• ADVANCE ETHICS AND VALUES
• Introduction
•             Ethics refers to the various accepted code of conduct that governs how people act and the decision they make. Application of various codes of ethics in nursing helps to play a role in the ensuring that success and safety are maintained during the treatment of the patient (Noureddine, 2001). Nursing values also play a role in guiding and providing a framework for evaluating the behavior and influence the various practice decisions. According to the values of nursing a nurse should be caring in order to promote healing and hope to the patient. The nurses should also show integrity in their line of duty. In addition the nurses should also show cultural diversity and excellent while performing their duties. This paper therefore seeks to explore the various ethical theories and principle applied in nursing. In relation to this the paper also uses the case study to illustrate the application of the ethical theories and principles in nursing. In addition the paper will also seek to analyze some of the key conflicts that the professional nurse might face, and how to resolve them. Finally, the paper also seeks to discuss the influence of culture on values as well as identify some of the key ethical decision-making model used by nurses in delivering healthcare.
• The importance of ethical theory
•             Various ethical theories and principles guide and influence the decision made in the health care (Pera & Van, 2005). This is the ethical theories form the basis in which the professional ethics are developed. Many of the nursing decisions are based on the following ethical theories.
• Utilitarianism
•             The utilitarianism is one of the ethical theories that help to determine the rightness or the wrongness of an action based on the basis of an estimate of the probable outcome of an action (Morrison & Monagle, 2009). In this case assessing the possible outcome of an action is the best way of evaluating an action. For instance in the case where an action of a nurse lead to great good then that decision is considered to be right. This ethical theory finds application on the nursing since the aim of nursing in most case is to improve the patient condition (McCarthy, 2006). Application of this theory in health care setting can help to ensure that the entire patients are accorded equal care.
•             Kantianism proposed the rule of categorical imperative in which he states that nurses should do unto other what they would have expected to be given were they in such a situation; because human dignity must be upheld as much as possible (Dunham-Taylor & Pinczuk, 2004). According to this theory the morality of an action is determined by examining the will of the agent rather than the goals achieved. This categorical imperative Kantianism is premised upon the requirement that everyone is unique and should be treated with respects just as one would also like to be treated. It therefore defines how nurses and other profession should act.
• Virtue Ethics
•             According to the theory of virtue ethics the character of the moral agent is crucial while evaluating the ethical behavior (Allmark, 1998). In this case the main issue is not whether an intention is right or whether one is following rules rather the character of the person. Application of moral virtue in nursing enables the nurses to have right intention when treating the patient.
• Moral Particularism
•             From the moral particularism theory the moral status of an action is not determined by the principles rather it only depends on the morally relevancy of the action. Moral particularism requires nurses to turn to reasons for action (Fahey, 2007). This is to say that nurse must reason out what is best before taking any action. They believe that there is no particular principle that must be followed but one should prescribe to what their judgment tells them to be sufficed about any situation
•             One of the applications of utilitarianism theory in the health care can be a situation where premature babies destined to lead only a margin life while making their live of their parents miserable and placing a great burden to the society (Freeman & McDonnell, 2001). In this case utilitarianism can be applied through letting the baby to die. This is because in such a case the death of baby will be for the greatest good of the greatest number. Application of the theory in this case has helped in making a decision that can be justified.
• C. Relate the principle of confidentiality to the concept of reasonable limits.
•        The principles of confidentiality allows for the disclosure of patient information based on           the following grounds:

Kantianism

1. Provide one example that shows the importance of ethical theory as it applies to nursing practice

1. disclosure to any other treatment provider dealing with the patient
2. disclosure of the patient information to other healthcare services payers including the financiers
3. Disclosure of such information to the health care researchers
4. disclosure of the patient information to various agencies that are charged with the overall oversight of the health care system
5. disclosure of information to the families under special circumstances
6. disclosure of the patient information to the other officials including the law enforcement officials
7. disclosure to the public health officials

