Ethics and Professional Advocacy
Ethics and Professional Advocacy
The nurse practitioner (NP) is responsible for patient care, including diagnosis, treatment, and examination duties. As healthcare has taken more collaborative and inclusive approaches, the need for advanced practice registered nurses has increased in demand in efforts to deliver prompt, effective, and optimal patient care. A failure to help a patient make an informed decision about his or her care can result in harm, injuries, conflicts, and damages, which can lead to legal proceedings and a negative effect. This paper will discuss ethical issues revolving around end-of-life care and the implications to the society and the nursing practice by nurse practitioners.
End-of-life is a medical term used to refer to people who have terminal illnesses, and as a result, have a shorter than usual expected lifespan. End of life care’s focus is on the patient’s management so that they are given the quality care necessary to ensure they die with dignity. Offering end-of-life care to patients conforms to other ethical practices like patient rights, autonomy, and respect of humanity (Karnik & Kanekar, 2016). Additionally, palliative care helps improve the quality of life and alleviate the pain associated with terminal and chronic illnesses (Stol, 2018). During this care, ethical issues such as failure to observe the patient’s autonomy, medical futility, and withdrawing or withholding medications can occur, hence the need to be knowledgeable and have the necessary interventions and strategies essential to avoid any conflicting interests associated with the task (Stol, 2018). A nurse practitioner may implement these issues. The nurse practitioner also advocates adherence to the patient's advance directives by patients and families. These directives arise from the routine medical check-up, which is usually held to help discuss any arising concerns rather than leaving it to the end of care (Karnik & Kanekar, 2016). The nurse practitioner should also provide an accurate explanation of the statements to patients and families in cases of unclear or conflicting opinions for the dying patient (Karnik & Kanekar, 2016). According to Karnik and Kanekar (2016), lack of proper documentation of the patient’s wishes can cause conflicts between the physician, the patient and patient’s families, or surrogates. Such an issue can also prevent the nurse practitioner from delivering quality care, and compromise the nurse practitioner’s moral and ethical principles. It can also cause patient dissatisfaction, decreased organizational productivity, incurring high costs, engagement in other related ethical issues, and a possibility of lawsuits from the concerned parties. The nurse practitioner can be accused of going against the patient’s express decisions. This impinges on the ability of the nurse practitioner to deliver quality end of life care as desired by the patient (Karnik & Kanekar, 2016). Such acts can also lead to misunderstanding between patients and medical providers or between the patient and family. The lack of the proper document without advance directives can cause negatively in providing quality of care to the patient (Karnik & Kanekar, 2016).
In case of conflicts arising from end-of-life care, nurse practitioners can utilize the American Nurses Association (ANA) Code of Ethics for Nurses. Nurses' Code of Ethics has the express aim of explaining the core objectives, principles, and responsibilities of the nursing profession by the ANA. The Code of Ethics for Nursing is an interpretation of nurses understanding of its obligation to the society, as well as the non-negotiable ethical principles of the profession, a concise explanation of the ethical responsibilities, and duties of the nurse with respect of patient's autonomy in decision-making process and solidarity, avoiding harm and doing good, and promoting fairness in care (Haddad & Geiger, 2020).
The cultural aspects of a patient touching on their ethnicity, worldview, values, language, gender, religion, and the social circumstances should not be ignored during end-of-life care (McCleskey & Cain, 2019). Respecting cultural differences helps concerned parties to make appropriate decisions about the end-of-life support to the patient. For example, if a patient’s culture does not allow for certain aspects of the care, the nurse practitioners should respect that decision and agree with the patient on the best way to approach the care.
To ensure high quality of palliative care, healthcare professionals should formulate a healthcare policy that informs the health providers, including nurse practitioners, in their practice. The internal systems should focus on the facility's goals and objectives and conform to the main principles guiding care practices (Stol, 2018). Additionally, these policies should cater to the diverse needs and cultural perspectives of the patients, as also provide for the bio-ethic committee to deal with any arising conflicts related to end-of-life care (Stol, 2018). Literatures explains the principles were touching on end-of-life care provision, as discussed above. However, it is essential to incorporate practices that support effective and efficient care based on their internal policies. Health providers, including nurse practitioners, should promote planning in advanced directives, shared-decision making processes, and extending options to offer care as a way to ensure that any ethical dilemmas arising are dealt with professionally (Moss, Lupu, Armistead, & Diamond, 2020).
Nursing advocacy is essential in nursing practice. Since advanced directives indicate a way for patients to express what they want for themselves at the end of their lives, nurse practitioners should provide options about the end of life with clear explanations to patients and respect patients' wishes in their practice.
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References
Douglas R May. (n.d.). Steps of ethical decision-making process. International Center for Ethics in Business. https://research.ku.edu/sites/research.ku.edu/files/docs/EESE_EthicalDecisionmakingFramework.pdf.
Haddad, L. M., & Geiger, R. A. (2020). Nursing ethical considerations. Stat Pearls.
https://pubmed.ncbi.nlm.nih.gov/30252310/
Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care. A narrative review, 4(2). https://dx.doi.org/10.3390%2Fhealthcare4020024.
Lima, M. d., Rego, S. d., & Siqueira-Batista, R. (2015). Decision-making process in end-of-life care. Scielo, 23(1). http://dx.doi.org/10.1590/1983-80422015231043
Mallari, G., & Tariman, J. D. (2017). Ethical frameworks for decision making in nursing practice and research. Journal of Nursing Practice Applications & Reviews of Research,7(1). https://doi.org/10.13178/jnparr.2017.0701.0707.
McCleskey, S. G., & Cain, C. L. (2019). Improving end-of-life care for diverse populations: Communication, competency, and system supports. American Journal of Hospice and Palliative Medicine. https://doi.org/10.1177%2F1049909119827933.
Moss, A. H., Lupu, D. E., Armistead, N. C., & Diamond, L. H. (2020). Integrating palliative care. Palliative Care in Nephrology. New York: Oxford University Press.
Stol, A. (2018). Ethical dimensions of caring well for dying patients. AMA Journal of Ethics, 20(8), 678-682. doi: 10.1001/amajethics.2018.678.
