Personal & Prefessional Issues in Adult Nursing Essay
Personal & Prefessional Issues in Adult Nursing Essay
I experienced an incident of such a breach myself. The breach of confidentiality I witnessed came up on my clinical placement. It was undertaken by a qualified staff nurse whom, for the purposes of this assignment (and to maintain confidentiality); will be referred to as “Nurse Jones.” During clinical placement, a patient who was known to both Nurse Jones and I had been admitted to accident and emergency (A&E) following a horrific road traffic accident (RTA). This patient, whom I will refer to as “Mandy,” had sustained severe head and internal injuries that proved to be fatal. In fact, she died shortly after her arrival at A&E. Personal & Prefessional Issues in Adult Nursing Essay.
The following day while I was working in the hospital, a patient called me over and she asked me if I knew anything about Mandy, the accident and the injuries Mandy had sustained. I asked the patient questions to ascertain how she knew Mandy. Was she a member of Mandy’s family? Was she Mandy’s friend? The patient replied that she did not know Mandy well and she was only an acquaintance. I explained to the patient that one of my roles as a nurse is to protect patient confidentiality and that I am governed by the Nursing and Midwifery Council (NMC, 2004) Code of Professional Conduct and my contract of employment to keep information acquired from work confidentially and as stated by NMC (2004) Code of Professional Conduct “use it only for the purpose for which it was given”. I also explained that if I did have any information, I was not at liberty to say.
Additionally, I asked the patient how she would feel if nurses divulged sensitive information about a member of their family or about one of her friends. The patient seemed to accept my explanation.
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This essay is based on a case scenario of an older woman, who has been considered as an addict and is prescribed a pain treatment of alternating a weak analgesic with a placebo. A placebo is sham medication (often take the form of sugar pills, saline injections, or minuscule doses of drugs) or procedure designed with no beneficial effect based on their physical or chemical properties (American Society for Pain…
The real cause of injury or ‘but for’ need to be proven, that is the action of the person had caused the injury (Mikos-Schild, 2008). As in this scenario the inaction of the nurse to manage the patient pain caused the suffering (Dalaika’s has been deprived from her sleep, food and she is not able to perform her activities of daily living) of the patient. Physician order was administer a placebo alternating with low dose analgesic; the nurse has neglected the patient’s need for the pain medication by following this order. In addition the nurse failed to maintain her standard of care as she did not assess and evaluate patient’s pain in her plan of care (Turton,
This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Personal & Prefessional Issues in Adult Nursing Essay.
Background
Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care.
Methods
A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analyzed using descriptive statistics, cross-tabulations and Pearson correlations.
Results
A total of 422 questionnaires were used in the analysis. The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients’ rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly.
Conclusion
Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. Personal & Prefessional Issues in Adult Nursing Essay.
INTRODUCTION
Nurses everywhere have long struggled with ethical challenges in patient care. In fact, in Florence Nightingale’s Notes on Nursing, she discussed ethical duties of confidentiality, communication, and the centrality of meeting patients’ needs (Nightingale, 1859; Ulrich & Zeitzer, 2009). Similarly, nurses today are bound to uphold the foundational moral virtues, duties and principles central to the nursing profession. However, it has become increasingly difficult for nurses in all parts of the world to practise with integrity amidst the complex moral choices and pressures that nurses confront.
Today’s healthcare environment is demanding for nurses at a time when there is a critical shortage of staff to meet the multifaceted needs of patients. An ethical issue can occur in any healthcare situation where profound moral questions of “rightness” or “wrongness” underlie professional decision-making and the beneficent care of patients. For example, critical care nurses often face suffering head-on, and might question the balance between the value of attempts to preserve a patient’s life and aggressive physiological measures that appear to prolong anguish and yield no fruitful outcome. Understandably, all members of the healthcare team, including nurses, can be affected by ethical decisions as they address the stressful and sometimes exhausting nature of working through ethical problems. Personal & Prefessional Issues in Adult Nursing Essay.
BACKGROUND
This study was guided by nursing, ethics, and health services theory and literature. Rest’s (1986) four-component model of ethical decision-making identifies the importance of recognizing ethical issues that evolve from the social, cultural, and organizational environment in which one is embedded. The ethical issue or problem needs to be identified by the moral agent before moral decision-making processes can be activated. Thus, individuals may differ not only in their recognition of the moral or ethical issues they encounter but also in how they respond. This could vary by age, gender, ethnicity, years in practice or some other identified factors. Additionally, the intensity in which nurses experience these ethical issues or problems can influence the degree to which they engage in moral behavior (Jones 1991). Thus, it is essential to identify the ethical problems nurses face, the frequency with which they confront them, and the level of stress they produce.
