ethical issues in critical care nursing
Depending on the prevalent culture at any one of these levels, nursing practice may be highly ethical or less ethically justifiable. The integration of ethical principles in everyday work practice requires concordance with care delivery and ethical principles. (2)University of Barcelona, Spain. Personal ethics may be described as a personal set of moral values that an individual chooses to live by, whereas professional ethics refer to agreed standards and behaviours expected of members of a particular professional group.2 Bioethics is a broad subject that is concerned with the moral issues raised by biological science developments, including clinical practice. The lack of planning may produce morbidity and mortality that could otherwise have been prevented, thus creating a fundamental duty to … Where the patient is incompetent, healthcare professionals ought to act so as to respect the autonomy of the individual as much as possible, for example by attempting to discover what the patient’s preference would have been in the current circumstances. Bertolini, C.L. Regional Health University Proposal for a trial project in Ostergotland (LIV) (1981) Report from the Linkoping Commission on Integrated Health Care Education, Regional Health University: Linkoping. To show lack of respect for an autonomous agent, or to withhold information necessary to make a considered judgement, when there are no compelling reasons to do so, is to repudiate that person’s judgements. For example, codes relevant to nurses have been developed by the Australian Nursing and Midwifery Council (2002). After reading this chapter, you should be able to: • understand the diversity and complexities of ethical issues involving critical care practice, • understand key ethical principles and how to apply them in everyday practice as a critical care registered nurse, • be aware of the availability and access to additional resource material that may inform and support complex ethical decisions in clinical practice, • discuss the ethical implications of the organ donation for transplantation decision-making process, • understand consent and guardianship issues in critical care. The guidelines from the Council for International Organizations of Medical Sciences (CIOMS) – a body established jointly by WHO and UNESCO – take the position that research involving human subjects must not violate any universally applicable ethical standards, but acknowledge that, in superficial aspects, the application of the ethical principles, e.g. Levine, M.E. Ethical Issues - Consent Introduction. However, even for formally-appointed guardians, certain procedures are not allowed and the consent of a guardianship authority is required. However, it is incumbent on all critical care nurses, as patient advocates within the critical care areas of ICU, CCU and the emergency department (ED), to be aware of the potential impact and possible outcomes of therapies delivered in the critical care environment. Although some nurses draw a distinction between ethics and morality, there is no philosophical difference between the two terms, and attempting to make a distinction can cause confusion.4 Difficulties arise in ethical decision making where no consensus has developed or where all the alternatives in a given situation have specific drawbacks. In general, nurses focus on aspects such as patient dignity, comfort and respect for patients’ wishes, while medical staff tend to focus on patients’ rights, justice and quality of life. Blackwell, C. (1989) ‘Elective ventilation for transplant purposes’. University of Barcelona, Spain See all articles by this author. As the provision of care to the critically ill becomes more complex due to technological advancement, and the profession of nursing more Over 10 million scientific documents at your fingertips. Leavitt, F.J. (1996) ‘Educating nurses for their future role in bioethics’. In general, nurses focus on aspects such as patient dignity, comfort and respect for patients’ wishes, while medical staff tend to focus on patients’ rights, justice and quality of life.47 Involvement of the patient (where possible) and family in decision making is an important aspect of matching the care provided with preferences, expectations, values and circumstances (see Figure 5.1).48, Despite the importance placed on quality of life in terms of its influence in the decision-making process, it is difficult to articulate a common understanding of the concept. Critical care nurses face ethical issues on a daily basis, whether involving professional ethics or helping a patient or family sort out their own ethical issues. Yet, when cast against a wider backdrop of global health, economic inequalities and cultural diversity, such models often prove limited in effect and inadequate in their scope.2,3 Attempts to address both of these concerns have generated a wide range of ‘capacity-building’ initiatives in bioethics in developing and transitional countries. Not affiliated Nursing codes of ethics incorporate such an understanding of patient’s rights. Cite as. b. patient as part of the hospital admission process. In critical care nursing, there are ethical issues that come up all of the time. This situation particularly arises when the patient is incompetent and is therefore unable to participate in the decision-making process. To deny a competent individual autonomy is to treat that person paternalistically. Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. Although there is a legal and moral presumption in favour of preserving life, avoiding death should not always be the pre-eminent goal.32 The withholding or withdrawal of life support is considered ethically acceptable and clinically desirable if it reduces unnecessary patient suffering in patients whose prognosis is considered hopeless (often referred to as ‘futile’) and if it complies with the patient’s previously stated preferences. An explanation of whom to contact for answers to pertinent questions about the research and research subjects’ rights, and whom to contact in the event of a research-related injury to the subject. In addition, individual preferences may change over time. In health care, egalitarian theories generally propose that people be provided with an equal distribution of particular goods or services. Nurses require more assistance to meet the ethic … Ethics in critical care in nursing Crit Care Nurs Clin North Am. Much ethically-desirable nursing practice, such as confidentiality, respect for persons and consent, is also legally required.4,10. and Sibbald, W.J. This principle is clearly articulated by the General Medical Council in the UK with the following statement: Successful relationships between doctors and patients depend on trust. Resource limitations can potentially be seen to negatively affect distributive justice if decisions about access are influenced by economic factors, as distinct from clinical need.9, Ethics are quite distinct from legal law, although these do overlap in important ways. