Analysis of an Ethical Dilemma in Healthcare

Overview

This study paper seeks to explore the subject of human dignity in health care. Basing on a given case study, the scenario raises the crucial debate of ethical matters in the health care field. In this case, a student nurse on placement in a medical ward of an Australian teaching hospital. The hospital had just acquired a new portable bath for the intensive care unit. During the rounds in the ward, a registered nurse was attending to a patient in the bath, and this attracted many nurses and people who wanted to witness the functioning of the bath. However, this fascinating equipment and advancement in technology was at the expense of a male patient fully exposed. The patient lay in the bath fully naked and yet people kept on streaming in to view the bath. This can be quite uncomfortable for and not ethically right in healthcare. In this situation, the dignity of the male patient had been totally ignored as the nurses placed their focus on the technology. To the nurses, the male patient was merely an insignificant object, placing him secondary to the magical bath. Such cases raise the question of bears the responsibility of protecting the dignity of patients while undergoing medical care. More so, the case raises questions of the ethics behind certain procedures in medical facilities.

In a more complicated aspect, people will question the eligibility of a student’s view concerning the malpractice. In the above description, the student who witnessed the case refrained from raising the question because of the insubordinate aspect in most work places. Nursing ethics literature provides few accounts by nursing students on various ethical practices in the health care field. However, student nurses are in a better position to offer valuable information in relation to ethical issues (Newell & Woodroffe, 2000). Regular nurses who have been in the working profession for a long time tend to handle things differently and for granted. On the other hand, student nurses will view these practices differently because of the fact that they have fresh knowledge. Despite this view, nurse students are powerless on whom and when to air their views concerning unethical practices in the hospitals. Since theirs is a dependant relationship, they end up not mentioning a thing in order to avoid complicating work relationships at an early level.

When it comes to the issue of dignity in healthcare, it is the obligation of the registered nurses to ensure that patients get treatment with the dignity they deserve. Nursing studies offer a more theoretical perspective of the code of ethics which object to the treating patients as a means to an end. Despite this stipulation of code of ethics, the above case clearly indicated the lack of consideration of the patient’s perspective. From the scenario, no one cared about the male patient’s comfort and dignity. In healthcare practice, codes of ethics have little meaning, and this has an impact on the student nurse’s future practice. Nursing studies teach the students the role of ethical behaviour, but, the real world does not offer a platform for these practices. Both the student nurse and the patient face a dependant affiliation with the registered nurses, which does not allow free communication. This poor relationship between registered nurses and student nurses together with patients raises the issue of ethics at healthcare workplaces.

From the case study, it is evident that placements do not offer the student nurses an opportunity to practice and reflect on the ethical issues learnt in class. Such situations find direction from the codes of nursing ethics, but, there is minimal association between theory and practical (Newell & Woodroffe, 2000). Ethics dilemma in healthcare is a common occurrence and the subordinate staffs usually feel out place because they lack people to address. Code of ethics in nursing encourages student nurses to address their observations while on placement. This allows for better nursing practices once they get the power to act in the capacity of registered nurses. From the above case, one questions the role of the registered nurse, student nurse, and also consideration of the rights of the patient. The scenario provides a clear response on this, as we see the student nurse willing to speak on behalf of the patient but has no power to address such ethical matters. When considering dignity, every individual, irrespective of his or her health state, have a deep-seated human right to dignity. The registered nurse equally has a vital role in guarding the dignity of patients since they are granted with the power to take care of them.

Ethical issues in the Case Study

The above case study presents various ethical aspects in the healthcare department. Most notable is the role of registered nurses in the care of patients. Training of nurses prepares them for their future jobs which includes taking care of people seeking medical attention. Caring for patients is a broad activity which ranges from personal care, to emotional support, together with medically. In so doing, the registered nurses need to uphold high levels of ethics as this is the requirement for professionalism in the medical field. In the event, the patients are so weak that they cannot help themselves, the registered nurse steps in and ensures that everything is in order. In this case, the registered nurse plays the lead role in the lives of the patient. Referring to the above case study, the registered nurse was responsible for the male patient in the intensive care unit. The fact that the nurse let other people view the bath with the patient fully naked was unethical. It was the ethical role of the registered nurse to understand the discomforting feeling which comes with displaying the male patient for the viewers of the birth.

Codes of ethics in nursing calls for patients’ protection in all medical procedures they undergo whether they are conscious or unconscious. In as much as the medical procedures aim at curing or improving the health status of the patient, the patient should be comfortable while undergoing the procedures. In relation to the above case study, the male patient seemed uncomfortable with the whole bath procedure but was powerless towards the situation. No one, whether sick or well, will be comfortable with people viewing his or her nakedness. There needs to be some sense of privacy in such matters. Before such procedures take place, the patient has to give consent to the relevant authority. Consent is whereby the patient approves the performance of certain medical procedures which will lead to better health. Every medical process or medication has to in line with the patient’s consent which can be in writing or orally.