• 2. Summarize the elements of the concept of reasonable limits.
• 4. Based on reasonable limits, justify keeping or breaking confidentiality.
•             In the case under study, the confidentiality must be breached because the patient is potentially harmful to herself and to the people she is living with. She is likely to commit suicide because she is becoming more sick, weak and depressed. Her husband pays her bill; therefore, making him legally responsible and in turn should give him access to her medical records
• D. Identify how to resolve conflict between two or more ethical principles.
• 1. Summarize one ethical principle that would be in conflict if confidentiality were broken in the given case
•                Considering the guideline provided in the American Medical Association the physician should ensure that they do not reveal confidential communication or information without the consent of the patient unless required to do so by the law (Gastmans 2013). In this case breaching the confidentiality of the patient would in turn result in breaching of the ethical principle of respect for people's rights and dignity. According to this ethical principle the nurses are supposed to maintain dignity of the people and ensure that they accorded their rights.
• 2. Explain an appropriate ethical theory that could support the decision to keep or to break confidentiality.
•                One of the ethical theories that can support the breach the confidentiality is the theory of utilitarianisms. This is because according the theory of utilitarianism an action is deemed right if it leads to goodness of the greatest numbers. This therefore implies that the doctor may be forced to breach the confidentiality of the patient in the case where such decision would be more beneficial.
• E. Discuss the influence of culture on values.
•                Culture has an inherent influence on the values held by people. for example, once an individual comes from a family that believes that the everyone has an equal right in the family to make decision, they tend to be shocked when they realize that they have to change their belief or values,. For example, the wife may have come from family that believes that the wife has the same role or authority in the family as the husband, but these changes as she joins the husband’s family. In this case she has to deal with the new changes and is forced to submit to the new culture and this mean changing her values. Therefore the influence of culture is imminent as it redefines a individuals value’s (McLaughlin & Braun, 1998

               The reasonable limits clause is the clause that allows the government or health officials to limit the rights of patient or individuals. In such cases the individual’s charter rights. This cause is used to prevent objectionable conduct or protect persons. This clause is only applicable in situation in which it can be shown that law and that that the objective in limiting the right is clearly justified prescribe the limitation. It is also important to ensure that thee means used to limit the right is very clearly justified (Butts & Rich, 2005). 

3.      Provide a rationale for breaking confidentiality

               The patient confidentiality can be breached in some cases. One of the incidences where the patient confidentiality can be breached is the situation where the patient gives consent. Another incidence where the patient confidentiality can be breached is the situations where the doctors feel that they have to share information with other colleague in order to facilitate the management of the disease. In addition the doctors may also be forced to inform the local authority in case they detect a communicable disease. 

1. Compare and contrast the cultural values related to confidentiality for the Z family and for the providers (nurse and physician).
2. Propose two nursing interventions that could help reduce or resolve the ethical conflict of keeping or breaking confidentiality.

               According to the principle of confidentiality the nurses are not supposed to release confidential information of the patient with his or her consent. However, in the case presented Z family prefers that the confidential information must be kept within the family and as such everybody must know about each other and that no secrets must be kept from each other. It is therefore important to note that there is a complete conflict of interest because the nurses cannot disclose Mrs. Z’s medical results to the family member while the families members have tend to have a cultural value allowing access to confidential information of all the family members

• Nursing intervention to reduce ethical conflict of keeping or breaking confidentiality

1. Explain to the patient the incidence where her confidentiality may be broken. This can help the patient to understand the reasons for disclosing her medical record.
2. Reading to the patient and the family members who require the patient’s medical result the hospital policies and the nursing ethics that they are required to adhere to and tell them that it is a policy and you must maintain professionalism in relation to adhering to these policies (Pojman, 2010; McLaughlin& Braun, 1998; Badzek, et al, 1998).

