Autonomy- the Right of a Client to Self Determination

Consider the six major ethical principles of autonomy, veracity, confidentiality, nonmalfeasance, beneficence, and justice. Think back over your many years of educational experiences. Provide examples from your past (either recent or distant—your choice) that illustrate the importance of these 6 major ethical principles. The experiences you recount may have happened to you personally, you may have witnessed them, or you may have read about or heard about them from others. Any of these types of examples are fine to use in your journal entry.

The most important point is that you choose examples that made a lasting impression and influenced your feelings and perceptions related to education (either positive or negative—your choice). Write a conversational paragraph for each of the six principles, including your illustrative example and then brief discussion related to how the example shaped what you know and feel about the educational process. Autonomy- the right of a client to self determination In the ER where I currently work, I am usually not privy to the conversations between the physician and the patient.

I am usually providing care to another patient. I receive the orders for pain medication and then proceed to the room to administer the medication. I feel it is my duty, as a nurse, to educate the patient regarding their right to refuse the medication the physician ordered. I empower them with education regarding the effects and side-effects and allow them to refuse the medication if they desire. I educate them to the importance of knowing as much information regarding their own healthcare as possible and allow them the choice to accept or refuse the offered medications.

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I feel strongly about this aspect of care in the ER. I do not feel the patient should blindly accept medications simply because it was prescribed by a physician. Veracity- truth telling; the honesty by a professional in providing full disclosure to a client of the risks and benefits of any invasive medical procedure. Often times children are fearful of nurses and the procedures they endure in the ER. They often cry as soon as we walk into their room. I feel it is a disservice to these tiny people to lie to them about the medicine they will take or the IV that may need to be started.

Even though they are minors and veracity might not be a law that applies to them, I feel they will be more trusting of me and of future nurses if they are told that an IV actually will hurt, but just for a moment, rather than surprising them with a painful procedure when they are trusting you that it will not hurt. Lying to patients is wrong on an ethical level and it also put nurses in an untrusting light. We should always be forthright with every patient, even if they are young or old. Simply procedures may hurt different people on different levels but everyone deserves to know if they are going to be uncomfortable or not.

Confidentiality- a binding social contract or covenant to protect another’s privacy; a professional obligation to respect privileged information between health professional and client. Confidentiality is inherent in the field of medicine and nursing and many professional are accustomed to this ethical principal. HIPPA has been drilled into the nurses’ head and the associated fines for violating this law. The aspect that I feel strongly about regarding confidentiality is when my patient in the ER has ingested or used an illegal substance or a narcotic that is altering their care.

If the patient believes we will keep their medical information confidential then they are more likely to reveal the drugs they have used so we can better treat them. I remember years ago when I was working as an EMT in the ER and a young man, in his 20’s, came in with chest pain. The EKG showed an acute MI. The patient has no risk factors and it was amazing to everyone that the EKG was showing this at this early hour while he was on his way to work. In the end, after going to the cath lab and having an angiocath inserted in his groin and not heart disease was discovered did he reveal that he had used cocaine.

If this patient had been informed that his information would be confidential, and had HIPPA been in place, he might have felt more comfortable revealing this information and avoiding this unnecessary procedure. I assure my clients that no police will ever be notified and that legally their information is protected so they may feel more at ease in revealing the drugs they have taken so we can treat them properly. Nonmalfeasance- the principal of doing no harm. Nonmalfeasance encompasses negligence and/or malpractice (Bastable, 2008). Malpractice can encompass failure to follow standards, communication, ocumentation, monitoring, acting as an advocate, and delegating. The first few hours and days after delivery of a preterm infant are critical times when head bleeds may occur. Simply lifting the legs while changing the diaper can result in a head bleed. Having this understanding and not rushing through cares is critical as a NICU nurse. There are serious developmental problems that may occur with third and fourth degree bleeds and the long term sequelae are daunting. As a nurse at the bedside with these neonates and communicating with the parents, we should always hold in mind the ethical principle of beneficence.

It may be very easy to transgress in these areas of the nurse is not attentive and diligent in their work. Being a nurse means stepping outside of our feelings and judgments and treating others, “attentively and vigilantly so as to avoid mistakes (Tong, 2007, p. 25). Beneficence- the principle of doing good; acting in the best interest of a client through adherence to professional performance standards and procedural protocols. Beneficence encompasses patient welfare but not necessarily to the well being of the healthcare provider (p. 34). I feel an example of this is lifting and moving of heavy patients.

It is my duty to assist them to a position they request or to find a more comfortable position if they state they are uncomfortable or if I am aware that their position my cause skin breakdown or harm but not to the detriment of my own body. Nursing injuries are preventable and hospitals have a duty to provide equipment to ensure their nurses do not get injured. There are hoists, slide boards, and even extra man power available to ensure the nurse does not get injured lifting an increasingly obese population. Protocols for lifting ensure the patient is not harmed if the nurse falls while helping them also.

I often ask for more assistance in moving patients from chairs to beds and I also enlist the help of the patient if they can assist me with their position chance. Justice- equal distribution of goods, services, and burdens regardless of client diagnosis, culture, national origin, religious orientation, and sexual preference. there may be times when a patient is deemed unworthy by the nurse and he/she may feel that the patient doesn’t deserve to be treated the same as other patients. One example that comes to mind is occurring this week. The shooter of the 6 officers wounded last week is alive and in hospital right now, receiving care for a gunshot wound he suffered. As his nurse, I might need an extra few minutes each day to reassess why I am a nurse and the duties I must conform to before entering his room. The prisoner deserves the exact same treatment as the officers, yet he will be facing the death penalty once the court proceedings start. The same is true of the high profile mental health patients at the Utah State Hospital. They all deserve the same treatment as any other individual, yet they have done such tremendous harm to others.

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