Professional Nurse Epistemology

Introduction

A life well-lived is lived in such a way that it makes a positive difference to others. However, I have come to appreciate the fact that it takes more than raw skills and good intentions to be of optimum use to society. A strong educational background is necessary for one to be truly effective. Health care which is defined as the prevention and treatment of the various ailments and injuries that affect man’s physical and mental well-being plays a very significant role in modern society. For this reason, all nations across the globe have invested heavily in the health sectors of their countries in a bid to ensure that all citizens have access to quality health care. One of the key players in health care provision is the nurses. Professional nursing traces its roots to Florence Nightingale who founded the first training school for nurses at St. Thomas’s Hospital in London (Zerwekh & Claborn, 2009). The contribution that nurses make to the medical industry cannot be overstated and the World Health Organization confirms that nurses make a substantial contribution to health-delivery systems all over the world.

Owing to the crucial tasks that nurses engage in, elevated levels of professionalism must be exhibited by nurses despite the numerous challenges that they face in their practice. Nurses are “professionals who are science-driven, technically skilled and caring” (Zerwekh & Claborn, 2009). The nursing profession more than any other discipline is concerned with issues of professional values and behaviors since professionalism results in better care which might translate to improved health for the patient or even prolonged life. This report shall give an elaborate epistemology of the nursing profession.

A personal reflection on nursing

My career objectives have always revolved around health care providers to the community. In particular, I purpose to work among the minority community who suffer disproportionately from diabetes, hypertension, and heart diseases. I have been a nurse for more than four years. Through that period, my work experiences have changed me into a better and efficient nurse. I am a foreign nurse and have been in New Zealand for two years now. Back home I was working in a small 20-bed hospital doing mainly community nursing. But since I came to New Zealand, I have been working with the hospital’s internal Nursing agency. So, I get to go to different wards each day. As a result, I have had diverse experiences in the emergency department, wards, cardiac CU, and ICU. In summary, I have learned everything after coming to NZ and joining a nursing agency. My experience in New Zealand has made me a more confident nurse and my nursing skills have improved significantly.

I have had various experiences which I believe are of great relevance in my profession. My experiences as a community nurse back at home was especially a big eye-opener since it demonstrated to me the importance of the nursing role in health care. I witnessed firsthand the profound impact that nurses have in the lives of patients. I am very passionate about my career in nursing and there is no doubt in my mind that my future success hinges on this passion. In the past four years, I have made use of the vast resources afforded by the institutions I work with to advance my knowledge in the field and become a credit to myself and my community.

Elements of nursing

Johnstone (2008) reasserts the fact that professional nursing ethics require nurses to protect and promote the interests and wellbeing of the people in their care. This is following the nursing code of ethics which explicitly states that nurses place great value in quality nursing care and refrain from providing services that are deemed as below standard and therefore unacceptable. To ensure that each nurse understands the importance of this field, scholars have been developing theories and philosophical ideologies which act as guidelines to medical practitioners. Some of these concepts include theories and principles which help nurses do the right thing at the right time and in the right manner.

Ethical theories are the criteria that we use to make a judgment as to the fairness or unfairness of actions undertaken regarding problems (Crisp, Potter & Perry, 2005). The theories provide support to decision-making and shed some light on the thought process behind a conclusion. These theories include Consequentialism, Deontology, and Virtue ethics. They can be applied interchangeably in various settings or can serve to complement each other.

Theoretic framework

The consequentialist ethics theory holds that actions can be judged as right and/or good only based on the consequences they produce with no consideration for their intentions or motives. This principle dictates that the collective welfare of the people overrides the individual’s right and as such, the theory advocates the maximization of happiness for the greatest number of people (Crisp, Potter & Perry, 2005). In this approach, the net benefit is calculated, and the net consequences evaluated. From these evaluations, a decision that adheres to the theory by having the most “productive” result is chosen.

Deontological ethics emphasize the assumed duty. This implies that duty is the basis of all moral actions regardless of the consequences. This theory is in contrast to the consequentialist theory which emphasizes the results with no regard to how they were obtained. The deontological theory focuses on the rules rather than the outcome to justify an action. In the nursing practice, the duty to care and do no harm to the patient is a manifestation of the deontological theory.

