The nurse plays a key role in providing the patient with a high quality of care. In their professional practice, they face many ethical challenges; therefore a nurse is required to be friendly with the concept of ethical decision making and ethical codes of conduct. The nurse should always be sure that the medical advances used for the patient are compatible with his/her safety. It is a code of ethical conduct for a nurse to maintain the confidentiality of the patient and share information judiciously. This easy is focused on discussing the role of the nurse in caring for the individual, including the legal, professional, and ethical aspects of care and the biological, psychological, and social factor that affect the care and health of Mr. Khan’s case study.
In this case study, Mr. Khan is an old 72 years old man who got myocardial infraction issues. Myocardial infarction (MI) is referred to as myocardial necrosis that develops because of coronary ischemia. The biological factors might include smoking, blood pressure, gender, and physical inactivity. In this case, as the patient is an old man so it's clear that he might not be doing sufficient physical activities and he is also unemployed means that he does not even walk outside his house to go for office. According to Chan et al. (2019), if there is good communication either non-verbal or verbal between the nurse and the patient then it can help in overcoming the psycho-social factors and provide better psychosocial care. There should be open-ended questions and trust-building steps that result in making the patient comfort and involving him and his family to support him. The psychological factors include stress at work or family life or unhealthy behavior. In this case, the patient had sustained a myocardial infarction (MI), and when the doctors earlier suggested him to change his diet but he did not. These factors together resulted in his bad health status.
The social factors include low economic status or social isolation. In this case, the patient is from South Asian heritage that shows that he might be staying with his wife, children, and grandchildren. His medical history was not good and being an old man he is not able to earn money for his family as he is an old man and unemployed. This might stress him about his low economic status resulting in his poor health. According to Evensen et al. (2017), usually, the patients with old age and no physical activity are admitted to the hospital with serious health issues. A nurse can promote physical activity in the life of the patient by suggesting him incidental walking or short walks that increase slowly with time and benefit the patient. Moreover, a nurse should overlook the social and economic status of the patient while providing him with health care. This provides the patient with effective care without any disparities. According to Ervin et al. (2018), a patient can be provided with good health care if the nurse establishes such an environment that the patient pushes himself to achieve his daily health goals, share his feelings openly to reduce the chances of stress and depression, and follow his recommended plans with honesty. Thus, a nurse can promote a patient with poor health towards a better health condition by making him understand his treatments and encouraging him.
According to Salminen et al. (2016), in nursing, there are 4 main ethical principles: 1. Beneficence – nurse must refrain from minimizing harm, maltreatment, and promote good towards patients; 2. Autonomy – this involves that the patient has the right to make his own decisions and he can also refuse his medications and other medical interventions and the nurse should respect his decisions; 3. Justice – the patient has a right to be treated equally by health care providers and fairly as well; 4. Non-maleficence – this involves that the nurse should provide care to the patient in such a way that he does not get harmed. In this case, the autonomy and non-maleficence ethics are disturbed because the health professionals are discussing among themselves only whether to provide Mr. Khan with resuscitated or not after he has lost life, this attitude harms the patient’s health. Every moment is important during operations and the professionals are instead of providing immediate actions for him, are discussing only what to do. According to Nusbaum et al. (2017), the legal role of a nurse included that provides safe and competent care to the patient. As per the informed consent, the client has legal and ethical rights to provide or restrict/stop his treatments or procedure.
In this case, this legal aspect of informed consent is violated because neither the patient nor his family members were informed about that the resuscitated and the doctors along with other health care providers were discussing only among themselves regarding the same. Moreover, this conversation took place in the doctor’s ward round at the nurse’s station and can be overheard by visitors. This violated the privacy and confidentiality of the patient’s health. This shows that the health care providers did not show professionalism, legal, and ethical aspects while providing care to the patient. The professionals were supposed to inform the patient and his family before the start of the surgery about the consent of information. They should also never disclose a patient’s private information such that any third person does not use it in the wrong manner. The information should be shared precisely and judiciously only with the patient and his family members (Nusbaum et al. 2017).
