Page 57 - Essentials of Nursing Leadership and Management, 5th Edition

CikguOnline
2208_Ch04_039-056.qxd 11/6/09 5:55 PM Page 44
44 unit 1 | Professional Considerations CikguOnline
the exactness of the law (Macklin,1987).Here is an Nurses are often in a position to protect a
example: patient’s autonomy. They do this by ensuring that
others do not interfere with the patient’s right to
Mrs. Van Gruen, 82 years old, was admitted to the
proceed with a decision. If a nurse observes that a
hospital in acute respiratory distress. She was diag-
patient has insufficient information to make an
nosed with aspiration pneumonia and soon became
appropriate choice, is being forced into a decision,
septic, developing adult respiratory distress syn-
or is unable to understand the consequences of the
drome. She had a living will, and her attorney was
choice, then the nurse may act as a patient advocate
her designated health-care surrogate. Her compe-
to ensure the principle of autonomy.
tence to make decisions was uncertain because of her
Sometimes nurses have difficulty with the prin-
illness. The physician presented the situation to the
ciple of autonomy because it also requires respecting
attorney, indicating that without a feeding tube
another’s choice, even if the nurse disagrees with it.
and tracheostomy Mrs. Van Gruen would die.
According to the principle of autonomy, a nurse
According to the laws governing living wills and
cannot replace a patient’s decision with his or her
health-care surrogates, the attorney could have
own, even when the nurse honestly believes that the
made the decision to withhold all treatments.
patient has made the wrong choice. A nurse can,
However, he believed he had an ethical obligation to
however, discuss concerns with patients and make
discuss the situation with his client. The client
sure patients have thought about the consequences
requested that the tracheostomy and the feeding tube
of the decision they are about to make.
be inserted, which was done.
In some situations, two or more principles may Nonmaleficence
conflict with each other. Making a decision under The ethical principle of nonmaleficence requires
these circumstances is very difficult. Following are that no harm be done, either deliberately or unin-
several of the ethical principles that are most tentionally. This rather complicated word comes
important to nursing practice—autonomy, non- from Latin roots: non, which means not; male
maleficence, beneficence, justice, confidentiality, (pronounced mah-leh), which means bad; and
veracity, and accountability—and a discussion of facere, which means to do.
some of the ethical dilemmas that nurses encounter The principle of nonmaleficence also requires
in clinical practice. that nurses protect from danger individuals who
are unable to protect themselves because of their
Autonomy physical or mental condition. An infant, a person
Autonomy is the freedom to make decisions for under anesthesia, and a person with Alzheimer’s
oneself. This ethical principle requires that nurses disease are examples of people with limited ability
respect patients’ rights to make their own choices to protect themselves. Nurses are ethically obligat-
about treatment. Informed consent before treat- ed to protect their patients when the patients are
ment, surgery, or participation in research is an unable to protect themselves.
example.To be able to make an autonomous choice, Often, treatments meant to improve patient
individuals need to be informed of the purpose, health lead to harm.This is not the intention of the
benefits, and risks of the procedures to which they nurse or of other health-care personnel, but it is a
are agreeing. Nurses accomplish this by providing direct result of treatment. Nosocomial infections as
information and supporting patients’ choices. a result of hospitalization are harmful to patients.
Closely linked to the ethical principle of auton- The nurses did not deliberately cause the infection.
omy is the legal issue of competence. A patient The side effects of chemotherapy or radiation ther-
needs to be deemed competent in order to make a apy may result in harm. Chemotherapeutic agents
decision regarding treatment options. When cause a decrease in immunity that may result in a
patients refuse treatment, health-care personnel severe infection, whereas radiation may burn or
and family members who think differently often damage the skin. For this reason, many patients opt
question the patient’s “competence”to make a deci- not to pursue treatments.
sion. Of note is the fact that when patients agree The obligation to do no harm extends to the
with health-care treatment decisions, rarely is their nurse who for some reason is not functioning at an
competence questioned (AACN News, 2006). optimal level. For example, a nurse who is impaired