Nightingale Pledge: Medical Ethics Perspectives

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Topic: Health & Medicine
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Introduction

The Nightingale pledge was developed as an oath students graduating from the Farrand Training School for Nurses (Veatch, 2000). The pledge was created in 1893 and revised in 1935 to improve its scope (Brown, 2003). Since then, it has undergone several modifications in order to fit the values and practices of different nursing schools.

The pledge was named after Florence nightingale for her contributions during the Crimean war (Brown, 2003). She is considered as the mother of modern nursing because of her innumerable contributions (Small, 2001). Examples of her contributions included the environmental theory of nursing and development of methods for graphical representation of statistics.

The pledge was developed by making minor changes to the Hippocratic Oath, which was the main pledge administered to professionals in the medical field (Small, 2001). Nightingale was very influential because of her description of nursing paradigms that include nursing, health, environment, and person. Her postulates and theories are used in contemporary nursing as guiding principles. The Nightingale pledge has several benefits and limitations.

The practice of taking oaths is common in all professions. It involves promising to abide by a certain set of rules that guide the conduct and behavior of professionals in specific fields (Veatch, 2000). Oath taking is based on the philosophy that all professionals should be responsible for their conduct because their actions influence the actions of the people they serve (Small, 2001). As mentioned earlier, the Nightingale pledge was named after Florence Nightingale for her contributions to modern nursing. Lystra Getter developed the pledge for nurses who graduated from the Farrand Training School for Nurses (Veatch, 2000).

Function and purpose

The Nightingale pledge forms the foundation of modern nursing because it promotes professionalism and integrity (Vickie, 2009). It encourages nurses to adhere to the code of ethics of their profession. The pledge has been recited by graduating nurses for a very long time. Nurses promise to fulfill their duties with professionalism, improve their profession, maintain loyalty to patients, and act with honesty and integrity (Brown, 2003).

They pledge to live in purity and practice professionalism in their work, refrain from ill behaviors, improve the standards of the nursing profession, and maintain loyalty to patients. In the original pledge, nurses also promised to maintain loyalty to physicians by assisting them in their duties. The pledge has undergone many changes in order to incorporate certain aspects of the nursing practices and values of different nursing schools.

Ethical benefits

The Nightingale pledge has several ethical benefits. It provides a foundation for the code of ethics of the nursing profession, encourages professionalism among nurses, provides moral guidance with regard to patient care, and promotes the standards of the nursing profession (Vickie, 2009). In addition, it promotes honesty and trust between nurses and patients.

The pledge plays a vital role in influencing the decisions made by nurses. These decisions involve their conduct, behavior, improvement of the nursing profession, interactions with other professionals, and loyalty to patients (Veatch, 2000). Two of the most important aspects of the relationship between patients and nurses are honesty and confidentiality. It is unethical for a nurse to lie to a patient or divulge any medical information without their consent (Veatch, 2000). Confidentiality is one of the challenges of modern medicine.

The pledge cultivates an environment of trust and honesty because nurses promise to refrain from divulging medical information without the consent of patients (Vickie, 2009). The pledge stops nurses from violating patient-nurse confidentiality. Moreover, it keeps nurses in check in order to avoid violation of patients’ information privacy. Modern science is an ever-evolving field that requires constant research and improvement. Nurses pledge to improve the nursing profession. For that reason, many nurses pursue higher education and undertake extensive research studies in order to improve the standards of their profession.

Limitations of the pledge

The pledge has several limitations that have been the source of widespread criticism. Examples of these limitations include reference to God, pledge to purity, and pledge to support physicians in their duties. In contemporary society, the pledges do not meet the standards of the diverse population that subscribe to different beliefs, religions, and values (Russell, & Cohn, 2012). The promise to support physicians is two-sided. First, it is feminist and second, it undermines the autonomity of nursing as a profession.

The nursing profession has been a reserve of women for many years. On the other hand, male physicians have dominated numerous medical fields for many years. Therefore, requiring nurses to promise to support physicians in their work is seen as a feminist sentiment that should not be part of the Nightingale pledge (Herman, 2013). All professionals in the health care system play complementary roles that contribute towards the excellence and effectiveness of the system.

Arguments in support of the pledge

The pledge plays an important role in the improvement and development of the nursing profession through research and pursuance of higher education (Vickie, 2009). The health care system comprises many professionals whose services are in great demand. In order to improve the efficiency of the system, it is important for all professions to work together and support one another (Veatch, 2000).