In this case, the strategy of communicating for effective care should be informed consent. Informed consent is a part of shared decision making but a very crucial communication approach between the patient and health carers. This involves information disclosure, active listening, overcome ethical issues, advocacy, and promotes strong coordination between patient-family-health professionals to provide effective care to the patient (Nusbaum et al 2017). As per the NMC code of conduct (2018), the patient’s dignity and integrity should be maintained but were violated in his case. Mr. Khan’s wife’s questions and concerns were also not answered depicting that the concern and needs were not listened to and fulfilled. Neither early communication was conducted nor the right to confidentiality and privacy maintained.
The communication strategies employed in this case are between the patient-family and between the health professionals. The patient’s condition was deteriorating, this was observed by his wife's through non-verbal communication/behavior and the professionals were communicating among themselves using verbal and visual strategies, that is, by observing the patient's condition and discussing among themselves. The Ottawa charter identifies 3 strategies: advocate, mediate, and enable for health promotion. A health promotion strategy could be a focus on food habits and role modeling. As in this case, Mr. Khan was told to shift to a better diet but he did not and suffered myocardial infarction. This shows that a proper healthy diet is of prime importance for a heart patient and now his wife should take the doctor’s recommendation about her own diet also in serious considerations. According to Gorski and Roberto (2015), the government has banned alcohol and tobacco for children below 18 years and released new food standards like no junk food in school, fruits, whole grains, vegetables, and many others. Many other policies like the removal of toys from unhealthy food items for children, limited sale of beverages and fried foods, and limiting the sale of certain products like alcohol.
The doctor’s recommendations should always be taken seriously especially when the patient has a heart condition with no proper physical activity and a healthy diet. The bio-psychological and social factors affect the patient’s health. Factors like stress, depression, no physical activity, and others can result in poor health. Effective communication between the patient and health providers can result in effective care to the patient resulting in better health. It could be verbal, non-verbal, or written communication. Therefore, the nurse is required to win the patient’s trust and have an active patient-nurse relationship for better nursing management. Moreover, the patient’s privacy and confidentiality is a right that every patient can exercise without any boundaries. It is the role of the nurse that professionalism, code of ethics, and the legal aspects of nursing should never be violated while providing health care services to the patient. If a health promotion plan or program is made then it should cover the Ottawa charter strategies to have more effectiveness.
Chan, E. A., Tsang, P. L., Ching, S., Wong, F. Y. and Lam, W. 2019. Nurses' perspectives on their communication with patients in busy oncology wards: A qualitative study. Plos One, vol. 14, no.10. https://doi.org/10.1371/journal.pone.0224178
Ervin, J. N., Kahn, J. M., Cohen, T. R. and Weingart, L. R. 2018. Teamwork in the intensive care unit. The American Psychologist, vol. 73, no. 4, pp. 468–477. https://doi.org/10.1037/amp0000247
Evensen, S., Sletvold, O., Lydersen, S. and Taraldsen, K. 2017. Physical activity among hospitalized older adults - an observational study. BMC Geriatrics, vol. 17, no. 1. https://doi.org/10.1186/s12877-017-0499-z
NMC. 2018. The NMC code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [Online]. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on July 21, 2020].
Gorski, M. T. and Roberto, C. A. 2015. Public health policies to encourage healthy eating habits: recent perspectives. Journal of Healthcare Leadership, vol. 7, pp. 81–90. https://doi.org/10.2147/JHL.S69188
Nusbaum, L., Douglas, B., Damus, K., Paasche-Orlow, M. and Estrella-Luna, N. 2017. Communicating risks and benefits in informed consent for research: A qualitative study. Global Qualitative Nursing Research. https://doi.org/10.1177/2333393617732017
Salminen, L., Stolt, M., Metsämäki, R., Rinne, J., Kasen, A. and Leino-Kilpi, H. 2016. Ethical principles in the work of nurse educator—A cross-sectional study. Nurse Education Today, vol. 36, pp.18-22. https://doi.org/10.1016/j.nedt.2015.07.001
White, J., Phakoe, M. and Rispel, L. C. 2015. ‘Practice what you preach’: Nurses’ perspectives on the code of ethics and service pledge in five South African hospitals. Global Health Action, vol. 8, no. 1. https://www.tandfonline.com/doi/full/10.3402/gha.v8.26341%40zgha20.2015.8.issue-s4
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