Ethics are integral part of nursing practice. Nursing ethics can be broadly defined as "the examination of all kinds of ethical and bioethical issues from perspective of nursing theory and practice" (Johnstone, 2009). There are codes of ethics for nurses. They outline the ethical responsibilities of nurses towards their clients, their own practice and nursing profession. Everyday nurses confront ethical issues and deal with them using their ethical knowledge. If nurses confront any ethical dilemma, there are ethical principles which guide nurses in resolving the ethical dilemma.
In New Zealand, the legislations and regulations are passed by the New Zealand Parliament. Law impacts various issues in nursing practice. There are several legislations or statuary acts which are applied in nursing practice such as the Health Practitioners Competence Assurance Act 2003 and Mental Health Act 1992. It is vital for nurses to know how law regulates their practice. The laws define the standards of nursing education and practice which enable nurses to maintain standards of care and respect rights of clients (Patricia, 2008).
All over the world, the code of ethics has been developed for registered nurses in order to assist nurses to practice ethically everyday and make ethical decisions in challenging situations of ethical dilemma. This code is framed by set of principles and values for nursing practice. It clearly outlines the moral responsibilities of registered nurses in order to promote and safeguard the well being, welfare and interests of persons with health care needs and persons receiving care (Johnstone, 2010).
According to Canadian Nurses Association (2008) the main purpose of code of ethics for nurses is to identify core ethical standards, values and responsibilities which nurses are expected to uphold. It serves as a means of evaluation and reflection by which nurses can reflect on their own conduct and others. It provides guidance for nurses to make decision ethically and apply them when working as a nurse. It also informs members of public about human rights standards and values expected from nurses to accept as being part of nursing profession.
The International code of ethics for nurses (ICN) (2006) has four elements. These elements outline nurses` professional responsibility towards their clients, the accountability for their personal practice, their role in maintaining standards of practice and maintaining trust among others. Maintaining human dignity of clients is a key value in providing services of an appropriate standard. Nurses value the legal and moral rights of clients of informing them. Nurses engage the clients actively in making decisions, care plans and evaluating outcomes of care given which helps to preserve the integrity of clients. They respect the wishes of clients to receive or refuse the information about care and make sure that the clients receiving care have given informed consent for (Perry 2005).
ICN states that nurses are accountable for decisions related to their own nursing practice everyday. They must have adequate knowledge and skills to apply it in practice. The regulatory authorities review nurses' practice annually or at regular intervals and ensure that nurses are competent to deliver quality care to the clients. If nurses do not maintain standards of care they may endanger safety of clients. It is called breach of care (Mair, 2010). Nurses report if they recognize that others do not respect the dignity of clients.
Nurses know their scope of practice and maintain a trustworthy relationship with clients and co-workers. Therefore they always work towards benefits of the clients. Nurses report if they recognize that others do not respect the dignity of clients. Therefore they always work towards benefits of the clients.
Ethics enable nurses to critically evaluate their decisions and actions. Nursing itself is an ethical activity as it is primarily aimed at doing well and minimizing harm. However, it is not always easy to accomplish these targets (Chaloner, 2007). Nurses confront moral and ethical problems very often. If they do not actively participate with these issues, they can not deliver optimum standard of care to patients. Ethical dilemma occurs when two or more than principles may arise a conflict in providing care to the client. Therefore, nurses should be able to critically analyze the dilemma and resolve it (Leddy & Peppers, 2006).
In order to resolve such dilemma, a systematic ethical decision-making process is proposed to help nurses to recognize the moral problems in practice and considering all aspects surrounding a situation before taking action. After resolving the dilemma nurses evaluate and reflect on their own actions and develop new strategies to resolve same situation in future.
To make it more real, it will be critically analyzed using following scenario. "A 45-year-old woman makes an informed refusal about life-preserving treatment against the advice of her clinical team. Clinicians encounter ethical dilemma: they wish to achieve the good of life-preservation and avoid the harm of death. However, they also wish to achieve the good of respecting the patients' decision and avoid the harm of overriding her autonomy" (Chaloner, 2007).
As per this scenario, the health care team has confronted a dilemma. Now there is need for them to analyze the situation in order to identify the problem and determine the presence of more than one ethical concern. After analyzing this situation, the two equally strong but conflicting principles are identified based on deontology and utilitarianism approach. The principles are autonomy and beneficence. "Autonomy is the right a person has to direct their own life and their own decisions" (Mair, 2010, p. 325). "Beneficence refers to the obligation to do good, not harm, to other people (Burkhardt & Nathaniel, 2002, p. 318).
After identifying the actual problem, the available actions are determined and each alternative is analyzed. In present scenario, clinicians can select utilitarianism approach. If they follow it they will use beneficence as ethical tool to continue the life-preserving treatment. On the other hand, they can follow deontology approach and will prioritize rights of client. They will respect client's decision to refuse her life-preserving treatment. The course of action is chosen after considering institutional values, code of ethics for health professionals and outcomes of actions, identifying which actions will result subsequent dilemma (Hood & Leddy, 2006).
