The health care field is so broad with so many different fields that each profession has its own ethical codes and standards. The American Nursing Association (ANA) provides nurses with a code of ethics that we must all adhere by. “The Code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession” (American Nursing Association [ANA], 2010) Three ethical concepts from our weekly reading that are shared in the ANA code of ethics are the right to self-determination also known as autonomy, confidentiality, and addressing impaired practice.
The ANA states under provision one the right to self-determination which is also known as autonomy. Autonomy as mentioned in chapter one is defined as the philosophical basis for informed consent. It is not only an ethical necessity but a component of health care. The principle of autonomy states that one is not to treat a patient without informed consent directly from the patient or by their surrogate. As a nurse we have the obligation to be knowledgeable about the legal and moral rights of autonomy as well as protect and support the patient’s interests and wishes by assessing their comprehension of the information given to them as well as the implications of their decisions. “Competence, or capacity, in health care is the ability to make choices based on an understanding of the relevant consequences of that choice on one-self and others” (Garret, Ballie, McGeehan, & Garrett, 2010, p. 34) When a patient is signing an informed consent the “how” of the treatment is not ethically important, but the consequences of having or not having the treatment is the main factor. In the case that a patient is incompetent and unable to make a decision for themselves such as if the patient is in a coma or under the age of eighteen, a surrogate is appointed to make the legal decisions for the patient. Surrogates have the obligation to make decisions based on what the patient would have wanted or chosen and disregard the interest of others including themselves. During my rotation this semester in the hospital I encountered a patient who has end stage COPD. Along with his COPD he also has diabetes and requires insulin. Per the patient’s request he has denied any treatment except for his pain medication and respiratory therapy and refuses to have his insulin and eat whatever he wants. As a nursing student I am knowledgeable that without his insulin he can have a spike in his glucose level, become more hyperglycemic, and lead to ketoacidosis which could be life threatening. As nurses we have chosen this field because we want to help people but in situations such as this, it is difficult to help a patient who does not want to be helped. In such a case all we can do as nurses is assist the patient and help him feel as comfortable as he can be. Each person has the right to autonomy and the right to refuse treatment knowing the consequences of their decision. As nurses we must respect each patient’s autonomy and the decisions that are made.
Under provision three from the ANA code of ethics confidentiality which is associated with the right to privacy is stated. As nurses we have an obligation to all patients to maintain their information confidential. The only situations where the patient’s information can be disclosed are with those members of the health care team with information such as the treatment and welfare and if the patient’s well-being and safety is in jeopardy. Ethically it is forbidden to disclose any information to a family member of a competent patient unless given permission from the patient. As nurses in the health care field our relationship and loyalty is first to the patient. The information of the prognosis or treatment is kept from the family due to that the disclosure of the disease may cause anxiety or cause devastation to the family member. Such is a case where a patient has been diagnosed with cancer and the patient does not want to cause sadness and anxiety to his/her family the nurse is obligated to not reveal any information about the diagnosis nor treatment. The ANA approved a limited ethical privilege to disclose probable exposure if the patient does not protect others from being infected with HIV or AIDS. In such situations where a male patient is diagnosed with HIV or AIDS and the wife is unaware of her husband’s disease and is having unprotected sex as well as a situation where the wife would be pregnant or trying to get pregnant. In these cases it is ethical to inform the wife because now not only does the patient have the disease the wife and child might be infected as well. As a nurse we must follow the standards of practice and keep patients information confidential unless given reason.
Lastly under the ANA code of ethics, provision three also states the right of addressing impaired practice. As health care professionals we have the general obligation to avoid all evil as well as prevent evil from happening and meet the needs of the public. In the case that one witnesses repeated unethical violations of a patient’s rights it is in probable cause to denounce a fellow employee for the protection of the patient as well as to assure the impaired individual receive help in regaining optimal function. A chain of command should be used if a dangerous scenario should occur and one should first notify the supervisory personnel. As a nurse we should be advocate for our fellow colleagues whose job performance is impaired and help them receive appropriate treatment and access to a fair institutional and a legal process. We must show compassion and caring to those colleagues who are in recovery from an illness or when that illness interferes with their work performance.
The ANA nursing code of ethics provides a framework by which all nurses must follow. It is of high importance that all the provisions stated under the code be followed by all nurses in the clinical practice to provide equal care to all patients. The right to self-determination, confidentiality, and addressing impaired practice along with many other fall under the ANA Nursing code of ethics. These three factors so far have gone hand in hand with our weekly discussion board topics. They have lead to many interesting conversations with many different points of views, but at the end of the day there is an understanding amongst all that is clarified when reading the ethical meanings behind each topic in ANA code of ethics.
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