Registered nurses (RNs) should adopt an active position, especially when the basic patients’ rights are threatened. This paper evaluates the hypothetical clinical situation from this perspective. The situation will be described below in detail. The patients’ rights will be examined, and the consequences of their violation will be evaluated. The actions of other healthcare providers will be closely considered. The Bioethical Decision Making Model will be applied in the discussed situation. The discussion of nursing advocacy in the clinical setting will be provided. The nurse’s role, as a patient advocate, will be specified. In general, modern nurses should pay closer attention to patients’ rights and prevent any potential threats.
It is possible to analyze these issues using the following hypothetical clinical situation. A given RN always fulfills all her functions properly and respects patient autonomy, as well as other related rights. Informed consent is considered as one of the major aspects in this regard. However, other healthcare professionals do not always act in accordance with the principles of informed consent. In this hypothetical situation, they did not get permission from the patient before initiating their intervention. Although they were motivated by positive intentions, they violated a person’s rights, as informed consent was required by all regulations under such conditions. Thus, these healthcare professionals did not get complete informed consent from the patient and initiated their intervention. The RN became aware of this fact only after some time. There is a need for developing the optimal strategy for dealing with such a situation, as well as avoiding similar problems in the future.
Application of the Bioethical Decision Making Model
Although different models may be applied for examining this situation, the Bioethical Decision Making Model seems to be the optimal option. The reason is that it allows using a step-by-step procedure to apply the analyzed situation, determine the responsibilities of all the involved parties, as well as the optimal solution. The major ethical principles include beneficence, nonmaleficence, autonomy, and justice. As the major question under examination is the proper nurse’s strategy under the conditions of other healthcare professionals’ violating the principle of patient autonomy, it is necessary to consider the above ethical principles closely. It is evident that the principles of beneficence and nonmaleficence are also violated by the actions of professionals. The reason is beneficence should be understood not only in an objective sense (through evaluating the corresponding health indicators), but a subjective one as well (as a degree of addressing patients’ rights).
If this aspect is neglected, the results of intervention can be negative because the important patients’ needs are not satisfied. Even if the actor’s intentions are positive, it cannot justify the intervention without considering the interests and needs of a given patient. The principle of justice requires the non-discriminative treatment of all patients. At the same time, it also requires to implicitly utilize all the possible knowledge and information to generate the maximum possible results. Therefore, the healthcare professional neglecting the position of a patient regarding a particular treatment decision does not follow the principle of justice to the maximum extent.
It is reasonable to apply all steps of the selected decision-making model to the analyzed situation. The first step is identifying the specific question that should be addressed. The selected question is the optimal nurse’s strategy under the conditions of improper behavior from the side of other healthcare experts. As some misbehavior and improper actions made by other professionals is possible, it is reasonable to specify the optimal response strategy under such conditions. The next step is identifying the issue under examination. It refers to introducing interventions without receiving the proper informed consent from the patient in a situation when it is explicitly required.
The next step is presenting the facts of the case in a precise way. The facts are such that some healthcare professionals have decided to introduce interventions without obtaining the informed consent from the patient, and the nurse was unable to prevent this situation from an occurrence. However, there is a need for developing the proper response strategy to change the current state of affairs, as well as prevent the possibility of a similar situation in the future. The next stage is identifying the whole set of potential decisions in this case. The first potential strategy is a passive one. Thus, the nurse may remain passive and not initiate any changes, especially in the absence of any explicit complaints from the patient. The second potential strategy is explaining the misbehavior to other healthcare professionals and developing the organizational mechanism for avoiding such a situation in the future. For example, all healthcare professionals may be required to consult with nurses and not initiate any interventions that require informed consent without the nurses’ approval. However, the second strategy does not include any measures regarding the situation that already happened with a given patient. The third potential strategy includes not only the measures mentioned in the second strategy but also the responsibility of professionals for the violation of the patient’s right in this case. In particular, they can be fined and experience additional sanctions from their healthcare organization.
The next stage is collecting additional relevant information. It refers to the fact that the initial intentions of professionals were positive, and they aimed at minimizing the time needed for intervention and obtaining the desired (from their perspective) results. The next stage is determining the optimal decision. It seems that the third strategy is optimal. The first strategy is not optimal because the nurse should not be passive when observing the violation of patients’ rights, even if there are no explicit complaints from patients. The second strategy orients exclusively to the future without addressing the consequences of the actions made in the past. The third strategy is more complex and addresses these strategic issues effectively. Thus, all professionals, violating patients’ rights, should be punished accordingly. Moreover, the organization should implement the necessary actions for preventing the occurrence of similar situations in the future. It seems that the above methods and tools may contribute to achieving these results.
The next stage is stating ethical principles that support the selected decision. All four major ethical principles support the third strategy. Beneficence is addressed because treatment decisions are analyzed from the perspective of a given patient, rather than healthcare providers. Nonmaleficence is addressed because all interventions are negotiated with the patient, and he/she is aware of the potential consequences of different decisions. Patient autonomy is respected, as the requirements of obtaining informed consent are enforced properly. Finally, the principles of justice are implemented consistently, as the interests and strategies of healthcare providers and the needs of patients are balanced with one another.
