Nursing Issues in the Critical Care Unit, Patient Confidentiality and Aboriginal Perspectives on Cancer

This article discusses safety issues in intensive care units (ICU) and strategies for ensuring safety. It also explores patient confidentiality and ethical dilemmas in nursing. Additionally, it reflects on the Aboriginal perspectives on the cause of cancer and their beliefs about it. The article highlights the lack of knowledge and ignorance about health issues among the Australian natives.

Running head: NURSING ISSUES IN THE CRITICAL CARE UNIT 1
Nursing Issues in the Critical care Unit
Name
Institution
Date

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Module one
Safety issues in a critical care unit
Healthcare workforce such as the nurses plays a pivotal role in patient care as well as
safety surveillance while in the healthcare facilities. For quality care and professionalism in their
positions the nurse require an accord on the significant set of parameters employed to ensure safe
practices. These measures determine decisions about resources allocation positively affect
patient outcomes and the nurse’s safety in the healthcare system. In this article, safety issues in
intensive care units (ICU) will be discussed and the possible strategies for ensuring safety be
outlined.
In the healthcare facility, the critical care setting is one of the most complicated
environments especially for the critical care nurses (CCN). The complexity of the ICU poses a
risk to the patient safety since they sometimes even sustain physical injuries in the process of
receiving daily care. Such a setting demands the management of intersecting issues of running a
high-tech environment by ensuring the staff’s competency in operating these machines. Also, the
core objective of providing quality care must be met by the team working in this very
traumatizing setting (Barry & Edgman-Levitan, 2012).
The severity of the patients’ health conditions is directly related to the number of safety
issues the patient is likely to encounter. The critically sick patients undergo invasive treatments
procedures using drugs and technology that despite its benefits endangers patient safety as well
as that of the nurses (Barry & Edgman-Levitan, 2012).
Moreover, the intensive job in the ICU brings about fatigue to the nurses which
ultimately affects patient safety negatively. Such an issue is worsened by the inadequacy of the

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CCN in most healthcare facilities required to enhance the implementation of a rotational or
working in shifts.
For the CCNs to address the safety concerns of their patients it is essential to seek the
support by engaging the facility’s leadership. The safety concern is then brought to the attention
of the management so that it can come up with and implement safety frameworks. In this regard,
the administration will request for the recruitment of more ICU staff to reduce the work burden
on understaffed workforce. Then it will also ensure that patient safety becomes a teamwork
effort whereby all the team follow the safety measures in the ICU. Great success in improving
patient safety will be achieved when the initiative is translated into a safety culture for the
facility. As a result of the safety culture the ICU staff will understand the best way to exchange
patient data in meaningful and respective manner. One of the ways to set off the implementation
of such a system is by beginning with the assessment of the prevailing climate in the ICU and
evaluate its effects on the patient care as well as safety (Bassuni & Bayoumi, 2015).
Another important safety measure is the assessment of the ICU equipment, technology as
well as its systems from a patient safety perspective before acquisition and implementation.
These devices endanger patient safety by causing injuries when they are not rigorously evaluated
before use. Sometimes inadequate knowledge on the use of these sophisticated poses safety
issues to both the patient and the nurses. Therefore, to ensure they are appropriately used and
serviced there is a need always to ensure that experienced staff operate or supervise the use of
these devices (Rhodes et al., 2012).
The development of a patient safety supporting culture in the ICUs coupled with the
specialized training of the CCN is crucial to alleviating most of the safety issues in critical care

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units. Also, it is essential for all the healthcare stakeholders to recognize safety in the facilities
requires teamwork effort for its successful implementation.
Module two
Patient or client confidentiality and the ethics dilemma
Confidentiality is the basis of providing nursing care as well as a foundation for building
a good relationship between the patient and the healthcare professional. According to Basevi,
Reid and Godbold (2014) confidentiality is the respecting of secrets of other people and keeping
security information obtained from individuals in the privileged situations of a professional
relationship. The nursing act of privacy accords the healthcare professionals with an option of
employing an expert opinion in the disclosure of patient information with first options ensuring
that safeguards have been exhausted (ICN, 2012). Sometimes the nurse is required to provide a
patient’s private information to carers to save the health of the client necessitating the breach of
patient confidentiality. Such situations present ethical dilemmas which require an application of
moral principles as well as theories before reaching a decision.
In the event, confidentiality is sacrificed patients may lose their trust in the healthcare
system discouraging them from seeking medical care for fear of disclosure of their private
information (Routledge, 2015). Also, the breach of confidentiality attracts legal and professional
issues, mistrust, disrespect, and feeling of betrayal and a sign of lack of professionalism in the
patient treatment. Similar to other healthcare departments the ICU gathers patient information
that is liable to the nursing act of privacy deserving patient confidentiality. The major questions
in the patient privacy and ethics are when is it necessary to breach confidentiality between a
patient and a healthcare provider? One such situation for contravening secrecy is when possible

