In medical nursing is one of the most important professions in a process of caring any patients in which knowledge and good skills are necessary. In this process sometimes nurses are forced to make some ethical based decisions based on the circumstances at that time and consider all the aspect of the results outcome with those decisions. For the convenience of the nurses a model is proposed which help the nurses to take best decisions with the maximum positive outcomes taken in account all the possible causes involving family, friends, physical, financial and emotional situations (Butts & Rich, 2012). This report explain the following paragraphs IPSG, its important points and its goals, code of ethics and professional conduct from SNB, than a case study similar to the scenario is explained, then ethical based model is proposed followed by systematic process of decision making, which consist of nine steps in this situation in which range of action and their outcomes are explained using a table.
Important points in IPSG
Goals of IPSG
The Code of Ethics and Professional Conduct from Singapore Nursing Board for nurses’ diagnoses core assets for this profession of nursing and provide the standards of conduct that are fairly accepted by all nurses or midwives. Previously there was Singapore Nursing Board Code of Conduct (1993) which was replaced by this code after 1993 (“All Healthcare Professionals | Ministry of Health”, 2017).
This code acts as a guide to reinforce the ethical decisions faced in the profession of nursing/midwives and provides a design for the practicing nursing profession in Singapore which acts on the basis of peer-review, continuing education and self-evaluation (Board, 2012).
This code comprised of ten value statements that may be explained under the ethical practices for actions and references which can be divided into three sections as follows (Schneider & Whitehead, 2013).
Primary responsibility of the nurse/midwives is to care for their clients according to their needs not taking in regard religion, gender, age and ethnicity, economic or social status. They should respect the autonomy and values of their clients and also advocate for them if necessary (Chervenak et al., 2013).
This is the responsibility of nurse/midwives to provide the highest standard of nursing care to their patients and also to provide best ethical practices within any circumstances at any time. Nurses/midwives should be familiar with the ethical stance of the profession on various issues like skills competency, maintenance of client dignity and privacy.
This is also the responsibility of nurses/midwives to maintain and enhance the reputation of the profession and should act all times in fulfillment with the practices of ethical healthcare, promotion of nursing ethics and confidence in the profession of nursing (Chervenak et al., 2013).
John posted with Abbie who is already in the same ward during the Clinical Attachment (CA) Both are classmates and friend, Abbie is noticing her friend John that he often came late to the ward and write wrong timing in the attendance chart as he arrived at 705 am and wrote 658 am on the attendance chart. She also noticed that He often goes out for tea and asks other students to sign on the attendance book.
First time she decided not to tell anyone about this but after his regular leave for the tea she is not sure that what she should do.
As a nurse Abbie believes this negligence of John is a very irresponsible attitude and he will keep doing it if any action is not taken against him. Abbie has responsibility as a nurse to look after that every patient gets the perfect nurse for their better caring, as CA is a very sensitive ward in which nurses notice the surgery processes done by experience doctors and else everything very properly and sincerely in order to do better surgery in future. This attachment helps in acquiring that patients does not have to suffer from certain problems during their medications or surgery. She should report this behavior of John to the senior doctors in order to give better medical services or surgery to the patients who will come to john after the completion of his CA. Other situation may be that John is suffering from certain dilemma and needs some serious help by meeting some friends. She should talk to him that what is happening to him and ask him if he needs some help by Abbie. She should also collect more data by looking after his behaviors that if he is in some problem to analyze or if it is his negligence or if this is just his habit (Goethals, Dierckx & Gastmans 2012).
The ethical decision model consist of several steps which are listed below
Step 1: Situation Review
Abbie must find out why John is doing such irresponsible activities as it may result to the serious loss to the patients and it can be taken in account as negligence which may result in abusive for the patients if CA is not practiced properly by any nurse. The other condition may be that John is very stressed in real with some of his family or social issues which may result in the anxiety and irresponsible condition of John. May be students are used to such behavior of John and he is completely relied on other students for his attendance, which results in the increment of this negligence contributed by students.
