Impact of Ethics and Morale on Nursing Practice: A Case Study

This study focuses on the impact of ethics and morale on nursing practice. It analyzes a case study of a cancer patient who has expressed his desire to die and discusses the application of ethical theories and models in such situations.

Running Head: Professional Growth And Development
PROFESSIONAL GROWTH AND DEVELOPMENT

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Table of Contents
Introduction................................................................................................................................3
Experience analysis....................................................................................................................3
Applying ethical theories or models...........................................................................................4
Critical reflection........................................................................................................................6
Conclusion..................................................................................................................................7
Reference list..............................................................................................................................8

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Introduction
Experience of nurses allows them to improve their ability to provide care by maintaining
nursing standards. Aim of this study is to focus on impact of ethics and morale on nursing
practice. I am analyzing my own experience as a nurse in a healthcare organization. The case
study is about a cancer patient, who has expressed his desire to die. As a nurse, I am confused
about whether I need to inform my hierarchy about his confession or I need to respect
autonomy of the patient. This ethical dilemma is being highlighted in this study and aspects
regarding application of ethical theories are being discussed.
Experience analysis
A brief description of circumstances that I have faced is explained in this part. I felt ethical
dilemma regarding informing my supervisor regarding my client's impending suicide attempt.
He was a 69-year-old man suffering from stage II lung cancer. His brother has also died due
to this disease and he is fearful about the same fate. Client says that he wanted to die before
increase of the sickness. However, later he told that he was joking with me and requested me
to maintain secrecy of the conversation.
If I did not report to my supervisor regarding this conversation then it may have a bad
consequence for the client. He can attempt suicide, which can take away his life. On another
hand, if I report it to my supervisor then extra arrangements of security and counseling can be
done to improve mental state of the person. However, he cannot trust anybody in this clinical
setup anymore, which will have bad implications upon the client.
I experienced moral dilemma in this case because if I do not report to supervisor then this
can result in suicide attempt of the client. On another hand, if I report then, trust of client may

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be broken. As stated by Hadjistavropoulos et al. (2016), moral dilemma occurs when there
are equally compelling reasons for or against regarding a course of action.
This case scenario has conflicted within my personal and professional beliefs. According
to CNA guidelines of nursing practice, it is my ethical responsibility to provide ethical care
and safety to individuals. CNA guidelines state that nurses need to build trustworthy
relationships with persons through meaningful communications and actions. This helps in
understanding people's need and concerns. It is the main responsibility of a nurse to question
and intervene in unsafe practices and conditions, which can help to provide safety to patient
(Cna-aiic.ca, 2019). However, request of this client regarding maintaining secrecy of this
vital information is raising conflict my professional beliefs. If I keep secret then I may assist
the client to commit suicide but if I report then trust of client may be broken and he will not
further share any feelings. This can impact in diagnosis process of the patient and that is
creating a conflict.
Applying ethical theories or models
Ethical dilemma refers to having equally valid reasons for more than one option of actions
and nurses feel confused while making decision (Cna-aiic.ca, 2019). CNO has developed
specific standards that are potent to help nurses to take appropriate decision. I have heard
from a cancer patient that he is wishing to die and later he has mentioned that it was a joke.
However, this incident has created ethical dilemma for me as I do not understand whether I
need to inform my hierarchy about this confession or I need to respect autonomy of patient.
CNO has mentioned practice standard regarding ethics and this standard can be followed to
solve ethical dilemmas in nurses. CNO has mentioned 7 ethical values and one of these
values is about privacy and confidentiality. As per standard of CNO, nurses are bound to
maintain confidentiality of patient's information. Patients have legal rights for privacy.

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However, nurses are allowed to discuss patient information with healthcare team in
exceptional cases. For example, if nurse learns information that can harm the patient or others
in future, the nurse is free to discuss it with healthcare professional teams for ensuring well
being of patient. For my case, I need to discuss with my hierarchy about the confession made
by my patient for preventing him from attempting suicide.
In the practice standard for privacy and confidentiality of personal health information, CNO
has mentioned about the Personal Health Information Protection Act 2004 (PHIPA).
PHIPA has been developed to maintain balance between right to privacy of patients and
permit of nurses to share information with medical team for providing best medical support to
patient (Cno.org, 2019). Medical team includes healthcare professionals, who are providing
medical support to the patients. For example, I can discuss the confession of my client with
the concerned doctor for this case for getting his assistance to change mind of the patient. It
may be possible that the patient is joking. However, as a responsible nurse, I need to apply
ethical theory properly to focus on wellbeing of patient. Considering the mental and physical
state of patient, it can be understood that his confession cannot be counted as a joke for
avoiding future risks. CNO has developed code of ethics that must be considered by nurses to
deal with ethical dilemmas. This code of ethics has included principles that are used by
nurses for fulfilling professional obligation.
Utilitarianism is the moral theory that can be used by nurses for dealing with ethical
dilemma. This theory postulates that if the consequence of action brings more pleasure than
harm, that action must be performed and it is considered as ethically correct. If I tell doctors
about the confession made by patient, collaborative effort of medical team can prevent
suicide attempt by my client. Thus, application of this theory may help to deal with such
ethical dilemmas regarding confidentiality of information of patients. Focusing on this

