Fidelity and Veracity Perspective for Case Study

Fidelity and Veracity Perspective

Considered the fundamental principles of the nurse-patient relationship, fidelity represents loyalty and promise keeping, while veracity represents truth telling. These principles often come up when nurses uphold their commitment to provide a certain quality of care, support for both patients and colleges, when representing their patients and colleges, and in circumstances involving truth telling. These principles are often challenged when nurses are placed in situations in which being loyal to patients or coworkers compromise personal ethical principles such as beneficence or autonomy. When deciding on how to distribute patient workload, a nurse abiding by the principles of fidelity and veracity is expected to divide the workload in a manner that is not only considered equal but also conforms to personal loyalties, promises, and the obligation to tell the truth.

Deontological Perspective for Case Study

Deontological Perspective

According to deontology, rules are established to determine what is right or wrong based on one’s obligations and duties, the foundation of which is the unchanging or absolute principles derived from universally shared values. Deontologists believe that standards for moral behaviour exist independently of means or ends. Perhaps one of the best known rule-oriented deontological theories was formulated by Immanuel Kant. According to Kant, philosophy is the concept that morality could be explained as the ultimate commandment of reason or imperative from which all duties and obligations derive. Kant’s categorical imperative or moral law suggests that one’s actions are only acceptable if they are to become universal law. In accordance to the fundamental teaching of deontology, patient workload should be divided evenly among the nursing team. Each nurse should be seen as an end in itself, and not merely as a means. That said, workload should be distributed in accordance to patient acuity, and not simply by a generic pre-assigned number i.e. each nurse gets a minimum of five patients regardless of their acuity. Nurses that are aware of imbalances in the distribution of patient workload should act in goodwill and in accordance with universally valid moral principles by advocating for their coworkers and working together to reassign patients in order to achieve some degree of workload equality

Justice:Applying Ethical Principles to Case Study

Justice

Considers the fairness of an action.  Resources should be equally distributed to the masses, thus the same goes for the distribution of burden.

In applying this principle to the case study, the nurse due to her heavy workload, was unable to provide equal care to all her patients.  Because some patients were of higher priority, the distribution of care was unevenly divided.  Based on the situation, it only makes sense for the nurse to give more attention to those patients who fell; however, if the workload was better handled in the first place, then the time allocated to each patient could have been more equally distributed and patients would less likely have fallen.  As a result of cost cuts, the quality of care provided to the patients has declined, this is not fair or is unjust.  The heavy workload for the nurse can be stressful, and physically and mentally draining.  These poor working conditions can easily lead to burnout and moral distress.  In addition, this workplace environment was also unfair to the nurses.

JUSTICE IN THE WORKPLACE

(PROMOTING JUSTICE Oberle, K. & Raffin S., 2008)

·        Nurses have a right to fair compensation for their work and reasonable working conditions.

·        It is unacceptable to put nurses or patients in jeopardy.

·        Nurses have an obligation to:

o   Speak out when they see any kind of injustice of other health care providers or patients

o   Obligation to treat other care providers fairly

o   Be respectful of other patients and co-workers, but also have a right to be treated with respect by patients and co-workers alike

·        Job action may be necessary, which require possible strikes to draw people’s attention to inequities in pay or working conditions.

Workload and Working Conditions

·        Workload and working conditions can have moral implications if they are such that nurses are unable to uphold their value of delivering safe, compassionate, competent, and ethical care.

A recent news story reported the death of a patient who was given a wrong dose of medication by a nurse.

o   If working under highly stressful conditions, with too many patients, it would be easy to see that mistakes were bound to happen.

o   Although it may be easy to place blame on the nurse, perhaps blame should be put on the system that put the nurse in a difficult situation.

o   These kinds of situations are often the basis of strike action.

o   When nurses strike to improve their salaries and working conditions, they are acting to ensure that they are treated justly in the workplace and that working conditions enable them to deliver quality care.

Nursing Mentality

·        Many nurses seem to view nursing as self-sacrifice.  However, nurses deserve to treated justly and should not be put at risk in the context of their work environment.

