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Compare and contrast between four ethical principles

Nursing Ethics Essay Paper

All civilization has faced health challenges from ancient times to the present. In traditional practice, ethics usually used casuistry case-based approach as a method of analysis for centuries in Jewish medical ethics. Therapeutic paternalism assumed as usual practice by most health care pros and their patient’s believed that whatever done by health care team will be better for them. Hence, the queries of medical ethics have been argued since the early development of Western medicine. “Ethics is a philosophical approach that covers entire associations of belongings and involved with good and bad, moral duty, obligations and values” (Lindbergh, J.B. et al 1994). Potter and Perry, (2010) present that it is a human fundamental right and moral decisions in health care should be practiced by four principles. Beau champ and Childless addressed the four moral and health care principles.Nursing Ethics Essay Paper

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Scenario: “a nurse is an assigned to a patient who has been diagnosed with an inoperable tumor and is terminally ill. The medical staff and the family insist that she is not to be told about her prognosis. She keeps asking the nurse, “Am I dying”. What should the nurse do in this situation?”

Consideration of the ethical issue using the Four Principles framework
Respect for autonomy: Respect for patient autonomy. It means that the patients have the rights to decide, which track of action good for them. The notion of autonomy is a basis and keystone of nursing practice as a due respect for patient. Autonomy concept is nothing. Miss Y may not be independent and not legally competent to respect for autonomy, but this does not mean that ethically her views should not be considered and respected as far as possible. She has spoken her wish clearly; she wants to know about her condition.

Beneficence: The ethics of beneficence such as ethical behavior is obliged to do well.

The benefits of acting beneficently would need to be weighed against the dis-benefits of failing to respect Miss Y’s autonomy. (From a legal point of view the wishes of a competent patient cannot be override in her best interests).

Non maleficence: the moral obligation to do no harm is familiar within both medical and nursing practice. Here, Miss Y would be harmed by telling about her end stage of disease. Which course of action would result in the greatest harm?

Justice: the principle of justice suggests that ethical behavior is a manner that treats people fairly (“Ethical issues,” 2001).Nursing Ethics Essay Paper

Moreover in the context of Pakistani system, Pakistan Nursing Council (PNC) offered the professional code of ethics with job description for registered nurses. It gives direction for decision-making regarding ethical matters and serves for self-evaluation and reflection regarding ethical nursing practice.

Compare and contrast between four ethical principles

Nurses are ethically compelled to deliver safe and sound, experienced and moral care to all patients. These main beliefs give us understanding about the nature of obligations associated with these principles. (Proof) Beau champ and Childless explain that ethics leads us to proceedings, but we still need to judge a condition and express a suitable response. This judgment and response learn from training as much as from moralities (Limentani, 1999).

According to given scenario, as patient is in critical condition with diagnosed case of cancer and in the stage of terminally ill. Nurse might not decide either she should gave the answer or not. In this critical condition, may answer create emotional tragic situation to the patient and may patient ailment become more deteriorate due to emotional disturbance or in this situation therapeutic freedom seems sensible. Moreover, the notion of ethical application in serious condition is the balance between respect for autonomy of the patient and wish to do in a beneficent attitude may results in dissimilarity and tension (Campbell 1994).

This type of moral dilemmas arise due to clashes between moral principles, such as truth telling decisions, autonomy, obligations of beneficence and non-maleficence. These three ethical codes can build conflict with the principle of justice. Mostly two types of issues arise from nursing practice. There is a conflict between obligations to respect of autonomy and obligations of beneficence and non-maleficence. In reality, there are many other types of situations in which this type of conflict occurs, such as feeding, giving medication to a patient against their wishes, and trying to prevent a patient from committing suicide etc. It is remarkable that conflicts happen in health care institutions across the country on a daily basis. Although most health care professionals are now qualified communication skills, they are not taught the compromise and conciliation needed to deal with severe disagreements.

One drawback of the “Four Principles” approach is that when different persons involved in an ethical decision might differ about the virtual weight to each code. For example in a given scenario, a patient who wants to know about their critical condition and asking you “Am I dying?” This might be arguing that the principle of autonomy should be uppermost, while the other clinical staff may maintain beneficence and non-maleficence on top priority. The health care principles do not portray and point out a hierarchical ordering by them. In this example, if patient need spiritual and religious support and nurse decides to tell them reality in the favor of respect of autonomy, they will lose the role of paternalism. In this way, autonomy will be high weighed and patient may be getting a golden chance to do pray for forgiveness from Allah. If they do not tell the real situation to the patient and keep a paramount of beneficence and Mal-eficence then paternalism will be weighed but patient might be so far to pray and some special religious practice. Actually, there will be no justice for the principle of justice. In nursing, justice often focuses on equitable access to care and fair scarce resource distribution. It is the requirement for nurses to focus on the patient’s particular care needs, vision, preferences and to acknowledge the individual’s unique practice (Wilson-Barnett 1994).

Arber and Gallagher (2004) stated that any news which is not warmly accepted is known as a bad news. Any insensitive approach increases the suffering of recipients of bad news, can exerts a long lasting impact on their ability to adapt and adjust, can lead to anger and increased risk of legal action. Furthermore, the situation becomes more complicated because some patients misinterpret messages that they hear. For breach bad news, strong communication are required which should base on both compassionate and kind attitude.Nursing Ethics Essay Paper

Analysis

Not to telling a truth, is an essential skill for health care provider because many of them find it challenging to communicate bad information, especially when involves a life-threatening situation. Some feel untrained while others fear the news will be distressing and adversely affect the patient, family, or the therapeutic relationship. Some colleagues embark on a very positive approach; giving the patient and relatives artificial expectation and believing that the patient is more ideal in her ignorance. Some of them take a middle pathway and explain all the facts to the relatives while keeping the patient in the dark. Mohandas (1995) stated that, few describe at some degree about their opinion regarding patient’s prognosis, and the severity of disease, expected possibilities of treatment, adverse effects, economic burden and short and long term prognosis. In this regard they upset some patients and families. The persons involved in this situation where my patient with a cancer diagnosed lady and me (as a staff nurse). The ethical principles involved in this situation where my patient’s autonomy and veracity verses non-maleficence. The ethical dilemma confronting to me that if I (as a staff nurse) did not deliver the news then might I was not following the ethical principle of veracity and patient’s autonomy. However, if I disclose the news to the patient then I would be violating the principle of non-maleficence. Veracity (telling the truth), although distressing in the short term, but will result in more benefit than harm in the long term (Sokol, 2006). Keeping the principle of non-maleficence in my mind if I delivered the information to the patient intentionally then it would be resulted the intrinsic effect of harming the patient that violates the negative duty not to harm.

Arguments and counterarguments
The literature support that it is ethically right to tell the truth to the patient. Sokol (2006) described that not telling the truth may breach the trust of patient-nurse relationship and leads to loss of trust. Veracity, although upsetting in the short term, but will result more good than harm in the long run. The patients should have full disclosure of awful news should tell the truth if this is their wish according to the scenario. Disclosing the information prevent further argument and loss of trust if the patient later discover the truth. The Islamic point of view regarding veracity is very clear as, it was narrated that “Abe-Allaah ibn Mastodon said: The messenger of Allah (PBUH) said: “Truthfulness is righteousness, and righteousness leads to Paradise. Lying is evildoing, and evildoing leads to Hell”. If patient is in acute condition and revealing the reality may affect adverse consequences, it would cause an excessive psycho social or spiritual burden on patient. In this critical situation then not telling the truth is favorable for the well-being of patient (Tse et al., 2003). The therapeutic privilege provides opportunity to the physician in few conditions when expose the truth is forbidden as it resulted in actual and expect able damage in patient’s health status. It is also a fact that doctors do not have a duty to disclose the whole facts about a patient’s medical condition in respect of beneficence and maleficence.Nursing Ethics Essay Paper

Advantages of truth telling: Disclosure is essential to future informed consent. The patient who are not communicated about their prognosis, and kept unaware may be at risk of future misdiagnosis. Veracity promotes trust between patient and health care providers. Truthful disclosure may minimize the probability of legal liability.

