Fundamentals of Nursing and Midwifery 2e

Chapter 11 Values, ethics and advocacy

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relationship. These prerequisites relate not only to skills and clinical competence but to the values and beliefs of the nurse or midwife. Therefore, nurses and midwives must have a well-developed understanding of the role of ethics in professional practice and how their own ethical position will affect the care they deliver. Ethics, or morality, poses ques- tions about how we ought to act and how we should live. It is an inquiry into the justification of particular actions (e.g. Are these actions right or wrong?), as well as a search for traits of moral character that promote more human growth. Nurses and midwives need to have a clear and well- developed personal moral compass to deal appropriately with the trust that is placed in them through the intimate and often privileged relationship they have with communities and individuals. They are increasingly confronted with moral and ethical decisions; the more that science and tech- nology increase the options available to people and healthcare providers, the more frequently nurses and mid- wives will find themselves confronted by situations not previously encountered. In these situations, often the ques- tion you will be confronted with is not ‘How do I do this?’ but, rather, ‘Should I do this?’ or ‘We can do this, but should we, here and now, for this person?’ Healthcare professionals can be distressed by the failure of society to provide adequate care for its most vulnerable members. Nothing is more disturbing for professional nurses and midwives than seeing first-hand the conse- quences of unmet healthcare needs. When caring for people who may lack the ability to comply with medical treatment on an ongoing basis, they have special advocacy obliga- tions. A shortage of nurses further complicates the nursing work environment, creating the necessity for nurses to be skilled advocates for safety, quality care, and their own needs. Never has it been more important for nurses and mid- wives to grasp the ethical dimensions of professional practice and to be confident in ‘doing the ethically right thing simply because it is the right thing to do!’ With their moral integrity under scrutiny every day, they need to be as skilled ethically as they are intellectually, interpersonally and technically. VALUES Ethical issues are a part of daily life in nursing. Such ‘every- day’ nursing practices as administering medication, providing physical care or communicating with patients all have the potential for ethical implications. Therefore, nurses require core professional and personal values. Johnstone (2009, p. 11) suggests that, when discussing and advancing debates on ethical issues in nursing and healthcare, it is vital all parties involved share a working knowledge and under- standing of the meanings of terms and concepts fundamental to the issues being considered. A value is a belief about the worth of something, about what matters, that acts as a standard to guide one’s behav- iour. If you think back to how you spent your last weekend,

you may observe something about your values. The amount of time and money you devote to relationships, work, study, fitness activities, leisure and other experiences reveal some- thing about the importance (value) you attach to these endeavours. Values are the link that ties together personal perceptions and judgements, motives and actions. A value system is an organisation of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. A person’s values influence their beliefs about human needs, health and illness; the practice of health behaviours; and human responses to illness. For example, individuals who place a high value on health and personal responsibility often work hard to reach their fitness goals. Individuals who value high-risk leisure activities may attach less value to life and health. Some values held by indi- viduals may be at odds with the values of others in the same family, community or society. This situation raises issues about the rights of individuals to express their values, about societal judgements regarding which values are to be toler- ated, and others’ tolerance for difference. Nurses and midwives who work effectively with people are sensitive to others’ values while being clear about how their own values influence their actions and interactions. The impact of personal and professional value systems can be explored in the following scenario. Abdul Naljib is an alert 32-year-old man in the inten- sive care unit who is begging to be removed from the ventilator. He understands it is highly unlikely he will be able to breathe on his own without the ventilator. He writes on the communication board: ‘If I die, I die. I can’t keep living like this.’ In this potentially very distressing sit- uation, you will have to consider your own personal value position as well as that of the profession. Now reflect on what your own personal value position would be if you were the nurse who had to respond to Mr Naljib. Would your own value system alter the way you responded? Investigate what the value position of the profession is towards such a request made by Mr Naljib. Then further reflect and consider if this aligns with your own values and, if not, does this change your position? Development of values People’s values develop in response to the environment, family and culture in which they are raised and in relation to the meaning they attach to their life experiences. Quality of life can be seen therefore as a product of physical, mental, social, environmental and spiritual health. As children observe the actions of others, they quickly learn what has high and low value for family members. If the parents spend a large portion of each day cooking, and the family spends a long time eating and talking at the table, the children learn to value food and the good times it represents. Similarly, children learn that helpfulness is a good and respected quality if praised when helping parents, grandpar- ents and siblings. Values are further refined through discipline

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