Ethical Guidelines For Professional Nursing: Utilitarianism And Principlism

Defining Professional Nursing

Question:

Discuss about the Use of Ethical Theories in Nursing for Patients.

Professional nursing may be defined as the duty of the nurses to provide protection to patients thereby promoting and optimizing their health and abilities to survive and lead a proper quality life. They have the duty to prevent any kind of illness as well as injury along with correct initiatives to alleviate their sufferings (Wanger & Dahnke, 2015). These are mainly conducted through proper diagnosis, different treatment of human response as well as through advocacy in the care of the patients, families and also communities and populations.  Therefore nurses of the present generation follow a set of key elements that guide them through their profession to practice not only competently but also with integrity. These set of guidelines which help them to follow rules and responsibilities of their nursing profession is called the ethical guidelines (Felzmann, 2017). Ethics help nurses to provide care irrespective of their ages, economic status, citizenship, disability, sexual orientation and others by following a proper ethical framework that helps nurses to practice their professions with the best outcomes, maintain patient rights, stay away from legal obligations, and overcome ethical dilemma and others (Hamric et al., 2015). Two of the most ethical theories which are often found useful in guiding the decisions of the nurses when they face issues in decision making or when they suffer from ethical dilemma are Utilitarianism/ Consequentialism and principlism. The essay will fist discuss about the two theories which would be followed by a detailed discussion of its weakness and strength.

Consequentialism may be defined as the result based ethics theory which states that among all the different actions taken by nurses in different situations during their care for their patients, one those will be considered morally right action which will have the best overall outcomes. Many of the researchers are of the opinion that this theory is based on two important principles (Hewitt, 2017). The first one is that whether an act would be considered right or wrong will entirely depend on the outcome of the act which will in turn describe the status of the action. Secondly, it also incorporated focus of the concept that better the consequences an act produces the better or more appropriate the act would be. This has been incorporated in the theories which nurses follow when they face ethical dilemma. It mainly helps the nurse to pick up these actions which they foresee to bring the most beneficial outcome when a set of actions are available to them as options to be taken for the patient (Casali & Day, 2015). Thereby this theory ultimately gives a good notion to be adopted by nurses in their practice that individuals should live in such a way so that they can maximize good consequences. Different forms of consequentialism have been stated by researchers over times which are utilitarianism and hedonism (Ivanov & Oden, 2013). While hedonism can be described as the guiding principles which state that humans should maximize actions which ensure human pleasure. The other is the utilitarianism which has been widely used by nurses when they face issues in decision making. This states that nurses should perform any activities which would help in maximizing human welfare as well as well being. Many researchers have defined the topic of utilitarianism as the ethical theory which says that a choice is ethically right in a particular given situation only when it produces the most happiness as well as the least unhappiness for a largest number of people. It is one of the most accepted ethical theories as it is based on the human behavioral concept that every human beings with stable mental conditions would take up the decisions to carry out activities by trying to far sight the consequences beforehand (Scott, 2017). Those activities they feel to being the best benefit are selected and the rest are rejected. The similar ideas are also adapted by nurses in their practices as they need to only perform those treatments to the patient which bring the best outcome and patient safety. For this they often need to continually upgrade themselves with continuous professional development to be knowledgeable about the current evidence based practices and implement them in their own care.

Utilitarianism and Consequentialism

Another ethical theory which needs to be used by the nursing professionals while planning care for the patient is the principlism. This theory mainly comprises of five important principles which each and every nurse should incorporate in their practices to be ethically, morally and legally right in her approaches. The first one is the maintenance of autonomy and dignity (Beauchamp, 2016). It states that every patient has the right to self determinations which means that they have the right to take decisions of their own lives without nurses’ interfering or pressuring them to change their decisions even though it brings out positive or negative outcomes. The next principle within this theory is the principle of justice. This theory states that every nursing professional should provide care and allocate resources to patients in terms of fairness, need and equality. They should provide care irrespective of the caste, creed, religion and social economic status of the patients so that they all can get equal importance and care from the healthcare centers (McCarthy et al., 2016). The third principle is called the beneficence which guides nurse to pick up those treatment plans which are the safest and would bring the best care for the patients. This principle ensures that the care plan selected would bring good to the patient and would have the least chances of the occurrences of errors (Casali & Day, 2015). The fourth principle is the principle of non maleficence which states that the care that is to be provided for the patients should bring no harm to the patients. It should be such that it would bring no suffering to the patient. The last principle would be called the confidentiality and privacy maintenance of the patients (Byrd & Winklestein, 2014). Privacy is the maintenance of information which an individual’s wants to keep for himself only unless he desires to share this with anyone else. Confidentiality means the sharing of the information within a closed number of individuals where the information shared should not pass onto others abroad (McCarthy et al., 2016). The nurse should not share any information which is not wanted by the patients to be shared. Breach in these principles may lead the nurses in legal obligation (McCarthy et al., 2016).