Disadvantages of truth telling: Patient may misinterpret the information. The other possible harm may be patient lose the hope. Patient health is the most important issue for the health care provider, which can be affected by truth telling, and patient may go to shock. Patient may develop stress and anxiety.

Implementation

Veracity (telling the truth) to the patient needs extraordinary focus, because now a day’s patients are, comparatively to earlier, more vulnerable to face serious harms if they are not completely acknowledged regarding their health status. Not only patient’s self-government destabilized, as well as patients who are not informed the actual truth about an intervention, practice a loss of truth which is mandatory for remedial process. Honesty counts to patients because they are not well exposed to the disease, and disturbed with lots of questions in their mind which require veracity. A bad news is always a bad news. But the manner in which it is conveyed can have a profound effect on both the patient and the health care provider. Breaking bad news suggested an approach which supports the health care providers to tell the truth in the critical circumstances.

Buckman (2005) suggested the S-P-I-K-E-S protocol a strategy to disclose the bad news and tell the truth by minimizing the hazardous effects of bad news. In this respect, the most important factor is setting. It includes isolation, involvement of the significant family member and kind and calm behavior. Before breaking the news, an accurate patient’s perception is necessary. It facilitates the health care providers a clue, that how patient view the meaning of the situation and calculate the facts and figure of the medical situation. What did you think something is going on with you? Such type of open ended question is helpful to understand patient’s perception. Invite the patient through indirect permission, and respect the patient’s right to know and ask for example that, how much extent you required information regarding your treatment and diagnosis? Before delivering information, provide the patient a few moments that she prepared psychologically. The last intervention is empathetic response. Empathetic approach can stabilize the patient’s emotions through acknowledge that you are feeling their emotions.Nursing Ethics Essay Paper

Conclusion
Keele (2008) described that according to Kant, veracity is a very important to learn that is categorical in nature, one should do their duty even it cause harm to others. Veracity is the medical principle which matter for the health of the patient. But in spite of all these facts according to health care system and the medical profession in our context, trust is the basic element to develop therapeutic relationship with patient. The image of health care providers would be destroying if they would not represent the real situation in front of patient. Truthful exposure of relevant information is a legal and ethical duty of medical professionals to be explored in front of patient. In this way, there is no final conclusion and nurse should do accordingly by their experience, honesty, wisdom and use the futility and theory of utilitarianism.

Nursing Ethics
This is the code of behavior that they are supposed to exhibit so as to attain the highest standards of health care possible. Patients have got trust for their nurses and thus place their well-being and health in the hands of the nurses. It is therefore important that ethics is followed so as to assure quality care as expected by the customers. Nurses are thus guided by a code of ethics that they should follow every day in their endeavors to provide quality health care. These codes are made known to newly graduated nurses before they can be sent to the field. It is also reminded to nurses that have been in the service for long. They are charged with the responsibility of making sure that the patients are accorded the best of health care.

Treat Patients with Dignity

Nurses are supposed to treat all patients in the hospital equally. When one is in a hospital and is sick, they should all be treated as equals. The nature of the disease and how unpleasant or contagious a disease is does not give them the choice. All patients deserve to be treated equally. There is no issue of class and all patients are equals. Nurses can nod discriminate patients because of class, wealth, position, gender, race and religion. As long as all need health care, no one is higher than the other and no one should be given any preference due to their social class or any other factors other than health.Nursing Ethics Essay Paper

Confidentiality
Nurses are supposed to do all it takes so as to offer the best form of care for their patients. They are thus allowed to ask or dig for any information about the patient that will be of help to them in providing the health care needed. However, patients have a right to confidentiality and the nurses must not disclose any information given to them by their patients. In special cases, it may become important for the patients health information to be disclosed to someone else. It can only be to someone who is close to the patient or one that is directly involved with the patients care. In these cases, the nurse has to discuss this with the patient and it is purely their right to agree or disagree with it. It must be clearly explained to the patient that withholding the information may only bring harm to them. There are set laws that should be followed before disclosing patients information.

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There is a growing amount of literature and media attention to ethical issues. Every week on medical and legal television shows, such as “ER” and “Law and Order,” characters are faced with ethical dilemmas and decisions. In reality, nurses are confronted with an increasing number of ethical decisions within their practice everyday. With unparalleled technological advancement, nursing and bio-medical research, and the present healthcare environment, nurses must be cognizant of their professional and personal views of ethics.
In this essay, a view of the aims of bioethics and more specifically nursing ethics will be explored. The influences of the present healthcare environment and societal developments as they relate to nursing ethics will be addressed, and some of the main ethical legal issues that have impacted recent practice will be identified and examined.Nursing Ethics Essay Paper

