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As frontline health care professionals, nurses face various degrees of challenges and issues during the fulfillment of their duties. The constant pressure to quickly attend to the needs of many patients, while making sure that these services are provided to them efficiently, impels nurses to be always on alert for any issue which they may encounter. Handling ethical and legal issues is already being taught in the classroom and is being supplemented by practical application during internships. Studying ethics as a major concern for nurses supplements the already rigorous training they had undergone when studying the field's concepts themselves.
However, new changes in legal and cultural aspects had led to new issues which are not traditionally being taught in nursing schools. For example, nurses may often face dilemmas pertaining to a patient's (or his family's) decision to have his life terminated once it is apparent his medical condition is incurable. In addition, nurses also need to deal with maintaining their professional image while constantly interacting with their patients. Interpersonal-oriented careers such as nursing are often vulnerable to extra-professional relationships which may hamper the delivery of otherwise objective diagnosis of medical condition and of giving treatments. Previous researches have pointed out that nurses may take advantage of their roles as health care providers in seeking sexual favors from their patients in return for their quality of care provision. This researcher would like to focus in her study some of the most common ethical and legal issues which nurses face in their profession.
She will discuss previous researchers pertaining to these issues. Finally, she will formulate her own conclusions based from the studies cited, supplemented by her own insights based from personal experiences as a nurse.
Responsibility of Nurses
As health care providers, nurses' ethics are also influenced by the concepts of the Hippocratic Oath. Being placed within modern context, this oath stipulates that health care providers should do all they can in ensuring that their patients are treated well. At the same time, the Oath compels health care workers to act with finesse and avoid behaving in such ways as to besmirch their profession's reputation. However, the complexities of modern health care has made it difficult to delineate which actions are ethically sound from the unethical. As shown in studies such as Fry and Jane-Johnstone (2002), the most common dilemmas in nursing at present involve: "termination of treatment decisions, abortion, in vitro fertilization, surrogate motherhood, euthanasia and assisted suicide, allocation of scarce resources and treatment of disabled infants and the mentally retarded." As several cases had shown in the past years, handling these issues present no single, encompassing and correct response which is applicable to all situations. More complicated issues have even reached to the courts when the parties in a situation disagree with the legal validity of the decisions being made by nurses.
Thomson, Melia and Boyd (2006) also point out that, in many cases, nurses do not have complete control over medical and health care decisions: "Most nurses are unlikely to be
directly responsible for decisions to terminate a pregnancy, terminate a treatment and in the allocation of medical resources." (emphasis by the authors).
Yet, nurses are the first health care providers being approached by the kin of the patients involved in those treatment decisions. (Thomson, Melia and Boyd, 2006). As a result, nurses should have a deep grasp of legal and ethical issues so that they can respond accordingly for those issues. At the same time, students focusing about ethical issues in nursing should consider the degree of responsibility the nurse bears in handling patient care, viz-a-viz the doctor or head nurse's over-all responsibility.
Daly, Speedy and Jackson (2009) detail some legal aspects of health care which nurses must take into critical consideration. According to them, various laws have been made to regulate conduct and wrongdoing with regard to patient safety, nurses' liability for civil and criminal negligence in mishandled patient care cases, regulation of patient's freedom of movement, facilitating patient consent for their treatments, control over patient property and records, among others. Nurses face liability, in various degrees, if they fail to fully comply with these legal aspects. (Daly, Speedy and Jackson (2009) .
Ethics in Nursing
Clarifying the broad concepts of nursing ethics, Thomson, Melia and Boyd (2006) suggest students to initially define : a.) the concepts of care within the context of the nursing profession, b.) pointing out the importance of citing specific cases in resolving ethical issues and delineating the relationship between general moral rules and the specific moral decisions.
In particular, the researchers point out that nurses should clearly delineate two contrasting demands in health care, namely: " the sensitive regard for the unique needs of a personâ€¦ with recognition of the demands of a particular circumstance" and the "general duty of care based on contractual and institutional duties and rules. This researcher believes it is important to discriminate between these two aspects of care since this will govern the level of professional relationship between the nurse and the patient. This is important in preventing this relationship from becoming too personal to the point that the nurse is unable to objectively fulfill his or her duties to the patient. In terms of using specific cases to help resolve legal and ethical issues ("casuistry"), the authors point out that this is helpful in guiding nurses to reach a decision based on previous cases. However, it is still important for them to make their own decisions based on the circumstances of a particular situation.
Related to this is the delineation of general moral principles with specific circumstances. This researcher believes that it is important to balance the two when considering a legally and ethically sensitive decision. Breaking away from precedents may cause ambiguity on how similar cases in the future will be handled. On the other hand, excessive reliance on casuistry may hamper nurses from making the correct and relevant decision on a specific situation.
In making decisions, it is relevant to go back to the basic ethical concepts applicable to
nursing. Finkelman and Kener (2009) detail these concepts as respecting the patients' autonomy, practicing beneficence and justice to them, and being truthful to the patients and his/her kin. In sum, a nurse should be able to respect a patient's decision to continue or cancel the treatment, even as he/she is able to give him the best care possible in line with the health care principles and the available diagnosis on the patient's health. Applying these principles needs some decision-making skills on the nurse's part. These skills primarily pertain to interpersonal skills, perceptiveness, moral deliberation and skilled know-how.
As this paper had shown, nurses face numerous and very challenging issues as they provide health care services to their patients. They need to deal not only with ethical considerations which are specific to nursing, but are now also including law. Based from this discussion, this student believes it is vital for nurses to deeply comprehend nursing ethics and their legal implications. The changing dynamics and needs of health care blur the lines in situations which traditionally require only black-and-white answers, so to speak. Adjusting to these changes requires nurses and nursing students to constantly review previous cases of health care-related problems while foreseeing possible new circumstances in future issues. This may be done during classes or even during review sessions. This situation also requires nurses to modify the way their deal with patients, especially those posing problems. The nurses firmly impose the rules if the patients start crossing the line beyond their welfare.