This essay will discuss about Anh who is a Registered Nurse (RN) working on the orthopedic ward of a tertiary hospital after completing her TPPP. She was working with most of the elderly and semi- dependent patient, which was being interesting and engaging for her. However, Anh has been assigned to one of the patient named Maddie who is relatively close to her age. In addition to that, she has enjoyed talking with Maddie and found many similar interests while helping her with her ADLs, dressings and exercises. However, while getting ready for discharge Maddie requests for Anh’s personal details to get connected in social media after discharge. Hence, Anh’s decision for this ethical dilemma will be discussed below by identifying and interrogating different ethical views and ethical values. The situation will be analyzed through ethical perspective. Similarly, the solution of this dilemma will be developed by using an ethical decision making model and ethical principles.
Identification of an ethical problem; the collection of additional information to identify the problem and develop solutions;
In the given scenario, Anh is in ethical dilemma whether to give Maddie her personal contact or not. An ethical dilemma refers to a conflict amongst alternatives where some ethical principle will be negotiated no matter what a person does (Staunton & Chiarella, 2013). Hence, Anh as an RN will follow the Code of Ethics, standard of practice and code of conduct of RN to make decisions as per ethical values that does not harm her profession. Ethics is a central part of nursing practice and a vital feature of good. The decision-making processes in nursing are directed by nursing ethics (Manfrin-Ledet, Porche & Eymard, 2015).). Ethical decision making can be defined as a process of choosing and evaluating the alternatives in a manner reliable with ethical principles (Baysal, Sari & Erdem, 2018). As stated by Staunton & Chiarella (2013), ethical decision-making process includes nurse’s education and their own learned possible inhibitors, such as professional and personal experiences, culture and beliefs. As stated in (Alba, 2018)that ethical conflicts in nursing practice are on the growth with an aging society, changes in the financial status, technological advances, limited resources, culturally and religiously diverse population and changing public expectations of the healthcare system. Thus, the following model has been identified to evaluate and resolve the ethical dilemma which includes several steps and criteria (Toren & Wagner, 2010).
Define the ethical dilemma;
Clarify the personal and professional values, ethical principles and laws involved;
Identify the alternatives for action & choose an action;
Generalize the solution to other similar cases in future.
Define the ethical dilemma: As described above, ethical dilemma is a situation where choice between two options needs to be made which resolves the situation in an ethically acceptable manner (Baker, 2013). In this given scenario, Anh an RN is in ethical dilemma as she has been asked by one of the patient’s named Maddie to stay connected through social media after getting discharged from hospital.
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Clarify the personal and professional values, ethical principles and laws involved: Personal values are grounded on what a person gives importance in the dilemma situation. For instance, doing no harm, maintaining his/ her professional integrity or keeping assurance (Toren & Wagner, 2010). In this case, Anh has to choose which one she values the most her professional values or Maddie’s request. As a nurse, she should be professionally capable to consider different situations and make the right choices that deliberate all possible alternate solutions before making ethical decisions. Similarly, professional values based on morals, ethics and standards of the profession which needs to be maintained during the dilemma situation (Schmidit & Mcarthur, 2018). As a registered nurse it is important to maintain the scope of practice and professional boundaries. Professional boundaries distinguish the therapeutic behavior of the nurse from any other behavior that could decrease the benefit of care to the patient. Boundary crossings can cause potential significances and implication to the nurse and the person who is involved in the care (Nursing and Midwifery Board of Australia, 2010). Inspite of having similar age, gender and common interests, professionalism should be at peak for Anh which should be prioritized by her while taking decisions. Similarly, the relation of Maddie and Anh is a nurse and patient in every situation which cannot be unnoticed in any form (Manfrin-Ledet, Porche & Eymard, 2015).
As mentioned in NMBA standard 2 “engages in therapeutic and professionals” the registered nurse should establish, sustain and determines the relationships in an approach that should differentiate the boundaries between professional and personal relationships (Nursing and Midwifery Board Australia, 2016). Anh should maintain this standard as being an RN she is responsible and accountable to NMBA (Baker, 2013). In addition to that, standard 6 mentions about “providing safe, appropriate and responsive quality nursing practice”. In view of that, Anh has to practice as per relevant guidelines, policies, standards, legislations and regulations without thinking about her personal values in order to maintain professionalism and ethics of nursing (Nursing and Midwifery Board Australia, 2016). Furthermore, the code of conduct for nurses involves professional behavior in the domain “act with professional integrity” under principle 4.1 “professional boundaries”. Consequently, Anh should should maintain professional boundaries for promoting patient centered care (Nursing and Midwifery Board Australia, 2018).
According to Health and Community Services Complaints Regulations of South Australia (2019) it has been stated that a health care worker must not involve in an inappropriate close personal, emotional or physical relationship with a client. Anh should consider the law and think about the consequences that can occur by breaching the law. As a health professional, Ann must take therapeutic relationship with patients seriously and examine her feelings and motives and how they affect her ability to practice ethically (Hall, 2011).