Many of the studies that focus on ethical problems in nursing practice produce data unique to a particular specialty area. Such study topics include ethical issues in restraint use in mental health (Redman & Fry, 2003); providing care to high risk neonates (van Zuuren & van Manen, 2006; Janvier et al. 2007; Kain, 2007; Epstein, 2008); initiating, withholding, and withdrawing treatment and advance directives in acute and long-term care (Crego & Lipp 1998; Burns et al. 2001; Redman & Fry 2003); conflict resolution in parent-child-provider relationships in pediatric care (Butz et al. 1998); and physician collaboration, autonomy, and insurance constraints in advanced practice (Laabs 2005; Ulrich et al. 2007).
Studies have shown that nurses, more often than their physician colleagues, feel that end-of-life ethical issues are not thoroughly discussed within the care team or with families and significant others (Levi et al. 2004). Preliminary studies (Corley et al. 2005) have explored professionals’ experiences of ethical stress related to their inability to take moral action.
Redman and Fry (2003) published exploratory work on what is known about ethical conflicts among nurse leaders. Fry and Duffy (2001) developed and tested a tool (Ethical Issues Scale) to assess the full range of ethical issues experienced by nurses in current practice and the frequency of their occurrences. Seventy-nine percent of the 934 nurses surveyed by the American Nurses Association Center for Ethics and Human Rights at the ANA Convention in 1994 reported confronting ethical issues in practice daily (43%) or weekly (36%). Personal & Prefessional Issues in Adult Nursing Essay. Over 50% of these nurses identified the following four issues as the most frequent: cost-containment issues that jeopardized patient welfare; end-of-life decisions; breaches of patient confidentiality; and incompetent, unethical or illegal practices of colleagues. Pain management, use of advance directives, informed consent for procedures, access to healthcare, issues in the care of persons with HIV/AIDs, and providing “futile” treatment completed the list of 10 (Scanlon 1994). Previous researchers, however, have not explored the type, frequency, and level of stress that ethical problems engender in nurses across practice specialties.
THE STUDY
Aim
The aim of the study was to describe the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice.
Design
In collaboration with the University of Virginia Center for Survey Research, we developed a cross-sectional descriptive survey and mailed a self-administered questionnaire to a sample of 1000 nurses in 2004. The data presented here are part of a larger survey on ethical issues, preparedness, and job satisfaction of nurses and social workers; the methods have been previously published (Ulrich et al, 2007). For purposes of this analysis, we include only responses from the nurse sample.
Participants
The sample was derived from state licensing lists from four states, one in each of the four census regions of the United States of America (USA) (California, Maryland, Massachusetts, and Ohio). In 2004, we randomly selected 250 nurses from each state list. Four mailings were sent to participants using Dillman’s Tailored Design Method (TDM) (1978, 2000) as a guide for the data collection procedures. A total of 422 respondents returned usable questionnaires.Personal & Prefessional Issues in Adult Nursing Essay. The response rate of 52% was calculated according to the standards of the American Association of Public Opinion Research (2000) that adjusts for those who have not responded to the survey and are assumed to be disqualified. The disqualification rate was equal to that known from returned surveys and disqualifications/refusal slips.
Data collection
Our procedures included: 1) A personalized signed cover letter with the complete survey packet; 2) A follow-up postcard 10 days after the original mailing encouraging completion of the questionnaire; 3) A cover letter and replacement questionnaire three weeks after the original mailing; and 4) A final postcard thanking the participants for completing the survey. Additionally, a small financial incentive (US$2) was included in the initial mailing, and both a paper and web-based format was made available.
Measures
Socio-demographic variables
Socio-demographic variables examined included age, gender, income, practice setting, years in practice, years in position, level of education, ethics education, and state of practice.
Ethical Issues Items
We adapted items developed by the American Society of Bioethics and Humanities (ASBH) to measure the frequency of respondents’ direct involvement with ethical issues in their healthcare practice. The Ethical Issues Item Scale was composed of two sets of 16 listed items, designed to measure the frequency of ethical issues that the respondent encounters and the ethical stress associated with each issue. Items include issues such as protecting patient’s rights, confidentiality, unethical practices, conflicts of interest, end-of-life concerns, among others. On a 5-point Likert scale from 1 (never) to 5 (daily), respondents were asked to indicate the frequency of their involvement with each of the specific issues over the previous year. Stress associated with each item was also measured on a 5-point Likert scale ranging from 1 (no stress) to 5 (very high stress). Personal & Prefessional Issues in Adult Nursing Essay. Higher scores indicated higher frequency of involvement with each specific ethical issue, as well as higher level of stress. Both scales were internally consistent (α = .82 and .89, respectively).
Ethics Stress Scale
In addition, we included a broader scale of ethics stress developed by Raines (2000) that was adapted to assess individual, organizational and societal effects of ethical decision-making in practice (e.g., powerlessness, fatigue, legal consequences, psychological effects). We used 30 of the original 52 items with good internal consistency reliability (α = .90).