The main strengths of these ethical theories are that they help the nurses as guidebooks when they face any issues in making decisions while choosing the best care for the patients. While utilitarianism is helpful in making the nurse go for the evidence based practice which she had found to be highly recommended in most numbers by the researchers over the years (reading newly published journal articles to get knowledge about the best care strategy which can be applied for the patient) (Hauck, Winsett & Kuric, 2013). By this, she should be assured that she had applied the best intervention which would bring out the best benefits to the patient which would in turn help the patient to lead a much better life by minimizing pain and maximizing the happiness and peace of the patient (Dinc, 2015). Moreover, anther of its strength is its simplicity as it does not require the acceptance of any prior beliefs above the nature of any religion. Rather its moral discussions and explanations are accepted by people in all nations. An example of a case study can be provided. A patient in a drunken state was taken to the hospital where he was suffering from chest pain. Seeing the necessity of the situation, nurse acted quickly and conducted tests to see whether he had any myocardial infarction since it had the highest chance. This quick action as well as proper critical reasoning of the nurse helped her identify the situation and provide the right interventions which saved his life thereby doing the greatest good to the patient.

Strengths and Weaknesses of Utilitarianism in Patient Care

The main weakness of this utilitarianism theory is that its effectivity depends on the results of the actions rather than providing interest to the real intentions of the professionals. This does not pay importance to the morals and the feelings with which an individual is applying the interventions (Langan et al., 2017). This is said so as it might happen that the nurse had provided the best evidence based care for the patient with the true feeling of saving the patient. However, the action might not have positive impacts on the patient for which an adverse situation occurred. All these would result in being judgmental about the nurses when her morals were true and rights (Silva, Sorell & Fletcher, 2014). This results in unethical complain against her which might affect her confidence and career. This theory does not support the integrity and moral responsibility of the moral actions which makes it, its weakness. One case can be depicted. An aggressive patient was admitted with stomach pain that was at a greater risk of self harm as stated by the family members. Therefore for his greater good, the nurse applied restraint to protect him from harming himself. However, in attempt to get freed from it, he bruised himself which resulted in negative impact. Although the nurses’ morale was to save the patient, yet she was criticized.

The main strength of the principlism is that it helps the nursing professionals to follow important aspects which they need to combine together to provide a comprehensive care. The first principle of autonomy and dignity helps the nurse to provide utmost freedom to the patients to choose what they want to decide regarding their treatment which help the nurse to keep the patient happy. It also helps the nurse to keep herself free form any legal obligations (Jons, Mitchell & Milligan, 2016). The other principles of beneficence and non-maleficence help the nurse in choosing the correct interventions which would reduce pain for the patients and will increase their chances of well being. Moreover providing justice by giving equal care to all helps the low socio-economic people or unprivileged classes of people to get better care thereby reflecting values and feeling of humanity in their approach. All these help the nurses to provide an ethical care that increases the well being of patients and develops their trust on healthcare (Wagner & Dahnke, 2015). Moreover maintenance of privacy and confidentiality also helps to prevent the patients from being victimized in adverse crimes by perpetrators and thereby helps them form protecting patients from the hands of criminals or those who want to provide harm to patients. Comprehensive approaches are therefore much helpful for maintaining case with certain rules and ethical guidelines. A case can be depicted here. A patient was admitted who was aged and did not wanted to go for surgery for her arthritis but this surgery was wanted by her family members. However, the professionals did not conduct the surgery due to her request which kept her happy. This principle therefore helps in maintaining human rights.

