Fundamentals of Nursing and Midwifery 2e

Unit II Foundations of nursing and midwifery practice

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advocating women’s rights to determine the direction of their own pregnancy and childbirth experience. Nurses and midwives as advocates must realise they do not make ethical decisions for their patients; instead, they facilitate patients’ decision making. They: • Interpret findings for their patients • Inform them of various aspects to be considered • Help them verbalise and organise their feelings • Call in those people who should be involved in the decision making (e.g. family, primary nurse, physician or spiritual adviser) • Help patients assess all of their options in relation to their beliefs. In this way, nurses and midwives advocate for the right of patients to make their own decisions concerning their health. However, not all individuals want to make their own treat- ment decisions, and you should not violate the spirit of autonomy (self-determination) by forcing it on anyone. Nurses and midwives sometimes advocate for patients by helping them to delegate decisions to a preferred decision maker whom they trust. In addition, when claiming to be a patient advocate, they must be careful to clarify exactly In this chapter you have been learning about values, ethics and advocacy and their influence on nursing and midwifery practice. Once you have had the opportunity to put this theory into practice you will become more confident in car- rying out the identified skills. What have you learnt? • The importance of developing a thorough understanding of the role of ethics in nursing and midwifery practice • How the nurse and midwife’s own values affect care delivery • How to develop skills in clarifying the values of patients • To define ethics and the broad categories of ethical theories • How to describe the formal study of nursing and midwifery ethics • An understanding of ethical conduct, ethical/moral agency and the importance of professional ethical development • Knowledge of the codes of ethics that guide professional practice • An understanding of patients’ rights • How to use a decision-making process when an ethical problem is encountered • Understanding of the role of nurses and midwives in advocating for patients. Developing knowledge skills

what it is they mean by advocacy because, in most instances, this is not simply supporting patients in all of their preferences. For example, if a woman in the early stages of Alzheimer’s disease, with the support of her partner, asks a nurse for help in terminating her life, the nurse would have strong ethical grounds for refusing to advocate for this par- ticular request. Being politically active No discussion of advocacy would be complete without noting nursing and midwifery’s continuing voice in the political arena on behalf of those least well served by the existing healthcare system, including homeless people, minorities, women and children. As governments become more involved in the delivery and funding of healthcare services, and as those designing rationing plans speak seri- ously of age and other variables as criteria for limiting care, nurses and midwives must continue to advocate for the healthcare needs of those least empowered to do so for themselves. Nurses and midwives are a powerful block of voters whose potential for influencing healthcare legislation is able to be tapped. 1. Students choose nursing as a career because of different values. A desire to help others, a love of money, wanting a career that allows you to work anywhere at any time, a commitment to provide for your children’s well-being, a love of science and technology, and respect for your parents’ wishes are all values that may lead to choosing nursing as a career. What were yours? 2. Interview your classmates and identify the values that brought everyone to nursing. When a classmate lists more than one value, ask him or her to rank these in order of their importance. Compare your lists. 3. Discuss which values, if any, provide the best motivation for professional nursing. Are there certain values that are incompatible with professional nursing and that ought to be grounds for rejecting candidates for the profession? 4. Make a judgement about how well your personal values equip you for professional nursing. Are any modifica- tions needed? 5. Make a list of all the values that might positively or neg- atively influence someone’s ability to lose weight. Think about how you could use this knowledge when counselling obese patients. 6. Another student tells you: ‘Who I am outside of school is no-one’s business and has no effect on my nursing.’ Do you agree? Why or why not? 7. Take any current ethical issue (assisted suicide, human cloning, how to allocate scarce organs for transplanta- tion, everyone’s right to healthcare) and poll your class Developing critical thinking skills

To enhance your learning and facilitate further understanding of this chapter, refer to thePoint and LNPS online resources.