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Nursing and its Ethical Issues: End-of-Life Care

Introduction

Health care across the world has arguably become one of the integral departments with significant advancements in the health care delivery and nursing practice becoming more eminent and increasingly imperative. As Hebert, Moore, and Rooney (2011) note, “Throughout history, nurses have sought ways to improve the quality of life for individuals, families, and communities during every phase of life’s journey” (p.325). With the technological innovations witnessed across the world especially in developed economies in the contemporary health care sector, the care of a dying patient has eventually shifted from communal or family responsibility to health professionals. Commonly done through palliative care and other modern integrated practices, the practice of handling people with chronic and terminal disorders has nonetheless proven challenging to nurses given the constantly rising need to observe and uphold legal and professional ethics in nursing (Allmark & Tod, 2009). This essay explores the question of end-of-life care by underscoring how nurses should handle the issue without breaking the law or becoming unethical in their practice.

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End-of-life care

Recent decades have witnessed a sudden augmentation in health care characterized by changing its professional behavior with critical social and ethical issues articulated in various healthcare articles (Thacker, 2008). Throughout human life, death has remained warranted to every living thing and in human beings, emotions and pain in patients have been considerable issues in modern nursing (Allmark & Tod, 2009). Since the responsibility of caring for dying patients shifted from communities and families to health care professionals and palliative treatment, the caring program has formed an integral part of end-of-life care. End-of-life care may typically refer to the care given to patients with chronic illnesses and to patients who have shown evidence of no complete recovery regardless of any medical interventions (Allmark & Tod, 2009). End-of-life nursing encompasses numerous aspects that involve “alleviating patients from pain, managing symptoms, and upholding culturally sensitive practices that assist patients and their families through the dying process and death” (Hebert, Moore, & Rooney, 2011, p.327).

End-of-life as an ethical issue in nursing

Efforts to respect the quality of life in the healthcare sector have augmented exponentially and before pronunciation of one’s consideration into the palliative care program, which supports the end-of-life care initiatives, all the responsibilities of patient care rest upon clinicians and physicians (Hebert, Moore, & Rooney, 2011). Since nurses became part of the decision-making involving fundamental values regarding preserving and alleviating suffering, while sharing this with fellow physicians in health care, much has protracted about ‘end of life care. As noted by Allmark and Tod (2009), “myths have developed surrounding the law and ethical principles at the end of life care, which can make care provision at the end of life complex and fraught with potential dilemmas” (p. 35). It seems excessively easy to slide from excellent healthcare to completely wrongdoing by following conditions and principles established in the nursing profession as nurses have always found themselves in ethical tightropes and legal dilemmas while undertaking their duties of taking care of dying patients. In recent days, a continuum of critical healthcare matters has led to difficulties and quandaries especially in crucial moments pertaining to end-of-life decision making.

According to Hebert, Moore, and Rooney (2011), fortunate or unfortunate decisions made to terminate or commence life-supporting treatments in most cases rest upon nurses and other health care professions, with assistance from family members. Unfortunately, many of these decisions probably contribute to patient deaths, which put nurses at risk of blame. According to Allmark and Tod (2009), withdrawing or maintaining life-prolonging treatment, for instance, nurses’ care team may remain in a dilemma while caring for patients under ventilators, artificial nutrition, dialysis, antibiotics, and hydration are constant complex issues in end-of-life nursing. As postulated by Hebert, Moore, and Rooney (2011), despite such complexities being quandaries in decision-making in end-of-life care, respecting the quality of life and providing compassionate end-of-life care appropriate and in accordance with patient’s aspirations remains an essential component in nursing.

Common legal and professional ethics issues

The nursing practices in the current days seem to be undergoing numerous reforms, with legal and ethical principles governing professional nursing. Developed economies have gone ahead to establish principles that Registered Nurses must adhere to and seek relevant guidance while in their nursing practice (Thacker, 2008). Akin to other developed nations including Canada, Australia, and the United Kingdom, the United States established the American Nurses Association (ANA), which is responsible for the ANA Code of Ethics (Thacker, 2008). It is normally the responsibility of American nurses to adhere to the principles established in the ANA Code of Ethics for Registered Nurses, among them being promoting good health and wellbeing, being compassionate to patients, remaining competent, observing ethical care, practicing while observing patient safety, coupled with respecting patient’s privacy, and confidentiality among others (Thacker, 2008). It also requires nurses to foster comfort in dying patients, preserve professional dignity, alleviate suffering, and uphold the sense of supporting a peaceful and dignified death by enhancing appropriate and compassionate care for dying patients.