Ethics Defined.
Ethics comes from the ancient Greek word meaning character or customs. Within each society, particular customs and norms develop. While a custom may be sanctioned in one society or context, the custom may not be seen as right by other cultures or societies (Bosek, 2001). Ethics suggests a code of acceptable behaviour or practice and includes the study of social morality as well as philosophical reflection on its norms and practices (Beau champ and Walters, 1999).
Bioethics and nursing ethics may be considered in the same philosophical realm but differ in both approach and application. Gerhardt (1986) views bioethics as “the study of moral and conceptual problems associated with healthcare and the biomedical sciences.” Bioethics tends to be medico-eccentric in nature and perspective (Johnston, 1999) with focus on identification of ethical concerns in medical and scientific research.
This author agrees with Reich (1978) that the aim of bioethics is the guidance of moral decision-making and discussion in medical science research and study. Bioethics holds to the philosophy that human life must be preserved at any cost, with “the medical ideology that prolonged life of any quality is a prime value (Barnum, 1998). This is contrary to nursing’s philosophy that the preservation of dignity and human rights should take precedence over preservation of life, including the right to die without suffering.
The aim of nursing ethics.
Nursing ethics is not a subcategory of medical ethics, but separate with its own literature, context and application (Veatch, 1985). Nursing ethics refers to the “principles governing the conduct of nurses in relation to patients, their families, associates, and society at large (Wlody, 1998). Johnstone (1999) further describes nursing ethics as “a practice discipline, which aims to provide guidance to nurses on how to decide and act morally in the contexts in which they work.
Nurses have a unique association with patients, a “more direct and therefore more ethically compelling relationship” (Loewy and Loewy, 2001). A recent Gallop Poll ranked nurses above medical doctors, teachers, and even clergy when asked which profession was regarded as “the most honest and ethical” (Www.gallup.com/poll/releases/pr001127.asp)
The aim of nursing ethics should be the examination of ethical issues specific to nursing. This incorporates the protection of patient rights and the de ontological principles of autonomy, beneficence, maleficence, justice and confidentiality, and offers practical guidance on decision-making in the practice setting, regardless of individual ideologies.
Developments in society and healthcare effecting ethics and law.
There are significant developments in society and healthcare delivery that influence this view of nursing ethics. With rapid technological advance and the present healthcare environment, nurses must deal with an increased number of new and complex ethical dilemmas. Sometimes these issues are previously unknown and “at any given time the practitioner may be confronted with particularities that are not yet accounted for in science or technology” (Puntillo, Brenner, Drought, Drew, Stotts, Stannard, Rushton, Scansion, and White, 2001).
Within society and healthcare delivery, the profession of nursing is advancing. A professional code of ethics is an important hallmark of a profession (Goldman, 1980). Acquiring a nursing licence does not ensure moral or ethical practice. The American Nurses Association, in response to social and healthcare needs, has developed a Code of Ethics. The Code articulates nursing’s moral duties and obligations, but ultimately the nurse is accountable to the laws of the land.
America has, potentially, the most medically litigious society. Recently in the media, there have been enormous case settlements, such as those for smokers, and, as a result, malpractice insurance costs have escalated. Although nurses make ethically based decisions, they must also be aware of the legal consequences. The laws of the land are still paramount and even those decisions based on a professional ethical code may not be dependable in court. Nurses are encouraged to “Chart for the Lawyer, not the Doctor”.
The progression of managed health care, with attention on cost containment and efficiency, has noticeably influenced patient care. The development of health management organizations, and for-profit centers has led to restrictions on patient access to care and even withholding of expensive therapies. The new technologies and procedures can be very expensive to implement but may be required to lure new patients and medical staff. Resource allocation and distribution along with rationing health care reflects a business, rather than patient care, focus.Nursing Ethics Essay Paper The Emergency Medical Treatment and Active Lab our Act of 1986 (EMTALA) was enacted to ensure access to health screening for all people who present regardless of their ability to pay. The number of people seeking and requiring medical attention without insurance or ability to pay is increasing, causing a shift in healthcare delivery, due to legal mandate to provide care for all. On any given night in a busy Emergency Room, the ‘regulars’, drug seekers and pungent homeless can be found, these individuals still deserve dignity and care, regardless of a nurse’s personal feelings or beliefs. System abuse and limited resources influence nurses perspective on ethical care. People in a society have a right to healthcare, but policy makers appear to disregard the ability of resource limited health systems to provide that care, potentially to the detriment of others. As a result there has been significant downsizing, and closures of care centers.
Another aspect influencing the aim of nursing ethics is modern globalization with changes in patient populations. Immigration in the United States, particularly from Latin-American countries is rising, with the Hispanic population now being the largest minority group.
Issues affecting professional practice
Professional nursing practice has been dramatically impacted by the recent implementation of the Health Insurance Portability and Accountability Act, or “HIPPA”, which went into effect April 14 2003. The Act makes legally accountable the ethical obligation to respect patient health information and privacy. Healthcare providers must now take active measures to protect against unauthorized uses and disclosures of personal medical information or be held in breach of confidentiality or criminally liable.
Olson (2003) suggests that nurses have a professional duty and responsibility to maintain confidentiality of patient information and to protect patients right to privacy. Protection of these rights is crucial with advancement in nursing informatics, computerized documentation, and medical record storage. However the new privacy law does have a downside: by inhibiting access to information, it can be very frustrating for relatives seeking information about a loved one’s health status. As a recent personal example, a woman’s mother was recently hospitalized and mechanically ventilated rendering her unable to give permission to divulge information. Other parties were then unable to find out the seriousness, and prognosis of her condition. Also the inability to provide information can inhibit or delay patient treatment, as health insurance providers often decide authorization for treatment. Nurses previously could supply information including, condition, injuries and vital signs.
There is undeniable evidence that the issue of nurse-to-patient ratio is a critical issue in current professional practice. A recent study identified staffing patterns that limit patient access to nursing care as the issue “most personally disturbing” to nurses (Fry & Riley, 2002). Studies further show that a lower ratio of licensed nurses to patients increases positive outcomes by decreasing infection rates, complications, re-admissions, and death (Philbrook, 2003). In September 2002, California Governor Gray Davis passed legislation to establish a nurse-to-patient ratio to address the quality of patient care and help meet current workforce needs. By ensuring adequate staffing levels and appropriate workloads, these regulations improve not only patient care but also nursing working conditions and satisfaction.Nursing Ethics Essay Paper As a result of cost containment and scarce resource allocation, nurses are presented with ethical challenges of justice in the present fiscal environment in healthcare. Sometimes providing adequate care and maintaining professional nursing practice is challenging in cost-constrained hospital environments (Ritter-Teitel, 2002). Nurses are expected to provide quality patient care based on the same or fewer resources (O’Connor, 1997).
Finally, of end of life care is also a significant issue in professional practice due to the aging population and the increase in life-extending technology. The Patient Self-Determination Act of 1990 provides a means for predetermination of care when the patient is unable to do so. This provides advance directives about withholding resuscitation and life extending measures, and by doing so ensures the patients right to autonomy. However, there can be family or medical refusal to adhere to these wishes and directives, using the excuse of benefiting the patient.
Conclusion.
With unprecedented advances in technology and health science, the profession of nursing faces a variety of ethical issues. Nursing’s ethic of care and respect of human rights, along with basic moral principles of autonomy, beneficence, non maleficence, justice and confidentiality provide a framework for ethical analysis and decision-making. The continued provision of competent and ethical care, when faced with today’s practice issues, illustrates the commitment of the nursing profession to nursing ethics.

Nursing is a career that takes more than just a handful of classes and certification programs to fully understand. Aside from the considerable academic workload and extensive paper writing that goes into becoming a nurse, there is a huge emphasis placed on ensuring that nurses are trained to understand the ethical implications of the actions they take. This sample essay provides an example of why clients rate Ultius as a five-star writing service.Nursing Ethics Essay Paper

Nurse’s ethical problems and decision making
Ethical problems in nursing are some of the most difficult to handle appropriately because of their naturally sensitive nature. Ethics require sound judgment and adherence to rules that are not always as clear cut as laws. Despite these difficulties, the issues are solved through the same dedication and resolve that other problems require. Ethical issues often arise in the nursing practice due to the delicacy of patient-caregiver interactions.

It is the nurse’s duty to assist the patient to the best of their abilities and to insure that the workplace is beneficial for all patients. Ethics can come into question in an individual’s own practice as well as observed issues in the practices of fellow nurses and doctors. It is vital that these issues be considered from an objective standpoint, and reported in situations where ethical codes are clearly broken.

Ethical implications in the nursing industry
One patient observed some questionable behavior from a fellow nurse that brought to mind various ethical implications. The nurse displayed a lack of focus when dealing with patients and student nurses during her shift. Compassion fatigue among nurses often causes judgment errors. And, in this case, it almost hurt the patient the nurse was supposed to be helping.

A student nurse informed the nurse in question that the student nurse would be taking care of one of the nurse’s patients during her shift. The student nurse was thus responsible for administering the patient’s medications. Despite the student nurses disclaimer, the nurse in question proceeded with her administration of the patient’s medication. The patient almost received a second dosage of medication from the student nurse, as the nurse in question forgot about the student nurse taking over the shift. z

The nurse may have forgotten the information the student nurse gave her due to drug abuse issues. Administering the patient’s medicine inappropriately was not the only observed issue for the nurse. She frequently took breaks of up to 20 minutes during her shifts, at which times she was unreachable. The nurse was sometimes agitated with her patients and spoke inappropriately about them to the other staff members saying the patients were dramatic and entitled.Nursing Ethics Essay Paper

The nurse downplayed the patient’s issue stating that the patient was simply lonely and was searching for attention. Although patients can be difficult at times it is the nurse’s duty to respond appropriately to patients issues. The nurse’s questionable actions indicate drug abuse. American Nurse Today lists signs of substance abuse including:

Nursing is a profession that is concentrated on the ability of a person to improve their skill in applying their roles and responsibilities to provide care for the patient. This means that the nurse is always available to ensure that proper care has been applied to the patient using the ideal standards of nursing principles. As a nurse, you are responsible for the prognosis of the patient to track their health condition while seeking treatment to the hospital. This is an important consideration because every patient has the right to receive a proper medical attention and treatment to any health care institution. As a patient, they also have the right to live a longer life, which is why they seek medical treatment and rehabilitation to prolong their longevity.

Nursing is one of the most challenging professions in our society because practitioners need to follow the proper standards of care in either the hospital or community setting. This is because ethics play an important role in the professional practice of ever nurse in our community. Nurses often commit negligence, which is the most common offense applied in the hospital or in the community setting while providing treatment to patients. An example of this is a wrong medication, wrong patient, wrong route, and accidents during a treatment procedure due to lack of assessment. When nurse commits errors such as negligence, patients usually suffer another form of injury aside from their present condition of medical illness. As a result, the life of the patient is challenged because they have been compromised by the nurse that should have been the right person to provide treatment to relieve signs and symptoms of the disease or disability.Nursing Ethics Essay Paper
In nursing ethics, veracity is often applied because all patients should be treated with fairness while addressing their health concerns. There are nurses who failed to abide by the rules by failing to practice diversity towards the patients. Nurses are sometimes denying access to health care to patients because of their sexual orientation and race. Professional malpractice is also committed by nurses when they practice certain procedures towards the patient in order to improve their skill while compromising the health of the patients. As a result, the patient suffers from complications, especially when an accident happens during a procedure such as inserting a gastric tube. Patients trust all nurses when they are going to seek medical treatment at the hospital or during a community mission to provide health care services to a certain number of populations.