• F. Identify one ethical decision-making model used by masters-prepared nurses in the delivery of healthcare.
• The most effective ethical decision-making model is the Thompson and Thompson model since it can be used to identify the ethical dilemma in the health care practice (Taylor, 2005).
• 1. Describe the steps in your selected ethical decision-making model.
•      a. Identify & explain the dilemma. Must be at least 2 choices, from which one must be made.
  • b. Determine if the choices are legal as provided by the various nursing principles and                                                                                                                         legality.
  • c.   If the option is legal then determine if it is ethical, if the options illegal, the determine if   the option is also ethical] for both choices: determine the values related to this choice and are the ethical principles related to this choice
    • i. For every choice it is important to determine the benefits of this choice, the burdens of this choice as well as the risks of this choice.
    • ii. Consider an ethical theory as validation
    • iii. Consider analogous decisions
    • iv. Make the decision on how to validate the decision
• 2. Apply your selected decision-making model to the given case to determine a decision for resolving the confidentiality conflict.
• The dilemma involved includes;
•             The choices are both legal from the different perspectives
• The choices are both ethical and legal
• The best option is to inform the family through legal officers especially in the presence of the family lawyer
• The ethical theory supporting this is the relativism and feminist theories
• The analogous decision partly support this decision to inform the family member because there are more legal considerations than principles
• Validation the decision depends of the theory of utilitarianism. That is to say the beauty of this decision depends on the number of people who will benefit from having this information including them family member and the hospital
• Reference
• Allmark, P. (1998). Is caring a virtue?. Journal Of Advanced Nursing, 28(3), 466-472.
• Butts, J. B. &, Rich, K. L, (2005). Rich nursing ethics: across the curriculum and into
• Dunham-Taylor, J., & Pinczuk, J. (2004). Health care financial management for nurse managers:   Merging the heart with the dollar. Sudbury, Mass: Jones and Bartlett Publishers.
•             Ethics. Oct;29(5):297-302.
• Fahey, C. J. (2007). Ethics and Disasters: Mapping the Moral Territory. Generations, 31(4), 61-65
• Freeman, J. M., & McDonnell, K. (2001). Tough decisions: Cases in medical ethics. Oxford:         Oxford University Press.
  • Gastmans, C. (2013). Dignity-enhancing nursing care: A foundational ethical framework.  Nursing Ethics (SAGE Publications) 20 (2): 142–149.
• Jul; 7(3):110-24.
• McCarthy, J. (2006). A pluralist view of nursing ethics. Nursing Philosophy, 7(3), 157-164
  • McLaughlin, L., & Braun, K. (1998). Asian and pacific islander cultural values: considerations for health care decision-making. Health and Social Work, 23 (2), 116-126.
• Morrison, E. E., & Monagle, J. F. (2009). Health care ethics: Critical issues for the 21st century.    Sudbury, Mass: Jones and Bartlett Publishers.
• Noureddine, S. (2001). Development of the ethical dimension in nursing theory. International Journal Of   Nursing Practice, 7(1), 2-7.
• Pera, S. A., & Van, T. S. (2005). Ethics in health care. Lansdowne, South Africa: Juta.
• Pojman, L. P. (2010). Ethical theory: classical and contemporary readings (5th ed., pp. 15-37).      Florence, KY: Cengage Learning, Inc.Taylor, H. (2005). Assessing the nursing and care needs of older adults: A patient-centred approach. Oxford: Radcliffe Pub.
• teaching virtue. Nurs Philos. Oct;7(4):257-65..

1. Identify and explain the dilemma

1. To disclose the information the family because they are inherently affected by the patient’s case.
2. Maintain patient confidentiality as it is a requirement of the nursing profession

2. Determine if the choices are legal:

3. Determine if the option is also ethical

4. Determine the values related to this choice:

5. The choice is beneficial to the family as they will now be aware of the burden they are faced with, the patient shall only be stressed for a few days and then will be relieved that the family now knows and the nurse shall not have the burden of keeping the important information from the family. It is also important to note that the matter shall be handled legality in the presence of the lawyer there keeping the hospital of any legal action that may ensue
6. Consider an ethical theory as validation

7. Consider analogous decisions

8. Make the decision on how to validate the decision