quantity of the patient’s life is more significant, important and more valuable than the quality of life. This ethical issue confuses many nurses and leads them to have moral conflicts with the surroundings.
Moreover, moral and ethical issues arise from the difference of culture and the diverse mind of human beings and specially that of the patients. These ethical issues are versatile in nature, different in each and require different method and technique to handle. There are people who have difficulty in speaking and understanding the native language of the medical setup and healthcare environment for instance, English language. Handling the patients having difference of language is a big problem and a burning issue for healthcare and nursing professionals. The barriers created by language increase the complexity of the situation and decrease the overall efficiency of the healthcare staff. Another big issue in such cases arises when the situation implies to take informed consent by the patient supported by law.
Several cultural differences result in very substantial ethical issues faced by the nursing and healthcare professionals, these issues are evident from the diverse minds of patients belonging to different cultures that lead to their own interpretation of healthcare treatments and medical services. For example, some families believe in not informing their elder family members about their health, nature of the disease, intensity of the suffering, and the relevant details about it as to protect them from unnecessary stress during their course of treatment. The families believe firmly that it helps and aids the patient to heal fast and prevents their condition to get worse (Miller, 2008).
However, the medical practitioners have their own opinion about it, and that is contrary and contrasting to the school of thought stated above. Health care professionals insist on informing the patient or the client, all the necessary details that the client should know. They have the firm belief that every client has the right to know about their health condition and the complexities that may arise while treating for a particular disease in that particular setup. Thus, it becomes the responsibility of nurses and healthcare professionals to identify the culturally affected mindset of the patient or client by asking different questions and then conclude the results obtained by these questions to inform senior practitioners about it. This situation sometimes becomes very complex to analyze and there is a sheer chance of misconceptions about the interpretation of patient that would result in wrong perception about the patient of mindset throughout the medical treatment.
There are particular ethical and moral issues that arise due to mismanagement and lack of moral values in the healthcare setup and nursing environment. The efficiency and the performance of nurses and healthcare practitioners are directly proportional to the ethical condition of the whole setup. If the nurses do not feel secure, satisfied and contented during their duty-hours, they are most likely to make a mess with their performance as well. Instead of giving their every attention to the respective patients and medical clients, their attention diverts to themselves as much as they become ignorant of the surroundings even if it is for the brief period.
For minimizing the moral conflicts and ethical issues faced by the nursing professionals, the medical and nursing practitioners should always work together to sort out the specific ethical issue in a particular situation. Nevertheless, the situation is always inadequate as the doctor is the main decision maker. The doctor’s duty is to diagnose the disease patient is suffering from, dictates necessary steps evaluating patient’s condition, and prescribe the medical treatment.
However, it is the duty of a nurse or a health care practitioner to act upon the doctor’s advice and to obey the instructions imposed by the doctor. In most of the criminal and civil courts of justice, it is a usual practice to disregard nurses, hold them guilty, and accuse them of charges even if the nurse act upon everything as prescribed and instructed by the doctors. Therefore, the ethical and moral issues faced by the nursing practitioners attain more significance, it is of prime importance to understand and solve these ethical, and moral issues in order to get the clear picture and understanding of any particular scenario related to healthcare practice.
Crisp, J., Potter, P. A., Taylor, C., & Perry, A. G. (2005). Potter & Perry’s fundamentals of nursing. Elsevier Australia.
Huber, D. (2006). Leadership and nursing care management. Elsevier Health Sciences.
Hunt, G. (1994). Ethical issues in nursing. Routledge.
Marquis, B. L., & Huston, C. J. (2008). Leadership Roles and Management Functions in Nursing: Theory and Application. Lippincott Williams & Wilkins.
Miller, C. A. (2008). Nursing for wellness in older adults. Lippincott Williams & Wilkins.