Patients usually file for criminal complaints against the nurse whenever they feel that they were neglected. This is especially for patients who sustained injuries when they sought medical treatment at the hospital. As a result, the license of nurses has been revoked because they were proven guilty after the hospital conducted a thorough investigation into the matter. Hospital institutions who were involved in an ethical malpractice when their health care workers were responsible for causing damage or injuries to the patients, the license to operate can be compromised. The worst-case scenario for nursing ethics is when the patient died from injuries because nurses were unable to provide the rightful care while they were on duty. Former nurses who have their licenses revoked have to find a way to continue their productivity by searching for new jobs that are not associated with their former nursing practice (Gastmans, 2013).

Ethics as it is being used in the health sector is a concept that has evolved over time. There is no doubt that every player in the sector seeks to continually improve their services delivery as well as attaining maximum patient satisfaction in the process. In the last few years, ethics in health has developed through a number of stages. Hippocratic culture dominated traditional ethics in the 1960s where health care providers established relationships with patients. The core values of this relationship were derived from culture. The technological advancements and intensive research has seen developments in biological sciences and biotechnology. With such changes, a new ethical dimension was introduced.

Ethical principles of human dignity, compassion, non-malfeasance and social justice Nursing Ethics Essay Paper

However, with time a dilemma arose from the liberalization of health care industry. There emerged a need to harmonize the differences in health needs and resources availed for filling the gap. The scope of health ethics was thus expanded to include quality control, economics, policy formulation and implementation as well as massive research and development. Such efforts and resource harmonization gave birth to an era of health policy and ethics. As time advances there are debates on human rights protection and respect of human dignity (Bryant, Hyder and Kauser, 2007). It is now a fundamental right for every individual to enjoy quality health care without discrimination of any kind. The most recent dimension of health ethics is the fusion of lauded human rights and the fundamental right to obtain quality health services.

Contrary to direct definition of health, as the entire state of well being in terms of mental social and physical status of an individual, ethics and human dignity issues are more complicated to completely expound on them. Ethics is solidly founded on cultural convictions developed over time. It derives its relevance and strength from religious and philosophical advocates deeply embedded on the present leadership systems. It is considered as the ability of a community to clearly and amicably draw a boundary separating what is perceived as wrong and what remains a right thing.

Such a boundary touches on the aspects of life right from the way of doing things to the general perception of life. It becomes a big understatement to define ethics without mentioning the famous dimensions used to describe it. It is a cumulative approach of respect to humanity with specific focus on maintenance of autonomy of a person, delivery of justice, rights and upholding of human dignity. Ethics in health policy formulation and implementation focuses on the most cost effective means of delivering a quality health care to all. It is in this light therefore, that ethics attempts to strike a balance between the policies and values cherished by an entire community.

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Equity is another paramount aspect of importance which cannot be neglected. It is about all that appertains to fairness in the ultimate distribution of gains derived from a robust health advancement which is socially acceptable. It is a concept that goes beyond just accessing health care products but touches on the response aimed at meeting the needs of all persons. Equity aims at ensuring that no one individual is favored in the allocation of resources as well as availing of equal chances of accessing health care (Bankowski, Bryant and Gallagher, 2007).Nursing Ethics Essay Paper

It is therefore a process justified by the outcome. It is important to examine the impact of decisions made on equity. The specific health decisions must go a long way in fostering equity in access to health care services. The health status of most vulnerable groups remains the action points of equity development. There are no specific parameters of determining a group to be classified as vulnerable. However, there are general features which help us in this. There are those who are vulnerable due to social construction while others are as a result of congenital disability. It is usually possible to get an overlap between the two possible causes of vulnerability.

The United Nations charter identifies the promotion of human dignity to be one of its core principles. This is evident in the ratification, conventions and declarations of numerous international agreements in respect of this. One thing that we cannot fail to talk about at the mention of health care is this core principle of promotion of human rights and upholding of human dignity. A good example is the right to information an individual is entitled to on everything that affects his or her health. It is this right that compelled cigarette manufacturing companies to put an information label on their packets. In the recent past, efforts have been put on the reduction of public health burden on the rights of individuals (Sen, Germain and Chen, 2004).

Trampling on the rights of a few individuals through quarantine, mandatory testing and isolation in the name of benefiting the majority is no longer ethically acceptable. A good and most recent example is United Nations’ advocacy of elimination of discrimination against people living with HIV. Together with human rights, dignity is considered an inherent and universal concept. Wide scopes of research in the biomedical field have continued to become the center of discussion on the inherent issues on human dignity. Law enforcers must also expand their focus to other sources of human dignity violation originating from areas outside medical field. Such determinants as political influence, economic factors, technological innovations, environmental concerns and changes in demographics must be looked into.Nursing Ethics Essay Paper

It is important to note that advances have been made so far in the maintenance of human dignity and respect of human rights. Majority of institutions dealing with human health care services have a deliberate way of issuing instructions aimed at improving ethics among-st their staff members. The extent at which ethics instructions are being given is a clear indication of a continuous increase in the expansion in respect of human dignity. The unprecedented attention given to research on health care ethics cannot be attributed to one particular factor. There are a number of reasons as to why every player is shifting focus to this study.

To start with, the knowledge explosion on the biotechnology field has availed a number of avenues available for a medical professional in the fight against diseases. It is now possible to handle situations which were once thought to be untreatable. However, this milestone in medical field has not been a bed of roses. A series of mixed reaction continue to emanate from various sections of the society on how ethical are some of these methods.

Secondly, the cost of accessing basic health care is sky rocketing across the world. Most governments of the day are spending a substantial portion of their Gross Domestic Product on health care expenses yet most citizens cannot get the care they need. This leaves us in total agreement with Howard Hiatt who say that we have a few resources to use in provision of health care and therefore as a society, we need to ask ourselves two important questions. That is how we spend and allocate them. It is as a result of financial constraints that have made us witness denial of adequate health care, limited access and unfair rationing (Hiatt, 2005).

Situational analysis

Issues of ethics in health care are numerous. They range from an individual responsibility to the entire corporate obligations. That is why such issues can be approached from two distinct sides. To start with, macro ethical situations entail what cannot be addressed by a specific practitioner. Such issues are those in which the entire body of health professionals and the community at large must deal with in a bid to ensure that health care ethics are defined and respected. As an illustration, issues such as termination of pregnancy, health care resources allocation and organ transplants are in the category of macro situations. On the other hand, micro situations lie squarely on the hands of a single individual health care professional. It must be realized that ripple effects of macro issues are flow into micro situations.

Ideally, the topic of health ethics should commence from the generally accepted responsibility a medical officer have towards meeting the needs of patients. This brings to our thoughts the issues of competence and trustworthiness of the health care practitioners. Competency goes beyond possessing enough knowledge to deal with a situation. It includes the ability to articulate issues of health and deliver the services timely and accurately. It is also equally important for a patient to have confidence in the person he or she has entrusted his or her body to. Trustworthiness therefore forms a core factor in the satisfaction of patients which finally culminate to enhancement of health care ethics (Berger, 2003).Nursing Ethics Essay Paper

Legal and ethical rights

We are living in an era with serious awakening in discovery of personal rights. The medical professionals have always been assumed to be an all knowing class. A patient would accept to undergo a surgery, take drugs and have a laboratory test without any question or hesitation. This trend referred to as medical paternalism is gradually dying. Patients are becoming consumers with a right to choose what they perceive to best suit them. It is therefore a mandatory standard practice to seek a patient’s consent before carrying out any procedures aimed at restoring health. Doing anything different from this will not only be unprofessional but totally unethical. The overstepping of a practitioner’s mandate in administering health care can also attract serious legal action whose far reaching effects can be detrimental in the career of a defendant. Just like any other customer, a patient desires to attain a definite level of satisfaction. Health professionals who are unable to meet the needs of their patients may not be such attractive in future if they survive legal actions.