Virtue ethics theory is derived from Aristotle’s ethical thinking which borrows from both consequentialist and Deontological ethics. The theory advocates the practice of moral virtues e.g., self-control, truthfulness, and compassion. I have come to realize that virtues vary from person to person and are also a product of cultural and environmental background. The theory borrows the deontological ethics emphasis on duty

There exist four principles that serve as a framework when dealing with medical ethics issues in any clinical setting. They act as guidelines and act as a basis from which judgments can be made. The first principle is that of Respect for autonomy dictates that the decisions made by a person should be independent of any influence by the nurse and should be respected. Nemie (2009) acknowledges that while this principle is upheld in western countries, it is not as valued in developing nations.

The principle of beneficence states that treatment should be balanced against the risks and costs. The nurse should endeavor to act in a manner that is beneficial to the patient. This principle stipulates that the patient’s best interests must be foremost in the mind of the nurse and failure to adhere to this may lead to legal repercussions.

Non-maleficence implies the avoiding of causing harm by the healthcare professional to the patient. This principle is following the fundamental responsibilities of the nurse which include their role as restorers of health. While it is noted that most treatments involve some harm and risk for the patient, this should never outweigh the benefits.

The last principle is that of Justice. This calls for the respect of justice and is practiced by the fair sharing of benefits, following the laws of the land.

In my current occupation, I have had to rely on the aforementioned ethical theories and principles in my handling of patients. A case in point was the treatment of a patient who was suffering from colon cancer in its advanced stages. The patient refused to be admitted to the hospital on a full-time basis but rather chose to be an outpatient. Given his fragile state, this was a medically sound move and I sought to make him change his decision. Application of the Consequentialist ethics theory would have required that I use whatever means necessary to achieve the means.

However, I chose the deontological theory and hence told the patient of the gravity of his actions. I also told him that regardless of his decision, his situation was bleak as his condition was terminal. This decision on my part was because I respected the patient’s right to make an informed decision with all the facts presented to him. On reception of the information from me, the patient was even more adamant on his wish to not be admitted to the hospital on a full-time basis. He expressed his desire to make the most of his short time left and did not view spending his days bedridden as the best way to do this. In line with the principle of Respect for the autonomy of the patient’s decision, I did not seek to influence his wishes but rather sought to find ways in which to implement an outpatient program that would be most beneficial to the patient.

Similarly, one of my core personal values is altruism which is defined as the unreserved concern for the wellbeing of other people (Clark, 2008). This personal value is very well reflected in my choice of profession as the nursing field affords one with numerous opportunities to be beneficial to the lives of others. As a result of my personal value of altruism, I show high levels of concern both for my patients and my staff members. A study on leadership by Alimo-Metcalfe and Alban-Metcalfe (2001) demonstrated that the single most important positive factor was whether an individual showed genuine concern for those they interact with.

Another value that I possess is having a positive attitude. As human beings, we are constantly predisposed to think the worse of situations and adopt a cynical view of life. I had an upbringing that instilled in me the value of a positive attitude from a very tender age. Most times, I work with patients who have had mastectomies and have chosen to undergo breast reconstruction. In these situations, I find myself going out of my way to ensure that the patient is well taken care of and optimistic about the success of the procedure. My leadership abilities are also enhanced by my recognition of my value of a positive attitude since I can inspire other employees.

The most significant lesson that I learned through self-reflection is that my core values and beliefs directly impact my ability to perform my duties. As such, my effectiveness as a nurse is inherently tied to my core values. This is a truth that is corroborated by Carroll (2005) who articulates that an effective employees must be in touch with their core values and beliefs. Knowing one’s values enables a person to be self-aware and he/she is, therefore, able to inspire other people through his/her values. Through the self-reflection of my personal values and beliefs, I have developed a greater self-awareness which I can use to enhance my nursing skills.

Issues in nursing

Law and ethics

While handling patients, situations arise that require the nurse to make a decision and the decision taken may be from an ethical viewpoint or a legal one. Legal issues on the laws of the land by which a nurse must abide. On the other hand, ethics include moral obligations or principles that are held by the nurse (Burgess, 2008). Ethics may be categorized as personal and professional. Personal ethics relate to an individual’s principles and may be a product of one’s upbringing, cultural background, or religious beliefs.

While at times both legal and ethical perspectives may be in sync, there are times when they appear contradictory, and as such, it is the nurses’ prerogative to choose which viewpoint to lay more emphasis on. Johnstone (2008) suggests that while some nurses might be inclined to view legal frameworks as inconveniences in their operations, these legalities do serve the best interests of both the patient and the nurse. This is especially the case when the nurse is in a dilemma and has no other justification for his/her actions. A legally prescribed action may act as a default. Despite the seemingly upper hand that the law seems to hold over ethics nurses do not always give legal issues preference over ethical issues.

