Caring originates in the relationships of shared human experience. The nurses primary roles of promoting health, preventing illness, restoring health and alleviating suffering places the nurse in a position to always remain an advocate for their patient. A scenario has been created in which a terminally ill patient has asked the doctor about alternative healthcare treatment options. The doctor in this case dismisses them as "quack" practices.What role does the nurse play in this situation? “When the patient’s wishes are in conflict with others, the nurse seeks to help resolve the conflict. Where conflict persists, the nurse’s commitment remains to the identified patient” (Code of ethics for nurses with interpretive statements, 2001). Moral courage is something that helps the nurse to address ethical issues and take action when doing the right thing is not always easy.
When a patient and doctor relationship is strained the nurse can sometimes help mediate a situation while always remembering her legal and ethical obligations. Physicians and nurses have different roles and duties in the hospital.
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Although nurses do not have the power to make certain types of care decisions, they do have the responsibility to follow the chain of command according to facility policy, until satisfied that good decisions are being made for their patients. Nurses spend more one on one time with their patients than doctors.
The closeness of this relationship may make it easier for some patients to disclose their complaints to the nurse rather than the doctor (Ofri, 2013). Nurse’s responsibilities are to provide the best care to the patients and to insure that all of their rights and interests are met.
“Once healthcare interventions have been adapted to meet the special needs of the patient, the nurse’s role is to articulate the patient’s request for care within the multidisciplinary team, creating patient-centered patterns of health care” (Hewitt, 2002).
As a patient advocate, ordering a consultation with those who can help further in the decision making process is paramount. Patient advocacy is described as “nursing activities aimed at securing patient’s legal and ethical rights and satisfying their existential needs, both on the level of the patient-nurse relationship and in the healthcare team or organization” (Vaartio-Rajalin & Leino-Kilpi, 2011).
The nurse should stand for the patient’s rights, dignity and health when others will not, thus becoming the communicator between the physician and patient. This ascertains that the patient receives optimal treatment. The Patient Bill of Rights states: “A patient has the right to obtain information about the specific nature of proposed treatment or procedure, a disclosure of the risks involved, and information about medical alternatives” (Patient’s rights, 2013).
Since the physician from our scenario has refused to discuss alternative health care options with the patient, it is the duty of the nurse to become a patient advocate. After first discussing this situation with the doctor, if the nurse is granted the doctor’s permission to provide information to the patient, there are some government agencies and resources like National Center for Complementary and Alternative Medicine (NCCAM), The National Cancer Institute, U. S. Food and Drug Administration (FDA) and CAM on PubMed.
These organizations assist patients and their families in learning about Complementary and Alternative Medicine therapies (Complementary and Alternative Medicine in cancer treatment, 2013). If the doctor refuses to give permission, it should lead the nurse to share his or her opinions with the medical staff involved in the patient care, following the appropriate chain of command.
Based on a survey held by The New England Journal of Medicine “most of the physicians reported that when a patient requests a legal medical intervention to which the physician objects for religious or moral reasons, it is ethically permissible for the physician to describe the reason for the objection but that the physician must also disclose information about the intervention and refer the patient to someone who will provide it” (Curlin, Lawrence, Chin, & Lantos, 2007). In order to provide the best care and safe environment to a patient, nurses need to band together and work as a team.
Gloria Ohmart, EdD, MN, APRN, offers a few strategies to protect patient’s rights and nursing profession. Some of them are: 1. “Keep an accurate record of issues that may be dangerous, illegal or unethical; 2. Check with other coworkers to see if they feel the same way about the situation, compare notes and discuss what the problem is and present a united front; 3. Talk to a charge nurse, head nurse, or supervisor to bring the problem to someone else’s attention; 4. Go up the chain.
If a superior does not act on the complaints, then nurses may need to go to the next level of administration and so on until they get to the top; 5. Pursue an advanced degree. Higher education empowers through knowledge and enables nurses to develop strong communication and conflict resolution skills, the ability to negotiate and provides a deeper understanding of professional ethics” ( Finn, 2013). “Nurses must examine the conflicts arising between their own personal and professional values, the values and interests of others who are also responsible for patient care and health decisions, as well as those of patients.
Nurses strive to resolve such conflicts in ways that ensure patient safety, guard the patient’s best interests and pressure the professional integrity of the nurses” (Code of ethics for nurses with interpretive statements, 2001).
The Code of Ethics for Nurses was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. When a hot topic arises in the industry, the American Nursing Association (ANA) will create an explanation, justification, or recommendation for a course of action otherwise known as a position statement.
The Code for Nurses published by the ANA is the standard by which ethical conduct is guided and evaluated by the profession. It provides a framework within which nurses can make ethical decisions and discharge their professional responsibilities to the public, to other members of the health team, and to the profession.
According to number eight of the position statement nurses must attend to and be aware of the conflicts of dual loyalty to patients, health care institutions, employers and agencies that provide payment for services (Code of ethics for nurses with interpretive statements, 2001).
Care and compassion are two traits that most nurses excel in. However these two qualities alone cannot facilitate being a voice for a patient. Education and moral courage are also essential needs when standing for the rights of a patient. It is imperative that a nurse understand their legal and ethical obligations to society and be able to carry forward their role as a patient advocate.
Nurses should always endeavor to become as skilled and qualified in their chosen field as possible by consistently trying to advance their education and training, as well as entering into a partnership with physicians and health professionals.
Policymaking and workforce planning should be done effectively to collect data and provide for a better information infrastructure. Educating ourselves as nurses will be essential to teaching our patients and allowing us to be a strong patient advocate, while standing united and taking comfort in knowing we are not alone.
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