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harm awaits the patient, or the society and the sharing of the information is the only way around
it. The nurses, CCN, should be informed of the regulations of confidentiality and the situations in
which to utilize and disclose a safeguarded health information is appropriate (NMBA, 2012). In
the case of ethical dilemmas, the nurse is to explore all the possible options of prioritizing the
protection of the client’s right to confidentiality and autonomy (McKeown, 2009).
The nurses can employ the Uustal’s model which guides them on the steps to pursue in
identifying the issue, stating of the nurse’s values and the ethical stance regarding the issues. In
this theory factors related to the situation are considered which lead to the generation of options
associated with the dilemma. Then the alternatives are categorized leading to the development of
the action, implementing and evaluating the outcomes of the activities (Barza & Cohen, 2015).
The theory facilitates the advocacy for confidentiality of patient’s information as well as arriving
at and implementing decisions that are beneficial to all.
The other approaches to ethical dilemmas are the Utilitarian, and the Deontology
approaches. In the utilitarian model, the best alternative that is bound to lead to less harm on all
the parties involved are identified and adopted (Kahane, 2015). The theory of deontology
emphasizes the performance of an individual’s duty which is universally recognized regardless
of the circumstance (Park, 2011).
Some of the principles applied in nursing in dilemmas to aid decision making is the
principle element of nurses and people. These principles involve the obligation of doing what is
acceptably good causing little or no harm (ICN, 2012). These principles together with the
theories of ethical dilemmas are referred to so as to ease the decision making process and

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resulting to reaching at the most appropriate answer. For more complex difficulties the nurse is
allowed to consult the clinical ethics committee found most healthcare facilities.
Confidentiality is crucial in propagating a healthy nursing-client relationship.
Nevertheless, there are instances when confidentiality conflicts with the nurse’s duties and
values. However, complex the law of confidentiality maybe there is a need to create a balance
between the patient’s rights and the responsibilities of the nurses.

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References
Barry, M. J., & Edgman-Levitan, S. (2012). Shared Decision Making — The Pinnacle of Patient-
Centered Care. New England Journal of Medicine, 366(9), 780-781.
doi:10.1056/nejmp1109283
Barza, L., & Cohen, M. (2015). Teaching ethics: a case study-based, interdisciplinary
framework. International Journal of Business and Emerging Markets, 7(4), 312.
doi:10.1504/ijbem.2015.072421
Basevi, R., Reid, D., & Godbold, R. (2014). Ethical guidelines and the use of social media and
text messaging in health care: a review of literature. NZJ Physiother, 42(2), 68-80.
Basuni, E. M., & Bayoumi, M. M. (2015). Improvement Critical Care Patient Safety: Using
Nursing Staff Development Strategies, At Saudi Arabia. Global Journal of Health
Science, 7(2). doi:10.5539/gjhs.v7n2p335
International Council of Nurses. (2012). The ICN code of ethics for nurses. International Council
of Nurses.
Kahane, G. (2015). Sidetracked by trolleys: Why sacrificial moral dilemmas tell us little (or
nothing) about utilitarian judgment. Social Neuroscience, 10(5), 551-560.
doi:10.1080/17470919.2015.1023400
McKeown, K. (2009). Book Review: Burkhardt MA, Nathaniel AK 2008: Ethics and issues in
contemporary nursing. New York: Thomson Delmar Learning. 554 pp. $78.95 (PB).

