Ethical Issues In Modern Medicine: Nursing Code Of Ethics And Conduct

Nursing Code of Ethics and Conduct

I am guided by the NMBA code of ethics and code of professional conduct to deliver proper and quality nursing care to patients. One of the codes of conducts that I have used is the one that states that nurses practice in a safe and competent manner. I understand that as a nurse I am accountable for providing a safe and competent nursing care. I ensure that the competence levels are maintained high by participating in professional development to improve my knowledge and skills. This code enables me to understand that taking part in any care plan that is out of my scope may compromise the provision of quality and safe care.

Another code of conduct that I have applied in practice states that nurses treat personal information obtained in a professional capacity as private and confidential. I understand that I am legally obliged to protect the privacy of the patients I am caring for. I must additionally seek consent from the patient or their representative before revealing any information that may have been confidentially acquired in the line of duty.

It is important to note that these standards provide clarity regarding role relationships, delegation, and supervision. The key features of the standards are as highlighted below.

1. The enrolled nurse is accountable in providing delegated care.

A registered nurse I must ensure that any activity delegated to an EN is appropriately delegated since they have a duty of care with regard to the patients. The enrolled nurse must ensure that the task delegated to them by the registered nurse id within their scope of practice to avoid harming the patient. Delegation is only appropriate when the RN only delegates tasks that are within the scope of the EN. The RN must then ensure that the EN is supervised and adequately supported for quality care outcomes.

1. The enrolled nurse keeps responsibility for their actions

The enrolled nurse must at all times accept responsibility for their actions and decisions that they make within their scope of practice. They are also responsible for making sure that they have the necessary skills and knowledge required to conduct any nursing care before they can claim responsibility.  

1. The enrolled nurse should work under the direct or indirect supervision of a registered nurse

The enrolled nurse must never practice in professional isolation and the registered nurse should be responsible for providing guidance and feedback regarding the practice of the enrolled nurse. The supervision may include monthly meetings, review of the contents of work and nursing activities, discussion of practice issues, and discussions involving professional development. This close operation between the enrolled nurse and the registered nurse is helpful in ensuring desirable care outcomes.

Consent to Treatment

There may be several reasons that may lead to complaints arising from patients and/or their families. However, once presented with a complaint, a nurse is required to consider some factors. These may include gathering facts to collect all the information regarding the rise of the complaint (Holmes-Bonney, 2010). The nurse should also consider factors that may have led to the complaint. These may include quality of service, lateness, long queues, and negligence among others. Once identified, the nurse should assure the patient that changes will be made to avoid a repeat of a similar incident.

Some of the communication strategies that I might utilize to address such complaints may include directly talking to the patient preferably face-to-face concerning the complaint. I would additionally employ active listening skills to ensure effective communication.

 An organization must have guidelines on how to handle complaints. The following approach may be useful in handling complaints from patients. Once a complaint has been received, the organization should acknowledge the complaint. Suggests a meeting with the complainant whenever possible and discuss his concerns with him (Holmes-Bonney, 2010). It is also imperative to keep all the parties involved in the complaint informed.

Consent to treatment may be defined as the standard that an individual must give permission before receiving any form of medical examinations, tests or treatment (Kim, 2009). Consent is only valid if it is voluntary and informed and the person giving their consent must have the capacity to make an informed decision. In some situations, an individual may not have the capacity to make a decision and they also do not have a lasting power of attorney. In such situations, the responsible healthcare professional may go ahead with the treatment if he/she believes that it is best that way (Kim, 2009). There are three types of consent. The first type is implied consent. This type of consent is not explicitly given by the patient. It can, however, be inferred from their actions like when a patient extends there arm out to the doctor to draw blood (Farrell et al., 2014). The second one is verbal consent where the patient clearly mentions their mentions their agreement to a treatment procedure. This consent is normally obtained if the intended procedure is invasive. Finally, we have written consent where the individual puts down in writing their agreement to a treatment procedure (Farrell et al., 2014). If the procedure has potentially irreversible side effects then written consent must be obtained.  