In the United States, nursing care must always focus on meeting “patients’ comprehensive needs and promoting good health at all times and across the continuum of care” (Allmark & Tod, 2009, p.37). All American Registered Nurses have the legal obligation of patient care articulated in American law and it is their responsibility to avoid foreseeable harm to others. The duty of care covers omission as well as actions, and any patient harmed following nurse’s negligence of duty of care including giving patients drugs timely and as prescribed, remains entitled to sue the responsible nurse (Allmark & Tod, 2009). Any wrong action, including homicide such as giving a lethal injection or failure to provide life-sustaining treatment resulting from the omission of nurse’s responsibility or duty of care as per the expectations of the rule of law and the ANA Code of Ethics for Registered Nurses, is unlawful and normally treated as an offensive act (Allmark & Tod, 2009). This aspect provides nurses with quandaries while handling complex issues in the course of their practice.

How nurses must approach such situations

Any action taken by nurses without proper decision characterized by mutual agreement amongst patients, their families, and health care members leading or contributing to patient deaths in American laws and professional ethics is a crime. Despite the advancements in healthcare technologies, cultural disparities still prevail as, “many physicians are unfamiliar with common cultural variations regarding physician-patient communication, medical decision-making, and attitudes about formal documents such as code status guidelines and advance directives” (Hebert, Moore, & Rooney, 2011, p.328). Nurse competence in the profession remains questionable when they cannot manage to follow the principles embedded in the professional code of ethics and standards, and provide care according to patient’s wish as required. Since nurses act as vigilant advocates and leaders expected to deliver dignified human care, a number of practices may assist them to improve their professionalism and aid them to approach such critical situations and scenarios while still upholding legal and professional ethics.

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Understanding ethics and law in nursing

Ethics and law are two inseparable elements that nurses must always understand while undertaking their professional duties. In a bid to improve their decision-making regarding critical nursing affairs, all nurses should understand important aspects of law and ethics. Seeking legal guidance from the ANA Code of Ethics for Registered Nurses and American laws governing practices of health care is among the essential factors that may help nurses in improving their decision-making in critical end-of-life care. Understanding how cultural factors influence patients’ response to medical care is important for nurses as the United States is a state made of a population of different immigrants including African Americans, Asian-Pacific Islanders, Hispanics, and Indian Americans among others. A clearer understanding of law and ethics will probably assist nurses in employing appropriate interventions based on legal and ethical considerations. Considering professional advocacy in their practices to enable nurses to interpret legal requirements will help in improving their decision-making abilities in the context of complicated issues arising during their nursing practices.

Engaging in training & development

Training and development have been critical movers of advanced professionalism in almost all working sectors across the globe and in nursing, such elements are quite imperative. Several studies argue that the nursing education attained in nursing colleges has proven less competent in handling critical issues experienced in the practice (Thacker, 2008). Following a study conducted by the Agency for Healthcare Research and Quality (AHRQ), which aimed at establishing well nurses basic education prepared them to provide effective end-of-life care, Hebert, Moore, and Rooney (2011) discovered a number of issues. Through AHRQ research, Hebert, Moore, and Rooney (2011) discovered, “71% of RNs rated pain management education as inadequate, 62% rated overall content of EOL care as inadequate, and 59% rated management of other symptoms as inadequate” (p.326). Training and development will help them improve their research and development skills, which are essential in examining nurse-related problems including ethical dilemmas, legal, as well as helping them improve important leadership skills necessary for informed decision making.

Conclusion

End-of-life care has proven challenging for both novice nurses, experienced nurses, and other healthcare practitioners as making decisions in promoting and constructing informed decisions that foster comfort to patients and their families through the death and dying process are marred by complicated issues. Constant problems that arise in end-of-life care involve critical decision-making that puts nurses on quandary as some patient problems carry legal and ethical complexities that need appropriate use of interventions to avoid patient suffering. Therefore, when caring for dying patients, nurses find themselves in ethical tightropes that put them at risk of slipping from good care or serious malpractice. The care of the dying patient shifted from families’ responsibility and dramatically became nurses’ and physicians’ responsibility, and thus probably most old nurses were unaware or not properly prepared. Since it remains a legal obligation for nurses to protect life, promote good health, and above all avoid foreseeable harm to others including patients, improving their professional competence through training and development programs and adhering to codes of conduct provided may assist them in ethical decision-making.

Reference List

Allmark, P., & Tod, A. (2009). End of life care pathways: ethical and legal principles. Nursing Standard, 24(14), 35-39.

Hebert, K., Moore, H., & Rooney, J. (2011). The Nurse Advocate in End-of-Life Care. The Ochsner Journal, 11(4), 325–329.

Thacker, K. (2008). Nurses’ advocacy behaviors in end-of-life nursing care. Nursing Ethics, 15(2), 174-185.

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