There are many factors that influence the development of a person’s ethical framework. Ethical composition is made up of a person’s morals, values, and beliefs. Morals can be expressed as a standard of beliefs or behaviors and choosing to do what is right. People use ethics to guide in decision making throughout life. This foundation helps to direct us which path to take socially, educationally, and professionally. In nursing, ethics encompasses relationships with self, patients, and colleagues. Ethics is a part of the foundation of nursing. It defines how nurses provide care, empathy, and respect to others at all times, no matter the circumstances. As a profession, nurses frequently face ethical dilemmas. How does she/he handle ethical situations?
The Ethical System
There are many social factors that influence one’s ethical structure. Among these are parental guidance, religion, and culture. Personalities and behaviors are developed as we grow in experience. Therefore, being an ethical person is a learned process. In order to develop this process, it takes time, understanding, and experience. As we experience life, one learns to determine right from wrong. This starts in early childhood and can be learned from something as simple as listening to a story with a moral. As we grow, those morals develop more into a standard of behavior. As a nurse, we use ethics to determine what is the best treatment or intervention for our patients and their families. This is also a learned process achieved through patient care experiences that is founded on basic nursing knowledge and skill. Professional nurses must use a structural model to guide effective ethical decision making. The American Nurses Association is a valuable resource that provides a structural model for nursing ethics and code of conduct. Most health care organizations have an ethics committee that can be consulted if needed. Most importantly, ethical decision-making is the responsibility of the professional nurse and quality patient care stems from the ability to think ethically.
Ethics in Nursing Practice
The ANA Social Policy Statement (2003) provides nursing goals as stated: “Nursing is the protection, promotion, and optimization of abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations” (p 6). Nurses must learn to be empathetic, which is a building block of ethical conduct. Without empathy, one would find it difficult to understand the needs and wants of a patient. Practicing respect for every individual without prejudice is a must in becoming an ethical nurse. It is human nature for people to allow personal beliefs, values, and opinions to influence decisions. As a nurse, we must take our own personal values and integrate them with professional values. By putting all this together, we establish a framework. This framework not only provides the best care for patients, but also guides us in making the best care decisions for the patient.
Advocacy is also an important part of professional, ethical nursing. All hospitals have a common goal. That is providing quality patient care in a safe, uniform, and efficient manner. It is the nurse’s responsibility to promote this type of care by ensuring patient needs are met, care choices are consistent with cultural values, and family support is given. If, at any point, patient care deviates from the patient’s wishes, the nurse should support the patient by addressing issues in communication with the care team.
Nurses are accountable for their own lifelong learning and professional growth. Since ethical nursing is a learned process, then nurses are responsible for continuing education, building skills, and growing their knowledge base in order to be accountable for providing optimum patient care. Creasia and Friberg state that, “Nursing actions, then, are ethical if they use knowledge and skills to provide good nursing care” (p 263). Over time, nurses grow with experience and improve nursing practice.
Ethics in Patient Care
Most people do not decide to become a nurse to attend hygiene needs such as bathing and bathrooming or to be involved in family drama. These issues are important to patient care, however, we choose nursing because we want to help others. As part of our ethical conduct toward others, nurses must have empathy. Empathy allows us to “understand the needs and wants of others so that we may know how to treat them kindly and generously, or to practice any other virtue in our day-to-day relations with them” (Dinkins, p. 1). Virtues are simply practicing and doing what is right. Nurse-patient interactions can be very complex and personal. There can be obstacles. Nurses can overcome obstacles by practicing empathy and caring.
When we truly care, it requires use of knowledge and skills to address needs and solve problems. Professional nurses problem solve by using the nursing process of assessing the patient or problem, constructing a plan that will correct the problem while meeting the patient needs, implement the plan, and evaluate the outcome. All steps should involve how the patient and family will be affected by the care given. Nurses must also take into account that the benefits of treatment outweigh risks to the patient. In doing this, we are showing empathy while being ethical. This process will facilitate good patient care and successful outcomes in most cases. When outcomes are not as planned, then we simply repeat the nursing process while keeping patient and family needs as first priority.