1. Leadership for organizational change
2. Use of data to inform practice

• Workforce development  

1. Use of seclusion and restraint prevention tools
2. Consumer and family/carer involvement and roles in inpatient care
3. Rigorous debriefing

Antidiscrimination Laws

ITEM/TERM/QUESTION	MEANING OR EXPLANATION
What is statutory law?	This is a written law usually enacted by the legislative body and interpreted by the judiciary. The courts cannot read between the lines when it comes to statutory laws, they are rather bound by its express terms.
What is common law?	This law is derived from court’s judicial decisions and other similar tribunals. A common law is massively based on precedence.
What law is applicable for the protection of children in your state?	Children, Young Persons and their Families Act 1997 (Tas.). this act provides care and protection for the children and ensure that they grow in up in environments that are safe and stable.
What are the two codes administered by the nurses and midwifery Board of Australia which relate to nursing?	The two codes include the code of conduct and the code of ethics.
Where would you gain information on what continuing education might be required for enrolled nurses?	This information can be gained from the Nursing and Midwifery Board of Australia that requires nurses and midwives take part in some minimum amount of continuing professional development.
What antidiscrimination laws are relevant in Australia?	– Disability Discrimination Act 1992 -Sex Discrimination Act 1984 -Racial Discrimination Act 1975 – Age Discrimination Act 2004
What is the legislation in your state which deals with consent to treatment?	There are several legislations some of which include the following; – Guardianship Act 1987 – Guardianship Regulation 2016 –  Children and Young Persons (care and protection) Act 1998 NSW
What is a power of attorney?	Power of attorney can be described to mean the authority that an individual is given to act for another person in a particular financial or legal matter. In healthcare, the agent to whom you have granted the power of attorney can make medical decisions for you if you lose the capacity to do so due to mental incompetence or lack of conscious.
What is a living will?	This is a document that lets an individual state his/her wish for the end-of-life care in the event that they become unable to communicate and make decisions regarding their health. This document only becomes valid after meeting the state’s directive regarding witnesses and notarization. This document only takes effect after it has been extensively established that the patient can no longer make known their wishes regarding a treatment procedure.
What is guardianship?	It can be described as a legally authorized relationship that exists between a competent adult and an incapacitated adult or a minor child. The guardian always has the authority to act on his ward’s capacity and make clinical decisions affecting the ward’s life if they cannot make similar decisions. It is, however, worth noting that the powers of the guardian can be limited to reflect the needs of the ward. This limited guardianship is appropriate for individuals who have lost their ability to take care of themselves in particular areas but not to the extent that requires a full guardianship. The ward therefore retains some independent decision making.
What does the policy for social media recommend about the posting of information in its policy summary?	The health practitioners must remember that their National Board’s code of ethics and professional conduct and the national law apply. They should therefore only post information that do not breach any of the obligations. This can be done by: · complying with professional obligations · complying with confidentiality and privacy obligations · presenting information in an unbiased, evidence-based context · avoiding unsubstantiated claims
List the contemporary ethical concepts and principles in nursing	The five main principles of ethics are usually considered to be: · Beneficence · Truthfulness and confidentiality · Non-maleficence · Autonomy and informed consent · Justice.
What is the definition of ethics?	Ethics can be defined as the moral principles that influence the behaviour of a person or how they conduct an activity.
What are bioethics?	This is a field of science that deals with the philosophical implications of medical or biological procedures and treatments.
What are nursing ethics?	These are the values and ethical principles that govern the relationship, conduct and practice of nursing (Thacker, 2008).
List the ethical issues that may arise in the nursing situation?	· Disclosing the patient’s medical condition. · Failure to fully inform the patient and their families regarding a treatment procedure thus raising issues regarding informed consent. · Noticing incompetence in another health practitioner and being torn between speaking up or keeping quiet. · Moral distress
What is a defendant?	Any individual, organization or institution against whom charges are brought.
What is the plaintiff?	This is the individual or organization that initiates the lawsuit by pressing charges against the defendant.
What is the legal definition of harassment?	Can be defined as a course of conduct intimidates, threatens, annoys, or places another individual in a state of fear for their safety.
What is an expert witness?	This is an individual whose understanding of matters from a particular field exceeds the understanding of an ordinary person. This individual is brought to the courtroom to give an impartial opinion on a specific matter that is being addressed in the court.
What is a coronial inquest?	This is a public hearing held to investigate the circumstances surrounding the demise of somebody in an unnatural manner.
What are the functions of the coroner?	· Investigating certain kinds of deaths to determine the circumstances around the death. · He also investigates the reasons behind fire breakouts and explosions.

