Ethical action depends in part on the ability of people to be aware of the existence of moral issues in any given situation, and know how to make ethical action if and when required, and on personal and a genuine desire to achieve moral outcomes (Johnson, 1999, 46). The aptitude to be able to respond appropriately and effectively to moral issues, in return requires development of moral sensitivity, moral reasoning, moral motivation and moral character (Wilson, 1993, 29). The development of the fore mentioned abilities leads to moral behavior.

Moral sensitivity calls for awareness of situational aspects that affect the welfare and wellbeing of an individual. It requires insight, intuition, moral knowing and the ability to recognize the salient moral cues in a given situation to indicate that a moral issue is present. It inculcates evaluation of a person’s verbal and non-verbal behavior in knowing what someone requires and responding appropriately.

Moral reasoning calls for drawing of logical conclusions from evidence or facts presented, and also the ability to connote how moral decisions ought to be done. It is mostly put to task when we have conflicting ideas and values or what action one requires resolving a conflict of values more so where live is involved.

Moral motivation involves genuine desire and interest to achieve good moral outcomes. Moral character can be defined as the determination, strength of conviction and courage that moves a person to carry out activities of moral action that he or she has deemed morally imperative.

Learning about codes of ethics in nursing will help a nurse to develop his or her abilities to be moral and integrate them with problem-solving skills gained in earlier education.

Social workers working in social places deal with complex situations and confront challenging ethical dilemmas. The need for nurses to competently navigate ethical issues in casualty departments becomes even more frequent in the light of many abuses. This article seems contribute to the understanding of ethical decision making processes in hospitals through the analysis of a case situation presented that is non-compliant with normal behavior because of some religious beliefs. This case conflicts issues related to moral responsibilities of nurses to an extent that patience of a nurse is put into test.

Religious values

Like ethics, religious values are a product of the culture and history from which they have emerged. The values learnt in any religious context are powerful and durable, and may continue to have an influence on people’s attitudes and beliefs even when they have cast off a particular religious system. This contributes to the unwavering demand of the old man even if his life seems to be in a wanting situation.

Religious beliefs and practices can sometimes be acted out unconsciously, for the reason that the values may be embedded in the background and experience of the person and cannot be called into question without questioning that persons own concept of self (Leininger, 1984,  89). For instance some religions adhere to certain tenets that influence individual’s beliefs concerning life, medical care and death major among others. There are even others which advocate for no medical therapy when a person is sick and they don’t consider this one to be morally wrong, so the decision of the old man was religious bound.

The teachings of many organized religions seek to embrace almost every aspect of human dignity. For instance in Orthodox Judaism there are specific values and principles which are usually embodied in specific laws including those governing food production (Berkovits, 1990, 98). Hinduism is a diverse set of religious beliefs that gives all spiritual meaning to individual attitudes and actions towards others. Islam requires its followers to submit themselves fully to Allah in all aspects of living. The geographic mobility of modern society means that nurses may get themselves caring for patients with cultural values and religious beliefs very different from their own. Conversely, the values and beliefs have to be acknowledged and respected to provide effective care.

Ethical issues in nursing

The ability of nurses to engage in ethical practice in everyday work and to deal with ethical situations, problems and concerns can be the result of decisions made at a variety of levels- individual or organizational. The complex issues in nursing practice have both legal and ethical dimensions. An ideal system of law would be compatible with ethics in that adherence to law should never require the violation of ethics.

Professional values critical standards that have been agreed to, and are expected to be upheld by a professional group (Johnston, 1998, 28). Professional values in nursing are promoted by the by the professional codes of ethics, professional codes of conduct, professional competence standards and the practice of nursing.

Professional values are made explicit in the code of conduct and any other formal statement that establishes and makes contact with the publics the standards of a professional group. The UK code of ethics reflects professional values inherent in nursing in respect for human rights, including the right to life to dignity and to be treated with respect.

Ethical issues ignored

Both moral and non-moral values can easily conflict with one another with the patient’s rights and professional duties. Personal values sometimes may conflict with professional values, which in turn may conflict with cultural values. The nurses’ value of doing good to the patient in this case conflicts with her value of honoring the patient’s choices.

In the presented case the nurse is to be blamed of her utterances because the profession calls for identification of values involved, the strength and relevance of the of rights claimed and their relevant duties and the source of the conflict. A nurse should make decisions based on which values are most important and which rights claim is warranted and deserving respect.

The old man is not in his right senses and deeply embedded in the religious teachings of where he belongs to. The nurse is learned to understand what is going on and the old man doesn’t change even by the pleas of his family. To escalate the problem, the nurse utters a very nasty phrase which seems to lower the dignity of age and also the religion. The statement connotes that old people don’t have any value any more and even the religious believes of that particular group are full of errors. She also contravenes moral sensitivity and situational sensitivity as this is not the right environment for the particular clause. The clause is offensive to the old man, the family and the profession as a whole.

Ethical principles are fundamental concepts by which people judge their behavior. This principles help people make decisions and serve as criteria against which they measure behavior. Ethical principles are guiding ideals of contact that speak to the spirit of law, not necessary to its letter.