Step 2: Additional Information to Clarify the Situation
Abbie needs to understand exactly what John explains to other students for his proxies and what his emotional condition is and identify if extra information is required before explaining these activities to other doctors. Abbie might come at the conclusion that students are capable and the motivations are being done by the students to John and he is genuine and logical.
She can also conclude that students are subjected to emotional abuse and negligence.
Students might want someone to inform about this behavior of john to someone who can force John to be punctual, this may be Abbie who can help them.
As per the practices of nurses/midwives discussed in Code of Ethics above which emphases on to provide highest standard of nursing practice and ethical practices within any circumstances anytime. Abbie might be able to help the patients and the students by informing the higher authorities about the behavior of John or if he has any emotional issues. She may go and have conversation with him about his conditions and may help in improving his regular behavior by motivating him to do his duties with complete responsibility.
Step 3: Ethical Issues in the Situation
Students may not have got any chance to question John about his shifts or duty hours. He is making his attendance by accounting alter timing to the chart without concern with the seniors. As per the goal 5 stated above of IPSG it is very risky for the patients if any nurse get out into another environment for drinking tea or for smoking, as it can bring some bacteria or infections from that environment. Here Abbie has not any option as he was appointed by the higher authorities after the interview.
Students were not complaining to the authorities or senior doctors about the irregularities of John.
John had not any bad intentions for the students or the practice he was practicing but he was not consistent about the timing of his shift. This is also disrespecting the goal 3 of IPSG as if John is not punctual patients may fall from the bed or maybe there is an emergency for the high alert medication of the patient which might affect to experience he is about to getting during CA.
As per the clients of the nurses/midwives discussed in Code of Ethics of SNB, as a nurse he should be respectful with the patients as he was not arriving in time nor completing his shifts with punctuality, as a nurse he should respect their profession and do their practices professionally and complete CA sincerely.
John has a responsibility as he is the caretaker of patients as a nurse. He may fail in playing his role as nurse if he does not complete his CA with complete sincerity. As per the profession of nurses/midwives discussed in Code of Ethics of SNB above CA is the only way to enhance the reputation of his profession of nursing.
John will not learn his duties as a nurse completely if he does not completes his CA practice with complete concern as CA is a practice of real concern in order to learn how to give proper medication or caring to the patients. In future he may fail to care them regularly and also which is disrespectful for his job which is violation of the Code of Ethics of SNB a stated above.
John was dominantly making these irregularities without concerning anyone.
Step 4: Personal and Professional Moral Positions
As per the Code of Ethics which is a guide to the ethical decisions faced in this profession of nursing it can be concluded that Abbie needs to understand why John is behaving like an irregular person with the people in ward and she also believes that John is neglecting his duties. Negligence of other students is also not good for John and future patient of John in this case. Abbie understands that this may be stress which is leading John into such activities (Huffman & Rittenmeyer 2012).
Step 5: Moral Positions of key individuals included
He is also violating the clients of nurses/midwives discussed in Code of Ethics above that nurses should care their clients irrespective of any inequality, If Abbie thinks the situation in a different way and try to understand the aspects of beliefs of John or other members, maybe he is catholic so he is having problem in accommodating with others or may be due to some cultural work he needed more time to meditate or for other holy works.
Step 6: Identify the value conflicts, if any
There is not any value conflicts related to money but there is a value conflict in accordance with the profession and loyalty or responsibility towards the patient by not Practicing CA with complete responsibilities as goal 4 of IPSG states that concerned points are Correct-site and Correct-procedure which can only be known if he completes his CA.
Step 7: Who should make the Decisions
According to the Code of Ethics of SNB stated above there may be different aspects on actually who should make decisions, First aspect may be that other ward members should decide whether they should leave John doing same and not to interrupt with his non-punctuality nature or they could complaint about him and ask for another nurse for their care taking.