As a nurse, I have to apply some requirements for documentation. These may include documenting facts where I note down the things I saw, did, or heard in relation to the condition of the patient and care offered (Nswnma.asn.au, 2018). Secondly, I would document all the relevant information regarding the patient’s condition and how he responded to different treatment interventions (Nswnma.asn.au, 2018). Finally, I would strive to protect the integrity of the documentation and I must not at any time attempt to alter anything recorded in the patient’s notes.

First of all, I need to come up with a comprehensive confidentiality policy. This policy must then be regularly communicated to the patient and other members of staff. The staff, therefore, gets well equipped with the necessary protocols they must follow when handling patient information. Secondly, I have to ensure that any confidential information is stored within a secure system. This helps in keeping the info from the reach of just anyone within the facility. Always knocking on the door when getting into the patient’s room and locking the door once inside or outside. This helps in protecting the privacy of the patient and ensuring that they feel respected despite their condition. It may also be important to follow the privacy act and get the guidelines on the best ways of promoting privacy.  

I have benefited from applying the ethical principles in my nursing practice in a number of ways. One of the principles is beneficence which requires nurses to perform in the best interest of the patient by preventing or eliminating harm and promoting good (Sasso et al., 2008). I have used this principle in practice to offer nursing interventions that have turned out to bring positive care outcomes. Another principle is autonomy that requires that a capable patient is allowed to refuse or accept some form of medication. I have used this principle to respect the patient’s decision in refusing any form of treatment procedure as long as there is a proof that he is mentally capable to make such decisions. There is also the principle of non-maleficence that demands that the medical practitioner does not harm the patient (Sasso et al., 2008). Any medical intervention that I suggest for the patient must be one that will not harm the patient. Next is veracity which demands that the patient is provided with the complete truth about their condition. in my nursing practice, if I ascertain that the patient is mentally capable, I do not hesitate to reveal to him/her the facts about their treatment.

Guardianship

Contemporary ethical issues may be described as the current topics surrounding ethics in nursing. These issues requires that the person in charge of the organization to make a choice between several alternatives and evaluate them as ethical or unethical (Steinbock et al., 2013). Some of the contemporary ethical issues include;

• Disclosing the patient’s medical condition.
• Failure to fully inform the patient and their families regarding a treatment procedure thus raising issues regarding informed consent.
• Noticing incompetence in another health practitioner and being torn between speaking up or keeping quiet.

There are times when an organization faces ethical issues such as disclosing the patient’s information or even failing to inform the patient and their family regarding the full details of a particular treatment procedure. When such issues arise, it is best that they are solved swiftly to prevent escalation and protect the image of the organization. This can be done through effectively communicating with the individuals responsible. Having a word with him/her them in private and reminding them of what is expected of them. This communication is further extended to the other working stuff before a disciplinary action on the person responsible for the mistake can be initiated. It could also be important to apologize to the offended patient and assure them that the same can never happen again.

1. Access to care

All individuals shall be given an impartial access to the available and indicated medical care irrespective of sex, gender, religion, or sexual orientation among others.

1. Respect and Dignity

The patient shall be afforded a respectful and considerate care at all times while at the same time recognizing their dignity and worth.

• Privacy and confidentiality

The patient has the right to both personal and information privacy as stipulated by the law.

1. Personal safety and security

The patient has every right to expect reasonable safety in as long as he/she remains within the confines of the hospital.

1. Consent

The patient has the right of reasonable participation in decisions regarding his/her health .

1. Consultation

The patient has the right to consult a specialist at their own request and expense.

