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Chapter 7: Implications of professional values and ethics on nurses

Learning objectives

By the end of this chapter, you should be able to:

- Appreciate how professional and ethical values influence your practice

- Understand the potential positive and negative effects of these values from a personal and organisation perspective

- Identify and access the support mechanisms in place in your organisation

The positive impact of professional and ethical values

Through professional values in nursing, nurses are able to act autonomously in determining patient care, by virtue of knowledge and skills development throughout their career. These skills enable nurses to meet the needs of patients in diverse ways, providing a more complete therapeutic experience and avoiding delays in care provision. The professional values of nursing also demand extensive knowledge of therapies and care processes, benefiting both nurses’ profession and patient care. Therefore, professional values of nursing practice’s demand excellence in these areas provides motivation for nurses to become care experts and deliver the best possible level of care to their patients.

Professional values in nursing also allow you to advance your career and pioneer new treatment approaches by engaging in research and clinical leadership. Nurses’ contribution to research and leadership can advance personal practice, and also influence practice for others. Professional values provide a clear set of directives for integrating research, teaching and leadership into nurses’ daily lives, encouraging development of these skills.

Nursing leadership is increasingly important in research and practice, reflecting the knowledge and experience of nurses in addition to their central role of many healthcare processes. Promoting leadership among nurses encourages nurses to take control of patient care and promote advocacy of patients. Leadership also allows nurses to contribute to the development of their profession, while representing their profession within multidisciplinary care contexts. Therefore, leadership skills are a beneficial professional value, facilitating knowledge and skill development in addition to better patient care.

Teaching and research are also roles where nurses can make important contributions. Taking nurses’ experiences and applying them in research can inform the design of studies and exploration of gaps in knowledge that have been observed in practice. Similarly, when nurses teach others, they can solidify their own knowledge on a subject, as well as disseminating knowledge for improved patient care. Not all nurses may wish to participate in research and teaching, although informal teaching on the ward is expected of all nurses as a key part of continual staff training and development. However, awareness of research, engagement with teaching practices, and appreciation of evidence-based practice are traits common to all successful nurses.

The ethical values of nursing are also beneficial, providing guidelines for ethical practice, and also ensuring the wellbeing of patients. Ethics extend to all parts of decision-making and care delivery, and influence nurses daily; allowing nurses to engage in care that is fair, evidence-based and looks after the best interests of the patient. Thus, these values safeguard the most vulnerable, while providing nurses with guidance during difficult decision-making processes.

The negative impact of professional and ethical issues

Although these values help ensure the safety of patients and protection of their rights, they may have negative consequences. These typically relate to the pressures placed on nurses to achieve high standards of care for every patient and to engage in individualised, evidence-based practice, with an ever-increasing level of responsibility and accountability.

Technological and care advances have had the potential to reduce the ethical uncertainty regarding certain types of intervention -  therapies have become safer and more specific to the needs of the patient, reducing the need to consider net clinical benefits or harm-risk profiles of interventions. However, these advances also pose potential challenges for nurses in keeping up-to-date with their use and side effects, leading to an increased knowledge burden. Furthermore, these advances may further complicate ethical decision-making. As interventions become more sophisticated, the views of patients may be side-lined and jeopardised as a consequence. Indeed, nurses may struggle to maintain ethical practice and a compassionate and personal approach when facing an increasingly technological or medical approach to care.

Stress and moral distress

When professional standards need to be met in every instance of a patient interaction, this can be overwhelming, particularly considering time pressures, complex patient management scenarios, and challenging shift patterns. Furthermore, ethical dilemmas can significantly impact nurses on a personal level, leading to uncertainty over decisions and personal moral conflicts when courses of action may cause discomfort in patients, or where patient’s rights are violated for the greater good.

Stress can be a mental or physical experience, depending on the severity of the stressful situation and the vulnerability of the individual. Stressful situations affect people in different ways, and different people need different types of support. More experienced nurses have often encountered several stressful situations and may be more resilient, having developed coping strategies. Those with less experience may be more vulnerable to the acute effects of stress. Therefore, more experienced staff members may provide valuable informal support in stressful clinical situations. However, individuals respond differently to stress, so it is important that you recognise when you experience stress and are able to access support when needed.

The ethical and moral nature of nursing is another cause for stress in practice. Ethical dilemmas may arise and may require difficult decisions to be made. These decisions may conflict with your own personal moral values or may lead to moral distress - even when they are in the best interests of the patient. It is important that you do not allow your personal feelings influence patient decisions, or to compromise treatment of the patient in relation to their best interests. However, when you feel conflicted, you should be able to discuss this with colleagues or to seek support in other ways.

Job dissatisfaction and burnout

When stress levels are too high, there is a risk that you may not be able to function effectively in your role. This is particularly true when nurses are dissatisfied with their job, as a result of the demands of the job or because of specific stressful events. Stress can manifest in many ways, but its effect on your ability to carry out patent care is extremely important.