The legal rights of individuals are what we cannot avoid to talk about at the mention of health care ethics. The rights are those privileges a person enjoys as provided and defended in the Constitution of a country. Several legislations avails a patient with a series of rights. A patient seeking the attention of health care providers expects that clinical officers will utilize their gained experience coupled with their knowledge in striving to meet their needs. The patient’s rights ensure that independent individuals can expect the health care providers to meet their wishes of getting well without fear of otherwise.

From a broader view, health care systems are primarily based on the rights of individuals seeking treatment. Patients have a sole responsibility of selecting who or what best suits them in terms of health care facilities and doctors. It is required that the patient gives a go ahead of any process through a fairly attained informed consent. This scheme may look very attractive to a person whose has enough economic muscle to meet the cost of treatment. The patient’s right assumes that everyone patient can comfortably settle hospital bills. On contrary, this right is as good as not being there for the patient who does not have a medical cover or enough money to pay (Bankowski, 2006). Although United Nations Declaration of Human Rights says that “that all persons have a right medical treatment” you cannot walk to a health care facility and demand for treatment. It is not enough to receive medical treatment; safety and effectiveness of the services are two paramount features that a treatment seeker is entitled to put into consideration.

Ethical rights impose a responsibility on health care practitioners. The Hippocratic Oath results in a duty by the health professionals to do all they can in benefiting the patients and avoidance of any foreseeable harm. It can be argued that the health care providers must act at the best interest of the patients with disregard to how others are affected by their actions. A legality dilemma created by this Hippocratic Oath is diffused by the controversial exposition by Rem Edwards who claims that the health care providers are obligated to alleviating the aching and suffering of health care seekers.Nursing Ethics Essay Paper

The defects in this point of view are evident on the side of health professionals who operate under strict constraints of laws. The responsibilities of health professionals are thus in conflict with earlier mentioned rights of the patients in the light of ethical and legal correctness. Ordering a health care expert to pursue a personal approach and do what contradicts the law, yet ethical, process in the patient with total disregard of what may befall them legally is as good as telling them to suppress what is important to them in favor of the patient.

Ethical analysis

It is important for a health care provider to continually examine his action so as to ascertain whether he is doing the right thing or not. In 1989, Robert Veatch proposed a four step blueprint which can be used by the health practitioners. This method of analysis involves making sure that there is sufficient knowledge backed by facts for every situation. The second step is bringing in to play whatever is morally upright in relation to the situation at hand. Ethical principles are given a consideration it deserves at the third step. Once the three steps have been taken care of, a fourth and last step of looking in to ethical theories is done.

This provides health practitioners with a reliable, powerful tool available for use when faced with a situation demanding an ethical decision making. This theory formulated by Veatch approaches situation in a chronological manner. He goes ahead to argue that an ethical dilemma can be sorted not necessarily through the four steps but by just laying down the actual facts about a condition. If the application of step number one cannot provide a way out, step two is considered. This focuses on the moral rules guided closely by confidentiality or patient’s consent. At the event that dilemma persists, ethical guidelines of step three are used.

The ethical principle encompasses aspects such as maintenance of autonomy, fidelity, nonmaleficence and beneficence. At this point, the stalemate must have been broken. However, it is possible to have unclear solutions even with the application of ethical principles. It is because of such a situation that a health care professional is compelled to use an ultimate tool available in step four. Ethical theories are the final solution finder in a hard decision making procedure.

A particle and most recent example is seeking of consent of an organ donor. There have been several conflicting issues surrounding organ transplants. The ever growing imbalance between the number of organs demanded and those available for sale has played a major role in heightening the differences between proponents and opponents of this process. It is the obligation of clinicians to make sure that the wishes of prospective organ donors are respected to the later (Beauchamp and Childress, 2009). Various regulations have been put in place to ensure the respect of free will and human dignity of a donor whether death or alive.Nursing Ethics Essay Paper

Conclusion

The challenges facing health care professionals continue to rise with technological advancements and sky rocketing costs of health care. It is therefore of paramount importance to equip them with sufficient knowledge of ethical tools for use in such situations today or in days to come. Totally relying upon ethical codes, principles and theories may not be enough in decision making but serves by providing a rough idea.

This research paper traces the historical development of nursing ethics from the age of Nightingale to the present globalized age and provides an overview of ethical issues and future perspectives on nursing. The nursing profession commenced with sacred work values, and for a long time, a nurse’s primary role was to be a physician’s loyal helpers. However, from the 1970s onward, mainly influenced by the thoughts of the times in the USA, it enhanced its professional autonomy, and nurses came to play a role of patients advocates in order to protect patient’s interests and rights based on nursing advocacy. With the opening of the age of globalization, this also affected the nursing profession. Specifically, it is now facing the issue of the migration of the nursing workforce from poor countries to wealthier countries, which has led to serious problems, including unfairness and gap expansion in health care. It is also facing the issue of how to develop cross-cultural nursing in the world where different cultures intermix. This research paper presents a possible global basis for nursing ethics so as to promote ethical nursing under such an unprecedented circumstance.Nursing Ethics Essay Paper

Introduction
The development of nursing ethics has paralleled the development of nursing as a profession (Fry 1995). This research paper first provides an overview of the development of nursing ethics in the history of nursing. The values and ethics of nursing constitute the basis for nursing. Therefore, it focuses on how the values and ethics of nursing changed according to the evolving trends of the times, as well as changes in the role of nursing and its significance. It also provides overviews of the main ethical theories of nursing and codes of ethics of major nursing associations. Changes in the metaphors used to understand nursing and the development of nursing ethical education and nursing research are also briefly covered. Then, the paper examines the relationship between globalization and the nursing profession, focusing on nurse migration from poor countries to wealthy countries, and the impact of the nurse migration on health care and societies. Also, the paper examines nursing care in the globalized and multicultural settings from the viewpoint of cross-cultural or trans cultural nursing. Finally, the paper concludes by examining how ethical nursing can be provided in a world plagued with various problems with an emphasis on a global basis for nursing ethics.

History And Development Of Nursing Ethics
Nursing is an expression of the natural human feeling and desire to go and help the injured or the sick. So, it can be said that nursing began with the history of human beings. On the other hand, nursing can easily be linked with the religious and spiritual ends and as such brought about many activities of mercy and love. In the nineteenth century, Florence Nightingale took the first step toward an independent profession; however, the basic idea underlying nursing practice was the sense of sacred work derived from God’s calling, for which women with high character were desirable. And, despite the innovative ideas for making nursing an independent profession proposed by Nightingale, the core value of nursing was dedication to the spiritual ideals of Christianity. Christianity required women who were nurses-to-be to be well educated, polite, and virtuous. These requirements were evolved into nursing ethics later, but, in those days, there was no clear distinction between nursing morals and the nursing ethos of the physician’s little helper.Nursing Ethics Essay Paper

Through the two world wars, the role of nurses gradually changed. However, in the USA, which was a leading nation in nursing, changes in awareness and the nursing profession role did not take place until the period from the 1960s to the 1970s during which the human rights movement (civil, women’s lib, etc.) heightened. Meanwhile, remarkable advancements were achieved in medical sciences which forced the medical world to face new challenges, such as brain death criteria that caused challenges, and resulted in the birth of a new study, “bioethics.” In the modern society, facing the new challenges, and with a growing awareness of people’s rights, a “let’s protect our lives ourselves” sentiment arose among patients. In line with this, the Helsinki Declaration was adopted by the World Medical Association (WMA) based on the lessons and reflections from the Nazi crimes in World War II, which led to a new decision-making process known as informed consent. The basis for this decision-making was the concept of autonomy, which later became the prime principle of medical ethics and bioethics in the USA and Western nations. Hereupon, the way of decision-making shifted away from the paternalistic model to the patient-centered model.

Such a new wave in the medical world also made a difference in nurses awareness of nursing, which led nursing to develop and expand its professional role and to formulate a deeper understanding of the nature of care. These changes coupled with the improvement of nursing education, the mainstream of which had been shifting to college education, also provided backdrop for this development.