Thus, the clinicians will not continue life-preserving treatment because the client has given informed consent to refuse treatment. As client is competent enough, she is entitled to make decisions related to her health and care. Respecting the autonomy of patient outweighs all other ethical decisions relating this dilemma. After putting the plan into action, the outcomes will be identified. If dilemma is not resolved the current plan may be modified.
The New Zealand Parliament makes laws and passes them as statues. The statue further formulates rules and regulations, which are detailed and are called legislation (Keenan, 2010). There are various legislations which nurses have to consider during their nursing practice for patients safety and providing them standardized quality care. For example, The Health Practitioners Competence Assurance (HPCA) Act 2003 and Mental Health Act 1992.
One of most important legislation, the HPCA Act 2003 came in action in 2004. It regulates the practice of nurses and other professions (Director-General of Health, 2009). Its main aim is to protect public health and safety by ensuring that health practitioners are fit and competent to work within their scope of practice. Under HPCA Act Nursing Council of New Zealand (NCNZ) prescribes the qualifications and criteria prerequisite for registration (Burgess, 2008).
As per the criteria, in order to get registered to practice the applicant must have successfully passed nursing education; bear good character and is fit and competent to practice within scope of nursing practice. Then, NCNZ registers the applicant as registered nurse. The nurse is obliged to hold a current practicing certificate annually as long as the nurse wishes to practice (Burgess, 2008).
If any complaint is lodged against nurse endangering public safety, Under the HPCA act, NCNZ forwards that complaint to Health and Disability Commissioner. Then, Professional Conduct Committee (PCC) consisting of two nurses and one layperson investigates complaint. Health Practitioners Disciplinary Tribunal conducts all hearings against nurses. It may order to suspend or cancel registration of nurse if it is proven that nurse is incompetent to practice and endangering the safety of clients (NCNZ, 2008).
The other significant legislation is the Mental Health (Compulsory Assessment and Treatment) Act 1992. It covers the compulsory assessment and treatment of mentally ill clients. It defines the mental disorder to enable nurses to recognize the client is suffering from mental disorder and need mandatory treatment without his or her consent (Burgess, 2008).
Main emphasis is on protecting the rights of clients. Every client has right to be fully informed. The nurses should provide the written statement of rights to the clients. Nurses must respect cultural and ethical identity of client. If the client is unable communicate in English, the interpreter can be provided to him. The client must receive appropriate treatment which benefits clients' condition. If nurse neglects the care of client due to any reason, it is breach of duty of care (Burgess, 2008).
During the course of their nursing practice, nurses obtain significant amount of clients' personal information. They have moral and legal responsibility to keep the information strictly confidential. However, this confidential information may be revealed in limited circumstances (Delziel & Johnson, 2010). The privacy commission issued health and information privacy code in 1996. The code has 12 principle rules covering collection, storage, access to, retention and correction of any health information. These rules are based on 12 privacy principles in Privacy Act 1993. The health professionals should be familiar with these rules in order to apply these rules in protecting the rights of their clients and report if there is breach of code by others (Burgess, 2008).
The purpose of collecting health information must be lawful and necessary. For instance, nurses obtain information from clients as it is prerequisite to plan client's care effectively. The concerned person must be the source of health information. Patient provides all information relating to his health and illness history. If the patient is mentally incompetent or unconscious, then, in such circumstances, nurses should ask the client`s legal guardian or representative to get information (Delziel & Johnson, 2010).
Nurses should make sure that clients or their representative are aware of that information is being collected, its purpose, is it mandatory or voluntary, who have access to this data (Delziel & Johnson, 2010). By doing this, nurse preserves the right of clients to be fully informed. The health data must be must be collected lawfully and fairly (Beech, 2007). The information may be used for research and for training and education after being transferred to a non identifying form (Burgess, 2008).
Nurses are expected to maintain confidentiality of patients' records. The health data is not disclosed to any other person without consent of client. The clients are entitled to have access to their own records. Nurses should help clients in accessing the records and ensure that clients fully understand the written data. The clients have right to request corrections of health data if they want to (Delziel & Johnson, 2010).
Nurses are legally obliged to preserve accurate patient records as it serves as evidence of care given. If a nurse fails to do so, the patient may suffer any harm due negligence of nurse. For instance, nurse did not record the first dose she gave to the client and other nurse on duty has given same medicine to the client again. The client has a right to sue the nurse for this negligent act (Mair, 2010).
In conclusion, maintaining the safety and protecting rights of client is focus of care. Nurses have ethical obligation to provide effective nursing care to their clients. It is inevitable to avoid ethical issues arising in health care. However, nurses can deal effectively with these issues by applying their ethical knowledge. The code of ethics for nurses and ethical principles provide a platform for nurses to develop their ethical knowledge. Nurses must critically analyze the situation, identify available alternatives and make decision within best interest of clients.
Legislations play a vital role in regulating practice of nurses. Once, the nurses have adequate knowledge about what is expected from them in terms of professional duties, they can reflect back or evaluate their own actions whether or not they are providing standardized quality care to client. Nurses can report if there is breach of duty of care by others.