Dissatisfaction with your role as a nurse is a potentially serious situation, as may be indicative of negative experiences, or that the job is impacting your wellbeing. When protecting patients’ rights, dissatisfaction may arise if your organisation or department does not adhere to best practice principles, or you are unable to institute change. Often, when nurses feel powerless to help patients or staff, they may feel as though they cannot fulfil the duties of their role to the best of their abilities. This may be due to management constraints, poor resource availability, or a demanding time schedule, all of which can impact on how satisfying the job of a nurse can be when facing challenging situations.

Burnout occurs when nurses are no longer able to cope with the demands of their work due to stress and may have to have time off as a result. Nurses who experience burnout often have multiple reasons for feeling stressed and may lack effective support mechanisms to cope. The impact of burnout on the profession can be significant, as nurses may leave the profession altogether or for extended periods, affecting staffing levels and morale.

Support and coping strategies

It is essential to consider how nurses can cope with stress, reduce the occurrence of stressful situations, and utilise available support mechanisms appropriately. Individual techniques for managing stress vary significantly, depending on personality, experience, confidence and available support mechanisms. However, all nurses should have support available and should be able to apply strategies to minimise the impact of stress on their daily lives, thereby preventing burnout.

Support can come in multiple forms; it may be as simple as discussing concerns with a colleague, or may involve more formal processes such as counselling or structured reflection. You should consider what would work best for you, but keep an open mind for when situations are difficult. For most nurses, counselling is only necessary when dealing with ethical dilemmas leading to undue levels of stress, or to a reduction in job satisfaction or performance. Usually, simple strategies and coping mechanisms can be used to ensure that you can provide patient care to the best of your abilities.

You may not always have the right answer for a particular patient, but someone else may have managed a similar patient, or guidelines may provide clear instructions. Drawing on these resources and using them appropriately is a key skill that can help to reduce pressure. You should be aware of contemporary guidelines and ward/care setting policy on how to manage complex patient scenarios, including consent assessment and the use of restraint. However, these guidelines may not cover every eventuality; you should be prepared to discuss care with other colleagues, who may provide information  as well as professional and emotional support. Nursing is a caring process and decision-making cannot be reduced to ‘black or white’ options most of the time - sharing personal experiences and making sure patients are cared for in a manner consistent with evidence-based practice is an invaluable part of the caring process.

You should also ensure that you make the most of any opportunities to develop your clinical skills further. One of the most stressful situations that a nurse can be placed in is the need to manage a patient when they lack the appropriate skills to do so. This can delay patient care, may aggravate stressful situations and can cause anxiety. Being prepared and expanding your skill set can therefore be helpful in reducing the occurrence of these events. Furthermore, making sure you are aware of your colleagues’ skill sets is important, as an added level of support. Reliance on colleagues and working within a team setting is a vital strategy that you can use to reduce stress and optimise the potential for patient care that is professional and ethical. Colleagues can support your decisions, provide guidance, share the burden of care, and to discuss any issues with care. Using this support network is vital - not only to ensure that you have the support from other professionals when making decisions about patient care, but also in managing your time effectively.

Reflective practice

Reflective practice is one of the most common and widely advised techniques to reduce stress. Reflection involves reviewing your own performance in a specific scenario, making sense of how decisions were made and the good and bad aspects of those decisions. Typically, a reflective cycle is used, to formalise the process. Gibbs’ cycle is common, encompassing a description of the event, overview of your thoughts and feelings, an analysis of the situation, an evaluation of the strategies used, and an action plan based on the need to improve care and personal knowledge or skills. In this way you can continually strive to improve your own practice by reflecting on how you have cared for patients.

Reflection is not only about developing your knowledge and skills; it is also an important process that allows you to stop and take time to consider the issues that arose when managing a specific patient, reflecting on your own feelings and attitudes during the care process. This is a valuable process, as it permits you to identify components of care that caused you the most difficulty or were stressful. By analysing how these situations developed and their impact on your personal wellbeing, you may be able to avoid similarly stressful situations in the future.

Reflection is a support mechanism that all nurses can engage in on a routine basis. By sharing your reflective experiences with others, you can share information and learn from others’ experiences, broadening your ability to manage stress in the workplace.

Conclusion

This chapter has provided an overview of how the professional and ethical values of nurses impact on practice. Both positive and negative factors can arise from these values, and it is important to minimise the potential impact of negative factors on an individual. You need to be aware of situations that can cause moral distress or physical stress and utilise support mechanisms appropriately. This includes the use of effective practice and colleagues’ support whenever possible. This chapter concludes with an example essay focusing on ethical dilemmas in practice, exploring how nurses can be supported to make ethical decisions, preventing harm to the patient and others.


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