Patient’s Autonomy in Nursing

The nursing profession is deeply rooted in the ethical values, shared commonly and recognized globally. The assets based on compassion, care, communication, and many others reflect a human and spiritual approach to nursing in each country. Hospital setting, however, makes the core values and the real-life confront. Hence, nurses are forced to make accurate and quick decisions to deliver proper patient care and avoid fatal errors. The ethical conflicts the healthcare workers face may become a severe predicament while experiencing pressure in clinical practice. The efficiency necessary for a nurse’s performance coupled with patient autonomy may cause stress, to say the least. In this work, the ethical conflicts confronted with the patient’s autonomy and specific real-life cases will be contemplated.

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To begin with, values, regardless of the field, are the standards that establish a framework for one’s operations. AACN defines the nursing core values as autonomy, honesty, human dignity, altruism, integrity, and social justice (New consensus policy statement, 2020). All the values mentioned encompass compassion and humanity and serve to provide qualified patient care. Autonomy constitutes an essential human beings’ right to control their destiny and make choices regarding their lives (Bodenheimer & Grumbach, 2016). Bodenheimer and Grumbach state that in medical ethics, autonomy “refers to the right of competent adult patients to consent to or refuse treatment” (2016, p. 154). In clinical practice, the aggressive physiological measures and patient’s choice may not coincide. This is when the nurses face moral and ethical dilemmas, being forced to contemplate the questions of “rightness” and “wrongness” in order to save one’s life and maintain their health.

The nurses commonly confront such ethical predicaments as surrogate and end-of-life decision-making, patient’s right to privacy, autonomy, informed consent to treatment, and pain management. Protecting patient’s rights challenges nurses regardless of their working experience. The nursing codes emphasize the importance of serving patients’ interests, whereas the nurses trying to defend them are discouraged from doing it to the extent that they could eventually refuse its importance (Rao et al., 2016). In this case, the nurse should keep the patient’s privacy safe and, if necessary, ask for support from the colleagues.

One of the ethical concerns the nurses have to deal with is the end-of-life decision-making and patient’s sustainment during the treatment withdrawal. In such cases, the personnel have to engage in stressful ethical conversations and sometimes be the ones who give the bad news. To lessen the stress and frustration, one has to engage in more training in discussing these subjects. Further, clinicians may have to face the necessity to withdraw the treatment for critically ill patients. The challenge to withdraw life-sustaining treatments for these patients provokes stress and anxiety to the medical workers. One of the four principles of medical ethics – beneficence – claims “the obligation of health care providers to help people in need” (Bodenheimer & Grumbach, 2016). However, if the patient chooses to end their life, the medical worker may be unsure of how to act. In order to maintain efficiency, the nurse should ensure the adult patient is competent, aware of the consequences, and assist them in the best possible manner.

Another ethical dilemma arises when pain management is necessary. The less experienced nurses have their difficulties while withdrawing life-sustaining treatments or sedative relief for gravely ill patients. On the one hand, if the competent patient chooses to end their life, the right of autonomy demands the healthcare providers to respect their choice. Whereas, their obligation is also to deliver help to those in need; relieve pain, too. The older population tends to suffer from diverse diseases andor disabilities, which requires clinicians to be qualified enough to address the ethical problems related to their needs. Therefore, to adequately address the ethical conflicts, the nurses should obtain the necessary training in nursing colleges and then communicate with their colleagues if they need help or support on a specific case.

With such predicaments in the working field, the medical policy, both on the bigger scale and in specific cases, should be approached carefully. The international and national strategies are required to address ethical issues to boost nurse- and patient-related effective outcomes. Further, end-of-life decisions require patient-nurse and nurse-physician dialogue to reduce ethical stress and help personnel to feel comfortable while having ethical conversations. These are some of the possible methods to handle the ethical challenges in nursing.

Sometimes, the patient’s right to autonomy should be valued above all else. One such case is assisting and providing end-of-life treatments for critically ill patients. With the aging population, healthcare workers, particularly nurses, often encounter ethical conflicts while in hospital. Gravely ill patients may experience acute pain and be forced to apply to aggressive treatment measures. If the treatment lasts long enough, and no result is shown, the patient may not wish to endure further pain and look for ending their lives. If the patient’s consent is adequately given and approved, the healthcare workers may face the moral conflict of assisting with the treatment withdrawal (Bodenheimer & Grumbach, 2016). Here, however, the human right to autonomy of making the choices regarding their destiny and life should be valued above other medical principles and nursing values.

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In this case, the principle of autonomy is of exceptional importance. The core value of nursing, respect for human dignity, is also rooted in the patient’s autonomy recognition. If the patient continues suffering and is not being allowed to make this choice, the principle of nonmaleficence might be ruthlessly violated. Despite healthcare workers’ obligation to deliver patient care and provide all necessary operations to ensure one’s wellbeing, sometimes, the treatment may no longer be effective. One has the right to choose treatment for themselves – to consent to or refuse it. The exception is made for juvenile patients and patients unable to decide reasonably due to their mental or health states. If no such case is present, the decision of whether continue the treatment or not may be transmitted to the patient.

Ethical issues, while in hospital, play a specific part in the nursing profession. Relying on the values of humanity and compassion, medical workers have to face challenges in the working field. In some cases, making a decision might be a sheer predicament. When the core values of respecting human dignity, patient autonomy recognition, and a real-life encounter, it may provoke extreme hardships for healthcare workers. To lessen ethical stress and maintain efficiency, nurses should obtain adequate training in nursing colleges first. Then, it is essential to communicate with patients and colleagues in a specific case. When the decision is to be made, the nurse should ensure the patient is competent and aware of the consequences. Finally, dialogue remains the most effective way to manage frustration and stress and deliver proper care to serve one’s best patient’s interests.

References

Bodenheimer, T. S., & Grumbach, K. (2016). Understanding health policy: A clinical approach. McGraw-Hill Education.

New consensus policy statement on the educational advancement of registered nurses. (n.d.). American Association of Colleges of Nursing (AACN). Web.

Rao, D. A., Kumar, A., & McHugh A. (2016). Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue. Journal of Nursing Scholarship, 41(9), 73-79. doi: doi: 10.1111/jnu.12267.

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