In the nursing field, the interconnection between legal and ethical issues cannot be overplayed. This is because they affect each other and actively contribute to the actions which a nurse undertakes in a given scenario. Nurses must adhere to the legal requirements which affirm the commonly held opinion that all health practitioners should do all that is possible for the good of their patients. Legal requirements vary from place to place and as Nemie (2009) observes, practices such as active measures to cut short the life of a terminally ill patient are forbidden in Malaysia while the same practice is acceptable in Holland. Considering the professional manner in which nurses are expected to act, it may be argued that personal ethics should only play a secondary role in the decision-making process of the nurse since they sometimes hold no scientific backing. However, total disregard for one’s belief system may lead to psychological disturbances and hence greatly affect the productivity of the nurse (Pandey & Singh, 2008).

Working conditions

Many people throughout the world die each day due to a lack of insurance and insufficient medical facilities from which they could have access to proper health care. This is because it requires a lot of money, manpower, and facilities that are not readily available in most countries. For example, in the United States, New Zealand, and other countries, there has been a significant shortage of nurses, medical facilities, and infrastructures (Hawley, 2002). As such, the few that are available are in most cases overworked and underpaid. This not only poses a threat to the quality of performance they exhibit but also makes them less committed and motivated in their practice.

Political and economic influences

Most governments in developed countries have taken the initiative to provide free medical care for their citizens. According to Harrington (2004), this health care plan will improve the quality of life of the citizens, while promoting equality during service rendering. With free health care, people can easily adopt preventive measures by having regular checkups and physical examinations. However many countries like America or China cannot independently fund such a huge program due to their large population size and other economic constraints. In addition to this, this will have a massive impact on medical performance by doctors who will have to work for extra hours due to the consequential increase in patient numbers thereby reducing the quality of health care provided. This proposal also suggests that the government will be responsible for setting the price ceiling of all medical services.

Technology

There is a need for technological advancement in the world today. In the health care sector, much needs to be done to cater to the needs of the patients efficiently and effectively. Innovative technology is coming up but the cost of acquiring them is very high and despite their importance, many hospitals cannot afford them. Therefore, private payers must help finance the technology assessment program. Such an investment will ensure that more research is done and better means of providing medical care implemented.

Conclusion

This paper set out to expound on what it means for a nurse to act professionally by giving the attributes that make up a professional. The paper has also discussed the various legal and ethical aspects that a nursing professional should be adept at. From the discussions presented herein, it is evident that professionalism in nursing is not only desirable but mandatory for optimal health care provision. This paper has also mentioned and given a brief overview of existing ethical theories and principles that nurses adhere to. Various factors that influence the nursing profession have also been highlighted. By adopting the professional manner stipulated in this report, nurses can provide better services to patients, therefore, fulfilling one of their core obligations of assisting individuals to achieve health and recovery.

References

Alimo-Metcalfe, B & Alban-Metcalfe, R. (2001). The Development of a new transformational Leadership questionnaire. Journal of Occupational and Organizational Psychology, 74: p. 1-27.

Burgess, M. (2008). A guide to the law for nurses and midwives. Auckland, NZ: Pearson education.

Carroll, T.L. (2005). Leadership skills and attributes of women and nurse executives: Challenges for the 21st century. Nursing Administration Quarterly, 29(2): pp. 146-153.

Clark, L. (2008). Clinical leadership: Values, beliefs, and vision. Nursing Management, 15(7): pp. 30-35.

Crisp, J., Potter, P. A., & Perry, G. A. (2005). Potter & Perry’s Fundamentals of Nursing. Australia: Elsevier Australia.

Harrington, E. (2004). Health policy: crisis and reform in the U.S. health care delivery system. California: Jones & Bartlett Publishers.

Hawley, G. (2002). Nursing in New Zealand: Critical Issues, Different perspectives. Auckland, NZ: Pearson Education.

Johnstone, M. (2008). Questioning nursing ethics (ethics & legal). Australian Nursing Journal, 15: p. 19.

Nemie, J. K. (2009). Challenges for the Nursing Profession in Malaysia: Evolving Legal and Ethical Standards. Journal of Nursing Law, 13(2): pp. 54-63

Pandey, S. & Singh, M. (2008). Women Empowerment and Personal Values as Predictors of Reproductive Health. Journal of the Indian Academy of Applied Psychology, 34(2): pp. 309-316.

Zerwekh, G. J., & Claborn, C. (2006). Nursing today: transition and trends. Australia: Elsevier Health Sciences.

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