WEBSITES – IMPROVING PRACTICE ENVIRONMENTS

British Columbia Nurses Union (BCNU) – BC Nurses’ Union urges provincial government to reverse health care cuts after reviewing Canadian Nursing Advisory Committee recommendations.

http://www.bcnu.org/whats_new_media/news_releases/2002/08-21.htm

British Columbia Nurses Union (BCNU) Speaks Out – Improving Conditions for Our Members and Our Patients.

http://www.bcnu.org/publications_forms/update_magazine/2008/pdfs/Apr-May08.pdf

College of Registered Nurses of BC (CRNBC) – Working with Limited Resources

https://www.crnbc.ca/Standards/Lists/StandardResources/404WorkingwithLimitedResources.pdf

College of Registered Nurses of BC (CRNBC) – Quality Practice Environments

https://www.crnbc.ca/Standards/Lists/StandardResources/412qualitypracticeenvironments.pdf

Canadian Nurses Association – Taking Action on Nurse Fatigue

http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS112_Nurse_Fatigue_2010_e.pdf

Canadian Nurses Association (RNAO) – Nurse Fatigue and Patient Safety

http://www.cna-aiic.ca/CNA/practice/safety/full_report_e/files/fatigue_safety_2010_report_e.pdf

CRNBC Patient Safety Fact Sheet

https://www.crnbc.ca/Standards/Lists/StandardResources/463PatientSafety.pdf

Canadian Nurses Association – Staffing Decisions for the Delivery of Safe Nursing Care

http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS67_Staffing_Decisions_Delivery_Safe_Nursing_Care_June_2003_e.pdf

The Canadian Health Services Resources Foundation – Staffing for Safety

http://www.chsrf.ca/Migrated/PDF/ResearchReports/CommissionedResearch/staffing_for_safety_policy_synth_e.pdf

The Canadian Health Services Resources Foundation – Commitment and Care.  The Benefits of a Healthy Workplace for Nurses, their Patients, and the System.

http://www.chsrf.ca/Migrated/PDF/pscomcare_e.pdf

Article: Ethical Staffing.  There can be no compromise: safe staffing is an ethical issue. Nurses need moral courage and organisational support to ensure they work in an environment where they can practice ethically and patients receive the best care possible.

http://findarticles.com/p/articles/mi_hb4839/is_3_12/ai_n29261424/

References

 Oberle, K. & Raffin S. (2008). Promoting Justice. In Ethics in Canadian Nursing Practice:  Navigating the Journey (pp. 217-246). Toronto: ON: Pearson.

Consequentialism: Applying Ethical Principles to Case Study

Consequentialism

Looks at the moral rightness of an action solely based on its consequence.  Is the outcome beneficial to that individual?  The principle of utility is used as a decision making procedure.  Moral worth of an actions is determined by it's usefulness in maximizing utility and minimizing negative utility

Utility is defined as pleasure, preference satisfaction, knowledge or other things.  Utilitarianism is a form of Consequentialism.  The difference between Cosequentialism and Utilitarianism is that Consequentialism focuses on the greatest good for each individual, where as Utilitarianism focuses on the greatest good in greatest numbers.  There are many other forms of Consequentialism, each version vary slightly (Armstrong, 2006).

More information on Consequentialism:

http://plato.stanford.edu/entries/consequentialism/

Following Consequentialism, based on the case study, the greatest good for those individual patients were definitely not carried out.  Because of cost cuts and staff shortage, the workload that the nurse had on her plate was too heavy for her to handle.  With the heavy assignment, the quality of care for each patient was affected.  For these reasons, the outcome was tragic, and harm came about to three patients.  The falls could have been prevented, if each nurse had fewer patients or if there were extra staff to help out.  Even for patients that were not harmed, their quality of care was affected, as the nurse felt that she had little time to spend with some of her patients and had to neglect them since they were of  lower priority.  Some of the patients went to bed without their baths and hourly checks were impossible.  According to Consequentialism, we should weigh the possible outcomes to guide our decision on what the best action should be, thus in this case scenario the nurse should have the right to ask for additional help and such request should be carried out by management.  Cost cuts should not hold merit over patient and nurse safety.

References

Armstrong, S. Walter. (2006).  Stanford Encyclopedia of Philosophy.  Retrieved Feb 13, 2011 from       http://plato.stanford.edu/entries/consequentialism/