Identify the alternatives for action & choose an action: In this scenario, Anh is accountable to manage Maddie’s expectation by maintaining professional boundary. Without hurting the feelings of Maddie, Anh should explain about the professional standard and boundary of a nurse and the significances that can occur after crossing that boundary. Instead of giving her personal details to Maddie Anh can give her work phone number or work email address by explaining Maddie that it is not ethical to provide personal details or talking with her in social media (Baker, 2013). Social media refers to the online and mobile tools which includes websites and applications that can be used to share opinions, information, images, experiences, video and audio clips (Baker, 2013). According to the Nursing and Midwifery Board of Australia (2014), using social media as a form of contact with patient comes under boundary crossing which can cause potential implications for the health professional. The relationship between a nurse and patient has been based on effective clinical medicine, which is significant for patient health (Baca, 2011).
Alike friendship which evolves from more than a month or a few years, the relationship of nurse-patient also develops in a caring context which ends after achieving the goal of care plan or when the patient gets discharged (Baca, 2011). Anh can explain Maddie if she gets connected with her in social media she might breach the social media policy which was developed by National boards for helping registered health care professionals to understand their obligations while using social media (Nursing and Midwifery Board of Australia, 2017). Hence, by communicating effectively with Maddie about all these consequences Anh should end the therapeutic relationship with Maddie positively at the time of discharge.
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Generalize the solution to other similar cases in future: On future Anh should always maintain the therapeutic relationship with the patient, which is also called “zone of helpfulness” in a continuum of professional behavior. If anyone crosses this and goes in over involvement such as boundary crossings, then it affects the person and profession (Nursing and Midwifery Board of Australia, 2010). Similarly, she should not disclose personal information inappropriately while delivering care which is inconsistent with the code of conduct of the RN. If it feels like a boundary have been crossed then she need to seek help from her supervisor.
As stated by Beauchamp and Childress cited in (Flite & Harman, 2013), there are four core ethical principles, i.e. beneficence (do well), autonomy (control of the individual), non-maleficence (do not harm) and justice (fairness).
Considering the four principles
Beneficence can be described as nurse’s action which promotes good action to help others and often described as the principle of “above all, do good” (Flite & Harman, 2013). This desire to do good is undoubtedly what motivates most health care practitioners. However, it is valuable to recognize that one’s idea of what constitutes “doing good” may go against the policy of an institution. Similarly, getting connected with Maddie in social media can be taken as breaching the social media policy of registered health care professionals. There is no doubt that social media provide benefit to all the professions in huge amounts, but incorrect use of this can result legal problems such as malpractice claim, penalizing action from NMBA, job termination. This can affect in Anh’s nursing license and career negatively (Baker, 2013). As well as it can also affect Maddie’s privacy and confidentiality so Anh can provide work phone number so that Maddie can contact in the ward if she needs any help.
Non- maleficence is similar to beneficence, but it refers to not harming individuals or least harm for getting beneficial outcome. The principle of non-maleficence revolves around the concept of harm (Tiruneh & Ayele, 2018). Harm brings about pain and, hence, in the given scenario, Anh rejecting to provide contact information can cause emotional distress to Maddie which will have an effect on her recovery. Anh should explain Maddie that she cannot give personal detail in a manner that it does not hurt or harm Maddie. Thus, Anh should find alternative solution remaining with the ethical practice which does not have affects Maddie while going home.
Autonomy refers to a person’s ability to control what happens to us and how we behave (Skar, 2010). It is an important ethical principle as it involves respect for an individual and their personal space. Hence, in the given scenario Anh as a nurse should convince Maddie and explain that she can’t accept her proposal by respecting the ethical values and professional boundary. If they get connected in social media their communication and activities can be visible to others which can make trouble for Anh along with Maddie (Baker, 2013). As well as Anh might present Maddie’s data to other unintentionally which might affect Maddie’s personal space. Anh can breach her professional boundary and obligations as well as the privacy and confidentiality of Maddie.
There are two meanings of justice, i.e. justice as fairness and justice in relation to benefits and burdens (Tiruneh & Ayele, 2018). According to the principle of justice Anh should be fair and explain Maddie that during her stay in hospital Anh was treating Maddie in the same way as other patient despite her age, gender and similar interests. With this consideration in mind, Anh should clarify Maddy that her aim was to assist Maddy to achieve best quality of care rather than developing personal relationships.
In a nutshell, this essay clearly demonstrated that nurses should perform ethically viable action by considering fundamental ethical principles. Identifying ethical conflicts that might occur in daily life and making decision by taking responsibility of action is the duty of a registered nurse. Likewise, in this case scenario Anh was not able to distinguish whether or not to stay connected on social media, which created ethical dilemma. Similarly, she was not able to distinguish between professional and personal boundary. In the given scenario Anh was caring Maddie who got emotionally attached to Anh and ask her personal details to get connected in social media to continue their relationship after discharge. Hence, two ethical issues have been identified through the scenario which are breaching professional boundaries of nursing and breach of health care professional social media policy. Similarly, Anh should explain Maddie about the professional boundaries of nursing and the result of breaching it by communicating effectively. As well as she can recommend her to make new friends and can give work phone number by explaining that it is unethical for her to give personal details in a professional manner.
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