Second aspect may be that John needs to decide whether he needs someone to listen about his problems if any or ask help from Abbie or any other person who could help him.
Step 8: Range of Actions with Anticipated Outcomes
|
Alternatives |
Consequences |
|
No Action |
John might not be able to learn everything a surgeon needs to learn for a surgery. Students will continue experience the negligence of John. John will need real help may be from Abbie or he should be given warning by senior doctors otherwise he will keep doing this negligence. This will violate both goal 3 and 5 of IPSG. |
|
Confronting John |
John might leave the CA and not get the complete experience which may result in improper caring of future patients. John may start coming on time and be punctual. |
|
Temporary accommodation |
This will help in improving the nursing or treatment service for the patients as there will be all surgeons who complete his CA. May be John is not interested in this profession so he can leave it from here and move towards his goal (Elwyn et al., 2012). This may be the hardest decision based on Code of Ethics of SNB but it may help in regulating all the goals of IPSG and also help in practicing Code of Ethics of SNB. |
Step 9: Deciding a Course of Action and carrying it out
Abbie should choose an alternate option with the highest probability of positive results. In this case Abbie should complain the higher authorities or other experience doctors to take some strict action. This will be beneficial for both John and his future patients as he will become more conscious about his duties and complete his CA with complete sincerity (Butts & Rich, 2012).
It is the ethical duty of a nurse to protect patient from any harm than friendship and confidently and privacy for both Abbie and John and the ward patient have right to autonomy (Huang, Yeoh & Toyota 2012).
Step 10: Evaluate/ Review/ Actions
Abbie should consider the best care for the future of John and also care about the patients before taking any action in this situation.
Abbie can come to a conclusion that what and when she needs to take actions.
Abbie should go closer to John in order to understand and try to know the problems of john and try to motivate him to care for the patients more genuinely and help the patients in better caring by nurses.
Conclusion
On the basis of above report it can be concluded that nursing is a very responsible profession in which better skills and knowledge are needed in which a term arises which is Ethical Decision Making. Nurses have to face this situation daily and all their decisions involve patients and their family in that decision.
Using this model of ethical decision making which is stated above help the nurses in order to take decisions in more organizing way. Nurses who do understand the key principles of ethics and framework of ethical based decision making that can be used in this profession can absolutely make a better decision that can result positively and help in the betterment of caring of the patients.
References:
All Healthcare Professionals | Ministry of Health. (2017). Moh.gov.sg. Retrieved 30 June 2017, from https://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/allhealthcareprofessionals.html
Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.
Chervenak, F. A., McCullough, L. B., Brent, R. L., Levene, M. I., & Arabin, B. (2013). Planned home birth: the professional responsibility response. American journal of obstetrics and gynecology, 208(1), 31-38.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., … & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 1-7.
Goethals, S., Dierckx de Casterlé, B., & Gastmans, C. (2012). Nurses’ decision?making in cases of physical restraint: a synthesis of qualitative evidence. Journal of advanced nursing, 68(6), 1198-1210.
Hawkins, R. (2012). Managing the pre-and post-analytical phases of the total testing process. Annals of laboratory medicine, 32(1), 5-16.
Huang, S., Yeoh, B. S., & Toyota, M. (2012). Caring for the elderly: the embodied labour of migrant care workers in Singapore. Global Networks, 12(2), 195-215.
Huffman, D. M., & Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: a systematic review. Critical Care Nursing Clinics, 24(1), 91-100.
Lee, S. H., Kim, J. S., Jeong, Y. C., Kwak, D. K., Chun, J. H., & Lee, H. M. (2013). Patient safety in spine surgery: regarding the wrong-site surgery. Asian spine journal, 7(1), 63-71.
Lee, S. H., Kim, J. S., Jeong, Y. C., Kwak, D. K., Chun, J. H., & Lee, H. M. (2013). Patient safety in spine surgery: regarding the wrong-site surgery. Asian spine journal, 7(1), 63-71.
Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.
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