Ethical Dilemmas Health System

Question: Discuss about the Ethical Dilemmas for Health System. Answer: Introduction Australia has a long, mixed health system with both private and private sector roles in the provision and financing of the health care services (Toffoli, Rudge, and Barnes, 2011). The primary goal of the healthcare systems is to provide the good health and equal health care rights and services to all the Australians (Heti.nsw.gov.au, 2016). Moreover, the healthcare system of Australia is a multi-faceted network of private and public providers, participants, settings, as well as, supporting mechanisms. There are a number of health providers and health care settings, which consists of medical practitioners, allied health professions, nurses, clinics, hospitals, non-government and government agencies. The aim of these providers is to deliver efficient services and care across various levels, from preventive services and public health care in the community to the emergency health care services, primary health services, rehabilitation care, and hospital-based care and treatment (Aihw.gov. au, 2014). Registered nurses are often required to work in a vast range of settings including but not limited to a general ward, aged care, paediatrics, emergency, ICU, cardiac, rehabilitation and mental illness (YildirimAycan 2008).Further, it has been observed that the nurses comprises the largest group of workers in a health-care setting in various countries and moreover, in Australia, the nurses constitute the largest group of workers and comprises largest employee group in the healthcare setting. Hence, nursing skills attribute towards the care and outcome of the healthcare services with the patient (Jacob, McKenna, and D'Amore, 2013). Registered Nurse and Ethical Dilemmas Fundamental values related to alleviating the sufferings, as well as, preserving the life of the patients are shared by all the healthcare members of the nursing and medical professions. Nurses are accountable and responsible for providing effective, safe, and ethical care and services to their patients (Mason, 2005). There are different practice standards, as well as, professional codes that govern the nursing in the healthcare setting. For instance, the Nursing and Midwifery Board of Australia underlines the professional accountability of nurses in the healthcare setting. In Australia, Code of Ethics for Nurses has been developed for the effective management and better understanding of the nursing profession. The Code of Ethics outlines the commitment of the nursing profession to promote, respect, uphold, and protect the fundamentalrights of the individuals who are both providers and the recipients of the nursing, as well as, health care (Code of Ethics for Nurses in Australia, 200 8). Moreover, in conjunction with the code of professional conduct for nurses, they set and describe the minimum standards that nurses have to uphold in the regulatory jurisdictions both within, as well as, outside of the professional area and domains for ensuring good standing of the nursing profession in Australia (Code of Professional Conduct for Nurses in Australia, 2008). It is the responsibility of a nurse to make sure that the relationship which is based on the goals and plans are therapeutic in purport and outcome is well-maintained. (A nurses guide to professional boundaries, 2010). The registered nurse is legally accountable and responsible for the analysis, synthesis, as well as, evaluation of the data that is collected on clients through the direct observation by the registered nurse (Aihw.gov.au, 2016). However, there is a certain situation where ethical dilemmas arise and nurses have to face these ethical dilemmas to accept or reject the care of the patient. The refusa l of the patient care can lead to the ethical and legal dilemmas and may possess the implications on the practice of the individual as a health care professional (Turkoski, 2003). Refusal of the patient allocation and Ethical dilemma: The ability to assign tasks, delegate, and supervision are the primary skills required of the registered nurse in any sphere and level of the practice in a healthcare setting. Moreover, the registered nurse has the duty of carrying out the proper assessment, implementation, planning, and evaluation of the role of the provision of healthcare services to the patient (White and Dudley-Brown, 2012). The nursing staff who values the quality of the nursing care also recognize and understand that they are responsible for the decision-making regarding the care of the patient, accepting their legal and moral responsibilities to ensure that they possess the skills, knowledge, and experience, which is necessary and required for providing competent and safe nursing care to the patient, as well as, also to ensure that they practise their care within the boundaries and ethics of their professional position. However, in certain situations where the patient allocation is unsafe or risky, an ethical dilemma arises for the registered nurse to accept or refuse the patient. The action of the registered nurse may lead to the consequences on the professional life of the individual (Guidelines for the registered nurse in giving, accepting, or rejecting an assignment, 1997). Hence, refusal of the patient by the registered nurse should be within the norms of the ethics and conduct of the nursing care. For instance, according to the code of ethics for nurses in Australia, a registered nurse can refuse to participate in the treatment and care of the patient in case, the case is unacceptable on the religious or moral grounds of the nurse. Hence, if the provision of the care conflicts with the religious beliefs or cultural values of the registered nurse, the nurse may refuse the allocation of the patient or an assignment and will