I would apply good communication and listening skills to inform the patients, assess their understanding, and help them in making clear their preferences regarding treatment interventions. This can be done by providing clear and evidence-based information about the available options and the likely outcomes. I would further make this easier by telling the patient about the benefits, risks, and alternatives to a particular intervention. I would also apply the use of numbers and graphical illustrations to improve the understanding of the patient.

1. Involving the patient in decisions regarding their health

Involving a patient in decisions regarding their health is important because it makes them feel valued and connected while at the same time giving them the feeling that their opinion is respected.

1. Respecting the patient’s personal space

Bioethics and Nursing Ethics

It is important to always knock and ask for permission before getting into a room of the patient you are caring for (Lin and Tsai, 2011). Barging into their personal space is inappropriate and disrespectful.

• Promoting social activities

It is important to get the patients involved in social life as it instills them with a sense of belonging, purpose, and satisfaction which eventually helps in improving the quality of life.

1. Engaging the patient in friendly chats

Their lives in care may seem boring and uneventful and therefore sparing a few minutes to have a chat with them can lift their spirits by fulfilling their desire for social interaction (Lin and Tsai, 2011).

1. Properly address the patient

Ask the patient about how they would prefer to be addressed instead of just making assumptions as this may seem disrespectful.

The following are some of the principles of disclosure I would use in nursing practice;

1. Truthful, clear and timely communications

I would apply this principle by always providing information to the patient, giving the patient the opportunity to recount their feelings and concern, and listening and responding appropriately to the patient.

1. An integrated approach to improving patient safety

I would apply this principle by being accountable to learning from the incidents of patient safety and evidence of improving the healthcare system.

• Providing ongoing care and support to patients

I would apply this principle by treating the patient with empathy, consideration and respect they deserve.

Application of ethical principles to enrolled nurse practice
Ethics can be defined as the moral principles that influence the behaviour of a person or how they conduct an activity. Bioethics, on the other hand, is a field of science that deals with the philosophical implications of medical or biological procedures and treatments. Nursing ethics are the values and ethical principles that govern the relationship, conduct and practice of nursing (Fry et al., 2010).

It is important to know that nurses are able to show commitment, responsibility and offer quality care due to ethics (Gabel, 2011). Ethical principles install in nurses the ability to handle ethical issues in their working environment.

Ethical issues in abortion: abortion is among the controversial issues in medical ethics. Many nations have accepted abortion in cases when the mother’s life is at stake though other nations still hold abortion as unethical (Patil et al., 2014). Most people would argue that abortion is just another form of murder and for an enrolled nurse, it would be very unethical to perform an abortion especially an unsafe one that may even claim the lime of the mother.

Tissue transplant- is among the medical advancements in recent centuries and is perceived as a means of giving a gift of life to a patient with vital organ failure. An enrolled nurse must only perform this procedure if it is within their scope, otherwise, it would be unethical.

Ethical Issues in Nursing

Organ donation- Donation of organs must involve the participation of the donating individual, the one to which the organ is being donated and also the society. The donor of the organ must be allowed to make this decision on their own without any form of coercion or pressure (TONTI?FILIPPINI, 2012). This, therefore, means that the enrolled nurse must give the donor and the receiver all the necessary guidelines in making informed decisions.

Reproductive technology- Different governments have enacted laws to limit and regulate the use of reproductive technologies though they have left some issues unsolved. Issues like the disposal of an embryo after the conclusion of the medical process, pregnancy, and multiple implantations have not been tackled exhaustively (Zegers-Hochschild et al., 2009). In some cultures, it is generally perceived that the use of these productive technologies is unethical. This means that the enrolled nurse has an ethical obligation to educate the public regarding the use of reproductive technologies.

Mandatory reporting- is the act of reporting to the government agencies any suspected case of child abuse. Mandatory reporting in the US is not new and they have developed model acts for the concerned authorities to use in enacting the policy (Brashler, et al., 2016).

Conscientious objection- though in the rise in the healthcare setting mostly due to the controversy arising in abortion and emergency contraception, it is believed to be ubiquitous in women care and reproductive medicine (Savulescu, 2006). Conscientious objection leads to inefficiency, inequality, and inconsistency.