Principlism in Nursing

The main weakness observed in the principlism theory is that often the different principle clash among them while providing comprehensive care makes the nurses confused about how to approach for care. Certain explanations can be made to understand with the help of case studies. Often there are cases where conflicts take place between the principles of autonomy and the nurses’ perceptions of maintaining beneficence. There are often cases where decisions of the patients either does not allow the nurses to provide the ethics of beneficence in the care plans or does not even support her to treat the patients (Monrouxe, shaw & Rees, 2017). A case can be depicted here. Here, a patient who loses their will to live requests for withdrawal of medications and treatment to them as they no longer wants to survive. However, in such situation a nurse who is supposed to provide safe practice and care to patients to ensure their well being is torn between two principles of autonomy and beneficence and cannot understand what to choose. Ethical dilemmas make them feel stressed mentally. Moreover nurses also tend to lose confidence on their skills and decisions making ability which impacts their care on patients. They also tend to lose job satisfaction when such issues occur frequently. Moreover, nurses also face issues with justice as they also are not allocated with enough resources of that they can provide Equal care to all who cannot afford to pay for the treatments. Orders for the higher hierarchy to meet profits by restricting resource allocation make it hard to practice justice for all people by the nurses. Another case study can be depicted here.  In a case, patient tries to conceal his information from his family members or from his friends due to his own personal reasons or others. In such cases, family members of friends are not known about the patient’s information which increases their concerns and stresses them. Moreover they also become inquisitive about the patients (Langan et al., 2017). In, certain cases they lodge legal complaints when the patients expires or faces more adverse situation where they cannot reveal that it was their own decisions to keep the information private. In such condition, nurses have to suffer a lot as legal and ethical obligations entangle her in various adverse outcomes hat affect her career and working morale. In such cases, the principle act as negative aspects and affect smooth healthcare.

Importance of Principlism in Patient Care

From the entire discussion above, it is seen that utilitarianism which is a part of the consent is one of the most important theory that guides nurse to select interventions which brings the best outcomes among all available options. This principle has strengths as this makes the patient get the care which is of highest benefit to him. However, this approach does not consider the morale and good feelings and dedication of the nurses if the outcomes are not positive. This affects the nurses’ feelings and they develop job dissatisfaction as some times their best efforts may not bring positive results. This might act against the nurses’ career goals and motivation. Another theory is that of principlism which has five important principles of autonomy, beneficence, non maleficence, justice and privacy. However, although they help to provide nurses with effective framework for developing their decisions while providing care, these principles cause ethical dilemmas in many circumstances. These mainly arise when the values of each principle scales with one another. Therefore a nurse has to develop expertise in her fields to help her critically analyze the situations and apply the correct ethical guidelines to provide the best suitable care for patients.

References:

Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer International Publishing.

Byrd, G. D., & Winkelstein, P. (2014). A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions. Journal of the Medical Library Association: JMLA, 102(4), 247.

Casali, G. L., & Day, G. E. (2015). A taxonomic approach to understanding managerial ethical decision-making approaches of clinically and non-clinically trained healthcare managers in Australia. Asia Pacific Journal of Health Management, 10(3), SI8.

Dinç, L. (2015). Implementation and Evaluation of a Nursing Ethics Course at Turkish Doctoral Nursing Programs. Journal of Academic Ethics, 13(4), 375-387.

Felzmann, H. (2017). Utilitarianism as an Approach to Ethical Decision Making in Health Care. In Key Concepts and Issues in Nursing Ethics (pp. 29-41). Springer International Publishing.

Hamric, A. B., Arras, J. D., & Mohrmann, M. E. (2015). Must we be courageous?. Hastings Center Report, 45(3), 33-40.

Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence?based practice in an acute care hospital. Journal of advanced nursing, 69(3), 664-674.

Hewitt, J. (2017). Just healthcare and human flourishing: Why resource allocation is not just enough. Nursing Ethics, 0969733017707010.

Ivanov, L. L., & Oden, T. L. (2013). Public health nursing, ethics and human rights. Public Health Nursing, 30(3), 231-238.

Jones, J., Mitchell, M., & Milligan, E. (2016). Caring for one and all–Exploring ethical challenges in an ICU. Australian Critical Care, 29(3), 129-131.

Langan, J. C., Lavin, R., Wolgast, K. A., & Veenema, T. G. (2017). Education for developing and sustaining a health care workforce for disaster readiness. Nursing administration quarterly, 41(2), 118-127.

McCarthy, B., McCarthy, J., Trace, A., & Grace, P. (2016). Addressing ethical concerns arising in nursing and midwifery students’ reflective assignments. Nursing ethics, 0969733016674767.

McCarthy, B., McCarthy, J., Trace, A., & Grace, P. (2016). Addressing ethical concerns arising in nursing and midwifery students’ reflective assignments. Nursing ethics, 0969733016674767.

Monrouxe, L., Shaw, M., & Rees, C. (2017). Antecedents and Consequences of Medical Students’ Moral Decision Making during Professionalism Dilemmas. AMA Journal of Ethics, 19(6), 568.

Scott, P. A. (Ed.). (2017). Key Concepts and Issues in Nursing Ethics. Springer.

Silva, M. C., Sorrell, J. M., & Fletcher, J. J. (2014). Influences on Health Care Delivery and Nursing. Foundations of Nursing in the Community-E-Book: Community-Oriented Practice, 51.

Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: Applying utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300-306.

Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: Applying utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300-306.