9 Pages
2201 Words
Balancing Patient Safety And Autonomy
Task 1: Ethical Dilemmas in Nursing Practice
Ethical difficulties arise as healthcare professionals, especially nurses, confront opposing moral concepts or beliefs and must make decisions without a definitive right or wrong solution (Pozgar, 2023). In addition, ethical issues frequently arise from intricate situations that necessitate meticulous examination of multiple elements, such as patient welfare, autonomy, fairness, and professional obligations within the realm of health and social care (Pozgar, 2023).
Three Ethical Dilemmas Faced By Nurses
Conflict Between Privacy And Patient Safety
The initial ethical quandary concerns the clash between protecting patient confidentiality and guaranteeing safety (Chaodun et al., 2019). Cheryl advises Azad to stay near the patient, Alan, who has been separated into sections that raise concerns about violating his privacy. Alan views Azad's presence as a transgression that undermines the nurse's obligation to safeguard Alan from potential danger while also honouring his right to confidentiality. This predicament underscores the intricate equilibrium that nurses must maintain between protecting patients and respecting their autonomy. Cheryl, the staff nurse, advises Azad to stay near the patient, Alan, who has been placed under involuntary psychiatric care. The decision immediately raises questions regarding Alan's right to privacy and autonomy. Alan interprets Azad's persistent presence as an encroachment on his personal boundaries, which poses a potential risk of bodily injury until Azad withdraws. This scenario underscores the ethical dilemma that nurses encounter while trying to maintain patient safety that dealing with individuals with mental health conditions and also upholding the crucial responsibility to honour patients' privacy and autonomy. He may present a potential danger to himself or others, necessitating vigilant supervision to ensure his well-being due to Alan's mental suffering. However, the necessity for surveillance conflicts with Alan's entitlement to privacy, a core ethical tenet in healthcare.
Patient Autonomy And Threats To Personal Safety
The second ethical quandary emerges when Alan intimidates Azad, insisting on his immediate departure. Nurses are confronted with the ethical dilemma of balancing patient autonomy with the safety of healthcare providers in this situation. Nurses face the task of balancing the establishment of a therapeutic bond with patients while ensuring their own personal welfare. The decisions made in this particular situation underscore the intricate and subtle nature of nursing ethics, necessitating a meticulous assessment of potential dangers and obligations. Patient autonomy is a core tenet of healthcare ethics highlighting an individual's entitlement to make decisions regarding their own medical care, including the option to accept or decline treatment (Varkey, 2021). However, as a patient's ability to make independent decisions poses a risk to the well-being of healthcare workers a significant ethical quandary emerges (Hunt, Clarke and Lencucha, 2019). Nurses must balance the need to safeguard their own well-being and ensure a secure working environment with the duty to uphold the patient's independence. In this particular situation, nurses face the task of preserving a therapeutic connection with the patient while also addressing the possible danger caused by the patient's threats. The predicament necessitates meticulous examination of the elements influencing the patient's conduct, such as their mental health status, and an evaluation of the magnitude of the associated risk.
Role Ambiguity And Accountability
The third ethical quandary arises from Azad's ambiguity regarding his obligations and liability in the present circumstance. Nurses have difficulties associated with role ambiguity, particularly in intricate mental health situations. The absence of lucidity in understanding the essence of Azad's responsibilities highlights the significance of unambiguous communication and precisely defined tasks within the healthcare team. Nurses must handle these situations with a sharp awareness of their professional obligations seeking advice when confronted with uncertainty and promoting a cooperative approach to patient care. These issues highlight the complex and varied aspects of ethical decision-making in nursing which include thoughtful examination of principles, proficient communication, and a dedication to patient-centred care.
Task 2: Navigating Ethical Challenges in Nursing Practice
Nurses encounter ethical quandaries when it comes to striking a balance between preserving privacy and ensuring patient safety as well as handling potential risks to their own safety while respecting patient autonomy (Barnard, Jones and Cruice, 2022). The resolution of these ethical challenges in the healthcare industry can vary with instances demonstrating both exemplary and subpar approaches in the context of the case study.
Balancing Privacy And Patient Safety
Good Practice
Nurses who adhere to best practices would probably engage in transparent communication with the patient, elucidating the need for vigilant observation and underscoring their intention to guarantee the patient's safety in this situation (Ivynian, Newton and DiGiacomo, 2020). As feasible, they may solicit consent and engage the patient in decisions pertaining to their healthcare. Engaging in collaboration with the healthcare team and mental health specialists can enhance a complete approach that upholds the patient's autonomy while effectively addressing safety concerns (Edison, 2023).
Bad Practice
However, mishandling this conundrum could entail a lack of consideration for patient communication where nurses conduct monitoring measures without providing an explanation to the patient. The absence of clear information might intensify the patient's worry and opposition so worsening the ethical predicament (Friedrichsen et al., 2023). Neglecting to explore alternate solutions or engage appropriate healthcare professionals may result in an insufficient resolution.
Managing Threats to Personal Safety and Patient Autonomy
Good Practice
Nurses ought to emphasise the use of de-escalation tactics in order to effectively manage risks to personal safety (Stine, 2020). This involves developing strong communication skills to understand and address the concerns of the patient. They may enlist the assistance of mental health professionals to evaluate the patient's psychological condition and formulate a joint care strategy. Thorough documentation of the occurrence and effective communication with the healthcare team would enhance a complete approach that places equal importance on the safety of both patients and staff (Stine, 2020).