In the1970s, some American nursing researchers began to emphasize a concept called “nursing advocacy,” which is a view that nurses have an ethical responsibility as advocates of patients’ rights and interests. Some tried to argue that advocacy is the foundation for the philosophy of nursing. For example, some argued that “Advocacy is based upon our common humanity, our common needs, and our common human rights” (Tschudin 2002). Some nursing ethicists interpreted advocacy as “the ethical principle that underwrites what nurses do to protect the human dignity, privacy, choice, and well-being of the patient” (Fry 1995).

The concept of advocacy is not a new concept because nurses have always put patients well being first in their practice since the ancient times. Then, what is the difference between the advocacy concept emphasized at that time and the traditional one? They are not different in nature at all. However, the modern conception of advocacy places more emphasis on protection of patients rights and interests in difficult situations. For instance, imagine a case where a physician orders a clinical test which does not serve a patient’s direct interest. Traditionally, a nurse reluctantly followed such physician’s orders even if she/he thought it was an odd order. However, modern advocacy requires nurses to stand on the patient’s side, not the physician’s side, and protect patient’s interests and rights. In this case, the nurse can ask the physician a question. In fact, she/he must do it.Nursing Ethics Essay Paper

Accordingly, the primary professional responsibility of nurses became to care receivers. In this context, the role of the nursing profession recognized by nurses themselves was changed from a physician’s loyal helper to an independent practitioner. With this change in their role awareness, nurses began to regard themselves as healthcare professionals to be engaged not only in caregiving to the sick but also in disease prevention and health promotion and, eventually, expanded their awareness as healthcare professionals related to various issues, including social injustice and unfairness.

These changes in nurses awareness of the nursing profession are clearly reflected in the Code of Ethics of the American Nurses Association (ANA) and the Code of Ethics for Nurses of the International Council of Nurses (ICN). Since its adoption in 1950, the ANA Code of Ethics has been revised many times, and the newest edition clearly describes the object of nurses ethical responsibility and nurses role as advocates. And, since its adoption in 1953, the ICN Code has also been revised many times. It also clearly describes that a care receiver is the prime object of ethical responsibility of nurses, and a wide range of nurses ethical conducts are based on the concept of advocacy. Later, these codes of ethics influenced the code of ethics of each nation’s nurse association.Nursing Ethics Essay Paper

In this trend, the way of decision-making concerned with nursing care also changed. Up to that time, nurses had decided everything about care for patients and implemented it like a mother in the spirit of paternalism or “materialism.” Then, after patient’s autonomy began to be emphasized mainly in American society, some began to argue that the nurses’ role as advocates was to respect patient’s autonomy on decision-making and support them so that they could make better decisions for their well-being. This sort of relationship can be realized as a partnership between nurses and patients, which is called the “contracted clinician model” of the patient-nurse relationship introduced by Smith (Smith 1981). This is not a relationship where patients decide their care plans unilaterally and request that nurses implement them, but it requires agreement between the patient and the nurse. Only after nurses agreement is gained, a care service contract is concluded between a caregiver and a care receiver. Another model gives more authority to patients for decision-making. In this “technician model” introduced by Smith, patients unilaterally decide care programs, and nurses should accept them without evaluating them and implement them with their best nursing skills. In this model, nurses ethical responsibility is in exact implementation of the care plans decided by patients. Some nurse ethics uses the metaphor of “nurse as guest.” In this case, the host is not a nurse but a care receiver, and a nurse is the guest invited by the host to provide the host with the best care. The nurse has to provide the best care for the quality of life of the host, a care receiver, complying with the requests from the host, who is the expert of his/her own life. Nurse’s ethical responsibility lies in providing the best care for the host (Milton 2006).

The changes in the models of relationships in nursing over viewed here clearly show the changing process from “physician’s obedient helper” and “surrogate mothers of patients” to “advocates of patients” who support their decision-making and protect their interests and rights.Nursing Ethics Essay Paper

In the 1970s, nursing ethics was officially introduced in the nursing education curriculum, but it was not until the 1980s that satisfactory textbooks of nursing ethics were published. In 1979, the famous book Principles of Biomedical Ethics written by Beau champ and Childless was published. Influenced by this book, nursing researchers, for themselves, also began their researches on nursing ethical principles and the ethical basis for caring. Details will be described later.

In those days when “nursing ethics” was started in the curriculum in real earnest, the following topics were discussed in the lectures: “balancing harms and benefits in patient care,” “protecting patients autonomy,” “distributing nursing care resources,” etc. These are often discussed still today. The overall goal of nursing ethical education in those days was to produce nurses who could make good ethical decisions and fulfill their ethical accountability (Fry 1995). This has been handed over until today.

As nursing ethics education widely spread, research on nursing ethics became active. As the age of globalization dawned, international collaborative research has been conducted more frequently. Growth of the Internet has partially contributed to realizing this, since in the late 1990s when the world entered into the age of globalization. The term “globalization” first appeared in a dictionary in 1961 and had been used mainly by economists as early as 1981. In the late 1990s, it became widely known (Davis and Tschudin 2008). What caused the phenomenon known as globalization? Possible causes might be changes in geopolitics, the opening of borders, praise of free market economy by the demise of the Soviet Union, and spread of the Internet by advancement in information technology (Hirschfeld 2008). Here, details are not discussed. The nursing profession was also swallowed by the surge of globalization, and a new development took place.Nursing Ethics Essay Paper

New Ethical Issues And A Perspective Of The Nursing Profession In The Age Of Globalization
Nancy Crigger describes globalization as follows: “Globalization is defined as a process by which the world is interdependently organized and understood. This definition implies that the process is discursive and holistic, and will in turn affect people economically, psychologically, spiritually, politically and culturally. With globalization, the borders of nations become porous and encounters among people become inevitable. Exchanges and changes occur among people, nations and ideas” (Crigger 2008, p. 19). Using the well-known Adam Smith metaphor, she argues that globalization has formed the world society by its powerful and dynamic “hidden hand,” including exchanges of ideas and values. She introduces two models of globalization, referring to works by W. Schweiker and S. B. Twiss, “from above” and “from below.” The former is political and economic globalization, which often creates injustice through the complex tangled webs of business, politics, and economies among nations and enterprises. In other words, it has produced victims by causing exploitations, spreading poverty, and damaging the environment. The latter is social globalization supported by grassroots activities, primarily by NGOs, human rights advocacy groups, religious organizations, ecological groups, and scholars groups, including nursing. Crigger argues these are activities to improve social quality, heighten social awareness, and call for better health and wellbeing for all the people.

It is obvious that nursing has been hit by the wave of globalization similarly to others. “Globalization impacts nursing at all levels and in all places” (Davis and Tschudin 2008). Therefore, it is imperative to see nursing after the late 1990s in its relationship with globalization in order to have perspective on the future of the nursing profession.

Globalization’s Impacts On Nursing: Focusing On The Issue Of Nurse Migration
The most striking impact on the nursing profession caused by globalization is the international migration of the nursing workforce. A worldwide nursing shortage serves as a backdrop for this issue. Originally, developing countries had suffered a nurse shortage. Due to their poor education systems, the number of qualified nurses produced each year was limited, and although new graduates were willing to work, there were not enough workplaces to accept them due to the defective medical systems or money shortage to officially hire them. As a result, in those countries, there are many qualified nurses without employment, while health care is in high demand. In remote areas, imbalance between demand and supply of health care has become more severe due to the geographically uneven distribution of medical facilities in those countries. Among them, sub-Saharan African countries are in the most serious situation due to their nurse shortages (Hirschfeld 2008).Nursing Ethics Essay Paper

Besides, developed countries are also facing the serious nurse shortage problem caused by the population increase, especially the increase in the elderly population, and the growing demand for healthcare service. In addition, due to the low birthrate, the population of young nurses-to-be is decreasing. To make matters worse, young people, who are used to an abundant lifestyle in those countries, tend not to want to be healthcare workers. In Japan as well, nurse shortage has been a serious problem. In addition to the nursing profession’s low social status, bad working conditions, and other issues besides, Japan has had this problem since its vocational school-based nursing education system has kept young people seeking higher education away from the nursing profession. As in Japan, people’s educational background has been all-important; the more intelligent young people have tended to go to colleges or universities rather than to vocational schools. However, as the number of nursing colleges or universities has increased, the nursing education system has improved (Sawada 1997).