be protected against the retaliation (Code of Ethics for Nurses in Australia, 2008). In this case, the refusal of the patient by the nurse is within the norms of the code of ethics for the nurse and does not lead to the ethical dilemma. However, in some cases, the refusal of the patient can lead to the ethical dilemma. For instance, refusing the allocation of the patient if the case is unsafe or risky, like in care of the communicable diseases or pandemic break can lead to the ethical dilemma depending upon the nature of the case. A registered nurse can also maintain their own safety and promote quality practice by adhereing to procedures, precautions, protocols and guidelines created to protect staff and consumers of health care. For example preventing the spread of dieseases to other patients, staff or people in the community, by adheraring to infection control stadards for which there are various measures for different circumstances (Pittet 2005). Such as Personal Protective equipment for infectious patients, needle stick injury protocols and hand hygiene workshops. More over it is the registered nurses responsibility to know what to do if infection control is breached and then to report it to prevent or reduce the risk of it from happening again. However, in the case, where nurse receives an assignment or allocation of the patient is done that is considered unsafe to deal or perform independently, the registered nurse has the right, as well as, obligation to request a modified assignment and patient allocation, which reflects the level of competence of the registered nurse (Whitehead, Weiss and Tappen, 2007). Declining the allocation of the patient or nursing assignment can result in the workplace tension and stress, and in some cases, it could also lead to the loss of confidence by the healthcare management. Hence, it is very important to possess a healthy balance between personal, as well as, professional lives, and it often involves saying 'no' at certain times (Tschudin and Davis, 2008). As conscientious objection is allowed according to the code of ethics for nurses in Australia. According to the American Nurses Association, the registered nurses have the right to reject the nursing assignment that can put the patient or themselves in immediate and serious jeopardy. Moreover, even in the case where the nurse is allocated a nursing assignment where the nurse believes that he/she is not having required skills, knowledge, or experience that are necessary to perform and provide the duties in the allocated case, he/she should consult the supervisor and should state that she/he cannot accept the allocation of the assignment or the patient. However, it requires following proper steps and actions by the concerned authority and the registered nurse is liable to be answerable to the authority (Ketefian, 2000). As the foremost duty of the nurse is effective care of the patient, the inefficient skills or knowledge of the nurse about the case would affect the outcome of the care on the patient. This is why refusal of patient allocation is allowed in case no effect on the continuum of the care is observed (Schoonover-Shoffner, 2007). Registered nurses, as well as, licensed practical nurses, share the accountability and the responsibility along with the employer for ensuring the provision of effective and safe nursing care to the patients. However, there are certain cases where to face the questionable situation when the patient refuses the care. During these situations, it is very important for the nurses to explore various options in the most positive manner keeping in mind that the patients safe care along with the maintenance of their autonomy is their foremost duty. There are various situations where the patient refuses care on the basis of their spiritual and religious beliefs (Stringer, 2009). For instance, in Muslim culture, the chastity, modesty, and restraint for women are important. This highly valued modesty based on these cultural and religious beliefs make women reluctant to seek health care such as pelvic examination or cystoscopy. Hence, in some cases, Muslim women refuses seeking examination based on their religious beliefs of not allowing intimate exposures. According to the cultural and religious beliefs of Jehovahs Witness, it is not acceptable to have blood products or blood transfusion, based on their biblical readings. The people belonging to this community faces an obstacle in seeking proper treatment due to their faiths and beliefs as they refuse blood or blood products (Chand, Subramanya, and Rao, 2014). For instance, in Muslim culture, there are strongly religious and culture based concerns regarding modesty, most prominently seeking treatment from someone who is of opposite sex. A Muslim woman cannot seek care from the male nurse and vice-versa. Moreover, according to the Islamic culture, if the man dies at the hand of a female, they will be deprived of being virgins when they die and goes to hell (Leaman, 2010). Hence, the male Muslims during their dying hours refuse to get care from the female nurse because of the fear of dying in the hands of the female nurse. These kinds of activities are the cultural and religious beliefs of their tradition and these situations raise ethical dilemmas for nurses during the provision of the health care services and care. In this kind of ethical dilemmas, there is a contrast of research-based insights and knowledge gained by the nurses during their nursing practices to the beliefs achieved from this kind of things like religious beliefs (Stringer, 2009). In case, there is a limited male staff nurse in the healthcare organization, the situation can raise an ethical dilemma against the provision of the healthcare services to the patient. There are various other situations that can lead to ethical dilemmas