Ben Cappello, Student Nurse

            Upholding a patient's dignity is intrinsic to their humanity; emphasizing patient rights is essential. Patients' vulnerabilities render them at risk for potential violations within the healthcare system (Demirsoy & Kirimlioglu, 2016). Nurses must devote adequate attention to the multifaceted dimensions of human rights and bioethics to understand their role in a patient-centered approach. Forming a relationship with a patient helps to facilitate their treatment, and relationships are built on trust; patients must trust their nurses and their judgment to expedite the healing process. All our ethical standards aim to facilitate trust between a healthcare provider and the patients. In this paper, we will explore some key ethical issues within nursing to discover how they may impact our patient-centered practice and how we might address these issues.  

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Nursing Ethics

            “Nurses have a professional and legal obligation to provide their clients with safe, competent, and ethical care” (BCCNM, n.d.). Ethics are the systematic analysis of right and wrong related to the health and relationships between sentient beings (Pilkington & Guiliante, 2023). A broad topic that encompasses many facets of humanity with different sub-categories. Bioethics is a sub-category that primarily covers the ethical standards for human healthcare, and nursing ethics fall into this area. Many of the fundamental principles of bioethics are applied to this unique subfield. However, there are distinct features of nursing ethics that seriously impact a patient-centered approach (Pilkington & Guiliante., 2023). In order to understand the difference, we will look at the four principles of bioethics: autonomy, the right to self-determination of what happens to your body; beneficence, the goal of promoting health; non-maleficence, first do no harm and justice, being fair in the distribution of healthcare resources (Astle & Duggleby, 2021). These points are the cornerstone of any healthcare field, and nursing ethics expand on these values with human dignity, privacy, justice, autonomy in decision-making, precision and accuracy in care, commitment, human relationship, sympathy, honesty, and individual and professional competency (Shahriari et al., 2013). The distinction between bioethics and nursing ethics, particularly in their impact on a patient-centered approach, hinges on the emphasis on relationships. The emphasis in nursing ethics on fostering meaningful interpersonal relationships and human connection contributes to combining relationships and social context into ethical evaluations of actions. This integration is critical when addressing complex and challenging situations with patients (Pilkington & Guiliante., 2023). Nursing combines multidisciplinary medical knowledge with interpersonal skills to ensure the best patient outcome.

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Privacy and Dignity

            Upholding a patient's dignity is intrinsic to their humanity, and health problems create vulnerability. Under professional standard 4: ethical practice, the BCCNM website states, “provides care in a manner that preserves and protects client dignity.” A twenty-two-year-old female patient in a Chinese hospital was there to have an abortion performed, exposed, and alone with a doctor. The doctor invited 20 people with lab coats into the room without asking the patient for consent, and when she asked the doctor to remove them, he refused. Then he began a lesson using her private parts as an anatomical model (Zhang et al, 2021). With the social stigma attached to an abortion, the patient must have already been feeling vulnerable. To then have your genitals the subject of an anatomy lesson against your will must have been traumatizing. More people receiving information about the patient's procedure has also increased the possibility that it may leave the hospital. Likely, the patient wanted the procedure to remain private, and the aforementioned stigma involving abortion could have serious consequences for her in a social context. These traumas could easily cause fear and distrust of the healthcare system, creating the potential for the patient to avoid seeking medical attention in the future. Beneficence is one of the cornerstones of bioethics. If we create an environment of fear and mistrust, we will not successfully promote health in the community.

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Confidentiality

            “Nurses collect, use, and disclose personal and health information only as required to meet their professional responsibilities and/or legislated requirements, or as authorized under bylaws” (BCCNM, n.d.). Confidentiality is related to privacy and is often grouped into the same category. However, in today's world, it requires its own separate consideration. Technology is an incredible tool for storing and accessing information, and it has become a crucial part of our daily lives, with social media and the internet connecting people with information and each other like never before. However, it has also created concerns that the more ways that information can be disseminated, the more aware and careful healthcare professionals need to be. New York Presbyterian Hospital, along with ABC and a doctor, were sued in 2012 after an episode of a medical documentary aired showing a blurred image of a patient. Unfortunately, the patient died as a result of his injuries, and the network had not received permission from the patient to film him. They assumed that blurring the image was enough, but his widow recognized his voice (Zhang et al., 2021). The shock of seeing some of a loved one's last moments on nighttime television must have been devastating. A television show is unlikely to be taped in your local hospital, but this could have been catalyzed by a social media post just as quickly. There are also considerations for protecting patients from crime. Scammers and identity thieves are always looking for ways to access personal information that nurses can. A nurse's duty to confidentiality extends beyond simple silence; we must actively protect and secure all patient information as a legal and ethical obligation.

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Autonomy in Decision Making

            “Nurses recognize that informed, capable clients have the right to be independent, make choices that put their health at risk, and direct their own care. Regardless of this right, nurses do not comply with client wishes when doing so would require a nurse to act against law or BCCNM Standards of Practice” (BCCNM, n.d.). The right to self-determination requires independence in decision-making. A patient of sound mind must be allowed to make decisions regarding their care. Nurses must educate the patients on their conditions and suggested treatments while also educating themselves about their patient's decisions and beliefs. With an unbiased attitude, the nurse must advocate for their patient, which first requires understanding that patient. This patient-centered approach is critical in the nursing field. A woman gave birth to a healthy baby in Stamford Hospital in Connecticut, but she developed heavy bleeding due to placental residue. A blood transfusion was needed to save her life; the patient and the husband refused the transfusion on religious grounds. After all other treatments were unsuccessful, the physician submitted a request to the courts to force the transfusion. The transfusion was given, the patient survived, and an appeal to the Supreme Court ruled that her rights were violated (Zhang et al., 2021). We cannot assume that the patient's priorities are identical to ours. Autonomy in decision-making happens when a patient has the appropriate information on diagnosis, treatment, and prevention and feels free to make the decision (Shahriari et al., 2013). 

 

Conclusion

             “Nurses do not allow their personal judgments about a client, or the client’s lifestyle, to compromise the client's care by withdrawing or refusing to provide care” (BCCNM, n.d.). Nurses have a legal obligation to provide care to all clients. Personality conflicts and moral quandaries will arise, but we must maintain equal care regardless. We must maintain self-awareness to continually evaluate our biases, prejudices, and proclivities to ensure we are never tempted to substitute our judgment for the patients. We must also focus on developing communication strategies that allow us to articulate alternatives factually and without passion. Personal information is a powerful tool in healthcare, and we must handle it with great care and attention to detail to keep our patient's confidence. Finally, nurses must continue to educate themselves and maintain awareness of ethical issues in order to maintain a total focus on the patient and their health journey.