Autonomy

This is the right of self determination, independence and freedom. It is the personal right of individuals to absorb information, analyze it and carry their choice. Nurses demonstrate the principle of autonomy when they provide accurate information to the clients, help them comprehend it, and respect the decisions that they take as a result of their understanding. The information provided by the nurse in the case is not respecting, contravenes the rights of the client and she cannot be able to substantiate her statement if before a court of law.

Beneficence

This means doing good for the benefit of others. It involves more than providing technically competent client care by acting in ways that demonstrate genuine and accurate empathy, providing non-possessive warmth, listening, empathizing, supporting and nurturing. The actions of the nurse show nothing good for the other because they will never want to come to hospital to face the fanatical response that they received. There is no sympathy or rather empathy in the presented case and the best comfort that the family needed is empathy and not abusive clauses.

Non-malfeasance

It involves avoiding harm in any action that one engages in. It fundamentally involves not inflicting harm, preventing harm, removing harm and promoting doing well. The nurses’ utterances contradict this tenet to the maximum because they inflict a lot of pain to the family involved.

Justice

This implies fairness and equality which calls for impartial treatment of the clients. It is based on respect for human life and dignity. It calls for distribution of scarce resources equally and attending to complaints of pain by clients, no matter how difficult they can be. The nurse in the presented case in this case instead of attending to the complaints of the old man she adds more pain by her utterance. She was supposed to evaluate and communicate information about the old man with fairness and lack of biasness.

Legal and ethical implications of the case

If the family of the old man was to take action then the nurse could have found herself behind bars minus a job for a case of defamation. Old age for most people is a favour from God considering the man as religious. So when a person contravenes the same and has a wish that you should be dead, then there is no need of letting the person loose and closure to the health of other old people. The nurse from her utterances is capable of administering the wrong prescription to an old person if she comes close to one because she has a dislike for old age.

From an ethical point of view, a nurse who is morally good will has desire and motives in promotion of patients’ well-being. Such a nurse will be more likely to understand what should be done in the nursing role, more likely to perform the actions that are required and more likely to act on moral ideals (Pullman, 1994, 43). The ethical implications of the actions of the nurse are that patients more so the old ones are going to develop fear when in the hands of female nurses. It also brings into question the kind of training that nurses undergo if they are the sources of rebuke when they should be sources of consolation.

Secondly it brings to the attention of nurses that there are some challenges whose root origin is religion. Therefore it calls for both ethical and moral values when dealing with such issues and any personal values towards anything shouldn’t arise.

Honesty

Even when nurses must convey unwelcome information on the treatment option, they must do so truthfully. The information should be factual and the language used should be clear and appropriate to the age and capacity of the client. Genuine concern when giving unwelcome information  like in this case the nurse didn’t consider genuinely how much the family was concerned about the health of the old man to give them such disgusting information. To make matters worse the nurse is leaned and conversant with the issues that they are facing as a team.

Respect

Respect for nurses calls for the recognition of the right and ability of an individual to decide for himself/herself based on his or her own values, beliefs and life span. This implies that the patient may choose a treatment that may differ from the advised course of care. The patients’ decision should be informed and well considered, reflecting his/her values. It is acceptable, for, example, that a patient refuses a certain therapy because of binding religious beliefs. The nurse should have understood the case and look for other therapies to subsidize for the same to save the life of the old man. This contravenes the tenet of respect in that the will of the client is not adhered to and instead provided with another form of therapy which is hard for the family to take in.

Dignity for human life

This requires that clients be treated as unique and equal to every other individual and that special justification is required for interference with an individual’s own beliefs (Rawls, 1971, 21) the nurse has not taken the old man as unique in his own way and for her utterances she doesn’t offer an apology. This is what elevates respect for life, freedom including freedom to belong to a particular religious group and privacy of all humans. The principle of dignity is necessary for any moral system because there can be no human being moral or immoral, if there is no human life. The nurse ignored that the old man was undergoing a lot of pain and knew that the transfusion was emergent but was also barred by the religious beliefs.

Confidentiality

The information disclosed to the nurses should have been very confidential. If the nurse is able to disclose personal feelings that she has about age, what about information about her clients? Confidentiality is required to allow the patient feel free to make a full and frank disclosure of information to the nurses with a main objective that the nurse will use the information to help the life of the man at stake. In this case the family members are witnesses to the remark of the nurse and even the old man therefore information necessary will not be disclosed to the nurses.

In addition to the same courts in the UK generally allow a cause of action for a breach of confidentiality against a treating nurse who divulges confidential information without proper authorization from the patient.

Equity

Clients should be treated with equity disregarding the factors that the nurse is having at the back of her mind, i.e. age and religion. It is only the creator who is able to create live and take it away no other human being is authorized to do the same. She should have taken the live of that old suffering man as hers and the live of the man was in urgent need for medication and not for insults.

Valuing diversity

Diversity in the religious beliefs enriches human beings and culture. The diversity should not be taken as a weak ness but as an enriching factor and respect should prevail for the same. The nurse therefore should have considered diversity and taken the old man the way he was.

Conclusion

Each nurse has a personal value system influenced by his or her upbringing, culture, religious and political beliefs, education and life experiences (Barrett 1990, 98). We may not put all the blame to the nurse because there are some people who are ill mannered because of the way they were brought up and they don’t consider such talks as hurting. There are people also who cannot be able to hide their feelings and the only therapy for the same is to speak it out and be relieved.

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