INTRODUCTION:

In the complex modern world, we are surrounded by ethical issues in all facets of our lives. Consequently, there has been a heightened interest in the field of ethics, in an attempt to gain a better understanding of how these issues influence us. Specifically, in health care the focus on ethics has intensified in response to controversial developments, including advances in technology and genetics, as well as diminished health care and financial resources. To apply ethics effectively, nurses must develop reasoning skills and understand the concepts and principles that assist ethical analysis. In order to make suitable ethical decision a nurse should have an understanding of how law, ethics and nursing interface.

Ethical Principles:

Ethical principles are the tents that directs or govern actions. They are widely accepted and generally are based on the humane aspects of society. Ethical decisions are principled; that is, they reflect what is best for the client and society.

The major ethical principles are autonomy, nonmaleficence, beneficence, veracity, fidelity and justice. By applying the ethical principles the nurse become more systematic in solving ethical conflicts. Ethical principles can be used as guidelines in analyzing dilemmas; they can also serve as a justification for the resolution of ethical problems. These principles help to ensure the highest possible standards in every aspect of research and must be adhered to by nurses and midwives. [1]

The principle of autonomy refers to individual’s rights to choose and the ability to act on that choice. The individuality of the each person is respected when autonomy is maintained. Nurses should respect a client’s right to decide and should protect those clients who are unable to decide for themselves. This principle reflects the belief that every competent person has the right to determine his or her own course of action. [2]

Beneficence is the ethical principle that means the duty to promote good and prevent harm. There are two elements of beneficence: providing benefit and balancing benefits and harm. One undesirable outcome of the beneficence is paternalism, an occurrence in which health care providers decide what the best is for clients and then attempt to encourage them to act against their own choices.[3]

Nonmaleficence is the duty to cause no harm to others. Harm can take many forms: physiological, psychological, social, spiritual. Nonmaleficence refers to both actual harm and the risk of harm. It requires that the nurses act thoughtfully and carefully, weighing the potential risk and benefits of research or treatment. This ethical principle is considered the fundamental duty of all the health care professionals. [1]

Justice is the promotion of equity or fairness in every situation a nurse encounters. For obeying this principles nurses must do ensure fair allocation of resources, determine the order of the clients to be treated on the basis of priority need. It is a fair delivery of benefits and burdens. Veracity means truthfulness, neither lying nor deceiving others. Deception can take many forms: intentional lying, nondisclosure of information, or partial disclosure of information. Veracity is often difficult to achieve. It may not be hard to tell the truth, but it can be very hard to decide how much truth to tell. Veracity consists of truthfulness, trustworthiness, and transparency, all of which are in the eye of the beholder. To apply the ethical principle of veracity in practice, nurses need to be truthful, trustworthy, and transparent, and they must consistently apply these qualities in their conduct.[2]

Ethical decision making:

Nurses and other health care providers are constantly challenged to make ethical decisions about life and death issues in providing care to individuals, families and communities. To be relevant and ethical, these decisions need to be considered in the broader context of personal, societal, cultural and professional values and ethical principles [5] A dilemma refers to a conflict between two alternatives. In such instances, one’s moral decision is to choose the lesser evil of the two. However, various preventive strategies are available to help nurses anticipate or avoid certain kinds of ethical dilemmas. Ethical dilemmas are common and diverse in nursing practice. Although the situations vary and experience indicates that there are no clear solutions to these dilemmas, the fundamental philosophical principles are the same, and the process of moral reflection will help nurses to justify their actions.[6] According to Park, (2012) the approach to ethical decision making can follow the steps of the nursing process. Although the steps of the nursing process have been stated in various ways by different writers, the common components cited are assessment, diagnosis, planning, implementation, and evaluation. Assess the ethical/moral situations of the problem. This step entails recognition of the ethical, legal, and professional dimensions involved. Collect information about the medical facts, treatment options, nursing diagnoses, legal data, and the values, beliefs, and religious components. Make a distinction between the factual information and the values/ beliefs. Validate the patient’s capacity, or lack of capacity, to make decisions. Identify any other relevant information that should be elicited, the ethical/moral issues and the competing claims. List of alternatives should be compare with applicable ethical principles and professional code of ethics. Last decide and evaluate the decision. [7]

One of the other methods to safe guards the ethical principles is advance directives. These are legal documents that specify a patient’s wishes before hospitalization and provide valuable information that may assist health care providers in decision making.[4] A living will is one type of advance directive. Another type of advance directive is the durable power of attorney for health care, in which the patient identifies another individual to make health care decisions on his or her behalf. In this type of directive, the patient may have clarified his or her wishes concerning a variety of medical situations. Institutional ethics committees, which exist in many hospitals to assist practitioners with ethical dilemmas, also aid in preventive ethics. These committees usually comprise individuals with some advanced training in ethics; they are important resources to the health care team, patient, and family.[8] The nurses should seek continuing education opportunities to stay knowledgeable about ethical issues in nursing. She should participate in or establish ethics rounds. Ethics rounds uses hypothetical or real cases that focus on the ethical dimensions of client care rather than the client’s clinical diagnosis and treatment. [9]

CONCLUSION:

Ethics is an integral part of the nursing profession and forms the foundation thereof. Nursing is a profession that requires special knowledge and skills; ethical decision-making is one of the skills that nurses use daily. Nurses should possess a clear understanding of the key ethical principles that guide ethical decisions and a framework for ethical decision-making. This will enable them to ease the decision making process during ethical dilemmas.

REFERENCES:

1. Aitamaa, E., Leino-Kilpi, H., Puukka, P., and Suhonen, R. (2010). Ethical problems in nursing management: The role of codes of ethics. Nursing Ethics, 17(4), 469-482. doi:10.1177/0969733010364896.

2. Zalon, M., Constantino, R., and Andrews, K. (2008). The right to pain treatment: a reminder for nurses. Dimensions of Critical Care Nursing, 27(3), 93-103.

3. Voyce, A. (2009). Working through an ethical dilemma. Kai Tiaki Nursing New Zealand, 15(1), 12-13.

4. Allmark, P., and Tod, A. (2009). End of life care pathways: ethical and legal principles. Nursing Standard, 24(14), 35-39.

5. Fry, S., and Johnstone, M.J. (2002). Ethics in nursing practice: A guide to ethical decision making (2nd ed.). International Council of Nurses. Oxford, UK: Blackwell Science.

6. Mathes, M. (2005). Ethics, law, and policy. Ethical decision making and nursing. MEDSURG Nursing, 13(6), 429-431.

7. Park, E. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139-159. doi:10.1177/ 0969733011413491

8. Jecker, N. (2007). Principles and methods of ethical decision making in critical care nursing. Critical Care Nursing Clinics Of North America, 9(1), 29-33.

9. Chiaranai, C. (2011). Dilemmas within the context of nursing: a concept analysis. Pacific Rim International Journal Of Nursing Research,15(3), 248-256.

Received on 26.12.2014 Modified on 05.01.2015

Int. J. Adv. Nur. Management 3(1):Jan. - Mar., 2015; Page 52-53

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