Healthcare workforce such as the nurses plays a pivotal role in patient care as well as safety surveillance while in the healthcare facilities. For quality care and professionalism in their positions the nurse require an accord on the significant set of parameters employed to ensure safe practices. These measures determine decisions about resources allocation positively affect patient outcomes and the nurse’s safety in the healthcare system. In this article, safety issues in intensive care units (ICU) will be discussed and the possible strategies for ensuring safety be outlined.
In the healthcare facility, the critical care setting is one of the most complicated environments especially for the critical care nurses (CCN). The complexity of the ICU poses a risk to the patient safety since they sometimes even sustain physical injuries in the process of receiving daily care. Such a setting demands the management of intersecting issues of running a high-tech environment by ensuring the staff’s competency in operating these machines. Also, the core objective of providing quality care must be met by the team working in this very traumatizing setting (Barry & Edgman-Levitan, 2012).
The severity of the patients’ health conditions is directly related to the number of safety issues the patient is likely to encounter. The critically sick patients undergo invasive treatments procedures using drugs and technology that despite its benefits endangers patient safety as well as that of the nurses (Barry & Edgman-Levitan, 2012).
Moreover, the intensive job in the ICU brings about fatigue to the nurses which ultimately affects patient safety negatively. Such an issue is worsened by the inadequacy of the CCN in most healthcare facilities required to enhance the implementation of a rotational or working in shifts.
For the CCNs to address the safety concerns of their patients it is essential to seek the support by engaging the facility’s leadership. The safety concern is then brought to the attention of the management so that it can come up with and implement safety frameworks. In this regard, the administration will request for the recruitment of more ICU staff to reduce the work burden on understaffed workforce. Then it will also ensure that patient safety becomes a teamwork effort whereby all the team follow the safety measures in the ICU. Great success in improving patient safety will be achieved when the initiative is translated into a safety culture for the facility. As a result of the safety culture the ICU staff will understand the best way to exchange patient data in meaningful and respective manner. One of the ways to set off the implementation of such a system is by beginning with the assessment of the prevailing climate in the ICU and evaluate its effects on the patient care as well as safety (Bassuni & Bayoumi, 2015).
Another important safety measure is the assessment of the ICU equipment, technology as well as its systems from a patient safety perspective before acquisition and implementation. These devices endanger patient safety by causing injuries when they are not rigorously evaluated before use. Sometimes inadequate knowledge on the use of these sophisticated poses safety issues to both the patient and the nurses. Therefore, to ensure they are appropriately used and serviced there is a need always to ensure that experienced staff operate or supervise the use of these devices (Rhodes et al., 2012).
The development of a patient safety supporting culture in the ICUs coupled with the specialized training of the CCN is crucial to alleviating most of the safety issues in critical care units. Also, it is essential for all the healthcare stakeholders to recognize safety in the facilities requires teamwork effort for its successful implementation.
Confidentiality is the basis of providing nursing care as well as a foundation for building a good relationship between the patient and the healthcare professional. According to Basevi, Reid and Godbold (2014) confidentiality is the respecting of secrets of other people and keeping security information obtained from individuals in the privileged situations of a professional relationship. The nursing act of privacy accords the healthcare professionals with an option of employing an expert opinion in the disclosure of patient information with first options ensuring that safeguards have been exhausted (ICN, 2012). Sometimes the nurse is required to provide a patient’s private information to carers to save the health of the client necessitating the breach of patient confidentiality. Such situations present ethical dilemmas which require an application of moral principles as well as theories before reaching a decision.
In the event, confidentiality is sacrificed patients may lose their trust in the healthcare system discouraging them from seeking medical care for fear of disclosure of their private information (Routledge, 2015). Also, the breach of confidentiality attracts legal and professional issues, mistrust, disrespect, and feeling of betrayal and a sign of lack of professionalism in the patient treatment. Similar to other healthcare departments the ICU gathers patient information that is liable to the nursing act of privacy deserving patient confidentiality. The major questions in the patient privacy and ethics are when is it necessary to breach confidentiality between a patient and a healthcare provider? One such situation for contravening secrecy is when possible harm awaits the patient, or the society and the sharing of the information is the only way around it. The nurses, CCN, should be informed of the regulations of confidentiality and the situations in which to utilize and disclose a safeguarded health information is appropriate (NMBA, 2012). In the case of ethical dilemmas, the nurse is to explore all the possible options of prioritizing the protection of the client’s right to confidentiality and autonomy (McKeown, 2009).