Regardless of whether they are developed or developing countries, nurse shortage has become a worldwide phenomenon. The situation where the sustainability of public health care is being jeopardized has become a serious problem for the health maintenance of people. Under such circumstances, the idea of recruitment of nurses from developing countries was proposed to make up for the nurse shortages in the developed countries. As it was carried out frequently, the international nurse migration began to cause serious ethical problems.

With the power of money, developed countries have been recruiting nurses from developing countries, especially from Africa, Southeast Asia, and South America. According to the statistics as of 2002, the rate of unfilled post for registered nurse in Ghana was 57 %, and the vacancy rate for nurses in Malawi was 52 %. Specifically, Malawi is a country with one of the highest shortages of nurses, and according to the WHO’s nurse availability data in 2006, the stock per 1,000 population is 0.59. WHO recommends the minimum standard of nurses is 1.71 per 1,000 population. In Ghana, it is 0.92 (Twining 2010). Also South Africa is suffering the brain drain of nurses due to recruitment by developed nations, and now South Africa is recruiting nurses from other African nations to make up for its nurse shortage. In Peru, 15 % of the nursing workforce migrated primarily to Spain, Italy, and the USA between 2002 and 2006 (Hirschfeld 2008). In Southeast Asia, the Philippines has been the main supplier of nurses. Historically, the economy of the Philippines has been supported partially by overseas migrant workers, and with a view of nurse supply to foreign countries, higher numbers of nurses have been educated than its domestic demand. However, Bertram argues, referring to the article by J. Buchan and J. Sochalski, that recently the situation seems to be changing as the continued migration has left a shortage of nurses to provide care in the Philippines (Bertram 2008).Nursing Ethics Essay Paper

Nurse recruitment by developed countries has caused various problems in developing countries. Before looking at these problems, benefits brought by nursing workforce migration are briefly described below. First of all, from a standpoint of accepting countries, nurse migration contributes to easing those countries’ nursing shortages to some extent. Particularly, for countries like the USA where patients have different cultural backgrounds and languages, suitable nurses are more likely to be assigned to patients. And, migrated nurses can gain better salaries and improve their quality of life. In some countries, such as Saudi Arabia, Asian or African nurses are paid less than European and American nurses, but still their salaries are higher than those paid in their countries. With their salaries, nurses can support the livelihoods of their families left behind. Moreover, working in developed countries gives them opportunities to learn more, which leads to their career progressions. For countries whose economies are supported by its citizens working overseas, money sent by nurses working overseas enriches the nations’ finances. In this way, it can be said that nurse migration does not necessarily lead to bad results.

Nevertheless, many of the problems caused by nurse migration are very serious. Above all, health care in those countries from which nurses migrated has fallen into a desperate situation. With few exceptions, those countries originally suffered serious nurse shortages, and nurse migration has depleted their nursing workforces, which not only makes it impossible to satisfy their citizen’s health needs but also has seriously affected patients’ safety. Furthermore, as physicians also have migrated from those countries for better salaries and lives, the healthcare situation in those countries is critically serious. In families of migrated nurses, who are left behind in their countries, children lose a mother who takes care of them, and, in many cases, elderly people who need care are also left behind, which makes things much worse. Even in the case when nurses work in their own countries, many nurses from countryside’s move to big cities to find jobs, seeking better working conditions. So, the difficult situation of the children and elderly people left behind is similar to that of the migrated nurses’ families (Hirschfeld 2008). This is particularly true in sub-Saharan African countries with a high HIV/AIDS burden, especially where elderly women take care of their dying adult children and the orphans without any social sustainable means (Hirschfeld 2008). While those countries originally had suffered a serious nurse shortage, the drain of nurses worsened the situation extremely.

Globalization allows wealthy countries to economically exploit poor countries, widens the richpoor gap, and is ever widening the chasm between the have and have-nots (Austin 2008). And, it is said that the burden of poverty first comes to women. When families cannot live on their incomes, it is almost always women that go abroad to find jobs. That is because, in developed countries, a variety of jobs ranging from healthcare workers to live-in maids and jobs at brothels await poor women (Davis and Tschudin 2008). Globalization and gender issues are intricately intertwined with each other. These are challenges which must be considered seriously, and it must be kept in mind that poor female migrant healthcare workers are an integral part of health care in the healthcare systems of some wealthy countries (Hirschfeld 2008).Nursing Ethics Essay Paper

As just described, the nursing workforce migration from poor countries to wealthy countries has caused various problems, such as expansion of the rich-poor gap and unfairness. Is it morally acceptable to recruit nurses from developing countries in such a reckless manner? Some argue, referring to the A. H. Aiken’s article, that it is not acceptable, and, in the first place, wealthy countries have to address the nurse shortage by making effort for achieving self-sufficiency in their health workforces. Regarding the reckless recruitment, recruitment agencies seem to play active roles in the global healthcare market (Hirschfeld 2008). With this information, international society began making guidelines for nursing recruitment. The UK issued international recruitment guidelines in 1999 and 2001, and the USA did in 2005, which prohibited nurse recruitment from countries experiencing nurse shortages unless there is an explicit government to-government agreement to promote recruitment. However, the main focus of each guideline varies depending on countries. The ICN issued the position statement of Ethical Nurse Recruitment in 2001, placing focus on the right of individual nurses to migrate wherever they choose (Bertram 2008). This makes us face an ethical dilemma: when a country suffers a nurse shortage, is it ethically acceptable that nurses seek work outside the country? In light of the ethical principles, this is a conflict between the ethical principle, “autonomy” for nurses and their “freedom of choice,” to migrate and another ethical principle of “distributive justice” or fair distribution of nursing care for a nation’s common good. ICN claims that, basically, a nurses’ fundamental right of freedom of choice to migrate must not be infringed. Though, in this case, nurses need to take deliberate actions. They are asked to make an ethically correct decision through serious consideration by examining their nursing competence and their own situations.

Nurses And Patients In Cultural Diversity: Trans cultural Nursing
In the age of nursing globalization where nurses are internationally migrating, it adds another aspect to their workplaces: various cultures are brought to healthcare settings. According to the statistics in the USA, which has accepted a great number of nurses from overseas, 11 % of the US registered nurse workforce were “foreign born,” and, of these, 70 % immigrated from developing countries (Hirschfeld 2008). Such a circumstance may give rise to cultural friction between migrated nurses and patients or care receivers, but in the USA, many patients are also of culturally diverse backgrounds. It is said that there are roughly two cultural groups in the world. One group is an individualist culture which refers to mainly North American and Western European cultures. The other group is a collectivist culture which refers to Asian, African, and South American cultures. These are chiefly cultures of the developing countries and account for about 70 % of the cultures in the world (Davis 1999). As nurse migrations are mostly moves from the developing countries to the developed countries, it is quite understandable that people may have concerns about cultural frictions between nurses from collectivist cultures and people from individualist cultures. There is an exception. Japan, which has a collectivist culture, has accepted nurses from Southeast Asia due to its nurse shortage. Getting back to the issue of cultural friction, it is friction between a culture that claims individual rights, such as autonomy, and a culture of shared decision-making with one’s family or group. As already mentioned, the decision-making based on autonomy was born in American culture. As American nursing values and ethics have been disseminated to nursing societies all over the world (Davis 1999), even nurses in the collectivist culture group have some knowledge about them. However, their native cultures are so deeply rooted in the migrant nurses that it is not easy for those nurses to get rid of their cultures even after they migrate to the European and American cultural region.