Bad Practice
Inadequate management of this predicament may entail a responsive reaction, such as evading the patient or intensifying the issue without making an effort to de-escalate it (Young, 2022). In addition, insufficient documentation, lack of involvement of mental health experts, or failure to report the incident to the healthcare team may lead to a fragmented strategy that does not effectively address the root causes so jeopardising both patient treatment and staff safety (Young, 2022).
NMC guidelines
The Nursing and Midwifery Council (NMC) offers guidelines to aid nurses in addressing ethical concerns (Nmc.org.uk., 2023). In the given cases, the NMC would probably support a person-centred approach prioritising communication collaboration and a dedication to reconciling conflicting principles. The NMC recommendations promote the preservation of patient autonomy while still prioritising safety (Nmc.org.uk., 2023). They emphasise the importance of obtaining help when confronted with uncertainty and actively participating in continuing professional development to improve ethical decision-making abilities. In addition, the promotion of ethical standards that prioritise the autonomy and safety of patients, as well as the continuous professional growth of nurses (Nmc.org.uk., 2023).
Task 3: Legal, Ethical, and NMC Guidelines on Restraints
Legal Implications
The utilisation of restraints in the provision of patient care involves legal implications, including addressing the rationale and record-keeping of these interventions. Nurses are required to comply with both national and local standards that govern the utilisation of restraints in order to prevent any unauthorised or excessive application (Vergallo and Gulino, 2021). The legal consequences also encompass the possibility of being held liable as shackles has been used in an improper manner resulting in harm or injury. The NMC recommendations stress the significance of nurses being cognizant of and adhering to applicable legislation, guaranteeing that the utilisation of restraints is within legal limits (Vergallo and Gulino, 2021).
Ethical Implications
Ethically the use of restraints introduces a delicate balance between the duty to protect the patient and the obligation to uphold their rights and dignity (Zaami et al., 2020). In addition, the ethical principle of autonomy is particularly relevant as restraining a patient limits their freedom and decision-making ability. Furthermore, nurses must carefully assess whether the use of restraints is truly necessary for the patient's safety and explore less restrictive alternatives whenever possible. Hence, the NMC emphasizes the importance of respecting and promoting patients' autonomy even in situations where restraint may be considered (Zaami et al., 2020).
NMC Guidelines
The NMC Code, established by the Nursing and Midwifery Council, is organised based on four core principles that provide guidance for the professional conduct of nurses and midwives (Nmc.org.uk., 2023).
Effective practice entails showcasing proficiency and keeping elevated levels of diligence. In this context, nurses must utilise efficient and evidence-based strategies for patient care, guaranteeing that interventions like the implementation of restraints are not only legally and ethically justified but also in accordance with the highest standards of patient safety (Nmc.org.uk., 2023). This principle highlights the significance of continuous professional development and keeping up-to-date with the most recent evidence in order to improve the quality of care delivered. As to the NMC Code nurses have a duty to give priority to the safety and welfare of patients, while also upholding their rights and dignity. Nurses should employ restriction just when it is warranted, commensurate and for the patient's utmost benefit (Nmc.org.uk., 2023). The NMC emphasises the need of effective communication with the patient, actively involving them in decisions regarding their care and delivering relevant information. It is advisable to conduct ongoing evaluations and frequent assessments to determine if the use of constraint is still justified (Nmc.org.uk., 2023).
References
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- Chaodun, Z., Li, S., Chen, Y., Ye, J., Xiao, A., Xia, Z., Liao, Y., Xu, Y., Zhang, Y., Yu, L., Wang, C. and Lin, J. (2019). Ethical consideration on use of seclusion in mental health services. International Journal of Nursing Sciences, 7(1). doi:https://doi.org/10.1016/j.ijnss.2019.10.001.
- Edison, G. (2023). Transforming Medical Decision-Making: A Comprehensive Review of AI's Impact on Diagnostics and Treatment. BULLET : Jurnal Multidisiplin Ilmu, [online] 2(4), pp.1106–1114. Available at: https://journal.mediapublikasi.id/index.php/bullet/article/view/3490 [Accessed 30 Aug. 2023].
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- Hunt, M., Clarke, S. and Lencucha, R. (2019). When a patient's choices entail risks for others: third-party risks, relational ethics, and responsibilities of rehabilitation professionals. Disability and Rehabilitation, 2(2), pp.1–7. doi:https://doi.org/10.1080/09638288.2019.1637950.
- Ivynian, S.E., Newton, P.J. and DiGiacomo, M. (2020). Patient preferences for heart failure education and perceptions of patient–provider communication. Scandinavian Journal of Caring Sciences, 34(4). doi:https://doi.org/10.1111/scs.12820.
- Nmc.org.uk., (2023). The Code. Available from https://www.nmc.org.uk/standards/code/. Accessed on 05.12.2023
- Pozgar, G.D. (2023). Legal and Ethical Issues for Health Professionals. [online] Google Books. Jones & Bartlett Learning. Available at: https://books.google.com/books?hl=en&lr=&id=zBSwEAAAQBAJ&oi=fnd&pg=PP1&dq=Ethical+difficulties+arise+as+healthcare+professionals [Accessed 4 Dec. 2023].
- Stine, E.B. (2020). Effectiveness of De-Escalation Education on Nurses' Confidence and Aggressive Patient Outcomes. [online] etd.ohiolink.edu. Available at: https://rave.ohiolink.edu/etdc/view?acc_num=msjdn1588520157526246 [Accessed 25 Sep. 2022].
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- Young, R. (2022). Examining the Impact of Patient De-escalation Techniques Training on Nurses' Feeling of Safety. DNP Projects, [online] 2(2). Available at: https://uknowledge.uky.edu/dnp_etds/406/.
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