The nurses can employ the Uustal’s model which guides them on the steps to pursue in identifying the issue, stating of the nurse’s values and the ethical stance regarding the issues. In this theory factors related to the situation are considered which lead to the generation of options associated with the dilemma. Then the alternatives are categorized leading to the development of the action, implementing and evaluating the outcomes of the activities (Barza & Cohen, 2015). The theory facilitates the advocacy for confidentiality of patient’s information as well as arriving at and implementing decisions that are beneficial to all.
The other approaches to ethical dilemmas are the Utilitarian, and the Deontology approaches. In the utilitarian model, the best alternative that is bound to lead to less harm on all the parties involved are identified and adopted (Kahane, 2015). The theory of deontology emphasizes the performance of an individual’s duty which is universally recognized regardless of the circumstance (Park, 2011).
Some of the principles applied in nursing in dilemmas to aid decision making is the principle element of nurses and people. These principles involve the obligation of doing what is acceptably good causing little or no harm (ICN, 2012). These principles together with the theories of ethical dilemmas are referred to so as to ease the decision making process and resulting to reaching at the most appropriate answer. For more complex difficulties the nurse is allowed to consult the clinical ethics committee found most healthcare facilities.
Confidentiality is crucial in propagating a healthy nursing-client relationship. Nevertheless, there are instances when confidentiality conflicts with the nurse’s duties and values. However, complex the law of confidentiality maybe there is a need to create a balance between the patient’s rights and the responsibilities of the nurses.
According to Shahid et al. (2009), the Aboriginal Australians generally exhibit poor health evidenced by high mortality rates and less five years survival rates.
Their poorer health as compared to the Aboriginal and Torres Strait Islanders is chiefly attributed to their beliefs and attitudes towards the cause of diseases such as cancer. Similar to other native people of Africa they pose poor cancer outcomes despite the presence of an advanced healthcare system. In addition to the social and demographic disadvantages the natives of Australia, there is very low screening turn up, delayed cancer diagnosis, low uptake and poor adherence to medication as well as poor continuity of care (Condon et al., 2014). The Aboriginals associate cancer with spirituality believing that it’s a punishment for wrongdoing committed in the past (Mayer & Viviers, 2014). Apart from this belief surprisingly it is a contagious disease therefore separating themselves with those diagnosed with the malady (Davidson et al., 2013).
On reading the above article, I was surprised at the various notions the Aboriginal people had towards cancer. They highly regarded these perception and considered during the making of decisions relating to their health. The belief that cancer was a punishment for a past wrong act hindered them from going for screening fearing to be known by other community members as cursed and evil people. Even more, they isolated the sick from the healthy people to avoid the risk of contracting the disease. Maybe this was due to a lack of knowledge about the cause of cancer and whether or not it is transmitted by contact. But, the perception of it being a curse and then avoiding screening made me acknowledge the varied perspectives regarding illness and health. When the screening services are made accessible to them, are large number neglect the activity fearing to realize they are cursed if they are diagnosed with the disease at the expense of their wellbeing.
The cause of cancer is contributed to by a variety of factors such as genes but spirituality is not one of them. Moreover, it is not contagious but can result from genetic inheritance and other predisposing factors. So, regardless of what they believed I expected that they would gladly turn up for screening. At least to be sure they are not cursed, as their belief is, to proceed with medications.
These beliefs highlight the lack of knowledge and ignorance about health issues among the Australian natives. My expectations for people in the 21st century about cancer were that most people have a knowledge of the vital information about a disease such as cancer. Such a scenario has influenced me to ensure my patients get essential information about their ailments before and after treatment. It is costly to assume that the patients have the necessary information about illness and health. The Aboriginals had poor health outcomes due to health misconceptions. Also, I realized one of the best strategies to improve the health of the general population is providing them with information about their health as well as illness.
References:
Condon, J. R., Zhang, X., Baade, P., Griffiths, K., Cunningham, J., Roder, D. M., … Threlfall, T. (2014). Cancer survival for Aboriginal and Torres Strait Islander Australians: a national study of survival rates and excess mortality. Population Health Metrics, 12(1). doi:10.1186/1478-7954-12-1
Davidson, P. M., Jiwa, M., DiGiacomo, M. L., McGrath, S. J., Newton, P. J., Durey, A. J., … Thompson, S. C. (2013). The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery. Australian Health Review, 37(1), 70. doi:10.1071/ah10955
Mayer, C., & Viviers, R. (2014). ‘I still believe…’Reconstructing spirituality, culture and mental health across cultural divides. International Review of Psychiatry, 26(3), 265-278. doi:10.3109/09540261.2013.866076
Shahid, S., Finn, L., Bessarab, D., & Thompson, S. C. (2009). Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services. BMC Health Services Research, 9(1). doi:10.1186/1472-6963-9-132
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