Every individual has the right to decide on the medical procedures he, or she will undergo while seeking medical assistance. The universal declaration of human rights states that no one shall be subjected to degrading treatment. The description of the case study is a clear indication of a degrading medical procedure which is against the stated law. The fact that the patient’s nakedness was exposed to the viewers of the bath was degrading, and the patient did not give consent to such proceedings. It is unethical when nurse contravenes the set rules and guidelines while undertaking her duties. The nurses were excited about the bath, but, this does not imply that they overlooked the feelings and comfort of the patient. Both the registered nurses and student nurses ignored the male patient’s feelings towards being exposed to the entire staff while naked. More so, the other registered nurses were not directly linked to the care of the patient and this made the patient more uncomfortable. To make matters worse, the patient was an intensive care unit case which means he was unable to defend or speak for himself in the situation. When patients are incapable of speaking or expressing their feelings, the nurses caring for the patient have the role to play advocate for their patients.

The fact that other nurses were coming to the room and did not at any point consider the feelings of the patients is a clear indication of lack of sensitivity to ethical care. In addition, nurses need to act in their capacity as caretakers at all times. Failure to which leads to unethical aspect of the work. As registered nurses in charge of patients, the nurses should provide guidance in all matters regarding the patient’s well being while in hospital.

Ethical Decision Making Model

In this situation, the appropriate, ethical decision making model is the one which highlights ethical responsibility to clients. Both the registered and student nurses need to aware of the most prominent client interest. This means that the caretakers give priority the obligation to act in the patient’s best interest. Under this model, the nurses should uphold the rights of patients in relation to the medical procedures. The rights of the patient should be those which maximize the self-respect and self-determination. The model promotes respect and understanding of the patient’s informed choice whether it is an individual decision or not. This ethical model advocates for privacy and confidentiality of the patient’s information acquired in the process of professional service (Benjamin & Curtis, 1992). In the above case study, there was the lack of privacy in the treatment of the patient. The fact that the nurse exposed the patient to other people who were not his caretakers was a clear indication of lack of privacy for the patient. This can exhibit the level of unethical behaviour in the medical field.

The model equally promotes the application of fair fees, which guard’s reasonable charges in line with the services offered. Most hospitals charge high fees and then provide poor services to its patients, which results to unethical behaviour in the medical field. Patients need to be assured of the best services or at least services worthy their pay. The studied case reported an unfair relationship between the patient and the registered nurse. There was no mutual agreement in the services to be provided to the patient and consultation of the patient’s wishes. This model advocates for dual relationships, which objects the existence of exploitative relationships in the medical field. In the analyzed case, the relationship between the male patient and the nurse was exploitative as the nurse used the bathing process to show off the new technology. This was not part of the agreement when the hospital admitted the patient. Finally, the ethical responsibility to the client advises the nurses to practice appropriate clinical process. This outlines participation in proper healing course of action and closure for patients.

Stakeholders and their Interests

The medical field comprises of various stakeholders whose interests and claims have contributed to the establishment of the ethical situation. The government is a significant stakeholder whose claims have significantly contributed to the creation of the ethical issue. There are no strict rules which govern the nurses’ actions when dealing with patients (Beauchamp & Childress, 2009). The government has failed in the creation of laws which protect patients against nurses’ malpractices. Nurses and hospital substantially violate the rights and privileges of the patients while under their care. In the event, the government was stern in the implementation of the medical rules and guidelines then these unethical behaviours will not be witnessed. Patient protection in any medical facility should be guarded by the government’s laws. Medical officers and nurses organizations and training schools do not provide proper grounds for its employees to practice the learnt material. For instance, in the case study, the student nurse on placement witnessed an unethical practice from the same people she was supposed to emulate. Despite having strong feelings that the situation was wrong, the student nurse could not address the issue or raise her opinion on the issue. This gave rise to the unethical situation, and since it was not addressed immediately, there are high chances that the problem will occur again. Negligence in the medical field is the principal source of unethical behaviour and situations.

Resolution to the Ethical Dilemma

The fact that the registered nurse bathed the male patient in public without considering his feelings and privacy is a clear indication of unethical behaviour amongst the staff. Other staff members did not object to viewing the male patient in the bath which was assign that they too did not care about the patient’s privacy. In addition, the work relationship in the case study did not provide for correction in the event a colleague did something wrong. In this situation, the only resolution is for the workers to uphold the learnt theoretical knowledge during training. Organization of regular workshops and trainings in which the nurses are constantly reminded of their ethical responsibility will be effective in resolving the conflict. The student nurse observed the unethical behaviour because her school knowledge was still fresh and she could apply it to her daily activities in the hospitals. The other senior nurses had worked for a long time with constant renewal of their knowledge that they may have overlooked such situations. Taking the nurses on short-term trainings will help renew their knowledge and hence improve their patient sensitivity ethics. There should be forums in which nurses and other people can air their opinions in regards to the operations in the hospital.

References

Benjamin, M. & Curtis, J. (1992). Ethics in nursing. New York: Oxford University Press.

Beauchamp, T., & Childress, J. (2009). Principles of biomedical ethics (6th ed.).New York City, NY: Oxford University Press.

Newell, C., & Woodroffe, T. (2000). Case study. Whose power, whose ethics? A student nurse’s narrative. Nursing Ethics, 7(1), 63-65.

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