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Presurgical Functional MappingAndrew C. Papanicolaou, Roozbeh Rezaie, Shalini Narayana, Marina Kilintari, Asim F. Choudhri, Frederick A. Boop, and James W. Wheless, the Child With SeizureDon K. Mathew and Lawrence D. Morton, and Pharmacologic Consequences of SeizuresShilpa D. Kadam and Michael V. Johnston, Self-Limited EpilepsiesDouglas R. Nordli, Jr., Colin D. Ferrie, and Chrysostomos P. Panayiotopoulos, in Epilepsy: A Network and Neurodevelopmental PerspectiveRaman Sankar and Edward C. Cooper, Hematology, Oncology and Palliative Medicine, understand the diversity and complexities of ethical issues involving critical care practice, understand key ethical principles and how to apply them in everyday practice as a critical care registered nurse, be aware of the availability and access to additional resource material that may inform and support complex ethical decisions in clinical practice, discuss the ethical implications of the organ donation for transplantation decision-making process, understand consent and guardianship issues in critical care. These articles deal with the many ethical issues critical care nurses deal with every day. Common ethical principles that relate to critical care nursing practice are outlined in this chapter, with a description of how they may be applied to practical situations such as clinical decision making, obtaining informed consent and applied research. Marshall, J. Introduction: Nurses face many legal and ethical issues while providing patient care and it is essential to understand the law and the way it affects the nursing practice. Consent should never be implied, despite the fact that the patient is in a critical care area. For individuals wanting to document their preferences regarding future healthcare decisions with the onset of incompetence, there are ‘anticipatory direction’ and ‘advance directive’ forms available. Resource limitations can potentially be seen to negatively affect distributive justice if decisions about access are influenced by economic factors, as distinct from clinical need. and Liaschenko, J. • Discuss the concept of medical futility. Steps to address … While it is essential that all members of the critical care team be able to contribute and be heard, the final decision (and ultimately legal accountability in Australia and New Zealand for the act of withdrawal of therapy) rests with the treating medical officer. Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. Better communication skills among clinicians and more effective educational resources are required to solve these problems. Paediatric Considerations in Critical Care, Essential Nursing Care of the Critically Ill Patient. Search Google Scholar for this author, Teresa Lluch-Canut. Consent may relate to healthcare treatment, participation in human research and/or use and disclosure of personal health information. Individuals should be treated as autonomous agents; and individuals with diminished autonomy are entitled to protection. Consent provides assurance that patients and others are neither deceived nor coerced. they must not be impervious to reason, divorced from reality or incapable of judgement after reflection), be able to weigh that information up (i.e. A medical agent is someone chosen by an individual (e.g. To establish that trust you must respect patients’ autonomy – their right to decide whether or not to undergo any medical intervention … [They] must be given sufficient information, in a way that they can understand, in order to enable them to make informed decisions about their care.24, In many countries, if patients believe that clinicians have abused their right to make informed choices about their care, they can pursue a remedy in the civil courts for having been deliberately touched without their consent (battery) or for having received insufficient information about risks (negligence). Primarily, it is the treating medical officer who is legally regarded as the only person able to inform the patient about any material risks associated with a clinical therapy or intervention.18. describe the ethical conduct of human research, in particular issues of patient risk, protection and privacy, and how to apply ethical principles within research practice. Critical Care Nursing and Ethical Issues Conference scheduled on October 04-05, 2021 in October 2021 in Dubrovnik is for the researchers, scientists, scholars, engineers, academic, scientific and university practitioners to present research activities that might want to attend events, meetings, seminars, congresses, workshops, summit, and symposiums. People may also have a combination of both. when a doctor makes a decision to cease life-sustaining treatment for a particular patient). It should also be noted that nurses must seek consent for all procedures that involve ‘doing something’ to a patient (e.g. The ‘group think’ approach of ‘That’s how we’ve always done it’ requires critical reflection on what is the ethical or ‘right thing to do’.28 Clinical audits and other dedicated review systems and processes are useful platforms for ethical discussion and debate between critical care colleagues. (1995) ‘Creating an ethical practice environment: a focus on advocacy’. In Australia this predominantly includes the National Health and Medical Research Council (NHMRC) and the National Statement on Ethical Conduct in Human Research (2007); Although the specific detail varies between organisations and jurisdictions, in general ‘consent to medical research documentation’ should include the following: A statement that the study involves research, An explanation of the purposes of the research, The expected duration of the subject’s participation, A description of the procedures to be followed, Identification of any procedures which are experimental, A description of any reasonably foreseeable risks or discomforts to the subject, A description of any benefits to the subject or to others which may reasonably be expected from the research, A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject, A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained. 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