The next stage is identifying authorities, supporting the selected decision. It seems that it is either directly or indirectly supported by many experts. As the above ethical principles are generally recognized, it seems that any strategies that promote them are supported. For example, Trapani (2014) states that the role of patient autonomy is crucial for creating an autonomy-supportive environment. Therefore, autonomy cannot be violated under any conditions. On the contrary, it should be one of the foundational principles of the just society and healthcare system. The next stage is formulating a rebuttal. It seems that the designed strategy should be implemented in most cases. However, some exceptions can be made under extreme conditions. For example, if there is no time to consult with nurses and other professionals, it is possible to abandon some elements of the above-discussed strategy. However, patient autonomy should be respected in any case. The next stage is the degree of confidence in the developed claim. The degree of confidence in the developed claim is very high because it integrates all the relevant ethical principles, as well as allows balancing the interests of healthcare professionals and patients. The next stage is “boxing up” the case for explaining the selected decision. The transition mechanism between the interests of healthcare professionals and their ultimate decisions should be clarified. They should comprehend that positive intentions are insufficient for generating the needed results.
The final stage is reformulating the analyzed case by integrating the selected decision into it. The potential development of the situation is as follows; the nurse will be more effective in controlling the proper fulfillment of all regulatory requirements and ethical principles. Other healthcare professionals will also adjust their behaviors and strategies in a way to correspond to the major current challenges. Thus, patients’ rights (especially their autonomy) will be protected more effectively. It seems that the entire healthcare organization may enjoy long-term sustainable development.
Nursing Advocacy in the Clinical Setting
Nowadays, nurses should not be concentrated only on their narrow functions but also remember patent advocacy. The reason is that numerous challenges and difficulties in relation to patients’ protection emerge regularly. As a result, these issues should be addressed consistently and effectively. The major advocacy activities include confidentiality and privacy issues, informed consent, and patients’ rights, in general. Modern nurses should be aware of the major challenges in this field and be able to follow all the major ethical principles in their practice.
As nurses advocate the rights of patients, they should orient to their needs and preferences. At the same time, patients may lack the corresponding qualification, as many decisions require a deep understanding of various health-related issues. Therefore, nurses should provide the corresponding support to their decisions and explain the potential alternatives and their consequences. On this basis, patients can understand the situation adequately and make responsible decisions that allow meeting their long-term needs. Nurses should not impose their views on patients or try to influence their decisions. They should focus on providing the needed information to patients, as well as explain the potential consequences of various alternatives. Under such conditions, all patients will make rational (from their perspective) decisions.
When nurses ensure that patients understand the consequences of their decisions and corresponding risks, they should accept this choice and assist patients with realizing their plans. If nurses face any attempts of other healthcare professionals to violate patients’ rights, the urgent response measures should be taken. They should explain the need for respecting patients’ rights to other professionals, as well as the corresponding responsibility, associated with any violation of patients’ rights. In this way, the likelihood of any rights’ violation in the future can be minimized effectively. In addition, nurses should be very sensitive to privacy and confidentiality issues, as the modern rapid technological environment creates additional problems in this regard.
The nurse’s role, as a patient advocate, can change according to patients’ needs and preferences. For example, in some situations, the nurse should concentrate on protecting patients’ advocacy, while in others, confidentiality becomes the main priority. In any case, nurses should preserve the human dignity of all individuals, regardless of their physical or mental state. Patients should understand that all their concerns are addressed, and nurses and other professionals act in accordance with the basic principles important for a given patient. Only in this way, the atmosphere of mutual trust and respect may emerge. Patient equality should also be achieved, as nurses should not discriminate any of their patients. On the contrary, all of them should receive the maximum amount of attention and assistance. Finally, nurses should aim at minimizing patients’ suffering and create the most appropriate conditions for them. However, all people are different, and nurses should respect the diversity of patients’ needs and preferences. Therefore, they should concentrate on providing objective information to them, in order to specify their needs, preferences, and ultimate choices.
In conclusion, it is important to remember that advocacy issues tend to become more important nowadays. People face additional challenges, and close cooperation between medical workers is required. Nurses have additional responsibility in this field, as their qualification and experiences allow them to make responsible decisions and assist other parties when making choices. The hypothetical example shows that the nurse should explain the mistakes committed by other professionals, as well as contribute to creating the proper organizational environment to minimize the likelihood of such problems in the future. The Bioethical Decision Making Model seems to be highly applicable in this context. The role of nurses as patient advocates is comprehensive, as it includes numerous functions, including protecting patients’ rights, promoting their advocacy, confidentiality, and privacy. Moreover, many functions should be addressed simultaneously. as a large number of real-world situations are very complex. However, there is no other alternative to the sustainable development of the healthcare industry and balancing the needs of all parties. It may be expected that the significance of patient advocacy will continue to increase in the near future.