Ethical Considerations
The appropriate institutional review board approved the study. Return of a completed questionnaire represented implied consent. Confidentiality was maintained by using unique identification numbers and all data were reported in the aggregate.
Data Analysis
Data were analyzed using SPSS version 15. Descriptive statistics included frequencies, means, standard deviations, and medians. We used cross-tabulations and Pearson correlations to examine whether ethical problems experienced by nurses varied by sociodemographic characteristics (i.e., geographical region, direct patient care, level of education, and level of ethics education). Missing responses on the scales were negligible, consisting of less than 3% on any one item. For all comparisons, a two-sided statistical significance level of α = .05 was used.
RESULTS
Participant demographics
The sample of 422 Registered Nurses (RNs) was predominantly female (95.1%), White (84.1%), and middle-aged [mean age 45.9 9SD 10.80 years]. The majority worked full-time (67.2%), and practised in various types of direct patient care facilities (e.g., acute, specialty, sub-acute, and long-term care). This cohort was experienced in their professional practice [mean 19.8 (SD 11.6) years], but had been in their current positions for less than 10 years [mean 7.7 (SD 7.95) years]. Less than half were prepared with an Associate degree or Diploma (43.9%), while more than one in three had a Baccalaureate degree (37.8%) and 18.3% were prepared at the Master’s level or higher. The distribution of responses from the four states was fairly similar: Maryland (29.3%), Ohio (25.7%), California (23.3%), and Massachusetts (21.7%). Both Maryland and California had a smaller percentage of Whites and a higher percentage of Blacks compared to the other two states [χ2 = 34.19, df=9, p<.001]. Massachusetts had a higher percentage of Baccalaureate-prepared nurses compared to the other three states [χ2=24.19, df=12, p=.019]. Personal & Prefessional Issues in Adult Nursing Essay.
Frequency and stress of ethical and patient care issues
The majority of respondents reported frequently or daily encountering issues related to protecting patients’ rights (63.9%) and informed consent to treatment procedures (61.3%). Everyday encounters were also common with advanced care planning (41%), difficult staffing patterns (37.3%) surrogate decision-making (32.5%) and end-of life (26.2%) issues; respondents less frequently reported experiencing breaches of patient confidentiality and unethical practices (Table 1). More than one in every three respondents (37%) reported staffing patterns that negatively affected their work frequently or daily. This was more commonly-reported by nurses who worked for not-for-profit institutions than those who worked in for-profit institutions.
Table 1
Frequency and degree of stress related to ethical issues (n = 415).
| Ethical and Patient Care Issue | Frequency | Degree of Stress | ||||
|---|---|---|---|---|---|---|
| Frequently or Daily (%) | Sometimes (%) | Never or Seldom (%) | High or Very High (%) | Moderate (%) | None or Low (%) | |
| Protecting patients’ rights | 63.9 | 21.5 | 14.5 | 12.3 | 28.7 | 58.9 |
| Autonomy and informed consent to treatment | 61.3 | 21.1 | 17.7 | 6.3 | 20.3 | 73.4 |
| Breaches of patient confidentiality or right to privacy | 23.2 | 26.4 | 50.4 | 10.9 | 24.5 | 64.6 |
| Unethical practices of health professionals | 6.8 | 21.3 | 72.0 | 18.7 | 22.1 | 59.2 |
| Provider rights and duties | 19.9 | 20.6 | 59.6 | 6.1 | 21.3 | 72.5 |
| Advanced care planning | 41.0 | 20.2 | 38.7 | 4.9 | 16.1 | 79.0 |
| Surrogate decisionmaking | 32.5 | 25.0 | 42.5 | 7.1 | 20.5 | 72.4 |
| End-of-life decisionmaking | 26.2 | 26.7 | 47.1 | 16.2 | 23.6 | 60.2 |
| Beginning-of-life decision-making | 8.0 | 7.5 | 84.5 | 2.9 | 7.3 | 89.7 |
| Genetic testing and counseling | 5.1 | 5.4 | 89.5 | 0.7 | 3.4 | 95.8 |
| Conflicts of interest | 13.3 | 29.3 | 57.4 | 12.7 | 25.5 | 61.8 |
| Medical research, therapeutic innovation, or experimental treatment and related issues | 10.5 | 17.8 | 71.7 | 3.7 | 13.3 | 83.0 |
| Organ donation and transplantation | 12.1 | 15.5 | 72.4 | 8.3 | 10.0 | 81.6 |
| Resource allocation | 10.4 | 19.3 | 70.4 | 9.8 | 16.5 | 73.7 |
| Conflicting professional obligations to patient, institution, and/or profession | 9.7 | 27.8 | 62.5 | 13.1 | 23.8 | 63.0 |
| Staffing patterns that negatively affect work | 37.3 | 31.8 | 30.8 | 43.0 | 27.5 | 29.5 |
The majority of respondents reported no or low stress associated with each of the items encountered except for staffing patterns that negatively affected their work. Staffing patterns created the most stress (M= 3.20), followed by the stress associated with protecting patient rights (M = 2.41), and unethical practices of healthcare professionals (M = 2.37) (Tables 2, ,3).3). Almost 80% felt confident that they could justify their ethical decisions, and nearly two-thirds (62.3%) felt prepared to deal with ethical issues. Nonetheless, many reported being tired (44%), frustrated (57.5%), and overwhelmed (37.7%) when dealing with ethical issues in practice. Almost three-quarters (71%) reported that there were some ethical issues about which they could do nothing, and one in three (36%) reported feeling powerless. Personal & Prefessional Issues in Adult Nursing Essay.