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particular ethical theory is required for making appropriate decision through overcoming
ethical dilemma.
Critical reflection
I need to deal with this situation in an ethical way that can increase safety of the person in the
case. According to CNA guidelines, nurses must take job action in a practicing environment,
which can help to safeguard health and safety of patients. Nurses need to engage in research
and gain evidence about the patient to provide proper care (Cna-aiic.ca, 2019). I have
collected evidence regarding mental state of this person and it is my ethical duty to provide
this information to my supervisor. However, I must request them to maintain secrecy of the
matter and take necessary actions like motivating the 69-year-old person, suffering from lung
cancer.
This situation has resulted in moral residue because this residue can damage my personal
beliefs and career. As opined by Hadjistavropoulos et al. (2016), moral residue is a long-
lasting element that powerfully integrates with thoughts and views of a person. Moral residue
is an aspect of moral distress that can cause damage to one's self-image and career. If this
type of events occurs, this incident can act as an experience and I can take better decisions in
future. This is a moral residue because I have compromised trust of the patient and informed
to my senior regarding the tendency of committing suicide of patient.
The situation was complicated because patients suffering from chronic diseases like cancer
generally suffer from mental depression and suicidal tendency occurs. As mentioned by Ross,
Perry & Truant (2016), Canadian nurses involved in cancer care need to provide evidence-
informed care. This care can help a nurse in gaining excellence in nursing practice. The
situation was complicated a challenged CNA ethical guidelines and principles. This situation

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has taught me lessons regarding handling complex situations. As a nurse, I need to secure
safety of a patient, which I have done.
If I face same situation again then I will follow CNA guidelines first because that was
designed to provide safety to patients. However, I will first try to motivate the patient and
eliminate any negative thought. Continuous rapport and better assistance can help a patient
to eliminate negative thoughts and increase positive energy. Experience from this case will
help me to provide further care in this situation of moral dilemma.
Conclusion
From the above discussion, it can be concluded that code of ethics and nursing principles
designed by CNA can help a nurse to take proper decision during care of moral dilemma.
According to nursing values and responsibilities of CNA, nurses need to maintain their
ethical responsibilities to provide proper value to care receivers. Proper planning and decision
making must be done by maintaining principles and moral values. This can help to increase
effectiveness of the treatment and help the patient to get cured both mentally and physically.
In this case, safe practicing environment was maintained by taking proper decision. This
study has mentioned proper application of ethical theories such as Utilitarianism may help
nurses to deal with ethical dilemmas and in making appropriate decisions to provide the best
care to patients. From the discussion, it can be understood that nurses can share personal
information of patients with healthcare team for well being of patient.

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Reference list
Cna-aiic.ca (2019), Code of ethics, Retrieved on 29th May 2019, fromhttps://www.cna-
aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-
interactive
Cno.org (2019), Ethics, Retrieved on 29th May 2019,
fromhttps://www.cno.org/globalassets/docs/prac/41034_ethics.pdf
Hadjistavropoulos, T., Malloy, D. C., Douaud, P., & Smythe, W. E. (2016). Ethical
orientation, functional linguistics, and the codes of ethics of the Canadian Nurses
Association and the Canadian Medical Association. Canadian Journal of Nursing
Research Archive, 34(2). Retrieved
from:http://cjnr.archive.mcgill.ca/article/viewFile/1763/1760
Ross, B., Perry, K., & Truant, T. (2016). POSITION PAPER professional development of
Canadian nurses involved in cancer care. Canadian Oncology Nursing Journal/Revue
canadienne de soins infirmiers en oncologie, 26(4), 352-353. Retrieved
from:http://canadianoncologynursingjournal.com/index.php/conj/article/download/
726/692