Ethics in the Workplace
The type of nursing care delivered depends very much on environment. In order for nurses to provide quality care, they need to feel respected for the work they provide. “Nurses, like most people, need to feel respected for who and what they are: that they and their work ‘matters’, and their personal worth as human beings is recognized and acknowledged” (Johnston, p. 1). Nurses who are shown respect by colleagues tend to be more motivated. Coworkers play a vital role in the well-being of patients and outcome of care by how they support each other. Research proves that nurses want to work in an environment where they feel supported and offered opportunities to grow. Professional growth is needed in order to provide quality patient care and improve patient outcomes.
Respect for colleagues is as equally important as respecting your patient. Nurses must practice treating all with compassion and respect. This will help build trust, provide recognition, and portray respect among the health care team. Communication processes will be strengthened and coworkers will be encouraged to participate in patient care. Showing empathy and respect also tends to be contagious. If someone sees a kind gesture, they will hopefully do a kind gesture for someone else.
In conclusion, we are all on a quest for excellence in ethical nursing practice. This is a process that is learned over time. Nurses have a very important role in caring and advocating for patients and their families. We use experience to build skills and ongoing education to create a strong framework to help make good decisions in patient care. With practice, making ethical decisions will become easier. By practicing empathy, there will be a better understanding of patient needs and wants. By extending this practice to our colleagues, the workplace environment will be more cohesive and supportive, providing a positive foundation for ethical practice. References
American Nurses Association. (2001). Code of ethics for nurses with interpersonal statements. Silver Springs, MD: Author. American Nurses Association. (2003). Nursing social policy statement. (2nd ed.). Silver Springs, MD: Author. Cresia, J. & Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice. St. Louis, MI. Elsevier Mosby. Dinkins, C. (2011). Ethics: Beyond Patient Care: Practicing Empathy in the Workplace. Online Journal of Issues in Nursing. 2011, Vol. 16 Issue 2, p 1-1. doi: 10.3912/OJIN.Vol16No02EthCol01 Johnstone, M. (2012). Workplace Ethics and Respect for Colleagues. Australian Nursing Journal. 20(2), 31.
Principles of Social Learning Theory
Given the limitations of behaviorism, and operant conditioning more specifically, Bandura’s theory of social learning – which he first called a theory of observational learning – began to take shape. Before delving into the specific mechanisms through which people learn by observing others, the key elements of social learning theory – as discussed by Ormrod (1990) – are outlined below. • People can learn by observing the behavior of others, as well as from the consequences of those behaviors. • Learning and performance are not necessarily the same thing; people can learn behaviors at the time they observe them, but not perform them until a later time, or not at all. • Reinforcement plays a role in learning, although is not a necessary component of the learning process. • Cognitive processes play a role in learning. As Crain (2000) elaborates, “When new behavior is acquired through observation alone, the learning appears to be cognitive. Thus, Bandura, unlike Skinner, believes that learning theory must include internal cognitive variables” (p. 194). Bandura (1977) identifies four components to observational learning:
• Motor reproduction
• Motivation / Reinforcement
Bandura writes, “people cannot learn much by observation unless they attend to, and perceive accurately, the significant features of the modeled behavior” (p. 24). Secondly, the observer must remember what was observed. Thus, the behavior observed must be retained, and this occurs, Bandura argues, by using two different symbolic systems – by representing the behavior in image form, as a visual picture, or by representing it in verbal form, as a series of instructions. If a child is learning how to play tennis, for example, she may retain an image of her instructor demonstrating the proper forehand technique, and she might also retain a series of instructions, such as “I step forward with my left foot, turning my body perpendicular to…” Next, as the previous example suggests, one must be able to replicate the behavior. In other words, the individual must have the motor reproduction skills to enact the behavior she observed. If the tennis student doesn’t have the strength to swing a racquet, she might not be able to reproduce the behavior.
The final component of observational learning is motivation; people do not imitate all the behavior they learn but rather must be motivated to do so. Two points deserve emphasis; again, the distinction between learning and performance – people don’t perform all behaviors they have learned, only those they are motivated to perform. And secondly, expectation of reward can be as motivating as the reward itself. Bandura (1977) writes, “Reinforcement does play a role in observational learning, but mainly as an antecedent rather than a consequent influence. Anticipation of reinforcement is one of several factors that can influence what is observed and what goes unnoticed” (p. 37). It also influences what is performed, and what is not. Models