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main discussion

1. Discuss the concepts of ethics and morality and their application in the psychiatric nurse practitioner field.

2. Ethical decision making may be based on personal religious and philosophic viewpoints, but must always be grounded in professional standards and the statements of patient’s rights. Discuss a case or situation where you encountered an ethical dilemma and how you applied your ethical decision making.

Response one elege

The terms ethics and morals are closely related concepts, morals refer mainly to guiding principles, and ethics refer to specific rules and actions or behaviors. A moral precept is an idea or opinion that is driven by a need to be good. An ethical code is a set of rules that defines actions that are allowed or correct behavior (Buppert, 2018). The term ethics refers to the concepts of moral right and wrong and moral good and evil, to any philosophical theory of what is morally right and wrong or ethically excellent and evil, and to any system or code of ethical rules, principles, or values (Maluwa, Gwaza, Sakala, Kapito, Mwale, Haruzivishe, & Chirwa, 2019).

Professions distinguish themselves by placing special ethical obligations and responsibilities on their members (Akrami, Zali, Abbasi, Majdzadeh, Karimi, Fadavi, & Mehrabi Bahar, 2018). Several ethical issues can come up in a nurse practitioners’ daily practice, such as: when to terminate a relationship with a patient; accepting a gift or meal from a pharmaceutical representative; discussing deficiencies of a patient’s insurance coverage, and telling a patient, you are moving to another practice (Buppert, 2018). There are five main principles of ethics in nursing. These are Beneficence, Justice, Fidelity, Non-Maleficence, and respect for autonomy (Buppert, 2018).

According to the code of ethics and practice, nurses are expected to provide comprehensive, holistic, and ethically accepted care (Maluwa et al., 2019). The International Council of Nurses (ICN) code of ethics from where the code of ethics for nurses is derived; nurses are expected to promote health, prevent illness, restore health and alleviate people’s suffering (Maluwa et al., 2019).

Jansen & Hanssen (2017) points out that patient participation is an ambiguous, complex, and poorly defined concept in psychiatric nursing. With practical/clinical, organizational, legal, and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance, when constraints thwart moral, caring acts. Nurses have a particular ethical responsibility towards vulnerable patients and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Patient participation is often a neglected value in the current psychiatric treatment philosophy. When healthcare workers’ ethical sensibilities are compromised, this may result in moral stress (Jansen & Hanssen, 2017).

The following is an example of an ethical situation that I encountered. A colleague was impaired due to drug and alcohol abuse and was no longer competent, she ignored my warnings to get help, and I had to report her to the supervisor. It is not proper to endanger the life of the patients. I did not report her to the board because the board is not designed to help but rather to punish and demonstrate their value.

References

Akrami, F., Zali, A., Abbasi, M., Majdzadeh, R., Karimi, A., Fadavi, M., & Mehrabi Bahar, A.

(2018). An ethical framework for evaluation of public health plans: a systematic process for legitimate and fair decision-making. Public Health, 164, 30–38. https://doi-org.ezp.waldenulibrary.org/10.1016/j.p…

Buppert, C. (2018). Nurse Practitioner’s Business Practice and Legal Guide (6th ed.). Jones &

Bartlett Learning.

Jansen, T.-L., & Hanssen, I. (2017). Patient participation: causing moral stress in psychiatric

nursing? Scandinavian Journal of Caring Sciences, 31(2), 388–394. https://doi-org.ezp.waldenulibrary.org/10.1111/scs.12358

Maluwa, V. M., Gwaza, E., Sakala, B., Kapito, E., Mwale, R., Haruzivishe, C., & Chirwa, E.

(2019). Moral competence among nurses in Malawi: A concept analysis approach. Nursing Ethics, 26(5), 1361–1372. https://doi-org.ezp.waldenulibrary.org/10.1177/096…

Response two OMILE.

Concepts of Ethics and Morality and Their Application in The Psychiatric Nurse Practitioner Field

Ethical values are essential for any healthcare provider. Ethics comes from the Greek word “ethos,” meaning character. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Ethics are moral principles that govern how the person or a group will behave or conduct themselves. The focus pertains to the right and wrong of actions and encompasses the decision-making process of determining the ultimate consequences of those actions. Each person has their own set of personal ethics and morals. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. To practice competently with integrity, nurses, like all healthcare professionals, must have regulation and guidance within the profession. The American Nurses Association (ANA) has developed the Code of Ethics for this purpose. Ethical values are essential for all healthcare workers. Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse’s ethical values. Nurses are advocates for patients and must find a balance while delivering patient care (Haddad & Geiger, 2020). According to Buppert (2018), in nursing and in medicine, the guiding general rule of ethics is “do no harm.” This principle is attributed to the Greek physician Hippocrates, who died in 370 BC. His statement was “Make a habit of two things: to help; or at least to do no harm.” The clinician who employs Hippocrates’s guidance, every time something is ordered, or advice is given, will have a sound basis for ethical practice. Common medical/nursing ethics include the following:

1. Beneficence: Benefit others by preventing harm, removing harmful conditions, or affirmatively acting to benefit another or others, often going beyond what is required by law.
2. Justice: Treat others equitably, distribute benefits/burdens fairly.
3. Fidelity: Loyalty, fairness, truthfulness, advocacy, and dedication in relationships; includes promise-keeping, truth-telling, and fulfilling commitments.
4. Non-maleficence: Obligation not to inflict harm, balancing unavoidable harm with benefits of good achieved.
5. Respect for autonomy: Acknowledge a person’s right to make choices, to hold views, and to take actions based on personal values.

According to Sidhu & Srinivasraghavan (2016), within medicine, mental health practitioners are faced with ethical dilemmas that are unique and challenging. Only when a patient’s mental health is incapacitated, can rights such personal freedom be challenged. The patient’s disclosure of personal information puts information in the hands of the mental health practitioner that may be highly sensitive. Thus, patients often find themselves in vulnerable positions in such situations where the power differential is marked that can result in boundary violations. Compassion is an integral part of professionalism, along with transparency, honesty, listening to the patient, developing an understanding of the uniqueness of the patient and their story and respecting the basic human rights of the patient. A psychiatrist, psychiatric nurse practitioner, or therapist must always endeavor to act in a manner that upholds the highest values of his/her profession and value the trust put in his/her by the patient.

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An Encountered Ethical Dilemma Case and Application of Ethical Decision Making

On one of my consultations, I have a patient with schizophrenia, but with good remission, and in a stable mental health, who was accompanied by his mother to his appointment. Client was scheduled for psychiatric re-evaluation. Client has human immunodeficiency virus (HIV) infection, but his mother was not aware of it. Client was concerned of been diagnosed with HIV, and he asked the clinician that he wants the information confidential, and to be withhold from his mother. Clinician must respect his client’s choice, in this case, respect for autonomy, and the information was withheld from his mother per his request.

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References

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Buppert, C. (2018). Nurse practitioner’s business practice and legal guide. Sixth edition. Burlington,

Massachusetts: Jones & Bartlett Learning.

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Haddad, L. M, & Geiger, R. A. (2020). Nursing Ethical Considerations. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK526054/

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Sidhu, N., & Srinivasraghavan, J. (2016). Ethics and Medical Practice: Why Psychiatry is Unique. Indian

journal of psychiatry, 58(Suppl 2), S199–S202. https://doi.org/10.4103/0019-5545.196838