in the healthcare setting. For instance, what should be the intervention and plan for the nurse who is dealing with the patient that requires transfusion for a living but has the religious or cultural beliefs where transfusions and blood products are not acceptable as in the case of Jehovahs Witness. The nu rse is very much familiar with the fact that the patients live can be threatened if no transfusion is provided, but cannot continue to the process against the will of the patient. The ethical principles regarding the autonomy of the patient versus beneficence of the patient come into conflict where a healthcare practitioner believes that the transfusion is necessary and is in the patients interest, but the client refuses to undergo transfusion (Stringer, 2009). An effective and immediate communication regarding the situation among the staff members and shift coordinator to make necessary allocation changes should be made. Moreover, patient should be aware about the consequences of refusal of the care. To respect the personal and cultural beliefs of the clients is the foremost duty of the nurses and they have to work maintaining the autonomy of the patient (Knapp, Lemoncelli and VandeCreek, 2010). Response to the complaints to the Midwifery Nursing Board or Director of Nursing: Legal and ethical requirements for the practice by nurses exist to ensure the health, welfare, and safety of the general public, as well as, to protect nursing professions integrity. However, there are certain cases, where the nurses refuse the care of the patient and in this case, the refusal of the care and treatment of the patient could raise an ethical dilemma against the registered nurse. As a result, a situation can occur where a complaint is made against the action of the nurse of refusing the allocation or care of the patient. Hence, an investigation will be made in the case of refusing care in case the complaint is filed against the registered nurse (Anon, 2009). The Australian Nursing and Midwifery Federation (SA) is the most powerful industrial and professional organization composed of registered nurses, personal care assistants, and midwives. The main objective of the organization is to encourage and promote the community engagement on various issues that can impact the n ursing profession. They are the leading voice for the midwives, nurses, as well as, personal care assistants, which works together for negotiating the positive results for their members at state, local, and federal levels. Hence, the foremost step of the registered nurse should be getting enrolled in this organization and becoming a member of it. Being a member of this organization can help the nurse in various situations where ethical dilemmas occur and they can seek advice related to it for being conscientious (Anmfsa.org.au, 2016). The nurse should always remain to prepare the disciplinary actions that may result due to the decision of refusing an allocation of the patient. Therefore, at the time of refusal of the allocation of the patient, the registered nurse must provide a written documentation regarding the reason for refusing the care of the patient. The registered nurse should also keep a copy of the provided documentation with themselves and the steps that were taken durin g the situation. The documentation can provide a record which is valid regarding the situation in case of future references (Massnurses.org, 2016). The registered nurse should be able to provide a clear and evident reason that on what basis he or she have rejected the care of the patient, whether the reason for rejection is based on the moral grounds, religious beliefs, cultural beliefs, safety, or risk related to the care. The nurse should be able to provide an open, prompt, and constructive response, which also included an explanation of the related action (Medicalboard.gov.au, 2016). Moreover, the registered nurse should also be aware of the different options to contest any kind of disciplinary action if taken by the authority (Massnurses.org, 2016). The registered nurse can also take a legal advice regarding the situation and possible solutions when there is an ethical dilemma within the healthcare setting. Conclusion The Code of Professional Conduct for Nurses in Australia describes the set of various expected standards of nursing and the required conduct for the nurses in Australia. Any kind of breach of this Code of conduct may raise an unprofessional conduct or professional misconduct. Hence, nurses have the responsibility of providing a safe, as well as, competent care to each and every individual who is seeking medical and health care. Moreover, there are certain guidelines related to the code of ethics under which the nurse and other healthcare professionals have to provide the care to the patients. However, in any situation it is found that the nurse or midwife has not followed the code of ethics and other legal regulations during the provision of the care to the patient, the Nursing and Midwifery Council nursing would use these set of requirements and guidelines that are outlined for assessment of the performance and actions of any nurse or midwife involved in such a situation and will de termine if any kind of disciplinary action is required against the midwife or nurse or not. The situations that raise ethical issues for the nurse generally includes a conflict amongst the professional obligations of the nurse towards the patient and his or her personal obligations. Hence, the registered nurses should use a problem-solving method and approach which is ethically sound and can help the registered nurses for considering the relevant factors, as well as, best solutions for the ethical dilemmas (Anon, 2013). References A nurses guide to professional boundaries. 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