Artificially prolonging life- requires the consent of the patient or the family. Though many nurses are aware of the consequences of using life-sustaining intervention on patients, they claim that it is safer to provide the treatment (Welie and Ten Have, 2014). The patients may, however, opt out of this procedure and it is the ethical duty of the nurse to oblige.

Refusal and withdrawal of treatment- this presents an ethical dilemma since the nurse has a principle of the code of conduct of beneficence which puts the interests of the patients at the forefront and non-maleficence that ensures the patient experiences no harm. However, the patient may refuse or withdraw treatment if they feel that the benefits of such a decision outweigh the harms.

Stem cell research- it offers hope to a treatment of diseases like spinal cord injury and diabetes. However, human stem cell research has faces ethical controversies as it deprives embryos and oocytes pluripotent stem cell lines (Lo and Parham, 2009). Other ethical dilemmas arise on the consent to donate stem cells required for the research.

References

Brashler, R., Finestone, H.M., Nevison, C., Marshall, S.C., Deng, G., Bismark, M. and Mukherjee, D., 2016. Time to make a call? The ethics of mandatory reporting. PM&R, 8(1), pp.69-74.

Farrell, E.H., Whistance, R.N., Phillips, K., Morgan, B., Savage, K., Lewis, V., Kelly, M., Blazeby, J.M., Kinnersley, P. and Edwards, A., 2014. Systematic review and meta-analysis of audio-visual information aids for informed consent for invasive healthcare procedures in clinical practice. Patient education and counseling, 94(1), pp.20-32.

Fry, S.T., Veatch, R.M., Taylor, C. and Taylor, C.R., 2010. Case studies in nursing ethics. Jones & Bartlett Learning.

Gabel, S. (2011, May). Ethics and values in clinical practice: whom do they help?. In Mayo Clinic Proceedings (Vol. 86, No. 5, pp. 421-424). Elsevier.

Holmes-Bonney, K., 2010. Managing complaints in health and social care. Nursing Management-UK, 17(1).

Kim, S.Y., 2009. Evaluation of capacity to consent to treatment and research. Oxford University Press.

Lin, Y.P. and Tsai, Y.F., 2011. Maintaining patients’ dignity during clinical care: a qualitative interview study. Journal of advanced nursing, 67(2), pp.340-348.

Lo, B. and Parham, L., 2009. Ethical issues in stem cell research. Endocrine reviews, 30(3), pp.204-213.

Patil, A.B., Dode, P. and Ahirrao, A., 2014. Medical Ethics in Abortion. Indian Journal of Clinical Practice, 25(6), pp.544-548.

Sasso, L., Stievano, A., Gonzalez Jurado, M. and Rocco, G., 2008. Code of ethics and conduct for European nursing. Nursing Ethics, 15(6), pp.821-836.

Savulescu, J., 2006. Ethics: Conscientious objection in medicine. BMJ: British Medical Journal, 332(7536), p.294.

Steinbock, B., London, A.J. and Arras, J. eds., 2013. Ethical issues in modern medicine: Contemporary readings in bioethics. McGraw-Hill.

Thacker, K.S., 2008. Nurses’ advocacy behaviors in end-of-life nursing care. Nursing Ethics, 15(2), pp.174-185.

TONTI?FILIPPINI, N.I.C.H.O.L.A.S., 2012. Religious and secular death: A parting of the ways. Bioethics, 26(8), pp.410-421.

Uhsystem.com. (2018). Patient Rights and Responsibilities. [online] Available at: https://www.uhsystem.com/Conway/patient-rights-and-responsibilities [Accessed 26 Oct. 2018].

Uhsystem.com. (2018). Patient Rights and Responsibilities. [online] Available at: https://www.uhsystem.com/Conway/patient-rights-and-responsibilities [Accessed 26 Oct. 2018].

Welie, J.V. and Ten Have, H.A., 2014. The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making. Multidisciplinary respiratory medicine, 9(1), p.14.

Zegers-Hochschild, F., Adamson, G.D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., Sullivan, E. and Van der Poel, S., 2009. The international committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary on ART terminology, 2009. Human reproduction, 24(11), pp.2683-2687.