Pressure Ulcers Study: Ethical Perspectives

Introduction

The profession of nurses is multifaceted so the scope of their work encompasses both practical and ethical questions. The field of wound medicine is not an exception since there, nurses often have to deal with vulnerable population groups and consider the ethical implications of each decision. The way pressure sores and ulcers are treated heavily depends on economic, social, and cultural factors and not only on the specifics of each case and available medical equipment.

This paper presents level 1 and 2 research questions for the ethical and cultural perspectives of treating pressure ulcers. The first level deals with such questions as “How do ethical theories apply to the issue?” and “Which cultural values and/or norms influence the issue?”. The second level investigates the following questions: “What are the ethical issues of pressure ulcer research?” and “How do culturally defined family dynamics affect treatment?”.

Ethical Perspective of Inquiry

The ethical aspects of treating pressure ulcers in nursing practice may be explained through five ethical theories among which are egoism, deontology, care ethics, virtue ethics, and utilitarianism. Egoism might be seen as incompatible with nursing practice; however, one should avoid overworking and promote self-care among patients with this condition to lighten the workload. Encouraging patients to practice self-care aligns with the values of deontology and utilitarianism that call for transmitting all relevant information to a patient to bring about the best health outcome. According to Beldon (2014), patients’ choices should be guided by a nurse who is responsible for informing them about the implication of their condition.

At that, a nurse should take into account all the specifics of a patient’s situation to make treatment patient-focused and aligned with the principles of care ethics. Lastly, virtue ethics provide a framework within which it is encouraged that a nurse develops personal qualities that would enable them to provide services in the best way possible with regards to moral norms.

Pressure ulcer research should align with the main ethical principles of conducting a study. For a research nurse, it is crucial to recognize the heightened vulnerability of patients suffering from pressure sores and ulcers since they do not only experience pain but may also be self-conscious about their looks and body odor. A nurse cannot proceed with research unless he or she gains informed explicit consent from each participant.

Research methodology cannot contradict the principle of nonmaleficence, that is if the invasion or other forms of treatment are involved, they should not pose a threat to a patient’s health and body integrity (Parahoo, 2014). Lastly, a research nurse should make sure that participation is confidential, and personal and sensitive information will not be disclosed.

Cultural Perspective of Inquiry

Treatment perspectives are often linked to a patient’s cultural values, norms, and background. For instance, elderly patients usually operate under the principle “doctor knows best” and maybe inactive in proceeding with the treatment plan. They may ignore self-care guidelines as to how they should move and treat their skin and let their condition worsen. On the other hand, young individuals are more outspoken and individualistic and may confront a doctor on the chosen treatment methods.

As for the cultural context, one should be aware of the differences in pain perception in various cultures. In some cultures, patients express greater stoicism towards pain, whereas, in others, sick people are outstandingly communicative when it comes to painful experiences (Pillay, Zyl, & Blackbeard, 2014). In this case, a patient that belongs to a “stoic” culture may be silent about their condition and not report it to the doctor. Another difficulty may arise when a nurse tries to assess such a patient’s level of pain. When introduced to the pain scale, they might hesitate to be honest about their sensations, and a medical practitioner might fail to prescribe an appropriate dose of pain medication.

As for the level 2 research question, some cultural family traditions may affect pressure ulcer treatment significantly. For instance, family dynamics are often culturally determined, and the roles of family members may have an impact on how a condition is treated. If in a particular culture, a woman is socially obliged to be obedient to her husband, he may try to overtake the treatment process and speak on his spouse’s behalf. He may also dictate who gains access to his wife’s body regarding skin examinations for sores and ulcers. In some societies, parents are very authoritarian, and they may ignore their child’s autonomy and silence him or her when they attempt to share their experiences.

When involved in the treatment process, family members play several roles. According to Lin, Pang, and Chen (2013), these roles include but are not limited to an information broker and a patient’s advocate. The researchers discovered that when confronted with the necessity to make an important health decision, patients saw their family as a whole and cared deeply about the well-being and mental state of each member.

However, there are two sides to this phenomenon as family members that actively transmit information and advocate for a patient’s needs may both amplify and limit his or her autonomy. It is suggested in the study that nurses and other medical practitioners should be aware of a family’s cultural background to know to what extent family members’ opinions will impact a patient’s decisions. Appropriate communication may prove to be beneficial for both families and medical staff.

Conclusion

Treating pressure sores and ulcers encompasses taking into account ethical and cultural perspectives of the issue. When treating a patient with this condition, a nurse should be aware of ethical theories that prescribe how he or she should act. Patient should be given full autonomy; however, their decisions should be well-informed, and, at the same time, they must be familiar with self-care recommendations.

Treatment should be patient-centered, and, ideally, a nurse should possess personal attributes that would allow him or her to take care of a patient with ulcers in the best way possible. When researching pressure ulcers, a medical practitioner should not dismiss the vulnerability of participants and apply ethical principles accordingly. First and foremost, a researcher should gain explicit consent from each participant and ensure that there will be no breach of confidentiality.

A medical practitioner cannot overlook cultural factors when it comes to working with patients with pressure sores and ulcers. Age may affect how disagreeable and autonomous a patient is. A nurse should also pay attention to the way different cultures deal with pain and whether it is encouraged to express it. Family dynamics may interfere with a patient’s autonomy, especially if they are culturally defined, and some members of a family are seen as subordinate to others.

References

Beldon, P. (2014). The role of ethics in the wound care setting. Wounds UK, 10(3), 72-75.

Lin, M., Pang, M. S., & Chen, S. (2013). Family as a whole: Elective surgery patients’ perception of the meaning of family involvement in decision making. Journal of Clinical Nursing, 22(1-2), 271-278.

Parahoo, K. (2014). Nursing research: Principles, process and issues. London, England: Macmillan International Higher Education.

Pillay, T., Zyl, H. A., & Blackbeard, D. (2014). Chronic pain perception and cultural experience. Procedia – Social and Behavioral Sciences, 113, 151-160.

Silva, T. N., Freire, M. E. M., Vasconcelos, M. F., Silva Junior, S. V., Silva, W. J. C., AraújoI, P. S., & Eloy, A. V. A. (2018). Deontological aspects of the nursing profession: Understanding the code of ethics. Revista Brasileira Enfermagem, 71(1), 3-10.