Monday, December 21, 2009
Introduction
Ethics is the study of philosophical beliefs about what is considered right or wrong in a society. Discussions of ethical practice in nursing involve the topics of morals and values. The term bioethics is used in relation to ethical dilemmas surrounding client care. Bioethics in psychiatric mental health nursing is the application of ethical principles within the scope of the psychiatric nursing practice setting.
Ethical issues abound in mental health nursing. Consider discovering poor standards of patient care involving a nursing colleague or a doctor; or being asked to force a patient to take medication; or to tell a ‘white lie’ to petients or relatives. All to frequently, there is conflict between the imperative to act immediately and the need to provide a considered response to a complex situation. All these situations can pose acute ethical dilemmas for the nurse working in the mental health setting.
Many decisions nurses must make each day are affected by laws and ethical principles. It is important to be familiar with federal and states laws pertaining to nursing practice in general, and with those that have implications for the practice of psychiatric nursing in particular.
Mental disorders sometimes affect a person’s ability to make decisions about his or her health and well-being. Whenever possible, client autonomy and liberty must be ensured by treatment in the least restrictive setting possible and by active client participation in treatment decisions. The challenge for nurses is maintaining the client’s personal freedom in situations where public welfare and/or the clients best interests are threatened.
Nursing Ethics
Nursing is a value-laden practice. We are required to ake numerous ethical decisions every day. Fopr example, we make ethical judgments when deciding to use prn medication, restraints, or seclusion for the client who is losing control.
The expectation that nurses will deliver competent care is fundamental to the notion of professional nursing practice. Competence is both “knowing what” and “knowing how”. It is not a permanent state achieved when you get your nursing license but rather a continuing process or improving and refining your skills and knowledge. Competence is both education an attitude. Education is the academic program you are enrolled and continuing education throughout your years of practice. Attitude includes being open to criticism by colleaques, and a willingness to admit to lack of knowledge or error when appropriate. Competence is the recognition of one’s limitation as well as one’s strengths and skills. With the explosion of scientific information, competent nurses must stay current with developments in their areas of practice (Haas and Malouf, 1995).
Caring for clients who values and lifestyles are similar to ours does not challenge us to make the choice to accept the client’s inherent worth. As our society becomes more ethnically diverse and multicultural in character, the potential for rising ethical conflicts increases. When values and lifestyles are disimiliar, we are challenged to make caring, ethical decisions. Consider how each of the following clients might pose an ethical dilemma when admitted to a mental health care facility : a known drug pusher ; a mother who has killed her baby through physical abuse ; a teenager who has sexually molestedhis sister ; an adult daughter who has physically abused her elderly father ; an accused rapist. As nurses, we must be able to respect the humanness of every client in spite of differences in values and lifestyle.
Traditionally, nurses have been taught ethics from the perspective of principalism. This is based on the belief that there are universal, objective principles that ought to govern the moral behavior of people. The principles are autonomy, beneficence, nonmaleficence and justice. Autonomy is the right to make decisions for oneself. Beneficence is the performance of good acts that benefit others, in contrast to nonmaleficence, which is not acting in a way that would cause harm to self or others. The principles of justice states that people should be treated equally and people should be recoqnized for responsible behavior. The problem with the perspectiveof principalism is that socioeconomic and cultural contexts are completely ignored. They are also far too abstract to have any practical application in clinical practice (Artnak and Dimmitt, 1996;McGee, 1996).
Nursing is based on an ethics of care. We use many perspectives in the process of ethical decision making, which can be summarized in four categories; medical indications, client preferences, quality of life and contextual factors. Edical indications include the diagnosis, prognosis and treatment options with probable outcomes. Client preferences relate to the individual’s values and goals for life in general and their advance directives when they are acutely ill.
Ethical decisions involve morals and values that may differ widely among decision makers. Therefore, it is important to respect and protect the client’s autonomy and the client’s right to be the ultimate decision maker about decisions that affect his or her life. You must avoid trying to impose personal values on the client. Your life experiences may be dramatically different from those of the client, and part of becoming a professional is developing the ability to recognize and accept the client’s right to have an opinion that differs from your own.
At times, your value may be in conflict with the value syste of the institution. This situation further complicates the decision-making process and necessitates careful consideration of the client’s desires. For axample, you may experience a conflict in a setting in which there is abundant use of tranquilizer for the teratment of elderly or depressed clients. Whenever one’s value system is challenged, increased stress result.
Ethical principles : autonomy, beneficence (do good), justice/fairness, equity, equality, sanctity of life, avoidance of paternalism (informed consent), non-maleficene (avoid harm), rights, respect of persons, dignity, quality of life.
Three of the key principles: beneficence, paternalism and autonomy-will not be examined to see how they might apply in mental health nursing.
Beneficence
The ethical ideal of beneficence requires the nurse to practise in a way that benefits rather than harms the client. It my be difficult, however , to determine what constitutes ‘benefit’ and what constitutes ‘harm’. Underpinning beneficence is the assumption that the expertise of the nurse is important in determining what contitutes benefit and harm. For example, a nurse may judge that adherence to a medication schedule will benefit the client by controlling hallucinations and delusions. The same client may view the medication as harmful because it is associated with feelings of lethargy, a loss of libido, weight gain or tremor.
Autonomy and advocacy
The ethical ideal of autonomy or self-determination (Charlesworth 1993) requires the nurse to respect an individual’s freedom as far as possible. In order to demonstrate respect for patient autonomy ang to avoid paternalism, a nurse could leave decision making to the client and assume a passive, non-interventionist approach.
In applying an advocacy model to the case history outlined above, the nurse could actively to make an informed decision of her own determination. The advocacy model also requires attention to the client’s concerns and questions.
Before a nurse is able to self disclose personal values with a client as a means of assisting self determination, the nurse must have achieved an appropriate level of self-awarness and confidence. This requires a commitent to reflective that nurses closely examine their role, their nursing actions, the clinical setting in which they practise the process of reflection itself in order to reject mythical thinking and easy solutions.
Justice
Justice is treating others fairly and equally.
Fidelity
Fidelity (nonmaleficence) is maintaining loyalty and commitment to the client and doing no wrong to the client, for example, showing a commitment to clinical expertise by participating in continuing education.
Veracity
Veracity refers to one’s duty always to tell the truth. Clients have the right to know about their diagnosis, treatment, and prognosis. There are times when limitation of information may be justified (when the truth would be knowingly harmmful to a client).
Paternalism
The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of any of their number, is self protection. The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.
Daftar Pustaka
Clinton, Michael. 1996. Mental Health and Nursing Practice. Australia : Prentice Hall.
Fontaine, Karen Lee, J. Sue Fletcher. 1999. Mental Health Nursing.4th ed. California: Addison Wesley Longman, Inc 2725.
Harold I. Kaplan, Benjamin J. Sadock. 1995. Comprehensive textbook of Psychiatry. 6th ed. USA: Williams Wilkins Baltimole, Maryland 21201-2436.
Stuart & Sundeen .1995. Principles & Practice of Psychiatric Nursing Fifth
Edition .St. Louis Missouri : Mosby.
Varcarolis, Elizabeth M. 1994. Foundation of Psychiatric-Mental Health Nursing. 2nd ed. USA: W.B Saunders Company.
Varcarolis, Elizabeth M, Verna Benner Carson, Nancy Christine Shoemaker. 2006. Foundation of Psychiatric Mental Health Nursing A Clinical Approuch. 5th ed. Missouri: Elsevier. Inc.