Respecting the collectivist cultural traits of nurses mentioned above, what should we do to provide suitable care for patients who increase cultural diversity in the surge of globalization? Based on the awareness of such a problem, a concept of transcultural, or cross-cultural nursing, was born. Transcultural nursing refers to nursing practice and research focusing on cultural differences and similarities and is aimed at providing patients with culturally fitting care. Therefore, to provide care which fits the cultures of the care receivers is important, and the ability to achieve this is called cultural competence. To acquire this competence, nurses are required to sharpen their sensitivities to care receivers’ value systems as well as receiving a series of training for fostering such cultural sensitivities (Donnelly 2000). Care supported by those who have this competence is culturally competent care. However, there is a different view over the concept of cultural competence that questions: Is it possible to understand different cultures so easily? One’s self-confidence that he or she understands other cultures very well may sometimes lead to problems. Some researcher argues that it is important to know that a sufficient enough understanding of different cultures is difficult for us (Davis 2007). Nursing Ethics Essay Paper

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However, should nurses respect and accept all cultural customs of care receivers? For instance, if a mother who migrated from Equatorial Africa attempts to practice female genital mutilation (FGM), which is an African tradition, on her young daughter, how should nurses handle this case? Not only does FGM have substantial medical risks as a matter of developing complications for those girls who undertake the procedure, but also it encourages gender discrimination. So, this is an unethical act. Care with respect for one’s culture is necessary, but unethical acts must not be allowed. Then, a global standard on nursing ethics is needed. This issue is considered in next section.

Cultural issues of migrant nurses are also relevant. For example, at a hospital with few Muslims, a Muslim nurse asked for permission to wear a niqab (a veil over her face, leaving only eyes visible). The hospital decided to give her temporary permission in order to see patients’ reactions. The result was that in particular, children, elderly people, and confused patients were frightened by the invisibility of the nurse’s face. The hospital concluded that wearing a niqab would not lead to good care and forbade the nurse to wear it. In this case, producing a good result for patients was judged to have more importance than respecting nurses’ autonomy. In another case, a Muslim nurse asked for permission to wear a hijab which covers only her hair. It was approved because a hijab does not hinder contact with patients as much as a niqab (Rowson 2008). As seen in these cases, nurses’ cultural issues must be considered in line with nursing goals, and, if it becomes an obstacle to achievement of the goal, some argue that the nurse’s autonomy has to be limited. On the other hand, patients’ cultural customs must be respected unless they are unethical.

Global Basis Of Nursing Ethics
As mentioned above, in the age of globalization, different cultures make a culturally complex world, and various ethical issues have arisen, including gap expansion and unfairness in health care. In such an age, is it possible to establish a common basis for nursing ethics beyond the differences among countries and cultures? Richard Rowson stated at the international conference on Globalization of Nursing in the UK in 2006: “In the globalized nursing world and increasingly complex cultural situation, it is not easy to establish core values on nursing ethics.” Even so, if a common basis for nursing ethics cannot be established, nurses may fall into ethical relativism and allow themselves to do anything, in a way, by positioning each individual’s conscience under the traditions and social customs. In such a situation, it might be impossible to provide proper nursing. Then, Rowson set nursing goals in the age of globalization as follows: “to promote the health of, and to care for, all people, regardless of their cultural affiliation, race, sexual orientation, level of disability, and so on” (Rowson 2008). Nursing Ethics Essay Paper

In order to ethically achieve these goals, he proposed four basic elements of a global basis for nursing ethics. Those are fairly, autonomy, integrity, and results. With initial letters of each element, he termed them FAIR. Each means: nurses treat people fairly, respect people’s autonomy, act with integrity, and seek the most beneficial results (Rowson 2008). He argues that FAIR fits with most people’s personal values. It may be from the influence of American ethics that autonomy is included in the four elements, because such an ethical concept is largely a Western, specifically American, idea. In terms of autonomy, today there are criticisms against the trend that places too much emphasis on autonomy. Autonomy is surely important, but it is not an absolute principle. And, in these days, more patients tend to make decisions by consulting with important others like families or friends more frequently rather than alone (Tschudin 2002). In the Principles of Biomedical Ethics (2012) written by Beauchamp and Childress, the supremacy of autonomy has been toned down. The four principles proposed by them, autonomy, non-maleficence, beneficence, and justice, are well-known principles which have long been weighed in nursing ethics and are still applied to it (Beauchamp and Childress 2012). However, some argue that the principles of medical ethics do not necessarily fit nursing well, because the relationship between nurses and patients, and between doctors and patients, rests on different basis. The former is one of more intimate and more long-term care (Tschudin 2002). Then, nursing researchers have started studies on ethical principles that could be a basis for global nursing ethics like those established by Rowson, and, moreover, other researchers notice ethical elements as a basis for care. The following are samples based on the introduction by Tschudin (2002).

Simone Roach has established 5Cs for caring: compassion, competence, confidence, conscience, and commitment. Compassion is a gut-wrenching feeling we feel at others’ agonies. This is what is experienced rather than what is learned in theory and is the basic attitude of caregivers. Competence is a professional coping ability and one’s state of acquired knowledge, judging capability, skills, energy, experiences, and motivation. Confidence is the quality of fostering trusting relationships. Without that the essence of caring is lost. Conscience can be defined as a state of moral awareness, and it urges people to take moral actions. Commitment is necessary for confirming other 4Cs. This is a sort of devotion, because professional care is a form of love which entails a personal commitment (Tschudin 2002).

Rita Manning proposes five elements of care ethics: moral attention, sympathetic understanding, relationship awareness, accommodation, and response. Moral attention requires caregivers to take time for giving holistic care. Sympathetic understanding is close in meaning to what Carl Rogers called “unconditional positive regard.” Relationship awareness is described in three levels: the relationship with colleagues, the relationship of need and ability, and the relationship of professional and client. Accommodation is to think about all the people involved and listen to them. Response is to find out others’ wish through close communication and to act according to it (Tschudin 2002).

The abovementioned ethical standards proposed by nursing researchers were introduced as a basis for global ethics. The ICN Code of Ethics for Nurses can also be a common ethical standard in the age of globalization. In particular, the four responsibilities described in the “Preamble” – “to promote health, to prevent illness, to restore health, and to alleviate suffering” – can be standards easy to understand.

Many studies on the basis for nursing ethics that are suitable for the age of globalization are being conducted today. This is because it is of immeasurable importance for nurses to have common ethical standards in order to deepen their common understanding about the important issues. Not only absolute ethical principles but also broad ethical concepts were introduced in this article. In the age of globalization when diverse cultures, people, languages, and religions coexist, ethical expressions which allow flexible interpretations may be more suitable than rigidly defined ones.

However refined ethical standards we have, it is human beings that use them. That is the reason why caregivers are required to have a certain quality. On this point, A. Sen identifies ten human capabilities as central human capabilities: life; bodily health; bodily integrity; senses, imagination, and thought; emotions; practical reason; affiliation; other species (animals, plants, and the world of nature); play; and control over one’s environment. These are the benchmark on which to base the development of a global nursing ethic and have a direct link to our central nursing responsibilities (Hirschfeld 2008).

Some stress that ultimately everything depends on the level of trust in the relationships that nurses can establish with care receivers. Verena Tschudin (2002) considers that all ethical reasoning approaches start from here. She argues that, not acting rigidly based upon ethical principles, nurses need to think about care receivers’ needs from various aspects, including their emotional aspects, through communications with them, and conduct heart-based ethical decision-making and nursing. I and Thou (Ich und Du) by Marin Buber is a good model for the relationship of this kind. It might be too high an ideal to realize, but it is vital as a direction to pursue. Nurses who are caregivers are required to meet care receivers without any bias and relate to them with empathy. This is the basis for relations suitable for the era of globalization. Care starts with “we.”Nursing Ethics Essay Paper

Conclusion
In this research paper , the history of nursing ethics, starting from the Nightingale age to the age of globalization, was traced. Since the wave of globalization hit the nursing world, particularly with the global nurse shortage in the background, various ethical issues have emerged. Furthermore, healthcare settings have become increasingly multicultural. In the midst of such an age, what ethical principles that can be used as a common ethical basis for realizing ethical nursing were explored. Today, it is no longer possible to grasp our life-threatening issues within our domestic framework. Nurses are expected to be more aware of social justice and their global responsibility and play active roles. For achieving these, first of all, it is necessary for nurses to start from their own workplaces. Constantly thinking how they should live their lives as human beings and how they can fulfill their responsibilities for others, nurses should cultivate their capabilities for the future good. The arena for nurses’ activities is expanding.Nursing Ethics Essay Paper