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Table 2
Mean frequency rating and degree of stress rating for ethical and patient care issues
| Ethical and Patient Care Issue | Frequency1 | Degree of Stress2 |
|---|---|---|
| Protecting patients’ rights | 3.87 | 2.41 |
| Autonomy and informed consent to treatment | 3.69 | 2.11 |
| Breaches of patient confidentiality or right to privacy | 2.69 | 2.28 |
| Unethical practices of health professionals | 2.14 | 2.37 |
| Provider rights and duties | 2.43 | 2.00 |
| Advanced care planning | 3.03 | 1.84 |
| Surrogate decision-making | 2.77 | 1.92 |
| End-of-life decision-making | 2.56 | 2.26 |
| Beginning-of-life decision-making | 1.58 | 1.39 |
| Genetic testing and counseling | 1.39 | 1.28 |
| Conflicts of interest | 2.37 | 2.24 |
| Medical research, therapeutic innovation, or experimental treatment and related issues | 1.98 | 1.67 |
| Organ donation and transplantation | 1.92 | 1.66 |
| Resource allocation | 1.98 | 1.90 |
| Conflicting professional obligations to patient, institution, and/or profession | 2.23 | 2.22 |
| Staffing patterns that negatively affect work | 3.07 | 3.20 |
[Note: Correlation between mean frequency rating and mean stress rating is rs = .668, p<.01. A total frequency rating and a total stress rating were computed for each respondent with mean frequency total 39.6 (SD=9.50) and mean stress total 32.7 (SD=9.73). Pearson correlation = .711, p<.001 between the two total “scores.”]
Table 3
Five most frequently occurring and most stressful ethical and patient care issues
| Most Frequent |
|---|
| 1 – Protecting patients’ rights |
| 2 – Autonomy and informed consent to treatment |
| 3 – Staffing patterns that negatively affect work |
| 4 – Advance care planning |
| 5 – Surrogate decision-making |
| Most stressful |
| 1 – Staffing patterns that negatively affect work |
| 2 – Protecting patient’s rights |
| 3 – Unethical practices of healthcare professionals |
| 4 – Breaches of confidentiality |
| 5 – End-of-life decision-making |
Note: Frequency ratings based on mean values.
Interestingly, respondents in not-for-profit organizations were more likely to report greater frequency of encountering ethical issues associated with surrogate decision-making (p = .004), provider rights and duties (p = .017), end-of-life care (p = .028) and staffing concerns (p = .025).Personal & Prefessional Issues in Adult Nursing Essay. Finally, more than 45% reported that ethics-related stress had at least some influence on their thinking about remaining in their position and about 38% their thinking about remaining in active practice. .
Bivariate Analysis
Bivariate analysis using Pearson correlations revealed that several ethical issues were statistically significantly related to age and years of experience (Table 4). Younger nurses were more likely to report increased frequency of encountering issues related to provider rights and duties (r=−.19, p < .01), medical research (r=−.12, p < .05), and staffing patterns (r= −.16, p < .01). Those with fewer years in practice also more frequently encountered issues related to provider rights and medical research (r=−.17, p<.01), issues related to end-of-life (r=−.16, p < .01), organ donation (r=−.10, p < .05), resource allocation (r=−.11, p < .05), conflicting professional obligations (r=−.12, p < .05), conflicts of interest (r=−.15, p< .01), and negative staffing patterns that affect care (r=−.22, p < .01) than their more experienced counterparts. Younger nurses and those with less experience also reported more stress from specific ethical and patient care issues. Indeed, end-of-life issues, advance care planning, provider rights and duties, conflicts of interest and staffing patters were statistically significantly more stressful for those who were younger (Table 7). Generally, younger nurses were more stressed overall (r=−.14, p < .01). Personal & Prefessional Issues in Adult Nursing Essay.