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ISBN: 978 1 4180 4274 5. Nursing Ethics, 16(5), 670-671.
doi:10.1177/09697330090160051702
Nursing and Midwifery Board of Australia - Registered nurse standards for practice. (2012).
Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Park, E. (2011). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1),
139-159. doi:10.1177/0969733011413491
Rhodes, A., Moreno, R. P., Azoulay, E., Capuzzo, M., Chiche, J. D., Eddleston, J., …
Valentin, A. (2012). Prospectively defined indicators to improve the safety and quality of
care for critically ill patients: a report from the Task Force on Safety and Quality of the
European Society of Intensive Care Medicine (ESICM). Intensive Care Medicine, 38(4),
598-605. doi:10.1007/s00134-011-2462-3
Routledge, C. H. (2015). Ethical standards in clinical psychology: maintaining integrity, record
keeping and confidentiality. Journal of Applied Psychology and Social Science, 1(1), 15-
27.

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Module Three
Reflection on the Aboriginal’s perspectives on the cause of cancer
According to Shahid et al. (2009), the Aboriginal Australians generally exhibit poor
health evidenced by high mortality rates and less five years survival rates.
Their poorer health as compared to the Aboriginal and Torres Strait Islanders is chiefly
attributed to their beliefs and attitudes towards the cause of diseases such as cancer. Similar to
other native people of Africa they pose poor cancer outcomes despite the presence of an
advanced healthcare system. In addition to the social and demographic disadvantages the natives
of Australia, there is very low screening turn up, delayed cancer diagnosis, low uptake and poor
adherence to medication as well as poor continuity of care (Condon et al., 2014). The
Aboriginals associate cancer with spirituality believing that it’s a punishment for wrongdoing
committed in the past (Mayer & Viviers, 2014). Apart from this belief surprisingly it is a
contagious disease therefore separating themselves with those diagnosed with the malady
(Davidson et al., 2013).
On reading the above article, I was surprised at the various notions the Aboriginal people
had towards cancer. They highly regarded these perception and considered during the making of
decisions relating to their health. The belief that cancer was a punishment for a past wrong act
hindered them from going for screening fearing to be known by other community members as
cursed and evil people. Even more, they isolated the sick from the healthy people to avoid the
risk of contracting the disease. Maybe this was due to a lack of knowledge about the cause of
cancer and whether or not it is transmitted by contact. But, the perception of it being a curse and
then avoiding screening made me acknowledge the varied perspectives regarding illness and

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health. When the screening services are made accessible to them, are large number neglect the
activity fearing to realize they are cursed if they are diagnosed with the disease at the expense of
their wellbeing.
The cause of cancer is contributed to by a variety of factors such as genes but spirituality
is not one of them. Moreover, it is not contagious but can result from genetic inheritance and
other predisposing factors. So, regardless of what they believed I expected that they would gladly
turn up for screening. At least to be sure they are not cursed, as their belief is, to proceed with
medications.
These beliefs highlight the lack of knowledge and ignorance about health issues among
the Australian natives. My expectations for people in the 21st century about cancer were that
most people have a knowledge of the vital information about a disease such as cancer. Such a
scenario has influenced me to ensure my patients get essential information about their ailments
before and after treatment. It is costly to assume that the patients have the necessary information
about illness and health. The Aboriginals had poor health outcomes due to health
misconceptions. Also, I realized one of the best strategies to improve the health of the general
population is providing them with information about their health as well as illness.

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References
Condon, J. R., Zhang, X., Baade, P., Griffiths, K., Cunningham, J., Roder, D. M., … Threlfall, T.
(2014). Cancer survival for Aboriginal and Torres Strait Islander Australians: a national
study of survival rates and excess mortality. Population Health Metrics, 12(1).
doi:10.1186/1478-7954-12-1
Davidson, P. M., Jiwa, M., DiGiacomo, M. L., McGrath, S. J., Newton, P. J., Durey, A. J., …
Thompson, S. C. (2013). The experience of lung cancer in Aboriginal and Torres Strait
Islander peoples and what it means for policy, service planning and delivery. Australian
Health Review, 37(1), 70. doi:10.1071/ah10955
Mayer, C., & Viviers, R. (2014). ‘I still believe...’Reconstructing spirituality, culture and mental
health across cultural divides. International Review of Psychiatry, 26(3), 265-278.
doi:10.3109/09540261.2013.866076
Shahid, S., Finn, L., Bessarab, D., & Thompson, S. C. (2009). Understanding, beliefs and
perspectives of Aboriginal people in Western Australia about cancer and its impact on
access to cancer services. BMC Health Services Research, 9(1). doi:10.1186/1472-6963-
9-132