Nurses pledge to help physicians in their duties. Even though this promise has been criticized and deleted from the oaths of many nursing schools, it is important because it promotes cooperation between nurses and other professionals in the health care system (Herman, 2013). Examples of the pledge’s themes that work toward the realization of these benefits include loyalty, improvement of the nursing profession, beneficence, and honesty (Brown, 2003).

Finally, the quality of patient care is an important aspect of the health care system. The pledge plays an important role in improving the quality of health care services because nurses promise to stay committed to the welfare of their patients (Russell, & Cohn, 2012). The Nightingale pledge requires nurses to take great care of all patients regardless of age, religion, ethnical background, or race. The pledge guides the nursing profession and renders it a value and principle-based profession (Herman, 2013).

Arguments against the pledge

A promise to support physicians in their work undermines the role that nurses play in providing healthcare services (Herman, 2013). According to the pledge, nursing is a supportive profession that is inferior to other fields of medicine. For instance, a nurse is primarily required to assist physicians in executing their duties. For that reason, nurses cannot play roles such as prescription of medication and surgical operations. The pledge undermines the autonomity of the nursing profession.

Various nursing schools have modified their pledges by deleting the part of the pledge that requires nurses to support physicians in their work. These schools consider nursing as an independent profession whose services are not subordinate to the services of other professions within the health care system (Russell, & Cohn, 2012). The pledge to adhere to the instructions of a supervising physician or nurse is also limiting. Sometimes, nurses encounter situations that call for speedy intervention in order to avert calamities such as death.

In such situations, the judgment of a supervising physician or nurse could be wrong. However, according to the pledge, nurses promise to follow the instructions of their supervisor. A nurse could be forced to take action that could place a patient in grave danger. In addition, it strips nurses of any power to act based on ethical judgment rather than the personal judgment of their supervisors. The issue of loyalty is another limitation of the pledge. In the 1935 version of the revised pledge, nurses promise to be loyal to physicians.

Critics argue that nurses should only be loyal to their patients and not physicians (Russell, & Cohn, 2012). Loyalty to patients improves the quality of care, expresses compassion for the suffering, and promotes the standards of the nursing profession. Finally, the pledge’s reference to God is inappropriate because of the diversity in the religious affiliations of nurses. The pledge ignores the welfare of nurses who do not subscribe to any super power or religion. It creates a feeling of alienation in nurses who do not believe in God.

Finally, the pledge’s reference to purity is ambiguous and oblivious of the different beliefs and values of nurses (Herman, 2013). Personal principles and values are personal choices that should not be dictated by oaths or external forces. The pledge is oblivious of the complexities of modern science and the diversity of the contemporary society. The pledge has several principles that are important for promotion of nursing standards. However, the aforementioned weaknesses ignore the diversity in the beliefs and values that people treasure, as well as the innumerable complexities of modern science.

Conclusion

The Nightingale pledge was created in 1883 as a commemoration of Florence Nightingale for her contributions to modern nursing. Nightingale was a nurse who served during the Crimean war by providing medical services and patient care to wounded soldiers. She developed the environmental theory, which is a core theory in modern nursing. Her theories and nursing concepts are widely used in the nursing profession around the world. The Nightingale pledge is widely accepted and used as the foundation of nursing’s code of ethics.

However, it has undergone several changes in order to incorporate the complexities of contemporary society and medicine. The pledge has ethical benefits such as providing a foundation for the code of ethics of the nursing profession, maintaining professionalism among nurses, providing moral guidance with regard to patient care, and promoting the standards of the nursing profession. In addition, it promotes honesty and trust between nurses and patients.

Despite the benefits, the pledge has limitations too that include reference to God, a pledge to purity, and a pledge to support physicians in their duties. A promise to support physicians is considered as feminist and a degradation of the autonomity of the nursing profession. In addition, reference to God and a life of purity ignores the diversity that exists among nurses with regard to religious affiliations and choice of personal values.

References

Brown, V. (2003). The Hippocratic Oath and the Nightingale Pledge. The American Journal of Nursing, 10, 34-41.

Herman, A. (2013).Florence Nightingale Pledge. Journal of Holistic Nursing, 3(1), 18.

Russell, J., & Cohn, R. (2012). Nightingale Pledge. New York: Book on Demand.

Small, H. (2001). Florence Nightingale. New York: Constable & Robinson Limited.

Veatch, R. M. (2000). Cross-cultural Perspectives in Medical Ethics. New York: Jones & Bartlett Learning.

Vickie, A. (2009). A Closing Word: National Nurses’ Week and the Nightingale Pledge. Dimensions of Critical Care Nursing, 28(3), 145-146.